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

Autor: Mario Boccadoro, Sara Mariani, Massimo Massaia, Silvano Battaglio, Alessandro Pileri, Marta Coscia, C. Di Bello, F. Fiore, Myriam Foglietta
Rok vydání: 2003
Předmět:
Idiotype
Oncology
Cancer Research
medicine.medical_specialty
Antibodies
Neoplasm
Injections
Subcutaneous
medicine.medical_treatment
Receptors
Antigen
T-Cell
High dose chemotherapy
Adjuvants
Immunologic
Immunoglobulin Idiotypes
Maintenance therapy
hemic and lymphatic diseases
Internal medicine
Immunopathology
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Hypersensitivity
Delayed
Glucocorticoids
Neoplasm Staging
Retrospective Studies
Immunity
Cellular
Chemotherapy
Hematology
business.industry
Remission Induction
Vaccination
Hematopoietic Stem Cell Transplantation
Granulocyte-Macrophage Colony-Stimulating Factor
Interferon-alpha
Immunotherapy
Middle Aged
Combined Modality Therapy
Antibodies
Anti-Idiotypic
Survival Rate
Treatment Outcome
Case-Control Studies
Hemocyanins
Immunology
Multiple Myeloma
business
Follow-Up Studies
Zdroj: Leukemia. 18:139-145
ISSN: 1476-5551
0887-6924
Popis: 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-alpha 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.
Databáze: OpenAIRE
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