Snapshot A 55-year-old man presents to his primary care physician for evaluation of his peripheral neuropathy. He otherwise feels well. Physical examination is notable for decreased sensation to pinprick in the bilateral lower extremities. Laboratory studies were notable for an M spike in protein electrophoresis of the blood and M protein at a concentration of 2 g/dL in the serum. He undergoes a bone marrow biopsy, which demonstrates 4% monoclonal plasma cells. Introduction Overview premalignant clonal plasma cell disorder no evidence of multiple myeloma no CRAB findings hyperCalcemia Renal insufficiency Anemia Bone lytic lesions no evidence of amyloidosis that is attributed to a plasma cell proliferative disorder Epidemiology Incidence > 3% of the general population in patients > 50 years of age Risk factors black race family history radiation exposure ETIOLOGY Pathophysiology not fully clear; however, several oncogenic events affecting the plasma cell leads to clonal expansion leads to the overproduction of monoclonal proteins Presentation Symptoms/physical exam discovered incidentally when evaluating for other conditions asymptomatic Studies Serum labs protein electrophoresis of the serum or urine M spike monoclonal M protein (< 3 g/dL) Invasive studies bone marrow biopsy < 10% monoclonal plasma cells Differential Multple myeloma distinguishing factors CRAB findings ≥ 10% clonal plasma cells Treatment Lifestyle monitoring indication management of choice must monitor patient for progression to malignant disease Complications Multiple myeloma Other lymphoproliferative disorders Prognosis Associated with lower survival than the general population may be due to the development of multiple myeloma or other lymphoproliferative malignancies