Current presentation: Samuel presents with fatigue, unintentional weight loss (body mass index of 19%), and reduced lung capacity. He requires assistance to perform tasks of daily functioning, such as going up and down the stairs in his house.

Current laboratory results show an increase in IgG M-protein levels (4.0 g/dL), as well as changes in the free light chain (FLC) levels and ratio: Kappa FLC: 700 mg/L, Lambda FLC: 20 mg/L, Kappa/Lambda FLCr: 35.0. Beta-2 microglobulin level is 4.3 mg/L. Chemistry tests reveal hypercalcemia (10.7 mg/dL) and a reduced creatinine clearance rate (CrCl: 55 mL/min). Serum creatinine and lactate dehydrogenase levels are within the normal ranges. Hematology tests indicate anemia (Hb: 8.2 g/dL).

A repeat bone marrow biopsy shows 60% plasma cells. No bone lesions are detected by positron emission tomography. Fluorescence in situ hybridization (FISH) analysis does not reveal any cytogenetic abnormalities.

Based on these results, Samuel is diagnosed with multiple myeloma (MM). His disease is classified as ISS stage II. He is assigned an ECOG performance status score of 2.