Hi everyone, I'm Jorge Arturo Tado. I'm the senior manager of clinical research at Health Tree Foundation and I'm going to present an abstract that we did a poster for IHA. In this abstract we reviewed the evolution of the MSMART certification criteria. We know that version 3 recently was updated on last October to version 4 and in these updates we saw a huge change in terms of how we classify high-risk patients. According to the IMS updated criteria in consensus with the International Mobile Working Group, we saw that high-risk genetics are highly important when they appear with other abnormalities and not only as an addition effect as we saw in the version 3 but more of a compound effect. This version made those changes and we tried to understand how these changes would affect our patients. So we reviewed patients where we classify them with an algorithm that we developed at Health Tree looking at their electronic health records and we could classify them into both criteria. So on the version 3 criteria we saw that they use four levels of risk, standard risk, R-risk, double hit and triple hit. In the updated version 4 they removed the triple hit which was interesting but when we saw the results it became pretty clear why they made those changes. So the first thing is that all the standard risk patients stayed almost the same. 99% of them stayed as a standard risk in the new criteria but in terms of the high-risk patients about 70% of them changed to a standard risk in the new criteria and when we saw the double hit patients as well about 30% of them also changed to standard risk and almost 70% of them changed to high risk. For the triple hit patients that were defined like that on the LMSMR version 3 we saw that about 25% of them changed to double hit and the rest were high risk or a standard risk. So why do these changes matter? So as we know treatments are highly related to the risk or at least physicians try to guide their decisions according to the risk of the patients. So with these changes we know exactly which patients are truly high risk and ever more how important this risk is for double hit patients. Another of the things that will be important for us to notice is how changes such as these were guided from data and how the understanding of this data evolves through the years. So it wouldn't be surprising if in the coming years we saw more changes maybe the decision 17p with gain 1q is triple hit or something along those lines. So it's important that physicians try to reclassify the patients of course not many patients have the genomics to reclassify them with the new criteria but even without them it will be an important exercise to see how a patient can benefit from these changes.
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