Immune status and selection of patients for immunotherapy in myeloma: A proposal

A new framework for optimizing immune therapy in multiple myeloma (MM) based on distinct spatial immune types of the disease has been proposed by the Winship Center for Cancer Immunology at Emory University. This proposal aims to improve patient selection and therapeutic outcomes by considering the spatial and immune contexture of myeloma tumors.

The immune environment of MM is complex, with varied immune environments across different tumor sites affecting the efficacy of immune therapies such as CAR-T cells and bispecific antibody treatments. In this proposal, MM was categorized into five spatial immune types—immune-depleted, immune-permissive, immune-excluded, immune-suppressed, and immune-resistant—based on their immune characteristics and response to therapies. These classifications could be used to guide the application of specific immune therapies and help in selecting patients likely to benefit from them.

This study details how different immune types correlate with the responsiveness to immune therapies. For example, immune-permissive tumors, which are receptive to T cell infiltration, may respond well to T cell redirection therapies and have potential for durable remission. Conversely, immune-resistant immune types, characterized by the loss of T cell redirection targets, may require alternative treatment strategies. The proposal further suggests the integration of this immune classification with genomic analysis, imaging, immune monitoring, and AI to enhance the precision of therapy. Overall, the future effectiveness of immune therapy for MM will depend on access, cost, and regulatory factors, but maximizing its curative potential is key.

Reference:

Dhodapkar MV. Immune status and selection of patients for immunotherapy in myeloma: a Proposal. Blood Adv. Published online April 2, 2024. https:/doi.org/10.1182/bloodadvances.2023011242