You can't talk about the 2022 Congress season and transplant-eligible myeloma without talking about the DETERMINATION study. The DETERMINATION study, which actually was a plenary session at ASCO in 2022, has been going on for over a decade. What we knew many years ago when we didn't have good initial therapies for myeloma is that auto transplant was better than the standard at the time, which was something like VAD, infusional vincristine, Adriamycin (doxorubicin) and dexamethasone. The question is, with modern-day induction regimens like VRd, do we still need transplantation upfront? That's essentially what the DETERMINATION trial was, comparing patients who received VRd and ultimately going onto maintenance, versus VRd followed by transplant followed by maintenance. The study has been going on for quite some time.

Really, this is some of the biggest data we've seen in this arena to date. The short answers are patients who receive auto transplants seem to get a little bit of a deeper response on average. They have a longer progression-free survival. As of this time, there's no improvement in overall survival for patients who receive or don't receive transplant. Where things really, really become or are appearing to be almost identical, are people who achieve MRD negativity. If you achieve MRD negativity with your induction therapy, the true benefit for transplant may be so small that there may not even be a role for those patients. Now, longer-term follow-up is needed between high-risk and standard-risk, between people who just achieve MRD negativity once, or people who sustain it for a number of years. So far, it's starting to look like standard-risk who achieves deep remissions up front, like MRD negativity, although you may stay in remission longer with transplant, you won't live longer. This is really the first data to say, maybe our treatment nowadays is so good, we probably don't need transplant for everyone nowadays.