[Music] what is plasma cell leukemia normally plasma cells stay inside the bone and even with myeloma plasma cells usually stay within the bone marrow however in some patients these cells can escape into the blood if you can detect plasma cells in the blood on what we will call a more of a macro level so in other words if the pathologist and pathologist look under the microscope and they see circulating plasma cells that are malignant in high levels of this is called plasma cell leukemia it's often associated with high risk set of genetic features it's often a little more aggressive and often difficult to control what is plasma cell leukemia okay this is a terrible thing that we've named this I don't know why we named it this way it causes such confusion so what type of myeloma do you have that's one of my key things do you have easy to treat intermediate or hard to treat what's the status of your myeloma is it control waking up or uncontrolled and the last thing I ask in a small proportion of myeloma patients is where is your myeloma is it in the marrow and does it involve your bones is it chewing at your bones causing holes in your bones and increasing your risk of fracture is it in your blood is it slippery so that they can slip out of the bone marrow and head into your blood if these myeloma cells are slippery and head into your blood that means that they are already relatively chemotherapy resistant because they're so slippery they tend to be able to travel they are less like my in-laws and they can go and flourish wherever the heck they want to this is more aggressive and in fact if there's 20% or more of these things we call it plasma cell leukemia all that means is that it's hard to treat myeloma and it happens to have a large number of myeloma cells in the blood how do you diagnose plasma cell leukemia so on average you do a blood test at a reasonable medical center and they're going to do a CBC probably all myeloma patients here had a CBC of complete blood count white cells red platelets on the white cells they should do a differential and they should obviously see the myeloma cells percolating along in your blood that's how it should happen does it always happen that way no a lot of times people do differentials and they just look in the south there's some granule slides lymphocytes and whatever monocytes something rather sometimes they miss the fact wait a minute these are all myeloma cells circulating in the blood it's disturbing how often that is missed [Music]