When is the best time to potentially use a myeloma vaccine?

When is the best time to potentially use a myeloma vaccine? So the first important thing to say is that these are all under study and development. They're in trials, but none of these vaccines, except for a few examples, which I can mention, have been approved as therapies. The examples that have been approved are in prostate cancer and in melanoma. There have been vaccines that have been approved. But in blood cancers, these are still under development. And so that's the first important thing to say. We hope that these developments, of course, bear fruit, but that's where we are right now. So right now, these are mostly used as ways to treat the cancer, not to prevent it, but often treating it when the disease has been reduced, either with surgery or with other treatments and you're trying to prevent its relapse, but the patient already has cancer. There might be some day where we're thinking about this as a primary prevention, where the person might be at risk for it but doesn't have it. But right now, what we're doing is treating patients who have already had some experience where they've had cancer and we're trying to prevent it from flaring up again. The other important thing I should say is that vaccines, because they have to stimulate the patient's own immune system, take time. They're probably not great strategies when a patient's disease is rapidly growing to make it sort of slow down or stop. But what they might be actually better than things like CAR T cells is creating a longer term response. So we think about giving a vaccine against measles or against mumps. We don't use it to treat the active infection, but it can prevent it from showing up later on. So a lot of the work with vaccines is coming up with ways to first reduce the disease and then to follow with the vaccine in a way that would preserve the immune response. So for instance, one of the things we're working on as part of an MMRF effort is integrating CARs and vaccines. Where CARs do a great job in reducing the disease, but they don't always last that long. The average might be a little bit less than a year. Vaccines may be a way to stimulate a more longer term response, but they need to work on the heels of something that first reduces the disease. There are potentially a bunch of different applications for this. The likelihood is that you can't use a vaccine to treat someone that has a lot of myeloma. But this is where people have smoldering myeloma, for instance, where you're trying to teach the immune system that, look, this is an entity that has not gotten out of control yet, but let me try and teach the immune system to identify that and try and kill it. Or in situations where people have a very low amount of myeloma, like we have on the Allergenic GVax vaccine trial. What these will do is they will teach the immune system that this, to take this little bit of disease that's left over and mop it up and hopefully keep it under control for the longest time. You will see that myeloma doctors will tell you that they often have myeloma patients who have parted around with a little bit of myeloma protein in their blood and they go on for the longest time. And this is probably an interplay between the immune system and the myeloma. And what we're trying to do is put the balance in favor of the immune system by people giving people vaccines. So probably not the best thing to use when you, one has a lot of myeloma and you're trying to reduce it quickly. Chemotherapy or other treatments are best for that, newer treatments like CAR T cells. But in patients where you are definitely trying to prevent relapse or prevent progression, right now from smoldering myeloma to active myeloma and perhaps even one day from MGUS to smoldering to active myeloma, these are probably ideal situations for patients to try and use vaccines. Just like with vaccines such as with measles or with other infectious diseases where you're trying to prevent the disease from happening, what you're trying to do is prime the immune system to prevent this disease from becoming full blown, get out of control or grow beyond where it is right now.