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Survival analysis revealed that high expression of XPNPEP1, RNPEP, DPP3, and BLMH (p less then 0.05) was associated with shorter overall survival. Hydrolysis analysis demonstrated that melflufen is a substrate for aminopeptidases LAP3, LTA4H, RNPEP, and ANPEP. The sensitivity of MM cell lines to melflufen was reduced by aminopeptidase inhibitors. These results indicate critical roles of aminopeptidases in disease progression and the activity of melflufen in MM.Specific RNA sequences regulate functions essential to life. The Trans-Activa