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SAN DIEGO — It’s been decades since Vincent Rajkumar, a multiple myeloma physician and researcher at the Mayo Clinic, remembers first feeling that he was treating patients far too late. Myeloma, he explained in an interview, is unique among cancers in that it is only considered cancer once patients experience organ damage like renal failure and bone lesions. It would be better, he believed, to start treating patients sooner — rather than watching and waiting until after all that suffering has begun.

“Watching them means you condemn them to end-organ damage,” Rajkumar said.

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Patients at that earlier stage, a condition called smoldering myeloma, technically don’t have cancer yet — and many never develop active myeloma either. So treating patients with smoldering myeloma has long been a deeply controversial topic among myeloma physicians. 

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