[Music] what is em gas em gas is monoclonal gammopathy of undetermined significance which is a big long name that first of all it is not of undetermined significance because we know of the determined significance for it and I like to say the story that Bob Hyde who I trained with at Mayo Clinic coined the name he's the one who first described that word and it was because they found all of these monoclonal proteins in many people and him and yon waldenstrom who described waldenstrom macroglobulinemia were debating whether this is a benign condition or not and Bob Kyle said well I don't think it's benign maybe some of those patients will develop myeloma so he wanted to make sure we don't call them benign gammopathy so that we know that those patients may actually have an undetermined significance maybe they will go into myeloma and he's the one who developed the whole Olmsted County study to follow patients for 50 years to make sure that we understand that rate of progression of 1% per year so it's really special for me to have been trained by Bob Kyle and then now work on this area is Angus cancer MCAS is considered a precancerous condition it has cancer cells so it's very interesting the cells themselves have a lot of changes that are very similar to myeloma even the immune microenvironment of the bone marrow now we know that is also altered it's already changing even in an Angus stage but for some reason those cells have not been able to get to that next level of growing and proliferating and changing things to the point that they develop the disease so when you have a 1% chance of progression per year that's very low which means it's not those cells need something else to happen so that they go to myeloma that's something else we don't know what it is it could be a second hit mutation it could be an immune change you get some infection that triggers the whole point we don't have an understanding of why people go on to progress to myeloma how many people have M guests if we look at general and this was from Olmsted County at age 53 percent of the population has a risk of developing Angus now we know actually african-americans have a three times higher chance of developing em Gus and at the younger age at age forty or younger and we know that first-degree relatives of people sisters brothers mom dad have a two to three times higher chance of developing em Gus if they have a sibling or someone first-degree relative now if we look at the mass spectrometry which is a new sensitive test to look for monoclonal protein in Olmsted County and this was just published the number is 5% now so it's even higher than the 3% and in our own data were starting to see in the promise study the people who have high risk for developing myeloma so the African Americans or the first-degree relatives they're almost up to 13 and 15 percent that's a huge number and if that's true maybe that would be one of the options for us to say let's consider screening in the future for high-risk population because that's a big number of people who may actually have a monoclonal protein and we're missing it out because we're not looking for it how long can I have em Gus how long can I have em Gus I can have em Gus forever I may never have a myeloma in the future it's interesting there are some M Gus's that disappear on their own so it could have been a infection some autoimmune thing and then it goes away but these are rare the most common ones are M Gus's that are there forever or they go on to develop smoldering myeloma or they go on to develop myeloma or amyloidosis or waldenstrom or CLL or so many other things [Music]