[Music] will deletion 17p and other chromosomal abnormalities go away after an auto transplant it's hard to say if a stem cell transplant can eradicate a mutation whether it be a 17p or a 1q gain or a translocation the idea of the transplant in combination with the induction therapy is to try to minimize the amount of myeloma cells that are detectable in the body unfortunately the technology that we have to identify minimal residual disease or a small amount of myeloma cells in the body is still in the works right now and a lot of the times when myeloma tends to come back we might still have those genes there and we might see those genes or those mutations in in relapse but if you ask me will a transplant eradicate a mutation it's hard to say the only way of eradicating a mutation is by saying that you're cured from the cancer and in myeloma unfortunately we still cannot say that i do want to say though that if somebody has achieved a very good response to treatment and has achieved a stringent complete remission or an mrd status that is negative whether it be by flow or by next generation sequencing and you run fish testing or gene expression profiling there's a probability that you might not find the mutation there and that doesn't necessarily mean that the mutation is completely gone from the body it could mean that the that the amount of that mutation in the sample obtained is very little and does not meet that threshold of the test that says positive or negative or it could also be that the sample site that was used might not have a group of myeloma cells that have that mutation so i don't want to say that a transplant is going to eradicate a mutation because the odds are that there might still be some lingering cells with some of the mutations that are going to then lead to a relapse in the future what leads you to believe that transplants don't completely eradicate a chromosomal mutation a reason why i don't think we can eradicate that mutation with a transplant is because even though we have had patients with let's say one q gain or 17p deletion at the time of diagnosis and we do induction therapy and then we take them to transplant and they achieve a remission there's a probability when we see these patients and the long term while they're on maintenance that they're going to relapse earlier compared to people who have not had that mutation and the fact that that the patients that have that mutation at the beginning have a higher tendency of relapsing sooner even though they've achieved the same depth of response that tells me that there's a very good chance that there is still some mutated cells harbored in the body that we're not detecting with the current studies that we have what are the genetic subgroups in myeloma i can tell you about i can tell you a lot about the genetic classification of multiple myeloma and in my opinion there are six different kinds of multiple myeloma the major difference is between patients that have got igh translocations and we've talked about those but 11 14 4 14 14 16. that's about 40 percent of patients um and then there's about 40 or 50 of patients that have got too many chromosomes and it's typically odd-numbered chromosomes 3 5 7 9 11 15 17 19 21 and we call that hyper diploid that means they've got more than two copies of chromosomes um and then in that group there seems to be a difference as if you've got trisomy 11 versus if you don't so there's there's two kinds of hyperdiploid there's three kinds of patients who've got igh translocations and then there's the remaining patients so those are the six categories there is not 100 agreement among myeloma specialists as to how to subdivide myeloma patients into groups based on genetic features some say there are six subgroups while others say there are as many as seven or nine but all agree that there are different categories of myeloma genetics do the genetic subgroups have specific names so the best names are hyperdiploidy and then the name of the translocation so the those those those are the best names for genetic groups there are some other names for other things in there but it gets to be you know really quite confusing and there isn't a consensus on those is it important to know which genetic subgroup your myeloma is in i think it's an important part of the note it's the very first thing i put in my note is to say what category a patient is and so you might see it in your doctor's note they might say hyperdiploid they might say you know t1114 or t414 it's typically somewhere in a summary where they they summarize the characteristics um in terms of treatment um it it it we think that the use of velcade and kiprolis is is particularly important in the patients with the 414 and we think images work particularly well in the patients who are hyper diploid but of course we use those drugs in all patients and so it's it's perhaps more a matter of approach where we think the patients who've got the high risk genetics require a more intense approach