Quadruplet regimens combining CD38-targeting monoclonal antibodies, proteasome inhibitors, IMiDs, and dexamethasone are now standard induction therapies for newly diagnosed multiple myeloma (NDMM). Despite improved outcomes, many patients achieve incomplete responses or relapse. The immune microenvironment is central to therapeutic efficacy, yet the immunological impact of quadruplet therapy remains poorly understood.
We performed single-cell RNA sequencing of CD45* bone marrow immune cells from 84 NDMM patients in the phase III IFM2020-02 "MIDAS" trial treated with Isatuximab, Carfilzomib, Lenalidomide, and Dexamethasone (IsaKRd). Paired diagnostic and post-induction samples revealed extensive immune remodeling linked to minimal residual disease (MRD) status.
We found that IsaKRd drives coordinated remodeling across major immune compartments. MRD-positive patients display hypoxia- and inflammation-driven myeloid programs with dysfunctional lymphoid responses, whereas MRD-negative patients retain protective cytotoxic T, NK, and classical monocyte subsets. This immune atlas defines trajectories of responsiveness versus resistance and supports development of immune-based biomarkers to guide therapeutic strategies in multiple myeloma.
Comprendre le fonctionnement des organismes vivants, telle est l’ambition du Centre de biologie intégrative (CBI), à Toulouse. Pour atteindre cet objectif, le CBI développe des approches multidisciplinaires, multi-échelles des molécules isolées aux organismes entiers et aux sociétés animales, et utilise de nombreux organismes modèles, des bactéries à l'homme.
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