title: Immunologic microenvironment and personalized treatment in multiple myeloma.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Magna Graecia University and T. Campanella Cancer Center, Department of Experimental and Clinical Medicine, Medical Oncology Unit, Viale Europa, 88100 Catanzaro, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Rossi
authors.forename: Cirino
authors.initials: C
authors.lastname: Botta
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Correale
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Tassone
authors.forename: Pierosandro
authors.initials: P
authors.lastname: Tagliaferri
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006801:Humans; D007107:Immune System / Q000187:drug effects*; D007167:Immunotherapy; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000276:immunology; D057285:Precision Medicine; D059016:Tumor Microenvironment / Q000187:drug effects*
chemical_list: D000970:Antineoplastic Agents