Immune status and selection of patients for immunotherapy in myeloma: a Proposal

Blood Adv. 2024 Apr 2:bloodadvances.2023011242. doi: 10.1182/bloodadvances.2023011242. Online ahead of print.ABSTRACTNewer immune-based approaches based on recruitment and redirection of endogenous and/or synthetic immunity such as chimeric antigen-receptor-T (CAR-T) cells or bispecific antibodies are transforming the clinical management of multiple myeloma (MM). Contributions of the immune system to the anti-tumor effects of myeloma therapies are also increasingly appreciated. Clinical malignancy in MM originates in the setting of systemic immune alterations that begin early in myelomagenesis and regional changes in immunity impacted by spatial contexture. Pre-existing and therapy-induced changes in immune cells correlate with outcomes in MM patients including following immune therapies. Here we discuss insights from and limitation of current data about immune status and outcomes following immune therapies in MM patients. Pre-existing variation in systemic and/or regional immunity is emerging as a major determinant of the efficacy of current immune therapies as well as vaccines. MM is however a multifocal malignancy. As with solid tumors, integrating spatial aspects of the tumor and consideration of immune targets with biology of immune cells may be critical to optimize the application of immune therapy including T cell redirection in MM. We propose 5 distinct spatial immune types of MM- immune-depleted, immune-permissive, immune-excluded, immune-suppressed, and immune-resis...
Source: Adv Data - Category: Epidemiology Authors: Source Type: research