BETA - What disparities exist in disease biology?

One other thing that we see as a difference between ethnicities, and it's again more biologic, is that those myeloma defining events, so the hypercalcemia, renal insufficiency, anemia and bone disease. Step three, the CRA, the hypercalcemia, renal insufficiency and anemia are more common in African patients than in Caucasian patients. Caucasian patients are more likely to present with bone disease than Black patients, but Black patients are more likely to present with renal insufficiency, anemia and hypercalcemia than other ethnic groups. One really interesting point is that the high recited genetics, very different. Several studies have shown that Caucasian patients are more likely to have those high recited genetics, that deletion of the 17th chromosome, the addition of the first chromosome, the translocation of the 4 and 14th chromosome. They're more likely to have that Caucasian patient, more likely to have the high recited and less likely to have the, white patients are more likely to have the high recited genetics than Black patients, which is a huge difference. Black patients are more also patients of high African ancestry, which is what the study showed, more likely to have the 11-14 translocation, which is used, which is the target for the drug Moneta class than Caucasian patients. We found the 11-14 translocation is very sensitive. So there are very subtle but important biology differences. When patients have those two chromosomes connected to each other, the myeloma takes kind of a different flavor. Part of that different flavor is that it's very sensitive to a drug called Moneta Clax. Moneta Clax is a pill that is an inhibitor of BCL2. BCL2 is something that about 11-14 myeloma is very sensitive to. And so when they've done trials of giving Moneta Clax to patients with 11-14 translocation, their response rates are very, very good, up in the 80 percentile. If you give it to patients that don't have the 11-14 translocation, their response is a low, more like 20 percent. And so, Moneta Clax 11-14 is really the first precision, if I can pronounce that in the morning, precision medicine for myeloma, where we offer that to patients that have the 11-14 translocation, knowing that response rates are really good, and usually don't give it to patients that don't have 11-14 translocation, because again, the myeloma of a different flavor, that drug doesn't work as well. It'll be really important because again, 11-14 translocation is more common in the African-American community to have those African-Americans involved in those clinical trials to see the benefit of Moneta Clax and for us to learn more about how those benefits translate to myeloma care for the African-American community, 11-14 patients, and for the myeloma community in general. You know, multiple myeloma is a disease that's more common in African-Americans, so the incidence of myeloma in African-American is about twice what you see in Caucasians. We know that males and females are both at higher risk if they are African-American or black descent. Most of those patients present at a younger age. Some of them present more with bone disease and more with anemia. There are some biological differences in addition to the racial differences. We know that African-American, and I will say that with a little bit of a caution, but I think, and I think some data support that African-American patients present with less aggressive myeloma than more aggressive myeloma. So they don't have a lot of deletion 17, if you look at cytogenetics. They usually have more favorable karyotype or genetic profile than Caucasians. And if you look at access to care, if African-American patients have the same access to care that Caucasians have, the outcome is actually very good. Actually in our study here, which we published, and actually Emory published the same data, and then they looked at Sears database. So three studies have shown that if African-American patients receive the same treatment that Caucasians do receive, they have a better overall survival. That survival is about one year different in favor of African-Americans. So if you transplant them, give them imides, give them proteasome inhibitors, they have very good outcome.