Epigenetic reprogramming in multiple myeloma-Challenges and opportunities

In cancer, mutational processes act in concert with epigenetic reprogramming to endow malignant cells with hallmark properties that underpin tumorigenesis. Compared with the relatively rigid and slow processes of genetic evolution, the plastic nature of chromatin enables cells to adapt to a changing environment more rapidly. Multiple myeloma is characterised by high levels of inter- and intra-patient heterogeneity at both the genetic and epigenetic levels. Understanding the many layers of genetic and non-genetic evolution and their interplay is crucial to improve patient outcomes. In this short review, we discuss the most common and extensively characterised epigenetic alterations that occur during myeloma development. We also touch on emerging approaches to reverse the aberrant epigenome of myeloma cells as a treatment strategy.