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[Clinical Picture] Clonal heterogeneity in plasma cell myeloma

A 52-year-old man presented to the emergency department with fevers and chills in December, 2014, and was admitted with a diagnosis of pneumonia. CT to exclude pulmonary embolus showed diffuse osseous lytic lesions, and he was also found to have anaemia and an IgG kappa monoclonal protein of 55·8 g/L on protein electrophoresis (a single band). After a bone marrow biopsy he was given a diagnosis of plasma cell myeloma and was treated with four cycles of CyBorD chemotherapy (cyclophosphamide, bortezomib, and dexamethasone) in preparation for an autologous stem cell transplantation.