title: Idiotype vaccination of multiple myeloma patients using monocyte-derived dendritic cells.
abstract: OBJECTIVE
  Dendritic cells (DC) pulsed with multiple myeloma (MM) patient-specific idiotype (Id) protein can induce MM-specific T-cell responses.
  
  
  METHODS
  We established serum-free culture conditions to generate monocyte-derived DC for clinical use to circumvent anti-xenogenic immune responses with repetitive vaccinations. In a clinical phase I trial twelve patients responsive to high dose chemotherapy (HDT) were vaccinated with autologous Id pulsed DC vaccines followed by Id/keyhole limpet hemocyanin (Id/KLH) booster immunizations co-injected with granulocyte-macrophage colony-stimulating factor as adjuvant.
  
  
  RESULTS
  In vitro studies showed that serum-free-generated DC were equally effective in the induction of specific T-cell responses as were DC generated with fetal calf serum. On average 4.5 x 10(6) DC of >60% purity were generated from peripheral blood monocytes obtained 3-6 months after HDT and autologous stem cell transplantation. Ten of twelve patients received all planned vaccines without serious toxicity. Two patients developed Id-specific T-cell proliferative responses, in one patient an Id-specific cytotoxic T lymphocyte (CTL) response was measured. Id-specific TH1 cytokine secretion was found in one of the T-cell responding patients. All patients who received at least three Id/KLH vaccines mounted strong KLH specific T-cell and delayed antibody responses. Two patients remain in clinical partial response at 25 and 29 months after the start of the vaccination and ten patients have progressed, six of whom have died from progressive disease or infectious complications.
  
  
  CONCLUSIONS
  Serum-free DC vaccines induce Id-specific T-cell responses in MM patients.
authors.affiliation: Department of Hematology, Oncology, Immunology and Rheumatology, University of Tübingen, Tübingen, Germany. volker.reichardt@med.uni-tuebingen.de
authors.forename: Volker L
authors.initials: VL
authors.lastname: Reichardt
authors.forename: Caterina
authors.initials: C
authors.lastname: Milazzo
authors.forename: Wolfram
authors.initials: W
authors.lastname: Brugger
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
authors.forename: Lothar
authors.initials: L
authors.lastname: Kanz
authors.forename: Peter
authors.initials: P
authors.lastname: Brossart
mesh_terms: D000276:Adjuvants, Immunologic; D000328:Adult; D019496:Cancer Vaccines; D002478:Cells, Cultured; D016895:Culture Media, Serum-Free; D003713:Dendritic Cells / Q000166:cytology* / Q000378:metabolism / Q000502:physiology*; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000494:pharmacology; D006433:Hemocyanins / Q000276:immunology; D006801:Humans; D007130:Immunoglobulin Idiotypes / Q000627:therapeutic use / Q000633:toxicity; D007167:Immunotherapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000166:cytology* / Q000187:drug effects; D009101:Multiple Myeloma / Q000628:therapy*; D010641:Phenotype; D013602:T-Lymphocytes, Cytotoxic / Q000502:physiology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism / Q000494:pharmacology; D014611:Vaccination / Q000379:methods*
chemical_list: D000276:Adjuvants, Immunologic; D019496:Cancer Vaccines; D016895:Culture Media, Serum-Free; D007130:Immunoglobulin Idiotypes; D014409:Tumor Necrosis Factor-alpha; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D006433:Hemocyanins; C032808:keyhole-limpet hemocyanin