Is Dex Really Necessary? CAR T, Bispecifics & Myeloma Questions Answered | QA Replay

Dr. Joseph Mikhael (00:04):
Well, hello everyone and welcome to our International Myeloma Foundation Facebook Live here today coming to you live from Boca Raton, Florida. This is Dr. Joseph Mikhael Chief Medical Officer of the International Myeloma Foundation, and welcome to our Facebook Live. As we get started, as always, we would love you to enter into the comment section into the chat, who you are, where you're from, and of course, questions that you have for us, because in a few minutes, we're going to get a chance to dive into some questions. Let me start by telling you who are these two wonderful people sitting next to me. First of all, to my right is Dr. Melissa Elsina. She is a myeloma expert and she works at the Moffitt Cancer Center in Tampa. Welcome. Good to have you here, my friend.
Dr. Melissa Alsina  (00:54):
Good afternoon. Thanks for having me.
Dr. Joseph Mikhael (00:56):
It's always good to have Dr. Alcina in the room. Also, to my left is one of our amazing IMF staff members, Daniel Doheny, who leads all of our efforts in advocacy. So Danielle.
Danielle Doheny (01:09):
Thank you so much. Thank you so much, Dr. Joe. I'm Danielle Doheny. I'm the Director of Public Policy and Advocacy at the IMF. My dad is a longtime myeloma patient, so this cause is more important to me than anything. And this Myeloma Action Month, we are bringing patients to Capitol Hill. And if you have interest in learning more about advocacy or maybe even coming to the Hill someday, we have an advocacy masterclass. Feel free to send us an email at [email protected] (mailto:[email protected]) and we can give you more information on that.
Dr. Joseph Mikhael (01:41):
Well, thank you not only for telling us about advocacy, but reminding us, of course, that not only are we in the middle of our Boca Patient Family Seminar, we are also in the middle, it's hard to believe already pretty much halfway through the month, we are in the middle of Myeloma Action Month. So what is Myeloma Action Month? Well, Myeloma Action Month is actually evolved, the artist formerly known as Myeloma Awareness Month, but now it's an action month because we really believe that action is going to convert into better outcomes for patients with this terrible disease. So what we do, we do, of course, raise awareness over the course of the month. We have multiple ways of doing so. We've done so, of course, through social media and this Facebook Live. On all of our social media channels, we've also been using this tremendous hashtag of more than myeloma.
Dr. Joseph Mikhael (02:33):
We want to make it very clear that our myeloma patients are not defined by their disease. They are absolutely more than myeloma. So what can you do during myeloma action month? Well, share your story. Use the hashtag, of course, more than myeloma. Repost and reshare the ones that the IMF puts out. Raise awareness within your family, within your community, wherever it is. One of the ways that we've been raising awareness around the country, and frankly, around the world, is because myeloma is a blood cancer. And when we think of blood, we think of red. I'm actually wearing my blood cell tie today, because I am an absolute hematology nerd. We are lighting up things in red. We have all sorts of monuments and hospitals and community centers and all sorts of different, really important landmarks across the country that are at points during this month being lit up in red to raise awareness of multiple myeloma.
Dr. Joseph Mikhael (03:32):
Now, we're here, as I mentioned, at the Boca Patient Family Seminar. What is a patient and family seminar? Well, the IMF holds innumerable, literally, educational events for patients and their partners throughout the whole year. We have our flagship events, which are these patient family seminars. It's a day and a half seminar. We did this for half the day yesterday, Friday, and all day today, Saturday, that we do four times a year. We're of course now in Boca and coming up in the future, we will be having meetings in three other locations across the country. In addition, we have at least every month a community workshop, which is a one-day event. In addition, we have three virtual workshops, not to mention many others. So there's so many things to learn about multiple myeloma and so many ways to learn about myeloma. Please visit us at myeloma.org and you can learn more about all of these.
Dr. Joseph Mikhael (04:26):
If you go back/events, it'll take you right to the events page so you can see all these different activities because inevitably there's something near you that you can attend, or of course, a virtual event. One of the things that we do at these events, of course, is provide education to empower our patients. I believe that this is an opportunity for our patients to know their disease better, to be able to have the right conversations with their healthcare team, so that indeed they can have a better life with multiple myeloma. And in doing so, we have various sessions. We have sessions on frontline myeloma and relapse myeloma. We have sessions on advocacy, as we heard from Danielle. We had an incredible session yesterday from one of our support group team, Katie, who is a social worker who talked about the importance of our mental health and our wellness during the journey with multiple myeloma.
Dr. Joseph Mikhael (05:19):
And one of the great privileges we have during these patient family seminars is to bring in world renowned experts in multiple myeloma, which brings me to not only an expert, but my friend, Melissa Alcina from Moffitt. Dr. Elsina and I are going to chat for a couple of minutes. As we do so, let me remind you, please send in our questions because for the second half of this Facebook Live, Danielle is going to read your questions and I'm going to be happy to have Dr. Alcina answer them for you so I don't have to answer any more questions. We'll answer them together. But it is really great to have you here with me, Melissa. It's a privilege. Thank you. Dr. Alcina is originally from Puerto Rico, which you'll hear about whenever you talk to her for a few minutes. She's very passionate about her home and her family who still live there.
Dr. Joseph Mikhael (06:09):
And she has developed really incredible expertise, not only in multiple myeloma, but specifically in the area of these advanced therapies that we use now for multiple myeloma. And so she led this session just a few minutes ago. It literally ended 10 minutes before we started this Facebook Live on relapse myeloma. So maybe Dr. Alsini, tell us a little bit about how relapse myeloma is really just incredibly changing in the world of myeloma.
Dr. Melissa Alsina  (06:37):
Yeah. Yeah. Thank you, Joe. And I love your tie, by the way. It's very nice. No, no. We were just talking about, I was just telling the patients how incredible has been, all the changes. I always love this chart that I put on with all the treatments that have been approved in the past 30 years, but looking more into the last 10 years, it's incredible to see that there are 15 new therapies. Approved for myeloma is mind blowing, right? Especially for myeloma, which is a rare disease, 1% of all cancers. I mean, but the work has been tremendous and the improvement have been tremendous, right? So relapsed myeloma, patient with relapsed myeloma 10 years ago meant you're going to have a response. I mean, chance of responding of 30% and duration of response measure in a few months, right? And that has changed to not only having a response, right?
Dr. Melissa Alsina  (07:28):
But having 80% of the patients getting complete remission, minimal residual disease negativity, duration of response measure in years. CAR T, we just saw the data last year about Cilta cell, five years out, patients heavily pretreated patients, 30% of those patients being alive and without disease five years out.
Dr. Joseph Mikhael (07:53):
Yeah, that was amazing, wasn't it? Let's dive into that a little bit. So you mentioned, we think of all these things that have now happening in relapsed disease. Let's start with CAR T-cell therapy because you highlighted it. For those who may not be familiar, super simple overview, CAR T-cell therapy is when we take T-cells out of a patient. And think of T-cells kind of like soldier cells that can fight off infections, but also can fight tumors. So we take T-cells out of a patient and we essentially train them to fight against a patient's own multiple myeloma. We put a receptor on the outside. That's what CARS stands for, chimeric antigen receptor. That receptor is specific to their multiple myeloma, and then we give them back to the patient. And you were commenting, Dr. Osina, that now with these kinds of treatments, we already have two of them approved.
Dr. Joseph Mikhael (08:44):
We have both Abecma and Carvykti that we're seeing 70, 80, over 90% of patients respond with this really, really deep response. Tell us just super simply, how does CAR T-cell therapy work? I mean, how do patients have to go into a hospital for months or how does this happen for them? Yeah,
Dr. Melissa Alsina  (09:05):
No. So CAR T, if you think of patients frequently ask me is CAR-T like transplant, well, it's not. I think most patients say it's actually a simpler, easier, less side effects. We do it in the outpatient setting. So patients do not go into the hospital, except if they develop any side effect of toxicity that requires admission. So the most patients might be in the hospital maybe for about five days, middle of the month. They do have to be close to a CAR-T center for about within an hour for a month, but it's really well tolerated. I think the main side effect or most common side effect that we see is when we give those cells back, those cells go and find the myeloma and they sort of start a fight to heal the myeloma. And that creates like a immune reaction and usually patients would have a fever or maybe a little bit more than a fever, low blood pressure or shortness of breath, et cetera.
Dr. Melissa Alsina  (10:02):
But the majority of the patients have fever and we can treat that to mitigate sort of calm down that reaction. Patients could also have some neurologic toxicity. Usually it could be like some confusion, headache, but also in the majority of the patients, a mild and reversible thing. So in general, CAR-T is well tolerated. There could be some other toxicities that delay in retoxies that are definitely more significant, but it's a very small percent of the patients,
Dr. Joseph Mikhael (10:35):
Right? And one of the huge benefits, of course, of CAR T-cell therapy is patients get that one treatment and then it's done. They go onto a, "My favorite drug, nothing." The other major area, of course, where there's been huge improvement has been a bispecific antibody. So again, for those who may not be familiar, these are two arm drugs, if you will. One arm grabs onto the myeloma, the other arm grabs onto a local T-cell. So we don't actually have to take T-cells out of a patient. We can use their own T-cells with using these bispecific drugs. And we just had literally a week ago announced the FDA approval of the combination of one of these bispecifics teclistamab, along with daratumumab. We've been able to use bispeifics in much later relapse after people have had four lines of therapy, but now we can use it at first relapse.
Dr. Joseph Mikhael (11:22):
Is that exciting for you?
Dr. Melissa Alsina  (11:24):
That is super exciting. It's super exciting. The only issue with that is that now we have CAR-T and also a really good combination, teclizumab, both approve a second line. So okay, where do we go? It's
Dr. Joseph Mikhael (11:39):
A nice problem to have when you have choice, right?
Dr. Melissa Alsina  (11:42):
Absolutely. Absolutely. So no, we are super excited because these drugs, we know they are very, very effective. And before we had to wait until the patient relapsed four times before we can do it. And now we can do it earlier. And there's a lot of, I think there's more access to that combination, for example, than to CAR-T. It's something that patients can get in the community with their community oncologist. Whereas CAR-T, you really have to move to a big center that does CAR-T frequently away from your home. So I think these are definitely, like you mentioned, good problems to have more options and we are super excited to have that approved.
Dr. Joseph Mikhael (12:18):
Oh, that's fantastic. And just to throw one more into the mix, we've also had a recent approval of belantamab mafodotins orbellumab. So this is an antibody drug conjugate, so it works a little bit differently. It has that arm that hooks onto the myeloma cell, but then I sometimes say, I said during myeloma 101 yesterday, as I was explaining it to the team here in Boca, that it's kind of like it has an evil backpack, a toxic backpack that it drops into the cell. So those antibodies that typically hook onto a cell and trigger the immune system to respond, it also immediately responds by dropping this backpack in. And so to me, that even further expands the choice for patients.
Dr. Melissa Alsina  (12:59):
Absolutely. No, absolutely. No. And there's so many other things in the pipeline in clinical trials, newer CAR-Ts that seem to be maybe, I mean, at least as effective as ilta-cel, but maybe with less toxicity, we have aneto cell, which is a CAR-T that has a unique binding site and it seems to be less toxic. That's probably going to be approved later this year. And then super image, super Revlimids, right?
Dr. Joseph Mikhael (13:29):
Yeah, the cell mods are coming, absolutely.
Dr. Melissa Alsina  (13:31):
That are coming up too. So I think it's definitely much more option.
Dr. Joseph Mikhael (13:35):
So if you want to learn more about all that's happening in myeloma, make sure you make it to one of our patient family seminars, go to our resources on the website, come to one of our community workshops. In fact, this morning at our Boca meeting here, we had a session dedicated to the future of multiple myeloma. So I was interrogating Dr. Oloangren about what he thought about the future. And we talked about some of these new and exciting therapies that are coming in the future. So we believe when patients are educated, when they understand their disease, they're empowered to be able to communicate with their healthcare team and advocate for their best therapy. Well, on that note, we love questions at the IMF. I love answering questions and I always encourage people to send us questions. Always use the hashtag ask the IMF. You can do it through X.
Dr. Joseph Mikhael (14:31):
You can do it through LinkedIn. You can do it through Instagram, through Facebook. If you're watching us, you must be on Facebook. And of course, sometimes it's maybe more of a personal nature. You can call our info line. We even have a chatbot. Myelo is his or her name, their name, that you can use twenty four seven that you can go to the myeloma website at myeloma.org and ask questions. Well, on the subject of questions, Danielle, let's get to it. Let's get you to ask our first question. And please, if you're listening, feel free to send in your questions right away.
Danielle Doheny (15:03):
Thanks so much, Dr. Joe. I have the first question here from Michelle. Michelle lost her husband last year and has now relapsed. Should a person who live alone consider CAR T?
Dr. Joseph Mikhael (15:16):
Well, first of all, Michelle, I'm very sorry to hear about your husband. I'm also very sorry to hear about your relapse, but we're very optimistic about the future of myeloma, as we've said. When people relapse, as Dr. Alsina was saying, we now have more options than ever before. Maybe I'll turn it to you, Dr. Alsina. How do you help patients that may be on their own that don't have an immediate care partner when you're having the discussion about the options of treatment and specifically of CAR T? Yeah.
Dr. Melissa Alsina  (15:47):
Yeah. So Michelle, to answer your question again, like Joe said, very sorry about your husband, about your relapse, but I think there's definitely many options, right? CAR T is definitely one of them, but CAR T, you do need a caregiver because the treatment is quite involved in the sense that we have to put a central line. We have to drop blood every day. You could be having some side effects. You could have a fever at some point, that someone needs to take you to the hospital and so on. So you do need to secure a caregiver to get that. But the good news is that it's not the only option, right? We just talk about this combination of bispecific teclistma, datatumab that was just approved. The efficacy looks very similar to CAR T. And this is something that you can get with your community oncologist and something that you would not need a caregiver to be with you twenty four seven.
Dr. Melissa Alsina  (16:43):
And there's also other options. So I think while CAR T, we're excited about it because of the results and the fact that you get that treatment free interval, these other drugs are very effective as well and might be more accessible and better for you in your particular case.
Dr. Joseph Mikhael (17:01):
I would also add that there have been some moves and the IMF is involved with this with other organizations partnering together to really think about ways to provide care partners for individuals going through the CAR T process. So perhaps there is a family member or a friend who may be able to help you through it. As Dr. Osina said, it's not a prolonged months and months like commitment. It's really a question of a few weeks and there are options. And if you reach out to us even through the info line, we can talk to you about some of those options. All right, let's come to the next one, Danielle.
Danielle Doheny (17:33):
Sounds good. Our next question comes from Charles. Charles asks, "Can we take lower dose of pomalidomide?" He developed severe sepsis in November and had a neutrophil count below 300.
Dr. Joseph Mikhael (17:47):
Well, that's a great question, Charles. I'm sorry that you developed an infection that may or may not obviously have been directly related to the dose of pomalidomide. Of course, we can't give specific answers for your exact care, but I think in general, it's worth commenting on the fact that different patients respond differently to different drugs and pomalidomide is one of them. And pomalidomide is a drug that we typically start at the four milligram dose that was the usual used dose. But that being said, I have to say, and I'll see what Dr. Alcina thinks in a moment, I actually often use it at half that dose of two milligrams. And I do that for various reasons. One, back in the day when I was at Mayo Clinic, I had the privilege of actually leading with Dr. Lacey a clinical trial where we compared four and two milligrams, and it seemed to us that the efficacy or the benefit of the drug was the same, but we saw less of the low white blood cell count or neutrophil count that Danielle had mentioned, and that in general, it was a bit better tolerated.
Dr. Joseph Mikhael (18:44):
So I would speak to your healthcare provider, of course, about that, but that is a very accepted phenomenon of using a lower dose of POM. I don't know, Melissa, if you feel the same way about a dose reduction.
Dr. Melissa Alsina  (18:55):
Yes, yes, yes. I frequently start lower like you do depending on the patient counts and how many treatments they have in the past, but low counts is a very common side effect of these drugs, right? Pomalidomide. So definitely adjusting the dose. Sometimes patients feel scared that, oh, if I adjust the dose, maybe it's not going to be as effective. But I always tell my patients, "No, the drug is being very rough on your cells, other cells in the bone marrow." It's also being very rough on the myeloma. On the myeloma. Well
Dr. Joseph Mikhael (19:27):
Said.
Dr. Melissa Alsina  (19:27):
So it would be okay to go down to avoid these type of complications.
Dr. Joseph Mikhael (19:32):
And I think the last thing I would say around this is that it's so important with these new drugs and the way they work, I had a conversation with the patient the other day saying, "Well, Dr. Joe, you want to move me from four milligrams to two milligrams of pomalidomide." I mean, you're cutting in half. How can that be as effective? These drugs are a little less for the pharmacology people in the world. They're a little less dose dependent is the phrase that we often use, meaning that it doesn't mean that two milligrams is going to be half as effective as four milligrams. The way these drugs work and the way they interact with the immune system, even lower doses. The other drug in that family, lenalidomide, sometimes we use five milligrams, sometimes we use 10, 15, or even 25. So look at that huge range of dosing, and yet it can be very effective at all those doses.
Dr. Joseph Mikhael (20:16):
So we trust that goes better for you, Charles, going forward. All right, let's go to the next question, Danielle.
Danielle Doheny (20:21):
Thanks, Dr. Joe. And I think you'll like this one. Emma asks, "I'm over the Dex controversy in getting different opinions from different docs. Is it really that necessary? Does it increase the efficacy of Kyprolis? Is it for potential side effects or can you just forget it and go without?" Seriously, how necessary is it?
Dr. Joseph Mikhael (20:41):
Okay. Emma, you're my new BFF because I love to talk about dexamethasone. And we had a session yesterday where we talk what I call the hot topics of myeloma. We choose three topics to kick off the meeting and one of those three was how we're learning about dexamethasone super quickly. Dexamethasone in many respects is a wonderful drug. It does boost the effect of other drugs. It reduces the risk of certain reactions to drugs which should include Kyprolis, as you've mentioned. It also can reduce nausea, it can also reduce pain. So four things it can do and it can do well. On the other hand, it causes a lot of side effects. It can make people very jittery and have difficulty sleeping. It can make them a little bit grumpy. It can push up blood sugar. It can push up blood pressure. It can affect the skin and make it more easily to bruise.
Dr. Joseph Mikhael (21:34):
It can thin people's bones. And the longer we use DEX, the greater those side effects make manifest. So we have come recently. We just actually published a large review paper in the Journal of Clinical Oncology, a very important journal that your oncologist or hematologist almost definitely knows where we started to say, "Really, do we have to keep using this high dose of Dex?" Back years and years ago, we used to use even higher doses of Dex. We brought down to so- called low dose dex, 40 milligrams a week, which is still by every measure high dose. And what we basically said in this article was on the evidence that we have and the experience that we have, most patients get the greatest benefit of their dexamethasone for the first two cycles. And then we can really turn it down, as I call it, down with Dex.
Dr. Joseph Mikhael (22:20):
So I would have a conversation, Emma, with your healthcare provider about this to look at ways that you can turn down the DEX because the benefit that it's giving to you is really minimal after that first cycle or two and patients can live with a lot lower DEX. Is that what you're doing in your practice too? I'm leading the witness here, but-
Dr. Melissa Alsina  (22:38):
No, no, no. Cannot agree more. It's definitely DEX. So DEX, historically, when we did not have all these good therapies, it was a super important drug, right? It was the drug that probably was doing most of the work, but that has totally changed. So when we use quadruplet, the DEX ... I mean, we call it a quadruplet, but think one of those drugs is DEX. It's like, what? It's not really a fair partner. Yeah, it's not really a fair partner. So no, we feel really confident with these new treatments that we can drop that DEX very quickly, because it's probably not the most important drug. And in many cases, we use it more to prevent side effects from the treatment than to actually treat the myeloma with all the new drugs that we have.
Dr. Joseph Mikhael (23:18):
And when we do that, we do it at much, much lower dose. Absolutely. So I love how you said Emma seriously. Well, let me tell you, seriously, we can go down on Dex. All right, next question. The
Danielle Doheny (23:29):
Next question is from Clarinda, and she asks, "Can you still undergo CAR T after a bispecific?"
Dr. Joseph Mikhael (23:36):
Ah, great question. Then I will turn to you to answer Dr. Alcida.
Dr. Melissa Alsina  (23:41):
Well, the quick answer, Clarina is yes. Now it depends on the interval between when you receive the bispecific to when you're going to get the CAR T. I'm assuming that the bispecific is targeting the same protein as the CAR T, BCMA. We have bispecifics that target BCMA, like the CAR-Ts that we have available and one that targets a different protein. But if it's the same, then the issue with that is that you're taking this drug that is targeting the same protein and your disease is getting more active, I'm assuming, that we're going to consider CAR-T. So more than likely the CAR-T is not going to work as well. And that has been shown in clinical trials because you're targeting the same protein. So it's like doing that same target and your disease is still growing. It's finding ways of escaping that. But if you have a treatment-free interval, when you're not targeting that same protein, yes, you could easily get a CAR-T.
Dr. Melissa Alsina  (24:42):
And I think that is a challenge now with having teclistamab approve a second line. Are those patients are going to be able to get CAR-T later on? Well, yes, because I think even though the study continue these patients on treatment until progression, I am pretty sure that in practice that is not what we're going to do, right? We usually treat patients with bispecifics until we see that good response, and then we back off. And in many cases, we stop the treatment altogether, right?
Dr. Joseph Mikhael (25:09):
Yeah. And I think that stopping of the treatment, although it sometimes sounds counterproductive and patients like, really want to stop. It's dual benefit because they not only get the convenience of being off treatment back on our favorite NARA, but also that it gives their T-cells a rest. It gives their immune system, in that sense, a rest that could be then engaged again for a CAR T. Well, I think we have quite time for at least one more question, Danielle.
Danielle Doheny (25:33):
And I have a very easy one for you both. Mary asks, "Do you lose your hair with CAR
Dr. Melissa Alsina  (25:39):
T?" No.
Dr. Joseph Mikhael (25:41):
Next question.
Dr. Melissa Alsina  (25:42):
Not to worry about that, Mary. You won't lose your hair.
Danielle Doheny (25:44):
And another person who asks, "Could she get a tattoo with her myeloma?"
Dr. Joseph Mikhael (25:55):
I feel like my daughter asking me this question, but I'll let you answer the question.
Dr. Melissa Alsina  (26:02):
If it's my daughter, I would say no, but she will do it anyway. So no, I think it's okay in general, I would say that you would need to make sure that your blood counts are good, right? You don't have to get a tattoo when your white count is low and you would be at risk of infections or when your platelets are low, you would be at risk of bleeding. But if your counts are good and your immune system is okay, and you didn't get a CAR T last week, I think it should be okay. But I would always ask that question directly to your doctor that would know exactly in what stage of your treatment you are.
Dr. Joseph Mikhael (26:36):
If the tattoo is hashtag more than myeloma, then I might be more willing.
Dr. Melissa Alsina  (26:43):
Yeah. Or I love Dr. Joe.
Danielle Doheny (26:47):
Laura asks, "If you have had a stem cell transplant, can you get CAR T?"
Dr. Joseph Mikhael (26:52):
This is actually a really excellent question and great for our last question of our Facebook live today. I think both of us perhaps could answer this question because there was this initial study that came out of Boston that sort of questioned that maybe if someone had had a stem cell transplant that the benefit of the CAR T was a little bit less. But I think it's maybe not what we're actually really seeing in practice, especially because in the early days, the vast majority of our patients who got CAR T had had a stem cell transplant. So I don't typically say to a patient that by getting a stem cell transplant, you're burning a bridge per se, and you're not going to be able to ultimately get CAR T. That I really think we want to always, of course, keep options open, but we want to give the best therapy that we have at the time.
Dr. Joseph Mikhael (27:42):
Of course, in the future, we may be replacing transplant with CAR T, but in general, do you agree with that, Dr. Osina, that you don't think that a prior CAR T is in any way reducing someone's ability to get prior transplant is reducing their ability to get a CAR T?
Dr. Melissa Alsina  (27:57):
No, no, no, no. Absolutely. I mean, 80% of the patients in the clinical trials and in the real world that get CAR T have had a transplant before. But not only that, also in terms of safety, there's several studies that have looked at CAR T just following transplant, right? A patient gets a transplant three months later where they're not either in complete remission or their disease is starting to go up and they were able to get a CAR T. So in terms of safety, we know that you can actually do a CAR T, I mean, a transplant three months later have a CAR T safely.
Dr. Joseph Mikhael (28:30):
Excellent. Excellent. Well, I wish we had time to even go through more of questions. As I mentioned to you, we love questions at the IMF, so please feel free to send them to us through all of our social media channels using the hashtag ask the IMF, call the info line, use MILO, come to one of our patient family seminars as we have here today in Boca Raton, Florida, or one of our community workshops, be it in person or virtual, we would love to engage with you. And especially this month during Myeloma Action Month, share your story in just a few seconds, you can share a story that can have a tremendous impact on others and the myeloma community. So as we wrap up, I want to thank Danielle for being with me today and for sharing with us about advocacy and how people can advocate for the myeloma community.
Dr. Joseph Mikhael (29:17):
I want to thank Dr. Alcina for being with us to share her expertise and her passion for this disease. And I'd like to thank all of you for joining us, for taking the time on a, I'm sure a busy Saturday, or perhaps you're watching the replay later to listen to these Facebook lives to be engaged with us and hopefully to help answer your questions. I also like to take a quick moment to thank so many sponsors that we've had over the course of Myeloma Action Month, including Adaptive Biotechnologies, Amgen, binding site, Thermo Fisher, Bristol-Myers Squibb, GSK, Johnson & Johnson, Keriapharm Therapeutics, Kite Pharma and RSLX, Lengen Biotech, Pfizer, Regeneron, and Sanofi. That's a list. A lot of people are on on board for myeloma Action Month. So this is Dr. Joseph McHale, Chief Medical Officer of the IMF signing off our Facebook Live. Thank you again for joining us and we trust that we can help you as we seek a cure for this disease, but support patients through their journey.
Dr. Joseph Mikhael (30:16):
Thanks so much for joining us.