What are the challenges of precision medicine in myeloma?

[Music] what are the challenges of precision medicine in myeloma precision medicine is very clearly defined for a variety of diseases so in many lymphomas that express cd20 we can give a drug like rituxin and that's a form of precision medicine for cml chronic myelogenous leukemia it's the disease is defined by this 922 translocation and we have drugs that specifically target that to make the cancer regress myeloma is made up of what we call subclones meaning when we think about an individual's myeloma it's actually not one disease but subdivisions of an individual disease within a single person usually at the time of diagnosis an individual has between four and six different subclones within their myeloma genome within their body so one of the difficulties is these clones fight for dominance and one may be dominant now and less dominant later so as we precisely attack some of the clones they may go down but another clone may arise that's not responsive to that precise movement this is part of the reason why many of our approaches nowadays involve two three and even four drugs at the same time to make sure that even though it's not precise we're covering all the different subclones so that we can bring everything down you