<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 62-year-old retired professor comes to the clinic with the complaints of back pain and increasing fatigue over the last 4 months. For the past week, his back pain seems to have worsened. It radiates to his legs and is burning in nature, 610 in intensity. There is no associated tingling sensation. He has lost 4.0 kg 8.8 lb in the past 2 months. There is no history of trauma. He has hypertension which is well controlled with medications. Physical examination is normal. Laboratory studies show normocytic normochromic anemia. Serum calcium is 12.2 mgdL and Serum total proteins is 8.8 gmdL. A serum protein electrophoresis shows a monoclonal spike. X-ray of the spine shows osteolytic lesions over L2L5 and right femur. A bone marrow biopsy reveals plasmacytosis. Which of the following is the most preferred treatment option?? A: Palliative care, B: Bisphosphonates, C: Chemotherapy alone, D: Renal dialysis, E: Chemotherapy and autologous stem cell transplant,  <response>: This is a clinical vignette describing a 62-year-old man with back pain, fatigue, weight loss, and laboratory findings consistent with multiple myeloma, including anemia, elevated calcium, monoclonal protein spike on serum electrophoresis, lytic bone lesions on imaging, and plasmacytosis on bone marrow biopsy. The question asks about the most preferred treatment option for this patient with newly diagnosed multiple myeloma.Choice A of palliative care would not be the best option for a newly diagnosed myeloma patient who is relatively young and functionally independent. Choice B of bisphosphonates alone would not be sufficient to treat the myeloma. Bisphosphonates are used as adjuvant therapy for myeloma to help reduce skeletal related events but are not definitive therapy.Choice C of chemotherapy alone may be an option but is inferior to chemotherapy plus stem cell transplant.Choice D of renal dialysis would not treat the underlying myeloma. Dialysis may be indicated if the patient develops myeloma-associated kidney injury but does not address the malignancy.Choice E of chemotherapy and autologous stem cell transplant would be the preferred initial treatment for this relatively young, newly diagnosed myeloma patient with good functional status. This option provides the best chance for prolonged disease control.E: Chemotherapy and autologous stem cell transplant 