“…Cytogenetic/genetic/epigenetic instability leads to the stepwise and branching clonal evolution in myeloma cells, resulting in multiple molecularly heterogeneous subclones [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. The activation of oncogenic driver signals, such as MYC, RAS/ERK, PI3K/AKT, and NF-κB, as well as the dysfunction/loss of pivotal tumor suppressors, such as TP53 or CDKN2C, cooperatively and sometimes compensatively promote the disease progression, the aggressiveness, and treatment-resistant phenotype of tumor cells [ 3 , 6 , 10 , 11 , 12 , 13 , 14 , 15 ]. Cell-extrinsic tumor microenvironment supports the survival and proliferation of myeloma cells via adhesion molecules, soluble factors, or extracellular vesicles, and also protects myeloma cells from cytotoxic insults [ 6 , 16 , 17 , 18 ], whereas the disruption of tumor immune surveillance system allows disease expansion [ 19 , 20 , 21 , 22 , 23 , 24 ].…”