[Music] what is em smart before we get into specific guidelines let's talk about what risk stratification is because you'll hear the concept brought up a lot risk stratification is the process of separating patients into groups based on how aggressive or high-risk their diseases a stratum is a layer or a class myeloma patients are separated into these groups or strata based on a number of disease factors that make their disease harder or easier to treat so patients are stratified by their risk based on which group you're in you will be better suited to treatment different from someone in another risk group risk stratification helps get the right treatments to the right patients hello I'm more eager to I'm a consultant in hematology at the Mayo Clinic in Rochester Minnesota I'm smart which has found that M smart dot o-r-g is Mayo Clinic at three sites attempt to make recommendations for the diagnosis and management of multiple myeloma amyloidosis and waldenstrom macroglobulinemia although there are many places where you can find information regarding available therapies oftentimes the number of choices can be overwhelming what we've attempted to do with the M smart criteria is use the best available information that we have to make very specific recommendations about how a given individual should be treated our working paradigm is if a physician called us over the phone and asked us how a specific patient with multiple myeloma should be treated we wouldn't run through a litany of ten different choices we'd actually be very specific of one or two choices that they'd be allowed to select from in order to make a decision that best fits the patient in addition the guidelines that we use are also stratified based on what we believe would be the patient's risk of remaining myeloma free over the long term this is a large part driven by the fish genetics that are obtained on the bone marrow at the time of diagnosis or progression and we use those to classify patients into standard risk and increased risk and based on those we use different combinations of very active treatments for multiple myeloma to try and get the deepest and most durable responses available how does am smart stratify for risk we do this in a number of ways the actual international stage is important the presence of features such as extramedullary disease multiple myeloma that is outside of the bone marrow but most importantly we look at the genetics of the myeloma cell and when I say genetics I don't mean that this is inherited I mean that the cancerous cell acquires mutations that predict its biologic behavior and we can use those genetic changes to get a prediction of risk of myeloma getting worse or showing a shortened response to chemotherapy and we'll use that to drive our decision-making process with regard to selection of appropriate therapies or in many instances inappropriate research clinical trial that a patient should be participating in in order to get the latest treatment that would be effective for the management of their myeloma shown here are the M smart recommendations for newly diagnosed multiple myeloma and relapse and refractory multiple myeloma the treatment recommendations are based on a number of factors such as risk stratification transplant eligibility prior therapies and extramedullary disease these same guidelines can be found at Mayo Clinic's and smart website em Smart org you [Music]