[Music] thank you so much jenny um this is a terrific forum for educating patients and for giving you opportunities to interact with us and ask questions i'm going to lead off with just a single slide to try to help those of you who aren't familiar with mrd understand what it is and then dr fonseca is going to take it from there and i'll speak after dr fonseca so let me share my screen this is an upside down iceberg we all know that they usually float the other way around but in this case imagine that the patient's cancer is the iceberg and at the time of diagnosis the patient might have as many as a trillion cancer cells that may well weigh several pounds as we treat we melt that iceberg and all of you are familiar with the ways in which we measure this with m spikes and light chain measurements and uh ig heavy chain measurements um and we refer to things like a partial remission or a very good partial emission vgpr as that iceberg melts so if half of the disease is gone by m spike measurement it's a partial response if 90 is gone it's a very good partial response or a vgpr by the time the iceberg melts enough to be at the waters at the surface a lot of the cancer is gone but there's still cancer remaining that is not measured by m spike or a light chain it's under the water and it's invisible to us if we just rely on the conventional assays that we've been doing for the last few decades minimal residual disease or more recently measurable residual disease is the way by which we measure what's under the water that is the the last um uh three percent or two percent of the disease that we can't otherwise measure as you could see here when you get to the water's edge there may still be a billion cancer cells left and this is why patients even though they achieve what we call complete remission it's a misnomer because it's not complete people still relapse and i believe that we shouldn't be calling a complete remission it's confusing for patients and i think we should change our terminology but be that as it may it may take a few years to change our terminology but these days more and more we are able to measure what's below the surface and just so you understand even those patients who get to zero malignant cells in a million that's one way we can measure mrd these patients can still relapse so there's still something we can't measure that's even less than one in a million um i'm going to turn it now over to dr fonseca to introduce you more to mrd and i'll be back later