Hi, I am Claudio Certione. I work in Istituto Romagnolo per lo Storile a cura dei tumori di Namadori, located in Meldola, northern part of Italy. ASH 2024 was an amazing conference. We have seen many novelties and I think that research in hematology is reaching outstanding results, but particularly I think that the revolution in multiple melomas is going to continue. And we have seen several outstanding novelties in different settings. Particularly I will start from early stages, smoldering meloma, we have seen in high risk smoldering meloma, several new novelties, several new results, starting from Aquila study in which Daratumumab has overcome the observation, the watch and weight strategy. And I think that monoclonal antibodies, Anticid 38, will be the next future of early stages meloma. Also waiting for the results of monoclonal antibodies based treatments such as Ithaca, Isatuxia, Lenalidomidexamethasone, that I am sure that will be game changer even if we don't have interim results. Also Carfilzomib with Lenalidomidexamethasone has shown superiority versus Lenidex in high risk smoldering. And also we have seen the first data with the CILTA cell in early stage meloma. So I think that we should be ambitious, particularly with patients that have not developed the symptomatic disease and I think that MRD negativity should be the real end point in these patients. However, what is today I think a certainty is that we have to treat these patients. The high risk should be absolutely treated because they have too high rate to develop a symptomatic meloma. Going in frontline meloma, I think that the most important novelty is the study GMMG HD7 that has shown Isatuxia addition to Bortezomib Lenalidomidexamethasone is a VRD. And also in this case I think MRD negativity is going to be came in transplant eligible patient, the real end point, which correlates to the best long term outcomes. The therapy has shown incredible results in terms of overall response rate, MRD status, but also in terms of tolerability. I think that is going to be one of the potential next future standard of care, also according to the combination of BISA plus Lenalidomide in the maintenance randomized with Lenalidomide. In relapsed refractory setting we are going to see many new results, incredible updates with Belantam Mab Dream 7. Belantam Bortezomidexamethasone has shown the first data in terms of overall survival and I think that in early relapse, particularly in the one that have been treated in frontline with Dandis D38, Belantam Mab will be an incredible game changer in the next year. Moreover, we are going to see that CAR T can be placed also in early treatment, in early relapse, and CAR T2-4 has shown the superiority versus the standard of care. And we have seen also new potential strategies to bridge to CAR T. I think that TALCETAM Mab is really interesting in this sense, but let's not forget also other agents such as Nexon and Melfloufen that can be interesting in this situation. About CAR T data we have seen also real world evidences with CILTA cell winning on either cell in this analysis and I think that other interesting results is also from B-specific antibodies. We have seen an interesting study, Phase 1B, Magnetism 20, in which Elranatamab has been combined with Carfizomib, so I think that also this combination is particularly interesting and promising for next stage development. And also we have seen some studies in which B-specific antibodies have been compared in academic center versus community centers. And we have seen that these are perfectly feasible everywhere and also an elderly patient can offer the same outcome. So absolutely not stopping with using B-specific antibodies everywhere and for every patient in which we want to treat. Other interesting things are the data in academic CAR T. We are going to see the first results. These are particularly cost effective and I think that many institutions, also mine, that have approved cell factory will work on that and I think that we will see also in next conferences new data of new molecules in academic CAR T. We are going to see also data with new target CAR T and I think that the data in extra medullary disease seems to be really interesting. I think that other really important novelties are about the maintenance. I think that we are going to optimize the maintenance and maybe the combination B-specific and monoclonal antibody plus lenalidomide will be the best for the future but I am particularly curious to see also updates about data in terms of treatment suspension according to MRD negativity data because the patients don't want to be treated until progression. In the ones in which we reach a really deep response we should absolutely withdraw the treatment and watch and wait in a strict way. I think this is the future because we have seen also from some analysis from patient reported outcomes the patient that are achieving an outstanding response want to be without treatment, want to live their lives. And I think that in this sense we have seen a revolution in the revolution in meloma and I think that the care is not so far anymore according to the data that we have seen, according to the new targets and according to personalized treatment that we are going to develop. Thank you for this space.
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