Revolutionizing 2L+ Myeloma: A Podcast on the New Era of BCMA-Targeted Bispecific Antibody Therapies

00:00:00:

00:00:05: Welcome to this podcast where we spotlight evolving science, patient needs and innovation in multiple myeloma when patients relapse after their initial line of therapy.

00:00:16: I am Ajay Nuka.

00:00:23: Thank you Ajay and hello everyone.

00:00:25: My name is Roberto Mina, I'm a hematologist at the Winship Kansa Institute same institution as Dr Nuka.

00:00:32: thank You Roboto.

00:00:33: The big question to address today Is it still acceptable To use traditional standards of clear for patients with second line And beyond when the novel treatments are demonstrating unprecedented long-term outcomes?

00:00:48: In this podcast, we will share our thoughts on the existing unmet needs for patients with second-line therapy and beyond.

00:01:01: And how therapies targeting the B cell maceration antigen have transformed treatment landscape in use of PCMA targeted by specific antibodies.

00:01:13: So we've seen the evolution of the initial treatment for patients with newly diagnosed multiple myeloma and We've seen in recent years this transition between triplets and quadruplets, the addition of a monoclonal antibody target in C.T.A.

00:01:28: so Ajay what are currently recommended Initial regimens and approaches to patient with newly-diagnosed myelomas?

00:01:36: Great question, Robert.

00:01:38: As we saw the evolution from the doublets to the triplets and quadruplets when seeing these unprecedented response rates within initial induction therapies both in transplant eligible patients as well as transplants in eligible patients let me focus on the transplants eligible patients.

00:01:56: so if you start using the immunomodulator agents the protysome inhibitors CD-III monoclonal antibodies as well as the steroids, the combo of these quadruplets revealing as response rates as close to a hundred percent overall response rate among all this transplant helical patients.

00:02:16: The same applies for the transplant in helical patient's as well.

00:02:21: So in the past, we had this difference between the outcomes that were able to obtain between transplant eligible patients.

00:02:29: Patients who are fitter and able to tolerate more intensive treatment including transplants.

00:02:35: but now... with the adoption of quadruplets, we're seeing the outcomes becoming closer and closer.

00:02:41: So several studies now that have introduced a use of quadroplets based on VRD+, there are two women, Isatuximab leading to high response rates and more denigrativity rates almost as close as those we've seen in transplant-eligible patients.

00:02:58: so I would say today you can confidently use quadruplet for a transplant ineligible and eligible, knowing that still triplets such as DRD is an effective regimen for the frayless population.

00:03:11: Awesome!

00:03:12: That's amazing where we are today.

00:03:17: And the usage of transplant in the United States is probably a thirty percent of all newly diagnosed bottom-of-patients.

00:03:24: The other seventy percent patients do not receive a transplant yet.

00:03:29: what these novel studies have shown was the usage of quadruplets even among the transplant in eligible patients or the transplant deferred patients, yielding to their response rates that Roboto was quoting about.

00:03:40: The mRNA integrates are so good they're able reach an mRNA to didn't match out with the patient's.

00:03:46: So if you think about the transplant delivering those depths of responses through each of them are negativity and maintenance.

00:03:53: continuing to maintain those responses towards a sustained MRD.

00:03:57: We are making headway in the right way and the transplant in eligible patients.

00:04:02: So we've seen that the transformation of frontline treatment, what means in terms of patient's prognosis?

00:04:20: from patient eligible for transplant more than a decade or maybe even longer, then that with pursues and almost goes to one hundred months of expected projected PFS.

00:04:32: So great news for patients.

00:04:34: however we know there's still significant fraction of the patient will relapse in their disease would be resistant treatment.

00:04:41: so far are being administered until progression.

00:04:44: not all but many.

00:04:47: Ajay, what do you think this reflects into the second line treatment?

00:04:52: Do you think it poses a challenge to clinicians and patients in treating patients at relapse.

00:04:58: This is great way of putting things together.

00:05:00: Prabhatur Thank You for bringing up that front-line prolonged remissions one can expect with these quadruple treatments as you are alluding too.

00:05:10: It's just unbelievable.

00:05:12: even decade ago we were not even thinking about these kinds of responses, one would be anticipating.

00:05:18: So now expecting a median preface beyond fifteen years is just unbelievable.

00:05:23: yet the patient population at that time for first relapse One has to understand it's not the same as what we're dealing with almost a decade ago.

00:05:32: so this patients are more refractory had exposure and refracted us through all three classes particularly their image As well as the proteins inhibitors.

00:05:44: This highlights the need for starting to focus on, The type of a patient that we're dealing with at first relapse.

00:05:51: It is not the same as what they have been used using in past.

00:05:55: So What's challenge today?

00:05:59: We don't know driving these relapses.

00:06:03: so you can think about data map and other first line agents.

00:06:10: such exhibit both the direct on-tumor and the immunomodulator mechanisms of action.

00:06:18: While, their direct on tumor effects may be in over time that immunomodelator effects have data may still apply regardless of prior anti CDT-III antibody exposure.

00:06:28: to make it more difficult to interpret there is limited data on retreatment for the anti-CDT antibody in early line therapies.

00:06:37: so patients with refractory mass too, anti-CDT antibodies defined by the IMWG or the International Malamu Working Group, are the disease that is non-responsive to therapy.

00:06:49: Or the progress within sixty days of last lab therapy It may still benefit from the antecedent treatment.

00:06:55: in the second line and clearly alluding to combinations we really have in place especially the data to map treatments with novel antibodies targeting BCMA That can deliver synergistic effects that are independent of data-to-maps direct anti myeloma activity and even in the data to map exposed patients.

00:07:16: So, might be all patients regardless of prior exposure will require novel options beyond recycling traditional standard of care options.

00:07:27: What do you think?

00:07:29: I think this is absolutely true And i think This Is The Next Challenge how to tailor treatment based on several factors.

00:07:36: there are treatment exposure potentially also disease related factors, and of course patient-related factors.

00:07:43: And this in fact brings us to the next topic which is what kind of treatments can we use that are available nowadays at relapse?

00:07:55: What kinds considerations drive your treatment

00:07:58: selection?".

00:07:58: So

00:08:00: one motto everybody should move forward with for that specific patient at the time.

00:08:10: We're not in the business of saving treatments for a later time, we want to use the best available treatment get into the deepest transmission and let patients enjoy the transition from longest period.

00:08:21: As you understand, myeloma is characterized by increased electrician.

00:08:27: with every line therapy you lose patience.

00:08:30: You'll lose patients to not receiving the next one of therapy, this iteration increases and increase and increases.

00:08:36: so it makes more sense for us to start using the best available option as early as possible.

00:08:41: in the relapse regimen The appropriate relapsed regimen should be selected based on the rate of disease progression And patient characteristics such as the patient fitness and the patient comorbidities.

00:08:53: So there is a component of personal preference and the factors impacting the patient's quality of life, such as the adverse in priorities.

00:09:02: So not only that treatment convenience.

00:09:05: so if a patient is living four hours away?

00:09:08: Is it optimal for us to give weekly dosing for this specific patient?

00:09:12: bring the patient every four hours requirements with hospitalizations patients could have multiple other things that they'd be doing.

00:09:20: They'll be caregivers for somebody else, so all those need to be taken into considerations and including minimizing the steroid related toxicities as well.

00:09:29: And all these should help to guide treatment choice.

00:09:33: The treatment selection should include patients decision making.

00:09:37: So it's a shared decision-making Making sure patient is well informed about adverse events About benefits versus risks of every potential regimen.

00:09:46: The treatment sequencing also should be considered how usage of one treatment might have an impact on the future treatments.

00:09:54: Would one of these treatments that we're using now, does it have a potential to cannibalize the future treatments?

00:10:00: So among the traditional standard of care treatments there are different anti-CD.

00:10:04: that did they stand.

00:10:06: antibody regimens such as data tomb map, pomalidomide and dexamethasone from the Apollo trial, data tombmap, wortasmip and deoxamethosone.

00:10:16: data-to-map curfews map index map zone from the candidate trial, or using ESETUXMAP curfuelsmap index maps on.

00:10:25: This may be still used for patients that are sensitive with no refractoriness to anti-CD-thated antibodies.

00:10:32: For those patients who have anti-CD-thate refractory The traditional regimens such as curfels map laminamide index map this was from the ASPY trial.

00:10:43: this can be considered for lanylidamide-sensitive patients.

00:10:46: How about those patients that are lanyllidamidofracri?

00:10:50: Kerfelsmape and dexamethion from the NDIVA trial or kerfelsmep pomegranate mydexametzone, This is from a phase two trial showing the benefit of these regimens in the lanyltamide refractive space could be potential options.

00:11:05: Cellinexer based options such as the cellinexibortazimodexametsone or the pomegranate mites, vortices from texamethasone and these are all potential options that could be considered for patients.

00:11:24: It is important to note most studies of PI, AMID and anti-CD-III antibody regimens in early relapse setting included a limited number of patients with prior exposure at refractoriness to lended mites

00:11:38: or

00:11:38: anti CD-III antibodies.

00:11:41: Outcomes of these standard-of-care regimens have been largely suboptimal in the land-lead mitral fracture patients.

00:11:47: So there are systemic reviews and patients that have received more than one prior length of therapy, this has very short progression-free survival of eight point eight months at a land refractory cohort versus thirteen point eight month's.

00:12:03: in their intent to treat populations In addition to those traditional standards of care regimens Emeritus therapy started in BCMA on the myeloma cells, including the CART-D and the antibody that congregates are normal treatment options available for early line Myeloma therapies.

00:12:20: And now these are approved options very earlier than the course.

00:12:23: can we go over the data to show what kind of a benefit each of these regimens yield?

00:12:29: In this space with the early relapse.

00:12:31: Sure let's start with CART D cell.

00:12:33: so which is a BCMA CAR-T cell product approved in patients that have received at least one prolander therapy.

00:12:44: There are end refractory and exposed to a PI, so siltasell was approved based on results of the Cartitute IV study, Which compare single infusion of siltacell To continuous therapy with either DERAPOMNX or PVD And Syltasert met the primary point of this study, which was progression-free survival with an overall survival benefit.

00:13:03: So we have a PFS sort of benefit has ratio

00:13:06: .?

00:13:08: and a

00:13:08: .?

00:13:09: survival benefits.

00:13:11: so it clearly showed that as opposed to A non BCMA targeting option Was able to induce deeper remission remission that were longer.

00:13:23: that translated into a longer provision for survival.

00:13:26: Now, at three years almost of follow-up we don't have immediate PFS yet and also an overall survival benefit.

00:13:33: Syntacel has the advantage of being kind of one and done treatment patient under when luciferase is received bridging therapy and then a single infusion of SILTA cell.

00:13:44: We know, however that CAR-T cell therapy despite being extremely effective high potent also comes with specific side effects.

00:13:52: some of them are shared by specific antibodies CRS and ICANNs.

00:13:56: I believe these are not limiting factors for the recommendation of CAR-T, so we know how to deal with this but certainly long term.

00:14:04: We have some although rare important side effects non-icons to ROTOX, cranial policies and other immune effector cell adverse events.

00:14:13: So all these are certainly a potential issue with CAR T.

00:14:18: .We also that some patients will have a rapidly proliferating disease require an aggressive bridging therapy.

00:14:26: Sometimes, bridging therapies are not available or patients cannot wait and conditions of the patient can deteriorate so that a patient is no longer eligible for CAR-TCL therapy.

00:14:35: So CAR-T is certainly exceptional treatment but probably in real practice every single patient can be treated with CAR-TSL either because of disease Or because of the patients' condition.

00:14:48: We have other options.

00:14:49: we've seen two studies leading to positive results with an ADC that targets BCMA, so same target different mechanisms of action.

00:14:59: So EJ can you tell us a little bit about the better combinations?

00:15:03: Clinical trials for Bellantemap-based combination have shown positive results in patients who've received more than one prior line therapy based on the DREAM seven and DREAM eight studies dream seven evaluating Bellantimap botasmic dexameth zone and DIMS DREAM Eight evaluating Botasmic Pomegranate mydexamet song.

00:15:20: these regiments are approved In two-plus lines of therapy in Europe, UK and Japan.

00:15:27: And Bellantima Botasmic Dexamethosone is approved for use on third line setting in the United States.

00:15:34: In the dream seven trial of Bellantama Botasma Dexamicone or BVD.

00:15:39: Fifty to percent patients had prior exposure to lumbaridomide.

00:15:42: Thirty four percent had refractory miscellaneous lumbardomide and nearly all ninety nine percent of the patient's were anti CD that it needs and PVD demonstrated a median PFS of thirty six months, an overall response rate of eighty three percent.

00:15:57: And MRT response rates which will have complete responses better seen in twenty five percent patients.

00:16:04: these results from the early line-of therapy with combination of Belland map, Bortazma dexamethosone over Datatumapotazma Dexametosone.

00:16:14: In that dream aid trial we evaluated Balantylamide pomalidomide dexamethasone, all patients had prior laminate mined exposure.

00:16:22: Twenty-six percent have prior exposure to anticellurated thirty eight therapy and twenty four percent had refractorinase two anti CDT therapy at a median follow up of thirty six watts.

00:16:33: the median PFS was thirty two point six months with the balanthoma pomalidomydexametazone which CR rates are greater in forty three percent And twenty eight percent of these patients achieved MRD negative day.

00:16:48: Bellantema represents the first off-the-shelf BCMA target option for second line myeloma outside of United States, and third lines setting in the United States which may allow for broader patient access to this treatment.

00:17:04: Despite positive results from the dream seven and dream eight, bellantema morphodidine combinations have uncertainties on dosing strategy so optimal usage is yet to be confirmed.

00:17:17: The ocular toxicities need an ophthalmologist or an optometrist management through the dosing schedules and prior to every dose.

00:17:26: The management of these ocular events can be guided by regular monitoring, supportive care, and delaying a reduce in the dose over time.

00:17:35: In the same lines, Roberto we spoke about CAR-T.

00:17:38: We spoke about ADC.

00:17:40: Can you talk about the bispecific antibodies targeting BCMA?

00:17:47: So, we've heard about CAR-T cell.

00:17:49: We have heard about Belantemap but now also in another way.

00:17:54: to target BCMA which is with a biospecific antibody is brought to early lines thanks to the results of TEC-III, Majestic III which combined the Clistamab and direct tumor for patients with one through three proteins or therapy.

00:18:10: So we have used for a number years by specific antibodies single agent in late lines based on the pivotal results of studies such as Majestic I uh...with the clistamabs such as um...Linker with Linvoe and also Magnetism III and all of the studies showed in a very heavily pre-treated population, most of patients being triple class refractory to a PI anemia and acidity at

00:18:38: T.A.,

00:18:39: yielding is a single agent drug in patients with five six million prolinegeal therapy responses in range of sixty, sixty-five percent complete remission rates upto fifty per cent and have very long durability of those responses in late lines.

00:18:56: So the fair question then was, can these responses and the PFS and DOS that we've seen in late-lines become even better when this drugs are used in earlier lines?

00:19:07: Either single agent or in combination where patients are more fit but also their immune system is fitter because they have seen less treatment.

00:19:16: And so TECTERA applies this concept of moving the crystal mob early on in a patient with less heavily pretreated disease.

00:19:28: So Majestic Three is the first phase three randomized study that compare Teclistamab used in an early line of therapy, in combination with Deratumumab and patients who were randomized to receive Ida Teclisimab and Deratuumumab which was administered every four weeks starting from cycle seven onwards or standard of care at physician's discretion, which was DERAPONDEX or DRVD.

00:19:57: All patients enrolled in Majestic III were linearly might expose and the vast majority of them In fact we're also linearly might refractory while five percent of patients in both arms Were exposed to DRATUMA.

00:20:10: And what there are in N-Majestic III have shown To us is that the combination Of these two drugs second era yielded responses with complete remission rate, eighty percent of patients.

00:20:24: Sixty percent of patient being in complete remition and MRT negative at ten to the minus five.

00:20:29: And this translated into a progression free survival probability At three years of eighty-three percent which is one of the best, it's not the best progression free survivor that we have seen in studies testing combinations and early relapse refractory multiple myeloma.

00:20:49: And importantly also Tectera showed at three-year follow up already an overall survival advantage favoring Tecter versus DeraPD or DeraVD.

00:21:01: this important because he tells us when use these combination early on We don't only see a benefit in terms of responses and durability response, but this has an effect also on the overall survival already at quite early time point.

00:21:19: And Well, the safety profile was very much consistent in line with what we have seen.

00:21:28: In a more heavily pre-treated population The cytokine release syndrome rate is more or less what we've seen with single agent teclisimab in range of sixty percent So the neurotoxicity is unlikely to happen.

00:21:44: Very few patients had an ICANS event and What's instead most?

00:21:50: important side effects related to the use of a BCMA targeting by specific antibody, such as the crystal map is the risk of infection.

00:21:59: The majority of patients actually experienced at least one infection and more than fifty percent of patient, fifty four percent or patient had infections with three or higher.

00:22:10: It is important to notice that the infection rates were higher during the first six months where we have a number of factors, not just treatment but also the immune suppression carried by uncontrolled disease after sick.

00:22:27: for six month's the infections tended to decrease and this may be due in control for those patients, so less immune suppression.

00:22:40: There was a monthly switch in terms of to close them up dosing which may have helped and we also need to reinforce the use of an aggressive immunoglobulin replacement therapy approach because this has been demonstrated as an intervention that can make a difference with reducing the risk of infections when specific targeted BCMA are being

00:23:04: used.

00:23:05: So having said that, we've seen great results in terms of efficacy safety profile in line with what we know for teclistamab but this is a combination.

00:23:14: so this is tech and DERA.

00:23:16: as we have mentioned at the beginning of this podcast some patients will relapse and eventually become refractory not only to nanolidomide to PI the use of single agent BCMA targeting by specific antibody.

00:23:34: What do we know about this?

00:23:36: Great overview, what the TEC-III data was clearly delivering.

00:23:41: The biggest question is all about that...what happens with the data?

00:23:45: refractory patients or the data expose patients who had previously seen Datatune lab in their induction therapies?

00:23:52: like you've read it into before majority of the patients would be receiving equidruple therapy.

00:23:57: And, with results of TEC-IIIB applicable for that specific patient population?

00:24:02: That is a big question!

00:24:04: So, TECNINE's study will help us to inform the usage of TeclistMAP as early line of therapy among patients who have previously seen the attitude map.

00:24:16: So, Teknine is first randomized phase three study of teclistmap as monotherapy versus The traditional norms of pommelidomide, potassium dexamethasone or curfewsome dexamatosone among patients that had seen one to three prylons of therapy and have a prior exposure to an anti-CD-III antibody as well as lanylidomite.

00:24:38: Majority the patient on this study were refractory lanyllidomides and anti-CD-III antibody, it's seventy nine percent of the patients that are fractured to laminate might eighty five percent of those who have fractured into anti-CD-III antibodies.

00:24:52: The results of Majestic Nine build on the results of the Majestic Three which is a Tectera demonstrating a significant PFS as well as an overall survival benefit with TechListMap as monotherapy in a more heavily refracted patient population.

00:25:09: In addition to the Majestic III and the Majastic IX, there are additional datasets that have demonstrated the favorable potential.

00:25:16: So the results from the Trend II trial this is a small cohort as well as the Majistic IV, V & VII.

00:25:22: all of these support the competitions.

00:25:25: so I'm curious about your take on the combo of bispecific antibody as well GPRC-VD bispecific antibody here?

00:25:34: We also know that other drugs target different antigens, one of them is GPRC-PhD which is targeted by telketomob.

00:25:42: Which is a biospecific antibody and as we've seen teclistamab another biospecific antibodies are moving forward to the earlier lines of therapy.

00:25:52: The same it's happening for Telketomub And We have A couple Of studies Faced three large Studies monumental Three and Monumental six that Are Exploring the role of Teltketomab in early Alliance.

00:26:03: So Monumental III, for example is exploring the combination of talc with Daratumuma so kind of a majestic three-year approach.

00:26:12: With or without pomalidomus.

00:26:14: and in Monumentals VI on Geredan we have the combination Of Talc with only palm

00:26:20: Or

00:26:21: The Combination of Tekken Tal.

00:26:23: There are several other bi-specific antibodies are target BCMA and certainly the efficacy that we've seen has brought a lot of excitement about their development on this platform.

00:26:34: So now, we have other drugs such as Limposeltumab and Elranatana being explored in early lines of therapy.

00:26:41: these either as single agent like Limbo-Seltamab in the linker MMS study that is comparing limbo to elopomdex, in patients with at least one prolineal therapy.

00:26:53: Eranatannaba has been tested as well in combination with DeraTumumab.

00:26:58: One question for you Ajayis That now we have discussed all of the data CAR T ADC and also high specifics What do you think should be a general recommendation?

00:27:10: For our colleagues that had used these drugs every day?

00:27:13: in terms of sequencing.

00:27:14: What do we know, what did the guidance recommend?

00:27:17: Absolutely!

00:27:18: The IMWG has provided some guidance based on the sequencing... ...what will be most appropriate sequencing when you have BCMA, Byspecifics, BCMA-Carties, BCMAAdc's as well as GPRC-funded byspecographic antibodies that are existing out there and they're more in the future to come.

00:27:38: One other key principles that we talked about earlier was the usage of one treatment should not have an impact on their efficacy for the following treatment.

00:27:46: So that should be always in the mind of the user, so when you talk about a BCMA CAR T. it's a one-and-one therapy just like we talked about Roboto and these patients had prolonged duration of remission and at the time where patient is progressing this patient has option to receiving either BCMA bispecific antibody or GPRC-FIDI bispecific antibody.

00:28:10: If you flip the other way, if patients are receiving BCMA or GPRC-FIDB, these patients receive ongoing therapy either by themselves and with accommodations.

00:28:23: At that time when they progress their option of a CARP likely may not yield best response.

00:28:29: And in terms of the other sequencing approaches, so a BCMA bispecific antibody followed by another BCMA-bispecic antibody or a GPRC-FIDB bispecal antibody.

00:28:39: They should always have a sandwich if they're non-T-cell redirected therapy to let those T cells get some free time to recuperate.

00:28:46: and we've not mentioned that targeting BCMA and T-cell redirected therapies are certainly at the new coroner sternomyeloma treatment where there's also other compounds that are making their way up in the treatment of myeloma.

00:29:00: We've seen, for example, cell motes and we'll see ibertomide and mesytomide being two ideactive compounds.

00:29:08: And this will see positive results soon.

00:29:12: but it's also interesting to see how these drugs can be combined with biospecific antibodies both mechanisms of action and both kind of drugs, so I think it's a very exciting time for myeloma.

00:29:28: Very nice!

00:29:28: It is wonderful if you have to focus on three things that everybody who has received BCM and biospecific antibodies should be focused on.

00:29:37: what would those three?

00:29:39: So I think that the good thing with bi-specific antibodies is we really don't have an exclusion criteria, let's say.

00:29:48: More or less everybody can receive a Bi-Specific Antibody.

00:29:50: Three pieces of advice would be it is important to fully aware of side effects particularly acute side effects.

00:30:00: We know these are well standardized and preventative measures.

00:30:06: CRS is maybe an issue, even more logistical than clinical also in some patients.

00:30:11: We know that for example Tocillizumab is a very good drug to prevent cytokine release syndrome and allow for the outpatient administration which I think it's absolutely feasible.

00:30:21: but we need to have a plan to ensure patient safety.

00:30:25: so when you select the right patient then they have a set up to deliver these drugs but also in a safe way.

00:30:34: And I think the third piece of advice will be to be cognizant of risk-of infection, so IG replacement therapy and in their very first months of treatment being vigilant and hopefully in future we'll all be able too identify this patient at high risk of infection and adopt some kind of prophylaxis beyond the standard prophylexes that currently use.

00:30:58: Thanks everyone for your time.

00:31:01: We had an excellent discussion from Roboto and me talking about what the standard of care options should be for the second line beyond therapies in early relapse myeloma, especially with a focus on their bispecific antibodies.

00:31:16: And they're combinations yielding us such good benefits.

00:31:19: we realized that traditional standard of cure options are less effective increasing resistance populations.

00:31:25: CAR-T, particularly the cell to cell is a powerful, powerful lamination that every model one patient should be aware of and their provider should ready to use.

00:31:34: But this should be considered as an initial treatment option early on with all available treatment options that are proving.

00:31:41: The readily available plant morphodidin combinations may be considered after more effective therapies have been explored.

00:31:49: And so in this context, targeting BCMA with a biospecific antibody such as teclistamide either in combination or monotherapy represents the next evolution.

00:32:01: and the next treatment option for patients.

00:32:04: early has their second line therapy.

00:32:06: This is almost steroid free immunotherapy that offers also the convenience of being readily available off-the-shelf BNews, also in the community setting with some mitigation strategies.

00:32:20: Also for side effects and also to potential four monthly administration.

00:32:24: so overall certainly by specific antibodies including teclistamab do represent a new standard of care for this patient population.

00:32:33: So we reached the end of this podcast on behalf my co-author Dr Nuka.

00:32:39: thank you very much for attending this podcast.

00:32:42: We hope that you enjoyed it as much And it was a pleasure discussing BCMA and second line trickery out.

00:32:49: Wish you great day!

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