1. Overcoming the Immunosuppressive Tumor Microenvironment in Multiple Myeloma
- Author
-
Fatih M. Uckun
- Subjects
0301 basic medicine ,Cancer Research ,immunomodulatory imide drugs (IMiDs) ,medicine.drug_class ,immune-checkpoint receptors ,Review ,CD38 ,Monoclonal antibody ,spleen tyrosine kinase (SYK) ,transforming growth factor beta (TGF-β) ,Cell therapy ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,medicine ,Cytotoxic T cell ,tumor microenvironment (TME) ,multiple myeloma (MM) ,Multiple myeloma ,RC254-282 ,Tumor microenvironment ,business.industry ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,autologous hematopoietic stem cell transplantation (ASCT) ,chimeric antigen receptor (CAR)-T ,medicine.disease ,030104 developmental biology ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,bispecific T-cell engagers (BiTEs) ,Cancer research ,Bone marrow ,business - Abstract
Simple Summary This article provides a comprehensive review of new and emerging treatment strategies against multiple myeloma that employ precision medicines and/or drugs capable of improving the ability of the immune system to prevent or slow down the progression of multiple myeloma. These rationally designed new treatment methods have the potential to change the therapeutic landscape in multiple myeloma and improve the long-term survival outcome. Abstract SeverFigurel cellular elements of the bone marrow (BM) microenvironment in multiple myeloma (MM) patients contribute to the immune evasion, proliferation, and drug resistance of MM cells, including myeloid-derived suppressor cells (MDSCs), tumor-associated M2-like, “alternatively activated” macrophages, CD38+ regulatory B-cells (Bregs), and regulatory T-cells (Tregs). These immunosuppressive elements in bidirectional and multi-directional crosstalk with each other inhibit both memory and cytotoxic effector T-cell populations as well as natural killer (NK) cells. Immunomodulatory imide drugs (IMiDs), protease inhibitors (PI), monoclonal antibodies (MoAb), adoptive T-cell/NK cell therapy, and inhibitors of anti-apoptotic signaling pathways have emerged as promising therapeutic platforms that can be employed in various combinations as part of a rationally designed immunomodulatory strategy against an immunosuppressive tumor microenvironment (TME) in MM. These platforms provide the foundation for a new therapeutic paradigm for achieving improved survival of high-risk newly diagnosed as well as relapsed/refractory MM patients. Here we review the scientific rationale and clinical proof of concept for each of these platforms.
- Published
- 2021