How are the findings of a bone marrow biopsy used?

So, these results can be used in a variety of different fashions. One is it gives us a snapshot of do you tend to have high-risk myeloma or standard risk? And if you take two patients that are otherwise identical and one has standard and one has high risk and you treat them the same, they'll tend to respond the same but high risk will come back sooner. So, in a general sense, we may think of what are some general ways to treat that patient different or offset some of that high risk? Maybe giving a four-drug regimen instead of a three-drug. Maybe doing a transplant instead of ignoring it. So, that's the first level. The second level is we're starting to have genomically driven treatments. For example, if you have a translocation 11-14, there's a drug called venetoclax which is not approved in myeloma but approved in certain types of leukemia and lymphoma that will work exquisitely well in you. And we're starting to develop more and more of these. So, we're starting to get a playbook of how to more optimally manage someone's disease based on the bone marrow findings. So, the pathologist will read and interpret the results. The pathologist looks at the tissue itself and then other lab tests are done which the pathologist interprets and then there's a report that is basically summarized and uploaded to your Epic or MyChart or other electronic health record and that goes directly to your doctor or your treating team. And they use those results in conjunction with the rest of your clinical pictures or everything else you've talked to your doctor about and the symptoms you're having and the way your blood counts look to either make a diagnosis or guide treatment or understand your condition better. That whole process, like I said, takes about two to seven days or so to get all of those tests back. Rarely there are some genetic tests that can only be run at certain labs in the U.S. We call those like send out tests or you know that would be mailed out from our facility with the tissue. If we run those types of tests it can take up to two weeks or longer to get those tests back but that's very rare. I would say in general two to seven days to get all those back. Once all the tests are back then usually you'll have a meeting with your doctor or a phone call to go over the interpretation of the results and to tell you how it fits into your diagnosis or treatment. Is a new diagnosis found? Is a new treatment indicated? Are you doing well and everything looks great? But those decisions can be made once we get the bone marrow biopsy back. A lot of the tests that are send out tests are complex cytogenetic tests or what we call cytogenetic tests and so these are looking at usually they're DNA sequencing tests or they're complex sort of like cellular identification tests that can only be run at certain labs and so we have to send preserved tissue to the lab and then they have to process it, run the test and then send us a result back. So that whole process just takes a long time usually about two weeks or so. And so in multiple myeloma one of those tests is minimal residual disease next generation sequencing and so that's run at a lab in Seattle. So we have to send that there. If in the future they have a lab that is as sensitive as the adaptive next generation sequencing we may be able to run tests like that here and the wait times for those would be shorter.