Generally, risk is assessed at the time of diagnosis. That's really the most important time to understand the underlying biology of the myeloma and whether our assessment is that this is going to be more challenging or less challenging, easier to control. Having said that, myeloma is not a static disease. It evolves over time and the myeloma you start with may not be the myeloma that you have at 3, 5, 10 and 15 years. The myeloma cells, when they're treated, can mutate. You can select out, kill all the easy to kill myeloma cells and what you leave behind is the hard to kill myeloma cells. It's a genetically unstable disease so they'll develop new chromosomal abnormalities so that the risk actually will increase over time, which is, most people understand that the disease can be harder to treat if you failed multiple prior exposures to effective anti-myeloma medications. People can be extremely sensitive to treatment and so you can eradicate the myeloma so you can't even find it anymore, but generally that doesn't mean that the risk really changes. It's just that your disease is highly sensitive to treatment, clearly a good thing, but it doesn't mean that the original genetic or biologic variables that put you into a higher risk category are not still there. So we need to distinguish the statistical estimate of risk and that's all it is, a statistical estimate of outcome, not how you will do, they're averages from disease sensitivity, disease responsiveness and the durability of that response.
HealthTree • May 1, 2023