[Music] how long will I live with multiple myeloma so that's a very important question the one we get usually during our first encounter you know what does this mean to me and I tell patients from what we know today this is a disease that usually will run its course over many years we're not talking about weeks we're not talking about months we're talking about many years and even what we know with the most recent statistics we think that a patient that would be diagnosed today in 2019 and for instance would go through the usual treatments including stem cell transplant the maintenance that patient could approximate a median survival of at least 100 months now that doesn't mean there's a guarantee and that doesn't mean there's a time limit to that that means that at the end of that period of time patients will have ultimately required additional treatment that need something else for the relapse so we think patients are living in the range of 10 years plus sometimes with some of the new your treatments unfortunately that's not true for everyone so patients are dealt card set that it's a more aggressive myeloma that would have a higher propensity for coming back earlier and then those numbers tend to be shorter right now if you are diagnosed today some of it depends on your biology so the high-risk people still have a median survival that's probably around three to five years for people who have standard risk myeloma and our fit the it depends on whose data you're looking at but it's probably a minimum of eight years and in many studies more than ten right now and and that's for people who don't have a lot of other medical problems is there a cure for multiple myeloma that is a great question I would say every doctor or other provider you've asked will tell you that they have patients in there who have lived more than ten years a lot of those patients ten years off therapy a lot of those patients have had transplants and there's a couple of things going on we're trying within the center for international bone marrow transplant research to see if we can pick out clinical features about those kinds of people people who've gone at least seven years as a transplant and have never had any progression we believe that there are these individuals walking around and what we don't know was there's something special about their biology their type of myeloma was somehow easier to treat the the group they I think if there was a sobering note this morning it was that the high-risk patients even with these new innovations they're still not doing great so even the quadruplets that we heard about today VTT Dara they still had problems with a high-risk patients so I think there are some people that we're going to get to that point with very sustained longer missions but I think we've got a lot of work to do that is a philosophical question I come from the school of thought of years there's a cure for myeloma and we are on that road to curing myeloma and the fact that people are actually talking about this today is a testament to that is myeloma curable and all myeloma patients probably now do we need to cure myeloma in all patients probably not if you have someone who is you know older someone who is in their you know mid 80s and they have other health problems you don't want to give them something that will make matters worse for them and and maybe the best strategy for them may be to control their disease for as long as possible so they can continue to have a good quality of life but for someone who is fit and you know younger 70 is the new 50 and you know our treatments are getting better tolerable if we can come up with a strategy where we can eradicate all myeloma subclones in a patient at the time of diagnosis that would be fantastic I think our biggest promises with immuno therapy and that's a big umbrella under which we have cellular therapies we have monoclonal antibody based strategies but as we start picking out each of these targets BCM a GPR c5 d slam f7 cd38 and and develop an overall strategy where we give short duration of therapy with all of these different agents to a given patient based on their disease biology along with the existing platforms that we already use I think curing myeloma patients is possible you know people often get into arguments because they don't define what they're arguing before they presented arguments if you ask me are there patients out there that can complete treatment and never again require treatment the answer is yes with some people consider those patients cured the answer is yes when we look at old studies particularly there's a study from Spain that looked at very long term outcomes after stem cell transplant how long 20 years they found that a third of those patients who achieved a complete response by the criteria that was used back then did not relapse essentially they were functionally cured of course we all want to get to the cure that means you take pills or you take injections for a short period of time and you never again have to deal with multiple myeloma at least in a majority of patients we might be getting closer and I hope that's in the future so it depends on how you define it but there is definitely a group of patients that only require one intense face of treatment anyone who's watching this it was a myeloma patients should remember something very very important if you get eight to ten years of the C's control the treatments for myeloma eight to ten years from now will be radically different from what we're doing today that's something that economists call the value of options meaning you will have options that you don't have today just because the clinical research has been done during that period of time a great example for this is what happened with folks in the HIV and AIDS epidemic some of the individuals who could stay on treatment just enough so that they could see the next line of treatment are still alive today because of that innovation