Immunologic microenvironment and personalized treatment in multiple myeloma.

INTRODUCTION: Multiple myeloma (MM) is characterized by generalized immune suppression and increased susceptibility to infections and secondary malignancies. Malignant plasma cells (PCs) modulate the bone marrow microenvironment to favor their own survival and proliferation. These events lead to a severe deregulation of immune effectors. Extensive studies have been conducted to unveil the mechanisms through which MM cells negatively modulate immunity and to develop therapeutical approaches for restoring an efficient anti-MM immune response. AREAS COVERED: This review article covers both the immunosuppressive effects exerted by MM and the immunomodulatory potential of novel anti-MM agents. A brief overview on the most promising immunotherapeutic approaches in the field is also provided. EXPERT OPINION: MM leads to a progressive impairment of the immune system. Different approaches have been evaluated or are currently under investigation to boost a specific anti-MM immune response. The discovery that anti-MM agents like bortezomib also retain immunomodulatory properties provides evidence to support the development of combined treatment modalities. In the next future, immunotherapy will be likely included in selective treatments in early stages or in the post-transplantation setting with non toxic modalities that control or clear the neoplastic clone.