CAR-T shifting from salvage to preemptive therapy in smoldering myeloma

CAR-T is being pushed out of late-stage rescue and into a precursor state where patients don't even have symptoms yet. The phase 2 CAR-PRISM trial is giving BCMA-targeted CAR-T to people with high-risk smoldering multiple myeloma, aiming to wipe out disease before it turns into active cancer.

Early results, now in Nature Medicine, center on whether a one-time infusion can drive MRD-negative control without standard induction therapy and delay progression. It's the first study to try this in smoldering disease, and it sets up a clear tradeoff: using an intensive cell therapy up front versus waiting for symptomatic myeloma to emerge.