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Can Health of the Immune System Help Predict the Duration of Remission in Myeloma?

By: Amy MacDonald, MS
Posted: Friday, October 27, 2023

A majority of patients with multiple myeloma ultimately experience disease relapse. Current therapy is focused on strategies to prolong initial treatment response. However, the role of the immune microenvironment in creating or maintaining disease remission in multiple myeloma remains poorly understood.

David G. Coffey MD, of the University of Miami, and colleagues, comprehensively examined the immune profiles of patients with multiple myeloma receiving maintenance therapy with lenalidomide, to uncover clues to the immune system’s role. Published in Nature Communications, their research revealed marked differences in the composition of the immune microenvironment (in both the blood and the marrow) in patients (with and without transplant) who had, or had not, achieved measurable residual disease (MRD) status.

“Our study underscores how critically important the immune system is to patients’ ability to respond favorably—and achieve remission—through current therapies for multiple myeloma,” Dr. Coffey stated in a University of Miami press release. Moreover, we discovered that the immune systems of multiple myeloma patients being treated with modern combination therapy could ultimately recover to resemble those of healthy bone-marrow donors if they were able to achieve and sustain MRD negativity,” he continued.

The researchers examined the immune microenvironment of 23 patients with multiple myeloma (from a prospective, single-arm, maintenance trial) before and 1 year after lenalidomide therapy. They compared 12 patients with sustained MRD negativity during the first year of therapy with 11 patients who had lost or had not achieved MRD negativity.

Their results showed that patients with sustained MRD negativity had an increase in circulating helper T cells and a decrease in both terminally exhausted T cells and regulatory T cells. They observed that the frequency of immune cell subsets in patients with sustained MRD negativity (and no history of autologous stem cell transplant) most resembled healthy donors.

Disclosure: For full disclosures of the study authors, visit

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