[Music] can only a percentage of myeloma cells contain the deletion of 17p or do all myeloma cells contain the same genetics whenever we do chromosome analysis in multiple myeloma cells we try to see look for mutations that we know are associated to multiple myeloma and the studies that we do and whether it be karyotyping or fish or gene expression profiling are going to give us results of whether that gene a mutation is present or not but it also has the ability to determine out of the number of cells that the study analyzed what percentage of those cells have that specific mutation so for example let's talk about 17p deletion we associate 17p deletion to high-risk disease and a very aggressive type of multiple myeloma but having the mutation alone just knowing that you have that mutation is not going to give us the big the whole picture it's important to know what percentage of the myeloma cells in your body have this mutation so that we can have a better idea of if this mutation is going to really have an impact in the patient's survival and in the response to therapy or not so whenever we do fish studies the the genetician who does the study takes a group of myeloma cells analyzes those cells and then gives us a report saying we did find this mutation let's say 17p and we saw it in this percent of all the uh involved cell of the myeloma cells and it will give us a percentage whether it's five percent ten percent forty percent fifty percent eighty percent or none sometimes we will see mutations and they have a the labs have a cutoff value that below that percentage it's considered negative and above that percentage is considered positive that's important for the reports but in addition to that they also tell us if if it is positive how many of the myeloma cells are containing that mutation knowing what percentage of the myeloma cells have a specific mutation is important because that can help us determine the prognosis or guide us in the prognosis of the patient so talking about 17p deletion if we do fish on a bone marrow biopsy from a myeloma patient and we see that they have a 17p deletion and the report of the fish tells us that it's only 20 that is going to behave very differently than somebody with multiple myeloma who has a bone marrow biopsy and the fish results says that they have 60 involvement with 17p deletion the people who have greater than 50 involvement of that specific mutation they tend to have poorer prognosis and they tend to have a more aggressive type of disease when you compare it to people who have a shorter a smaller amount a burden of that mutation and the same thing applies for other mutations and translocations it all depends on how penetrated these abnormalities are in all of the myeloma cells that your body has you