A New ‘Atlas’ of Inflammatory Immune Cells in Lays Foundation for More Reliable Prognosis

Despite advances in treatment options, multiple myeloma is a rare cancer that develops in the plasma cells of the bone marrow and has no cure. It is also the second most prevalent hematological cancer, and its incidence continues to rise globally, especially in the United States, Australia, and Western Europe. [1]

Results from a new study, designed and supported by the Multiple Myeloma Research Foundation (MMRF), the Myeloma Solutions Fund, the Paula C. and Rodger O. Riney Blood Cancer Research Fund, and the National Institutes of Health (NIH) and published in the January 9, 2026 edition of Nature, maps the immune cell landscape of bone marrow in patients with multiple myeloma.[2]

The new, large immune cell atlas, which includes robust patient outcome data, provides unprecedented insights into how the immune system interacts with cancerous plasma cells and can be used to determine the likely aggressiveness of a patient’s multiple myeloma. This knowledge may improve survival predictions, guide treatment decisions, and inform the development of new immune-based therapies for patients with multiple myeloma.[2]

Co-led by a team of researchers at Washington University School of Medicine in St. Louis, MO, in collaboration with the Multiple Myeloma Research Foundation (MMRF) and other leading institutions across the country, the study was published in the January 9, 2026, edition of  Nature Cancer. [2]

“It is time for a better understanding of the immune system in multiple myeloma,” said WashU Medicine co-senior author Li Ding, Ph.D., the David English Smith Professor of Medicine and a research member of Siteman Cancer Center, based at WashU Medicine and Barnes-Jewish Hospital, St Louis, MO.

“In addition to targeting the cancerous plasma cells directly, we also want new and better ways to activate the immune system to attack the malignant cells. This large-scale immune cell atlas will serve as a critical resource to investigators studying multiple myeloma and working to develop better therapies,” Ding added.

Rare, but common
While considered a rare cancer, multiple myeloma is the second most common blood cancer after leukemia, accounting for about 15%-20% of new blood cancer diagnoses in the U.S. annually. Plasma cells are white blood cells in the bone marrow. When they grow out of control, they crowd out healthy blood cells. About 60% of patients are still living five years after diagnosis.

Many new treatment options have emerged for multiple myeloma in recent years that can extend survival for many patients, sometimes for more than a decade. Even so, the disease almost always returns after periods of remission, emphasizing the need for new and better options.

Novel approach
Several of the newest therapies for multiple myeloma are immune-based, including CAR T-cell therapies and bispecific antibodies. But researchers suspect there may yet be untapped opportunities for immune-based treatments for multiple myeloma, and the immune cell atlas is a new tool to harness in pursuit of such therapies.

“This immune atlas provides a roadmap for the next generation of myeloma care,” said coauthor and WashU Medicine oncologist Ravi Vij, MD, the Jeffrey S. and Prue H. Gershman Distinguished Professor of Medicine.

“As immunotherapies like CAR T-cells and bispecific antibodies become central to treatment, understanding the immune context in which they operate is essential. Clinically, this work lays the foundation for immune-informed risk stratification and rational development of new therapies that not only target the tumor but also restore effective anti-myeloma immunity,” Vij added.

Vij treats patients with multiple myeloma and other blood cancers at Siteman Cancer Center.

A cell-by-cell catalog of multiple myeloma
The research team performed rigorous, cutting-edge single-cell RNA sequencing on almost 1.4 million individual plasma and immune cells from bone marrow samples collected from 337 newly diagnosed multiple myeloma patients. This type of analysis can reveal how individual immune cells may function — or become dysfunctional — in the context of multiple myeloma.

CoMMpass
The data describe patients enrolled in MMRF’s CoMMpass Study (NCT01454297), the first large-scale, long-running observational study of patients with multiple myeloma focused on analyzing disease progression and treatment response based on patients’ genomic and molecular profiles.

WashU Medicine is one of multiple sites participating in the CoMMpass Study.

The investigators found that patients with certain types of immune cells in their bone marrow at diagnosis were more likely than others to relapse quickly, meaning their cancer returned soon after a first round of treatment. The researchers identified signaling patterns between cancer cells and immune cells that drive inflammation, which might be boosting cancer growth in patients with aggressive disease.

The team also identified a type of T cell that had stopped working as expected and, instead of attacking the tumor as it should, suppressed immune activity against the cancer. Together, these findings could help improve the accuracy of prognoses and aid in selecting the best therapies.

“This immune atlas represents the power of collaborative science,” said co-senior author and MMRF Chief Scientific Officer George Mulligan, PhD.

“The MMRF’s CoMMpass Study, combined with the expertise from investigators at WashU Medicine and leading institutions across the country, has created an unprecedented resource that will accelerate discovery and improve outcomes for myeloma patients,” Mulligan added.

Immune environment
Importantly, the researchers showed that knowledge of the immune environment in a patient’s bone marrow could improve upon current methods for predicting which patients are most likely to experience an aggressive course of the disease and have shortened survival. Such predictions can help guide treatment decisions by matching treatment intensity to the cancer’s aggressiveness.

Current methods for determining whether a patient has high-risk multiple myeloma versus standard risk rely on knowing the genetic features of the cancer cells combined with clinical aspects of the patient’s health. The new study found that adding an immune component to this analysis would likely improve categorization accuracy.

“More work is needed to develop specific immune-based blood tests, for example, that clinicians could order to better identify the aggressiveness of a particular case of multiple myeloma and help them select the best treatments for that patient,” Ding observed.

“This immune cell atlas fills a gap in knowledge that is needed to develop these types of new clinical tools,” she concluded.

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Note: The MMRF designed and funded this research, which involved collaboration among the Georgia Institute of Technology, Emory University, Harvard Medical School, and the Icahn School of Medicine at Mount Sinai.

Clinical trials
Relating Clinical Outcomes in Multiple Myeloma to Personal Assessment of Genetic Profile (CoMMpass) – ClinicalTrials.gov ID NCT01454297

Reference
[1] Padala SA, Barsouk A, Barsouk A, Rawla P, Vakiti A, Kolhe R, Kota V, Ajebo GH. Epidemiology, Staging, and Management of Multiple Myeloma. Med Sci (Basel). 2021 Jan 20;9(1):3. doi: 10.3390/medsci9010003. PMID: 33498356; PMCID: PMC7838784.
[2] Pilcher WC, Yao L, Gonzalez-Kozlova E, Pita-Juarez Y, Karagkouni D, Acharya CR, Michaud ME, Hamilton M, Nanda S, Song Y, Sato K, Wang JT, Satpathy S, Ma Y, Schulman J, D’Souza D, Jayasinghe RG, Ohlstrom D, Ferguson KE, Cheloni G, Bakhtiari M, Pabustan N, Nie K, Foltz JA, Saldarriaga I, Alaaeldin R, Lepisto E, Chen R, Fiala MA, Thomas BE, Cook A, Vieira Dos Santos J, Chiang I, Figueiredo I, Fortier J, Slade M, Oh ST, Rettig MP, Anderson E, Li Y, Dasari S, Strausbauch MA, Simon VA, Immune Atlas Consortium, Radkevich E, Rahman AH, Chen Z, Lagana A, DiPersio JF, Rosenblatt J, Kim-Schulze S, Lonial S, Kumar S, Bhasin SS, Kourelis T, Dhodapkar MV, Vij R, Avigan D, Cho HJ, Mulligan G, Ding L, Gnjatic S, Vlachos IS, Bhasin M. A single-cell atlas characterizes dysregulation of the bone marrow immune microenvironment associated with outcomes in multiple myeloma. Nature Cancer. Jan. 9, 2026. DOI: 10.1038/s43018-025-01072

Featured image: Researchers at WashU Medicine and their collaborators have created an immune cell atlas of multiple myeloma, a cancer of the bone marrow. The new resource could improve prognosis and guide the development of new immunotherapies. Shown is a sample of bone marrow from a patient with multiple myeloma, indicated by an overabundance of plasma cells (pink) compared with normal bone marrow (green). T-cells are in red. Photo courtesy © 2026 WashU Medicine, St Louis, MO, Used with permission,

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