Multiple myeloma is a neoplastic disease characterized by plasma cell accumulation in the bone marrow, the presence of monoclonal protein in the serum and/or urine, and related tissue damage in symptomatic patients. The growth of myeloma cells disrupts normal bone marrow function, reduces immune function, results in abnormal monoclonal protein production released into the blood and urine, and destroys and invades surrounding bone. The initial diagnostic evaluation of multiple myeloma includes examining the peripheral smear for Roulex formation, protein electrophoresis for an M spike, bone marrow aspirate and biopsy, and checking bones for lytic lesions.