Who are the most optimal candidates to receive immunotherapy?

Who are the most optimal candidates to receive immunotherapies? So immunotherapy is a treatment that everybody could receive because it's a broad, I would say term for treatments that use the immune system. So one immunotherapy is a CD38 monoclonal antibody and for instance there are two map or is a toximab. So everybody regardless how sick or how old are you can get a CD38 monoclonal antibody. It's very well tolerated. We use it not only for multiple myeloma also for amyloidosis and you know that amyloidosis patients can be very, very, very sick. So I would say immunotherapy monoclonal antibody is very well tolerated and it's part of all treatments. So the simple answer is yes everybody should get immunotherapy. Don't forget also lenalidomide and pomalidomide are immunotherapies. They are immunomodulatory drug that enhance the function of the T cells. So that's why patients have side effects for instance the rash or they get the diarrhea because your immune system is activated and it can even be targeted against your own body. So lenalidomide and pomalidomide are a type of immunotherapy, very important and we know that immunotherapy such as lenalidomide together with daratumumab together are very effective and even our patients who are not transplant eligible benefit from this therapy. We know that from the MYA trial daratumumab and lenalidomide. So we have also more immunotherapies that take advantage of the T cells directly. For instance the BITES, the bispecific T cell engages. Those treatments link the T cells together with the multiple myeloma cells so that the T cell can directly kill the myeloma cell. Those treatments are associated with the activation of your immune system so you can get flu like symptoms and you have the flu or when you are very sick your immune system is activated. You secrete cytokines that cause fever and low blood pressure in order to kill the viruses that are in your body. And the same thing happened when patients received the bispecific antibodies or bispecific T cell engages. Many large companies are doing currently trials, regenerin, Janssen, Emgen using and testing those BITES. I think they are very promising, they are off the shelf and the side effects such as the fever, we call that cytokine release syndrome, are usually tolerated and controllable. So I would say patients who are sicker, who are not transplant eligible candidates are probably candidates in the future for the BITES. And then I would say we have the most aggressive immunotherapy, the CAR-T cell therapy. What we do is a CAR-T cell therapy. We take out the T cells out of the patient, we modify the T cells that they recognize the myeloma cells and we give or re-infuse those CAR-T cells to the patient and the CAR-T cells are very angry and want to kill all the myeloma cells and they are modified and able to recognize the myeloma cells. And what happened then is sometimes we call that cytokine release syndrome as a cytokine storm. Patients can get extremely sick, they can have high fever, drop in the blood pressure, drop in the oxygen. That's why those patients need to be in the hospital. And I would be a little bit more careful if patients are frail and not transplant eligible candidates, they are maybe not good candidates for the CAR-T cells because keep in mind if the blood pressure drops and you have a patient who is already very frail with pre-damaged organs, for instance a heart failure, those patients might not survive really I would say a higher grade cytokine release syndrome. So I think the bites, the imides like lenalidomide, pomalidomide and the monoclonal antibodies like daratumumab, esetoxymab, also elutuzumab, I forgot this, are good treatments for everybody. CAR-T cells, you should be fit. So we also have the drug antibody conjugates, Blendwrap. Blendwrap is approved and Blendwrap is also a drug that is very well tolerated. We usually don't see CRS so I would say everybody who is eligible for a treatment for multiple myeloma should be able to tolerate the Blendwrap. Usually we don't see the CRS, we don't see the fever, we don't see a drop in the blood pressure. It's an effective drug especially when we combine the Blendwrap which is a drug-conjugated antibody together with lenalidomide or this pomalidomide. The downside is if you have already problems with your vision, I would not recommend Blendwrap because we know that 70% of the patients who are treated with Blendwrap develop a keratopathy. That means little air inclusions in the cornea. The problem is this is not life-threatening but it might decrease or in 70% of the patients it decreases the vision. It's a problem when you depend really on your eyes for instance, you are working and you need to read the computer or you need to drive for instance. Those patients I would say should think about that treatment or especially if they have already pre-damaged eyes from other toxicities or from pre-existing eye conditions.