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Myeloma

Long-term follow-up of idiotype vaccination in human myeloma as a maintenance therapy after high-dose chemotherapy

Leukemia volume 18, pages 139–145 (2004)Cite this article

Abstract

The aim of this work was to evaluate the long-term immunological and clinical impact of idiotype (Id) vaccination in multiple myeloma (MM) patients in first remission after high-dose chemotherapy. A total of 15 patients received a series of subcutaneous (s.c.) injections of autologous Id, conjugated to keyhole limpet hemocyanin (KLH) and in association with low doses of GM-CSF. The median duration of follow-up was 110 months from diagnosis. The vaccine induced immune responses that lasted almost 2 years after the end of treatment. Antibody responses included anti-KLH IgM and IgG (90% of patients), anti-KLH IgE (30%), anti-GM-CSF IgG (20%), anti-Id IgG (20%), and anti-Id IgE (30%). Id-specific delayed type hypersensitivity skin tests were positive in 85% of tested patients. Following vaccination, a progressive recovery of T-cell receptor (TCR) diversity was observed and the loss of oligoclonality was significantly correlated with the remission duration. Although Id/KLH conjugates did not eliminate the residual tumor burden, the median progression-free survival, and overall survival were 40 and 82 months, respectively. A retrospective case-matched analysis showed similar results in patients treated with IFN-α alone or in association with steroids. This vaccine formulation can overcome Id-specific immune tolerance by inducing clinical responses that are worthy of further investigation.

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Acknowledgements

We thank Professor John Iliffe for editorial assistance and Dr Claudia Voena for performing PCR analyses on B and plasma cells. This work was supported by AIRC (Milano, Italy), MIUR (Roma, Italy), Compagnia San Paolo di Torino, Oncology Program (Torino, Italy), and FIRMS (Torino, Italy). CDB is a fellowship recipient of CeRMS, Torino, Italy.

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  1. Divisione di Ematologia dell'Universita' di Torino, Laboratorio di Ematologia Oncologica, Centro di Ricerca in Medicina Sperimentale (CeRMS), Ospedale San Giovanni Battista, Torino, Italy

    M Coscia, S Mariani, S Battaglio, C Di Bello, F Fiore, M Foglietta, A Pileri, M Boccadoro & M Massaia

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Coscia, M., Mariani, S., Battaglio, S. et al. Long-term follow-up of idiotype vaccination in human myeloma as a maintenance therapy after high-dose chemotherapy. Leukemia 18, 139–145 (2004). https://doi.org/10.1038/sj.leu.2403181

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