Good morning. My name is Luca Bertamini. I'm a hematologist and a researcher. I work in the myeloma group in Rotterdam, the Netherlands. Today, I would like to talk about circulating tumor cells, which is a topic I'm going to present at this ASH in San Diego. Circulating tumor cells that we like to call also in short CTC represent myeloma cells that we can find in the peripheral blood, so in the simple blood of patients. They're quite common. So generally, myeloma is a disease of the bones, as we know, but cells can also go into the peripheral blood and we can find it and track it. So what we know is that patients that have more of these cells generally have a worse outcome. There's been a really a lot of studies in the last year, but still this biomarker, so this risk factor is not really tested in the clinic. And there's still some work to be done to get this biomarker really used to help certify patients. We have studied and what I'm presenting at this ASH is a sub-study of the PERSIUS study, which is a large phase three randomized study that compared VRD transplant and R maintenance to the addition of daratumumab, so DVRD transplant and DR maintenance. And this trial set the new standard of care for patients eligible to transplant. So what we wanted to know is if this biomarker, so this risk factor, is helping us identify patients that have a worse outcome and also in this context of a very advanced regimen. So what we did, we basically tested patients for this biomarker using the flow cytometry. So it's a simple method that can be used generally in all hospitals and it's the same method that we use also for minimal residual disease negativity. It's also very important because it's another prognostic factor that helps us to identify a patient that will do better than others. So what we found out is that patients that have more of these circulating cells, again as previously described, also in this context with a very effective treatment, they still do a bit worse. And what we also noticed is that this is independent of other risk factors. For example, we know that's very important biomarker from allomyo-cytogenetics like deletion 17P, translocations and so on. And also it's independent of other established risk factors such as international staging system and LDH. This is really important, of course, because when we want to look and implement a new biomarker, so a new test for a patient, we want to be sure that this adds up on what we already test for them. So it's independent, so it's helping us understanding better what's going to be the prognosis of patients. And then what we also noticed is that patients receiving their atumum, so they generally do better, either they have these circulating cells or not, and they generally have better MRD negativities, so better responses, and longer progression for supply. So we really believe that this biomarker is really important, can be easily tested in patients just from their blood, and can be done in centers that are also non-academic, and could really help us identifying patients that potentially would benefit for additional treatment or different treatment approaches.
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