Over the last decade, two strategies have advanced the treatment of patients with multiple myeloma and precursor diseases. First, the definition has changed to include patients without end organ damage, who previously would not be treated. Second, there is widespread enthusiasm to treat high risk smoldering myeloma. In this commentary, we explore the evidence supporting these therapeutic expansions. While treating early adds cost and therapeutic burden, it remains unknown whether survival or health related quality of life is improved from early treatment. Herein, we consider the implications of diagnostic expansion in multiple myeloma.