Why is it important for myeloma patients to know the cytogenetic abnormalities of their cancer?

[Music] why is it important for myeloma patients to know the cytogenetic abnormalities of their cancer so myeloma is very different from a lot of what we call solid tumors diseases like breast cancer or lung cancer so in solid tumors like breast cancer prostate cancer lung cancer they're staged from stage 1 to stage 4. typically but not always stage 1 solid tumors are simply removed either by surgery or radiation stage four typically we give chemotherapy and stage twos and threes are some combination of surgery or radiation or chemotherapy myeloma does not behave that way in fact myeloma has three different staging systems but they all go one to three in general that is not the better way that we describe patients because we don't treat someone with stage one different from stage three in our mind we define myeloma as being standard risk or high risk and in general if you take a standard risk patient and a high risk patient they tend to respond similarly to therapy but the high risk patient will unfortunately relapse sooner so part of our understanding of the disease and what's important to know is what type of cytogenetic abnormalities you have because that helps us understand what type of myeloma you have is it more high risk or more standard risk when we speak about genetic abnormalities they're not genetic abnormalities in the cells all over your body they're just within the cancer cells themselves and when we do those bone marrow tests we specifically look for certain types of genetic abnormalities that we know make people higher risk or less high risk one of the big ones we typically think about is something called a 17p deletion we all have 23 pairs of chromosomes and each chromosome has a long arm and a short arm the short arm is p and the long arm is q so when we say a 17p deletion we mean some of the information on the short arm of the 17th chromosome is not there and unfortunately that's where something lives it's called p53 it's this big tumor suppressor gene and it's one of the mechanisms of our body to prevent cancer and if you're missing that part on that chromosome your myeloma tends to behave in a more high risk nature so it's important to know these things in terms in terms of mapping out your long-term outcomes and different therapy options and as our technology gets better understanding which genetic abnormalities we have help drive specific therapies as in the case with venetoclax we know that people with an 11 14 translocation have a higher chance of responding to that drug so we often talk about different types of myeloma and the reason we're interested in different types of myeloma is that we recognize that myeloma is different in different people and we want to have better ideas of how to group the type of myeloma one individual has versus the type of myeloma another individual has i'm a geneticist so i look at the world through the lens of genetics and part of the reason that i look at the world of myeloma through genetics is that i recognize that there are different genetic variations different genetic abnormalities different genetic mutations that might define one particular group of myelomas so there may be a group of myelomas that have a deleted chromosome 13 or there may be a group of myelomas that have what's called a translocation where two chromosomes get together like chromosome 14 and 12. so these all are genetic definitions and we be we've become more aware that some of these genetic definitions now give us subgroupings of different types of myeloma and some of these genetic variations that occur are associated with either more or less aggressive myelomas so in my mind when i look at the genetics of myeloma i'm looking at genetic tests and genetic results that distinguish low-risk high-risk disease for example as genetic markers