A 71-year-old man is evaluated in the ER for a recent finding of high ESR in a routine blood test. He has history of hypertension, well controlled with metoprolol. His physical examination is completely normal. His laboratory workup reveals hemoglobin 12.6 gm/dL, leukocyte count 8500/mL, and platelet 265,000/mL. Total protein 6.2 g/dL, albumin 3.4 g/dL, BUN 16 mg/dL, creatinine 0.75 mg/dL, and calcium 9.2 mg/dL. Serum protein electrophoresis reveals a sharp, narrow spike, serum immunofixation reveals M-protein 1.2 gm/dL, bone marrow examination reveals less than 10% of monoclonal plasma cells. A skeletal survey is negative for any lytic lesions.