Bone pain (back or chest, less extremity) 60%, pain in movement, not at night, height reduced by vertebral collapse. 80% of patients show abnormal radiograph. Focal osteolytic lesions (high osteoblasts, low osteoclasts) 60%, osteoporosis, pathologic fractures, compression fractures of the spine 20%, weakness and fatigue (32%), anemia, fever (<1%), bleeding uncommon, weight loss 24%, complications: hypercalcemia, renal insufficiency, amyloidosis. History/physical exam, CBC/blood smear, Chem panel with Ca/Creatinine, SPEP, immunofixation, Ig quantification, routine urinalysis, 24h collection for electrophoresis and immunofixation, Quantification of both urine M-component (Bence-Jones protein), albuminuria, BM aspirate/biopsy with cytogenetics, bone survey including spine, pelvis, skull, humeri and femurs. B2 microglobulin, CRP, LDH, FLC optional if M-component negative or equivocal. Older age, poor performance status, higher beta2M, lower albumin, elevated Cr, LDH, CRP; low Hb, low platelets, plasmablastic morphology, deletion of chromosome 13, translocation 14 or 14/16.