Advances in immune microenvironment profiling during multiple myeloma progression and therapy

Area of Science:

• Immunology
• Hematology
• Oncology

Background:

• Multiple myeloma (MM) treatments have advanced significantly.
• These therapies impact the bone marrow immune microenvironment, crucial for MM.
• Immune dysregulation occurs early, even in precursor conditions like monoclonal gammopathy of undetermined significance and smoldering MM.

Purpose of the Study:

• To review immune cell dynamics during MM progression.
• To discuss how current therapies modulate the immune microenvironment.
• To highlight the role of immune interactions in MM pathogenesis and treatment response.

Main Methods:

• Literature review synthesizing recent insights into immune cell dynamics in MM.
• Analysis of how immunomodulatory drugs, proteasome inhibitors, and cell-based therapies affect the immune microenvironment.
• Examination of immune alterations in both precursor and active MM stages.

Main Results:

• MM cells manipulate the immune microenvironment to evade antitumor immunity.
• Therapies can activate antitumor immunity but may also sustain immunosuppressive pathways.
• Immune alterations are progressive, starting from early precursor stages.

Conclusions:

• A deep understanding of the MM immune landscape is essential for treatment optimization.
• Targeting immune interactions can overcome therapeutic resistance.
• Insights gained will guide the development of novel immunotherapies for multiple myeloma.