Objective To investigate the expression and clinical significance of tumor necrosis factor - α TNF - α and 5 - aminoimidazole-4-carboxamide nucleotide transformylase ATIC in bone marrow biopsy tissues of patients with multiple myeloma MM . Method A total of 90 patients with MM admitted to Yan'an People's Hospital between May 2021 and June 2023 were included in the MM group. Additionally 55 patients with benign haematological disorders admitted during the same period were selected using a random number table method to form the control group. Immunohistochemistry was used to detect TNF-α and ATIC in bone marrow tissue. Spearman ' s rank correlation analysis of the relationship between TNF - α expression and ATIC in MM organisations. Kaplan-Meier curve was used to analyze the relationship between TNF - α ATIC and prognosis. The Cox proportional hazards regression model was employed to analyse the prognostic factors influencing patients with MM. Result For the control group the MM group had a higher positive rate of TNF-α and ATIC proteins in bone marrow tissue P<0. 05 . The positive expression of TNF-α and ATIC was associated with the international staging system ISS P>0. 05 . Spearman's rank correlation analysis revealed a positive correlation between TNF-α expression in MM tissue and ATIC r = 0. 374 P<0. 001 . Survival curves showed that the 3-year survival rate of patients in the TNF-α ATIC positive expression group was lower than that of patients in the negative expression group P< 0. 05 . Univariate Cox regression showed that ISS stage Ⅲ TNF-α positivity and ATIC positivity were associated with mortality in MM P<0. 05 . Multivariate Cox proportional hazards regression analysis revealed that TNF-α positivity and ATIC positivity constitute risk factors for mortality in MM patients P<0. 05 . The AUC values of TNF-αand ATIC in bone marrow tissues of the MM group for predicting the prognosis of MM patients were 0. 640 95% CI = 0. 523-0. 756 and 0. 714 95% CI = 0. 604-0. 824 with a sensitivity of 67. 57% and 72. 97% respectively and a specificity of 60. 38% and 69. 81% respectively. The Hosmer - Lemeshow goodness-of-fit test showed that the ISS staging TNF-α and ATIC models fitted better χ 2 = 3. 061 P = 0. 216 . Conclusion The positive expression rates of TNF-α and ATIC in the bone marrow tissue of MM patients are relatively high both serving as prognostic factors for MM patients.