[Music] what is smoldering in multiple myeloma smoldering myeloma is defined as having 10% plasma cells or cancer cells in the bone marrow now that's a very arbitrary definition because I can do a bone marrow biopsy and one side has 5% the other side has 30% so suddenly I'm in M Gus on one side and I was smoldering on the other side that doesn't make sense and we know that even two pathologists can look at the same pathology slide and say oh this looks like a five to ten and then another person would say no this looks like a ten to fifteen so suddenly you changed as a patient from M Gus with a 1% chance of progression per year to small drink which is 10% chance of progression per year so just as we think about it a patient is not divided into M Gus and smouldering is a continuum and we put those arbitrary definitions we put those numbers just for us to talk to each other but that does not mean that a patient suddenly changed between M Gus and smoldering it's really a continuous disease and we need to treat it that way is smoldering myeloma considered cancer smoldering myeloma is a very heterogeneous area it's basically a bucket of a lot of people a bucket of people who maybe move be more like M Gus and may never develop myeloma and a bucket of people who are very active disease almost myeloma and it's just waiting to have the first fracture or the first anemia or the first kidney problem and we put all of that into 10 percent plasma cells or more and no crab criteria well that's very hard because you have a lot of people who are behaving very differently so the first thing we need to do is trying to redefine smoldering myeloma correctly and we're doing now a lot of next-generation sequencing where we're truly defining who is at risk of progressing and not just by using the M spike or the light chain but using genomics using the biology using the immune microenvironment to the sect truly who is that patient who will progress in two years these are the patients we need to treat and who are the patients who may never progress let's leave them alone and observe them carefully and that needs to be redefined so I would say smoldering myeloma needs to be redefined to you [Music]