Immune System Plays “Big Role” in Multiple Myeloma Development, Care

In a conversation with CancerNetwork^®, Manoj Bhasin, PhD, MS, spoke about research that he and colleagues published in Nature Cancer focusing on how a single-cell atlas may characterize the bone marrow immune microenvironment among patients with multiple myeloma. Findings showed that the immune system has a broad, treatment-independent influence on multiple myeloma outcomes.

Bhasin, professor in the Department of Pediatrics and in the Department of Biomedical Informatics at Emory University School of Medicine; and director of Genomics, Proteomics, Bioinformatics and Systems Biology and the Aflac Director of the Single Cell Biology Program at Children’s Healthcare of Atlanta, outlined how to adapt these translational findings to the development of novel anti-myeloma therapies. He noted that additional comprehensive, large-scale studies are necessary to help elucidate the complexity of multiple myeloma, which may inform other next-generation treatments.

Transcript:

If you look at the landscape of multiple myeloma, all the risk-staging and stratification is mainly tumor genetic-[centered]. We are mainly focused on the tumor part and some clinical features, whereas the extrinsic factors like the immune system are not taken in consideration when we are stratifying the patient into high risk or standard risk. The basis for this study was to figure out [if] the immune system is playing a role in the emergence of multiple myeloma, the therapeutic response, as well as the outcome. This was one of the first comprehensive studies where we profiled more than 1.4 million cells from newly diagnosed [patients with] myeloma before they were given any therapy. This was a study to answer some of the important questions because it was built up on the Multiple Myeloma Research Foundation (MMRF) CoMMpass registry study [NCT01454297]. That is a study with 8 to 10 years of follow up on the patients with very comprehensive tumor genetics along with the clinical information to understand if the immune system plays a role in multiple myeloma. This is the study we planned 5 years back.

We learned that the immune system plays a big role in myeloma. [The] next step we need to take is compare it with other cancers because [for] other cancers, the immune system is considered as a key player in the outcomes. Then, to further make these findings more translatable and more [adapted] to designing new therapies, we need to compare them with other things like aging so that we can figure out [whether] the changes are just driven by the aging, or [if] they are cancer-specific changes. That will help us in designing next-generation therapies. We should also look at people who are coming from diverse backgrounds and diverse socioeconomic status; is that also playing a role in altering the immune system?

A lot more comprehensive, large-scale studies are needed to understand the complexity of myeloma, as well as other cancers. I look forward to people working more in this area and doing some of these studies, which will help us to understand the complexity of myeloma and design next-generation therapies.

Reference

Pilcher WC, Yao L, Gonzalez-Kozlova E, et al. A single-cell atlas characterizes dysregulation of the bone marrow immune microenvironment associated with outcomes in multiple myeloma. Nature Cancer. 2026;7:224-246. doi:10.1038/s43018-025-01072-4