The Role of the Immune System in Hematologic Malignancies that Affect Bone

Publisher Summary Osteoimmunology in the context of multiple myeloma is a newly emerging field, and it is clear that interactions between myeloma cells and cells of the immune system are important both in terms of tumor growth and the development of the osteolytic bone disease. Increasing our understanding of the role of the immune system in myeloma bone disease, for example, the effect of the immunosuppression that is found in patients with myeloma will ultimately identify new therapeutic targets for the treatment of myeloma. Current knowledge is limited due to the difficulty of verifying intriguing in vitro observations in appropriate in vivo systems. Immune cells can have both a deleterious and advantageous role in myeloma pathogenesis. Macrophages and T cells, for example, can become altered by the presence of myeloma cells within the bone marrow cavity and act to support further cancer progression; however, the immune system can also be utilized for anticancer therapies. Within a healthy individual, the immune system provides defense mechanisms critical for protecting the body against foreign pathogens as well as tumor formation. The manipulation or stimulation of the body's natural immune system to fight cancer provides an attractive area for therapeutic potential. Emerging cancer research of recent years not only demonstrates genetic alterations to the cancer cells but also to the surrounding microenvironment. The future of effective cancer therapeutics will have a dual focus; treating both the tumor cells and the altered microenvironment.