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Multiple Myeloma Multiple Myeloma (MM) is the second most common malignancy in hematology ( Adenosine triphosphate (ATP), nicotinamide adenine dinucleotide (NAD + ), and cyclic adenosine monophosphate (cAMP) are, the main intracellular purine molecules serving as leading adenosinergic substrates in the extracellular tumor microenvironment (TME) for generating ADO ( Adenosine Production within the BM Niche Purinome and Metabolic Reprogramming A unique feature shared by the MGUS/SMM/MM stages of myeloma is the dependence of mPCs on BM microenvironmental signals