In the past decade, there have been major advances in the treatment of the blood cancer Multiple Myeloma (MM). The introduction of novel agents such as immune-modifying agents (IMIDs), proteasome inhibitors, monoclonal antibodies, with or without stem cell transplantation, has resulted in significantly improved patient survival. Meanwhile, the increased understanding of MM tumor biology has provided a rationale for new combinations of drugs and risk-adapted and individualized treatments to further improve patient management.

Extracellular vesicles (EVs) are cell-derived membranous particles that mediate cell-to-cell communication by transferring proteins, lipids and nucleic acids locally and through systemic circulation. EVs are active regulators in the cross-talk between MM tumour cells and bone marrow microenvironment, with the capacity to alter angiogenesis, osteoclast differentiation and immunosuppression, promoting tumour progression and drug resistance. Circulating EVs containing tumour-specific molecular signatures (oncoproteins, RNAs, DNA fragments) have potential clinical utility as next-generation liquid biopsy biomarkers in cancer diagnosis and management, with the potential to characterise both spatial heterogeneity and clonal evolution thus informing new modalities for diagnosis, risk stratification, monitoring and therapeutic intervention in MM. However, the nano-scale nature of EVs and the complexity of biofluids present challenges that need to be addressed before the potential of EVs as biomarkers and therapeutic targets can be achieved.

The Italian Society of Hematologic Oncology (SOHO Italy) was established as a non-profit organization in 2019 to promote worldwide research (education, prevention, preclinical and clinical studies and patient care) of hematologic malignancies and related disorders. In this scenario, SOHO Italy together with Australian colleagues aim to bring together international experts to discuss the latest advances in the pathophysiology and therapy of MM and to better understand the role of EVs in patients with MM.