[Music] what is meant by hyperdiploid myeloma and we know in studying these chromosomes just looking at the structure of the chromosomes that sometimes there are some abnormalities that we can see occurring in myeloma cell for example some of those abnormalities may be how many copies of chromosomes you get some of the abnormalities maybe chromosomes break and rejoin in unusual ways let me show you some examples of that here's an example which a term you may have heard in myeloma called hyperdiploidy hyperdiploidy simply means that you have more copies of chromosomes than what you would expect simply with a pear from mom and dad think about the fact that every time the sperm and the egg get together and form an individual that sperm and egg now have to divide to form all the tissues of your body so what are what arose from a single pairing of two cell now is being divided into trillions of cells that make up your body and every time those cells divide they have to copy their dna and pass it on to the next cell copy the dna pass it on to the next cell and organize those into chromosomes so that every cell gets its do share of pairs of chromosomes sometimes mistakes are made and in myeloma we're finding that chromosomes can be very abnormal in myeloma generating what we refer to as hyperdiploidy and as you see in this slide that one of these myelomas on the right has three copies of chromosome one three copies of chromosome three three copies of chromosome nine and eleven and fifteen there are a lot of chromosomes in this myeloma cell so one of the hallmarks of myeloma is the identification of these chromosomal abnormalities some of these abnormalities actually are associated with more aggressive disease so already looking at chromosomes we can learn a little bit about how aggressive this myeloma might be myeloma comes in about seven or eight flavors but at the very top level there's two flavors or two types one is which the ones that have the translocation and two are the ones that have extra copies of chromosomes that we call trisomys and there is a mouthful there that is a hyperdiploid version of multiple myeloma now i'm going to show you here on the right side yeah my arrow shows the the commonality of this translocation goes down so the frequency goes down as we advance in age and the frequency of this variant the hyperdiploid goes up as we advance in age so it's more likely that we'll see hyper-diploid patients that are older and and younger patients that have the translocations and high-risk multiple myeloma it's not absolute as you can see but there's a trend for that and this is important because sometimes for myeloma patients who are younger we'll go sometimes more with this this approach of what i'm calling now where we're trying to establish the pacs for mana we want to put full control and keep that control for some of our patients who are maybe in their late 70s and 80s it may be enough to be more in the control mode and that's often what we do with our treatments i wish we had a crystal ball for every patient but this these are things that you know we're thinking as we think about treatment of course you know it's a much easier thing to propose a transplant than someone who's in their you know late 50s early 60s versus when they're in their late 70s but also we have the opportunity that sometimes you don't have to do the full extent of of the treatment