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Pulling Back the Curtain: S. Vincent Rajkumar, MD

July 20, 2023

August 2023

In this edition, S. Vincent Rajkumar, MD, discusses his path from India to the U.S., the importance of great mentors, and his passion for health policy.

Mary Ellen Schneider

Mary Ellen Schneider is a medical journalist based in Setauket, New York.

S. VINCENT RAJKUMAR, MDVincent Rajkumar, MD, is the Edward W. and Betty Knight Scripps Professor of Medicine at Mayo Clinic in Rochester, Minnesota, the associate editor of the Mayo Clinic Proceedings, and the editor-in-chief of Blood Cancer Journal. He has been the principal investigator on several clinical trials of treatments for multiple myeloma and serves as the chair of the Myeloma Committee for the ECOG-ACRIN Cancer Research Group.


Tell us a little bit about your family and growing up in India.

I was born in the city of Madras, which is now called Chennai. I lived there until I was about 12 years old, and then we moved to a smaller town within the same state. As a child, my main hobby was music. Singing was my passion, though I tried to learn the guitar, violin, and piano. I can play a little bit of each, but that’s about it. We had a very middle-class lifestyle in India. I lived with my parents, two brothers, and one sister in a one-bedroom house. It’s hard to put my finger on exactly when I knew I wanted to be a physician, but my parents always wanted that for me, and I have a cousin who is a surgeon in Los Angeles who we all looked up to as a role model.

When did you first become interested in hematology?

I attended the Christian Medical College in Vellore, South India. It is one of the top medical schools in the country and home to some top-notch academicians, one of whom was a hematologist named Mammen Chandy, MD. He was probably one of the most established hematologists in the country and an inspiration for all the medical students. I quickly became fascinated by hematology. I also was fascinated by cancer and the realization that it cannot be cured. There is an excitement about trying to find a cure, trying to make people with cancer live longer, and figuring out how best to treat it. There was no formal hematology training program in India, so I decided to go to the U.S. to train, initially with the idea of returning home.

Dr. Rajkumar with wife Dr. Priya Sampathkumar, professor of medicine in the Division of Infectious Diseases at Mayo Clinic, in the Reading Room of Mayo’s Plummer Building.
Dr. Rajkumar with wife Dr. Priya
Sampathkumar, professor of medicine
in the Division of Infectious Diseases
at Mayo Clinic, in the Reading Room
of Mayo’s Plummer Building.

How did you end up at Mayo Clinic, and why did you decide to stay?

I met my wife, Priya Sampathkumar, MD, in medical school, and we were married in India. She is an infectious disease specialist, and our plan was for both of us to go to the U.S. to train and then return to our families in India. We came straight from Madras to Fargo, North Dakota, where one of the program directors, Anthony Gustafson, MD, found spots for both of us in the residency program there. It turned out to be a great decision because Dr. Gustafson was quite the visionary, and he was instrumental in encouraging Priya and I to focus on academia and research. He recommended Mayo Clinic as a place for us to continue our training. Mayo was just 300 miles from Fargo, and a lot of faculty in North Dakota were trained there. We applied and were lucky enough to both get in. When we finished our training, both of us received offers to stay on at Mayo. That offer was too good to turn down. Mayo is an incredibly good institution, and it felt remarkably similar in culture to our medical school with its ethos of service. For us, it was the ideal place to practice medicine. I was convinced that I could be of more help to India if I were doing research and making advances in the myeloma field at Mayo Clinic than if I had returned to India to practice medicine.

Dr. Rajkumar with one of his mentors, Dr. Robert A. Kyle.
Dr. Rajkumar with one of his mentors, Dr. Robert A. Kyle.

Dr. Rajkumar with his colleague and mentor Dr. Ayalew Tefferi.
Right: Dr. Rajkumar with his colleague and mentor Dr. Ayalew Tefferi.

Who are some mentors who have helped to shape your career?

People ask me, why did you choose to focus your research on myeloma? It’s very simple. Mayo Clinic is a place that is particularly well known for myeloma because of the incredible physicians and researchers in the field here. These people became my mentors, most notably Robert A. Kyle, MD. He turned 95 years old this year and still continues to work. He was already a legend in the field when I came to join Mayo, and working with him – the man who wrote the diagnostic criteria and who coined the term MGUS [monoclonal gammopathy of undetermined significance] – was just unbelievable. The best mentor is someone who doesn’t have anything left to prove and will now look out for your interests. That is who he was, and his goal was to help me become a good physician. He shared so much of his research legacy with me, and as a result, I was able to write papers with 25 years of MGUS follow-up when I had only been at Mayo for four years. That really propelled my career forward.

Another great mentor was Phil Greipp, MD. He passed away a few years ago. Phil was the head of the ECOG (Eastern Cooperative Oncology Group) Myeloma Committee, and he involved me in ECOG very early on, which allowed me to conduct randomized trials through that mechanism. Another important role for mentors is to help you find your faults and correct them. Ayalew Tefferi, MD, pointed out that to be successful, I would have to become a better public speaker and writer. You can be the most brilliant scientist, but if you cannot give a good talk, nobody listens. Maybe you can write, but nobody reads your paper unless it is crystal clear. Dr. Tefferi would let me know when a talk I had given or a paper I had written didn’t meet his standards, and he would practice with me to fine-tune those skills and become better. Finally, Morie Gertz, MD, was a very helpful mentor who offered me not just professional guidance but advice on life outside of medicine, including investing.

You have led multiple clinical trials that changed the standard of care, including the pivotal trial for thalidomide in myeloma in the U.S. What do you find most rewarding about trial work?

I have been fortunate to be involved in many clinical trials. The skill of bringing a trial from idea to full execution is difficult, and I love the challenge of doing that. I was also lucky to lead a trial that was the idea of a patient. Michael Katz was the patient advocate for ECOG and the International Myeloma Foundation; he has since passed away. He had myeloma, and after the thalidomide trial, he told me that although there have been many innovations happening in myeloma, we are still using too high a dose of corticosteroids, like dexamethasone, which is causing a lot of morbidity for patients. You are getting a higher response rate, but patients are paying for it with unnecessary toxicity, he told me, like tremors, diabetes, hypertension, weight gain, and infections. You’ve got to change the paradigm, he said, and suggested that testing out a lower dose of steroids should be the next trial. That was a hard trial to do when people were evaluating new drugs like lenalidomide and bortezomib at the same time we were proposing a trial to compare high-dose dexamethasone with low-dose dexamethasone. However, that trial ended up saving a lot of lives and lowered toxicity. Even at just one year, we found that by using the usual approach of high-dose steroids, about 13% of patients with myeloma died versus only 4% if we cut the dose of steroids. Immediately, practice all over the world changed to lower-dose steroids. That was a hugely satisfying outcome and made me feel like I was making a difference and fulfilling my promise from medical school to be of service to patients. Knowing that the trial was a patient-inspired idea was also very rewarding.

You’ve also worked on policy issues, such as drug pricing. Why are these issues important to you?

Cost became a concern of mine because I had been involved in trials for thalidomide, lenalidomide, and pomalidomide. These are very simple compounds that probably cost a dollar to manufacture, but when I looked at the price of these drugs post-approval, they were being sold in the U.S. for tens of thousands of dollars a month. I felt like I had to look into what was unique about the U.S. that allowed this to happen. I began to study how drugs were developed and priced in the U.S. compared with other countries. I started asking, what were the elements unique to the U.S. that allowed drugs to be priced at $15,000? If you take an iPhone, for example, Apple cannot price it at $15,000 because there’s Samsung and Google, and no one will buy an iPhone at that price. With drugs, though, certain market forces or non-market forces are at play. The more I dug into it, the more I found it was alarming that we have a situation where there are few allies campaigning for lower prices. Everyone in the supply chain from pharmaceutical companies to pharmacies benefits from a high price, so there is no move to direct policy to lower the price of drugs. I began writing about it and found other people, like Hagop Kantarjian, MD, of MD Anderson Cancer Center in Houston, who had reached the same conclusion, to join me in raising concerns.

Dr. Rajkumar (far right) plays guitar with colleagues at the Kyle Award Reception during the 2016 IMWG Summit in Copenhagen.
Dr. Rajkumar (far right) plays guitar with colleagues at the Kyle
Award Reception during the 2016 IMWG Summit in Copenhagen.

What do you do for fun outside of work, and how do you create that balance?

Work-life balance is very important. One of the things that helped me is that I have received grant funding from the National Institutes of Health throughout my career, and that protects my time to do research. I have enough protected time for research and protected time for practice. I have also cut down my hours to allow time for editorial work on journals, to be able to travel to India to see my parents, and to have enough time to devote to my wife and sons — that compromise has to be there. For hobbies, I have always tried to pursue some type of extra activity to keep my life interesting. I am very passionate about music, and I’ve tried to pick up the piano and guitar again. My advice for striking a balance is to understand that you cannot agree to everything. Dr. Kyle always advised me that if you are going to do something, it should be meaningful and true. That is how I adjudicate every opportunity.

This interview has been edited for length and clarity.


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