[Music] what is the difference between primary and secondary of plasma cell leukemia primary PCL is where the patients present with circulating plasma cells it's not clear how that arose because we don't know previously because they're presenting with the new diagnosis but again it's a very aggressive disease and it needs to be treated aggressively we do have treatment modalities that allow this to be controlled and control for a long period of time it used to be a real problem and now it's gotten better with better therapies especially with the new agents such things as extramedullary plasmacytoma z' plasma cell leukemia that secondary there are a variety of things that are probably a reflection of the fact that disease has become more and more resistant to therapy because usually these patients have received prior therapy and if they've received a lot of prior agents and running out of treatment options it often is a signal for of our more aggressive disease that could be very life-threatening