BETA - How does the bone marrow (immune) microenvironment effect myeloma therapy response? How does the microenvironment influence myeloma cells growth, prognosis and treatment resistance?

In previous Health Tree University lesson, we learned about what the bone marrow microenvironment is, how it is profiled, and how the bone marrow microenvironment of a healthy person compared to the bone marrow microenvironment of a myeloma patient. In this Health Tree University lesson, we will discuss how the bone marrow immune microenvironment influence myeloma cell growth, prognosis, and treatment resistance. We know that myeloma within the bone marrow is surrounded by a lot of immune cells. And while the genetic makeup of myeloma cell, of the myeloma cells can dictate how aggressive it is, more and more studies are showing that there is an interaction that exists between myeloma and its surrounding environment, whether it's the immune cells or the stromal cells. And we know that different people have a different makeup of the immune microenvironment, and they express their other at different compositions in terms of percentages of different cells or in terms of proteins and RNA that they're producing. We see that translate into clinical outcomes because now more and more we're using immunotherapy in myeloma and it's showing huge responses and that are durable and deep. But at the same time, we see we can see huge differences between different people. And with more studies right now, we're actually beginning to identify why that is the case. So some people have different immune compositions or different markers that they're producing in their immune microenvironment that's causing this less ideal response to immunotherapy. And our mission right now is actually trying to figure out ways to overcome this mechanism of resistance to immunotherapy. So now that we know certain targets that are possibly causing this lack of response to immunotherapy, we might be able to target those things in the immune microenvironment and allow patients to respond much better to immunotherapy. So that's what's currently happening behind the scenes. There are multiple cell type, multiple proteins, so many different things that are happening in the bone marrow. And one of the things that really changes in patients with myeloma is the ability to have effective T cells and B cells responses. So T cells and also NK cells responses. So all these immune cells, T cells, B cells, NK cells, they're all lymphoid cells. And these cells are important to fight infection, but also to fight and kill cancer cells. So it's kind of called like a sort of immune surveillance that in all of us every day is active to get rid of cells that are like, they're going like rogue. In myeloma patients, it's very important to rely and activate the opposite arm. So if the myeloma cells per se are trying to suppress this antitumor immunity, some of the medication that we give to patients are actually helping to activate those immune cells again. So for instance, immunomodulatory drugs, that's why they're called immunomodulatory drugs. They change and activate T cells and NK cells like lenalidomide, pomalidomide, all these drugs are able to kind of shift the balance and get more activation of these immune cells against the myeloma cells. And then it's kind of the same concept for lots of the new anti myeloma therapeutics, such as the bio specific antibodies that really activate and relies on activating T cells that are either in the tumor microenvironment, so in the bone marrow or like all over the body to kind of like become more effective in killing myeloma cells. So practically most of the medication that we use to treat multiple myeloma have some type of like immune modulatory or like ability to change the tumor microenvironment to be effective.