Which of the following is not associated with multiple myeloma?

MULTIPLE MYELOMA : Bone pain is the most common symptom in myeloma, affecting nearly 70% of patients. Unlike the pain of metastatic carcinoma, which often is worse at night, the pain of myeloma is precipitated by movement. Persistent localized pain in a patient with myeloma usually signifies a pathologic fracture. The bone lesions of myeloma are caused by the proliferation of tumour cells, activation of osteoclasts that destroy bone, and suppression of osteoblasts that form new bone. The bone lesions are lytic in nature and are rarely associated with osteoblastic new bone formation due to their suppression by dickhoff-1 (DKK-1) produced by myeloma cells. Therefore, radioisotopic bone scanning is less useful in diagnosis than is plain radiography. The bony lysis results in substantial mobilization of calcium from bone, and serious acute and chronic complications of hypercalcemia may dominate the clinical picture. Localized bone lesions may expand to the point that mass lesions may be palpated, especially on the skull, clavicles, and sternum; and the collapse of veebrae may lead to spinal cord compression. Skull X ray may show the typical "punched out" lesions characteristic of multiple myeloma. The lesion represents a purely osteolytic lesion with little or no osteoblastic activity The next most common clinical problem in patients with myeloma is susceptibility to bacterial infections. Ref: Harrison 19e pg: 714. / MAHESWARI 9TH ED