A 67-Year-Old Man Is Evaluated for Persistent Lower Back Pain

A 67-year-old man is evaluated for persistent lower back pain and fatigue.  The patient has no other medical conditions and takes no medications.  Laboratory testing shows anemia and renal dysfunction.  Serum total protein levels are elevated, and electrophoresis of the serum proteins reveals a narrow spike in the gamma globulin region.  A subsequent bone marrow biopsy shows abnormal marrow cells.  A medication that blocks cellular proteasome action is administered.  This treatment is most likely to cause which of the following effects on the abnormal cells?

A) Augmented cytotoxic T-cell response
B) Decreased DNA methylation
C) Impaired RNA splicing
D) Improved differentiation
E) Increased apoptosis

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