Version May 2024
| Entity | Bone marrow biopsy | Monoclonal gammopathy | Additional features |
| Waldenstrom macroglobulinemia | ≥10 percent infiltration by lymphoplasmacytic lymphoma | Circulating monoclonal IgM of any size | Anemia, hepatosplenomegaly, lymphadenopathy, and/or systemic symptoms |
| Smoldering Waldenstrom macroglobulinemia | Circulating monoclonal IgM ≥3.0 g/dL and/or ≥10 percent infiltration by lymphoplasmacytic lymphoma | No anemia, hepatosplenomegaly, lymphadenopathy, or systemic symptoms felt to be related to underlying lymphoplasmacytic proliferation | |
| IgM MGUS | Minimal or no lymphoplasmacytic infiltration of the bone marrow; overall marrow involvement by such cells should be <10 percent | Circulating monoclonal IgM concentration <3.0 g/dL | No anemia, hepatosplenomegaly, lymphadenopathy, or systemic symptoms felt to be related to underlying lymphoplasmacytic proliferation |
| Multiple myeloma | Infiltration of plasma cells in the bone marrow | IgM myeloma is rare; more commonly monoclonal protein is IgG, IgA, light chains only, or infrequently IgD | Hypercalcemia, renal insufficiency, anemia, and bone lesions felt to be related to underlying lymphocyte proliferative disorder |
| Chronic lymphocytic leukemia/small lymphocytic lymphoma | Bone marrow infiltration with small mature appearing lymphocytes that express CD5; expression of CD20 and surface Ig is dim | Monoclonal immunoglobulins can be seen in up to 15 percent | Anemia, lymphadenopathy, hepatosplenomegaly, and/or systemic symptoms felt to be related to underlying plasma cell proliferative disorder |
| Mantle cell lymphoma | Bone marrow infiltration with monomorphous small to medium-sized B lymphocytes that overexpress cyclin D1 | IgM monoclonal protein may be present | t(11;14) |
| Amyloidosis | Apple green birefringence under polarized light after staining with Congo red | Usually have an associated monoclonal protein | Nephrotic syndrome, restrictive cardiomyopathy, peripheral neuropathy, hepatomegaly, macroglossia, and purpura |
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