[Music] what is extramedullary disease extramedullary disease one of the big challenges we have in myeloma so all the drugs we have are great at targeting the bone marrow problem is myeloma cells are smart so they have things called adhesion molecules which is what make them stick to the bone marrow but as the myeloma changes and becomes more aggressive or deep differentiated those cells become less it's a plasma cell like they lose those little adhesion molecules or sticky factors and those cells then go into other spots in the body and it can be anywhere I mean we've all have cases we've seen some very strange areas but it's commonly you'll see it in the liver unfortunately the biggest challenge for us is when myeloma goes to the brain we still don't have a lot of good drugs or trials for those patients so that's another side of it what we call extramedullary outside the bone marrow disease is it considered high-risk extramedullary disease in general is it considered high-risk but usually it happens at the setting of someone's already relapsed multiple times so by definition and clinical behavior their disease has been high risk