With advanced diagnostics, immunological approaches and innovative clinical trials with the help of an extensive database of patient history that was started in 1985, advances continue to be made in the field of lymphoma. These advances are providing a better understanding of the biology of lymphomas, leading to more-accurate diagnoses and better treatment options for patients.
Uh huh. Right. I started the Mayo Clinic Lymphoma database in 1985. We have over 31,000 patients in that we have armor program and our leo and sport grant were able to do just remarkable studies on our own. And then in collaboration, nationally and internationally, we really believe that clinical trials are the way to affect change in the way to affect outcomes in patients. We have a phenomenal group of a meta pathologists constantly affecting change in their protocols and adding new new tests. One example of that is some of the studies that we've done looking at fish testing in lymphoma and determining basically that, you know, we take a certain approach to fish testing and diffuse large B cell lymphoma. So for our diffuse large B cell lymphomas, we know that a double hit lymphoma which has a Mc rearrangement and a BCL two rearrangement is a poor prognosis for the patient. So it's very important to identify those. And so we've developed essentially a triage system where first we fish for Mick and then we fish for BCL two if the Mc is rearranged. We also did a study by looking at retrospective data that just doing what's called a Mc break apart probe by fish alone was missing. A certain percentage of Mick rearrangements. We determined that adding a dual fusion Mick I. G. H. Probe along with the Mc break apart probe Up front would catch about 4% more of those Mick rearrangements that we were missing by just using the Mc break apart probe. So these were patients who potentially we're told you have diffuse large B cell lymphoma when they should have been told you have a double hit lymphoma um which is a higher grade lymphoma which behaves more aggressively and responds better to more aggressive therapy because of the now more widespread availability of different genetic testing of the tumor within pathology were much better able to understand the biology of these lymphomas and better able to translate that into our diagnoses. So classifications of these diseases are always changing because of that. Those discoveries that are being made in the genetic round. We're now taking very aggressive disease and taking an immunological approach. The therapies that are now starting to really impact the relapse refractory patients after transplant and vote in different settings are the car T cell therapies for the patients were treated on the carty studies overall. You know, when you look at that, we're talking about complete remission rate, you know, in the 30 to 40% range and even higher for for more rare type of lymphoma. Now that we've had 34 year follow up for the patients whose responded close to 30 to 40% of them have remained in remission for a very long period of time. So now you're talking about the median overall survival across studies are closer to, you know, 23 year range or longer. So that's a dramatic difference. And that's why we think this therapy is so transformative because there is a potential for cure for the patients who respond to this treatment. One of the question is, you know, who are the people to get carty therapy. And that I think is an area of um still ongoing challenge. And um that needs in a sense that it is very individualized personal medicine. Right? We're taking cells from the patient's were manufacturing these carty from the patient's own T cells. So essentially each party product is its own batch, its own lot of living drug. We've started our own manufacturing so we can make these cartoons on sites and get them to patients sooner. There are larger multi center studies in earlier settings. So now that we know it works after two lines of therapies, there have been randomized study comparing patients to get carty versus autologous stem cell transplant in the second line setting. So now we're trying to move it up one notch. The hope is that we're going to develop better cars, more specific cars, uh, and less toxic cars. That that is really changing the landscape over the last literally 24 months. I think this is just the beginning. You know, this is not the end. All what we're seeing is really the very first generation of Cartier and what it can do for for patients.