Dr. Anton Titov, MD.: Professor Munshi, you are pioneering researcher in multiple myeloma in blood cancers in the clinician, what is the future in multiple myeloma treatment to when multiple myeloma will be a reliably curable disease? I would say, we are curing myeloma today. Dr. Nikhil Munshi, MD.: But we are afraid to say that, because we feel we need a little more follow up. And if I expand on it, I think there are proportional patients, we all have patients who were followed for more than last eight or 10 years, whether myeloma disappeared, then and have not come back. The question is, when would I call that patient "cured patient"? We don't call it yet. And the reason is, in the old days, we all had patients who relapse after 10, 12, and 15 years. So we feel we can call cure yet, what if the patient relapses after a certain time. So there are proportion of patient I will say 15%, or a little higher, who have not relapsed for a long period of time, that in many cases we would call cure, we are not yet doing that. So I think that's the state and these are the patients who got treated 10 years ago with the treatment, which was state of the art, then today, we have much better treatment. And so we might be one affecting more patients. My hope is that in next few years, we will have enough data to begin to say which patients are not relapsing or are not going to relapse, and what treatments are providing that. And then we can build on this, to then increase the number of patients who are not going to relapse, and they will be officially declared cure, they can go back to living their life. Now cure has many meanings. What is cure mean? It means you're done with the treatment, everything is gone. We're not taking anything, that's one way. Or number two patients might be taking maintenance treatment, the myeloma is not coming back and disease's fine. So converting a disease into a state, which is more like say diabetes. Dr. Nikhil Munshi, MD.: But can we cure diabetes? The answer is no. Dr. Nikhil Munshi, MD.: But we can treat it very successfully for next 70 years. So if cancer becomes like that, what is the difference? It should not be a difference. And I asked my patients well, why would you worry if you can take one pill for rest of your life, the cancer doesn't come back. And that's kind of reassuring when you compare it with a situation like diabetes or hypertension. So it could be the disease is gone. Or it's a situation where it's not going to come back. And we take just maintenance treatment for a long period. Either way, patient would not die from myeloma, they were to be worried about other diseases, taking care of their heart and lung and other things. And be living healthy life. Not worrying as much about myeloma and dying from it. Or someone should do to think that the CAR T-cell therapy and other immunotherapies would be standard of care for all patients in the coming future. Absolutely, I think it's going to be standard of care for a very large number of patients all patient is a strong word. Because at certain age beyond 80, its utility would be a little bit less. Dr. Nikhil Munshi, MD.: But up to the age of 80. We do CAR T-cell therapy right now. We have done more than a few patients and safely. So I think the scope has expanded to include majority of the patients and it will become a standard for all those patients small minority. We may have to be careful how we use when we use it.
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