MKI67 and anemia: International Myeloma Working Group (IMWG) criteria can be fulfilled on paper (biopsy-proven plasmacytoma plus ≥ 2 osteolytic lesions) (13), yet the patient presented with left inguinal lymphadenopathy 3 years before diagnosis and slowly enlarged to multiple lymph throughout the body, lacked the classical CRAB tetrad (anemia, hypercalcemia, renal impairment, bone pain), showed only 0.5% marrow plasma cells and a clonal burden of 0.01% by high-sensitivity flow, and exhibited an indolent tempo (Ki-67 5%, LDH consistently normal).