Background/Objectives: Rho-GTPase signaling is involved in cancer progression and chemoresistance, with Ras-related C3 botulinum toxin substrate 1 (Rac1) being a major regulator. However, the role of Rac1 in multiple myeloma (MM) progression and its relationship with p53 and chemoresistance remains elusive. This study was conducted to evaluate the role of Rac1 in MM. Methods: Human MM cell lines (HMCLs), specifically KMS11, KMS26, and MM.1S, were treated with the Rac1 inhibitor 1A-116. The RAC1 mRNA levels in the purified bone marrow (BM) plasma cells of patients with newly diagnosed MM (NDMM) were measured using real-time quantitative PCR. Results: HMCLs exhibited reduced viability after treatment with 1A-116, independent of the p53 status. 1A-116 suppressed the cell cycle and induced apoptosis. Furthermore, 1A-116 intensified the effect of cereblon modulators on HMCLs but did not exhibit a synergistic effect with bortezomib. A total of 114 patients with NDMM, 70 with monoclonal gammopathy of undetermined significance and 15 controls, were enrolled in this study. The RAC1 mRNA levels in purified BM plasma cells were higher in patients with NDMM than in the controls. Patients with high RAC1 mRNA expression had a significantly shorter median time of overall survival (OS). In multivariate analysis of autologous stem cell transplantation (ASCT), revised international staging system, and RAC1 gene expression, high RAC1 mRNA levels and ASCT were identified as independent prognostic factors of OS. Conclusions: This study provided new insights into developing novel therapies targeting the Rac1 pathway and improving the prognosis of patients with MM, including those with p53 deficiency and mutation.
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