A 74-year-old woman was admitted to the ICU with pneumococcal bacteremia. She complained of recent severe fatigue, loss of appetite, nausea History: chronic HTN, aortic insufficiency, diabetes mellitus X-ray of the pelvis showed numerous lytic lesions in the ilium and a large lesion in the right proximal femur MRI confirmed a 9-mm lesion in the right femoral head and numerous bilateral T1 hypointense and T2 hyperintense lesions in both iliac region Laboratory results: Hb, 8.3 g/dL Ca2+16.35 mg/dL Creatinine, 1.0 mg/dL Creatinine clearance, 59 mL/min M-protein, 1.6 g/dL B2M, 4.9 mcg/mL SFLC, kappa, 150 mg/L Bone marrow biopsy, 70% plasma cells Molecular testing, t(4;14) ECOG 2