Idiotype-pulsed antigen-presenting cells following autologous transplantation for multiple myeloma may be associated with prolonged survival.
Vaccines are attractive as consolidation therapy after autologous stem cell transplantation (ASCT) for multiple myeloma (MM). We report the results of a phase II trial of the immunotherapeutic, APC8020 (Mylovenge), given after ASCT for MM. We compared the results with that of other patients with MM who underwent ASCT at Mayo Clinic during the same time period. Twenty-seven patients were enrolled on the trial between July, 1998 and June, 2001, and the outcomes were compared to that of 124 consecutive patients transplanted during the same period, but not enrolled on the trial. The median (range) follow-up for patients still alive from the vaccine trial is 6.5 (2.9-8 years), and 7.1 (6-8 years) in the control group. The median age was 57.4 range (36.1-71.3) in the DB group and 56.4 (range, 30-69) in the trial group. Known prognostic factors including PCLI, B2M, and CRP were comparable between the groups. The median overall survival for the trial patients was 5.3 years (95% CI: 4.0 years-N/A) compared to 3.4 years (95% CI: 2.7-4.6 years) for the DB group (P = 0.02). The median time to progression and progression-free survival for the trial group was similar to the DB group. Although not a controlled trial, the vaccines given after ASCT appear to be associated with improved overall survival compared to historical controls. This approach warrants further investigation to confirm this and define the role of vaccine therapy in myeloma.
Lacy
Martha Q
MQ
Division of Hematology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. lacy.martha@mayo.edu
Mandrekar
Sumithra
S
Dispenzieri
Angela
A
Hayman
Suzanne
S
Kumar
Shaji
S
Buadi
Francis
F
Dingli
David
D
Litzow
Mark
M
Wettstein
Peter
P
Padley
Douglas
D
Kabat
Brian
B
Gastineau
Dennis
D
Rajkumar
S Vincent
SV
Gertz
Morie A
MA
D000328:Adult; D000368:Aged; D000938:Antigen-Presenting Cells / Q000276:immunology / Q000637:transplantation*; D019496:Cancer Vaccines / Q000627:therapeutic use*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003713:Dendritic Cells / Q000276:immunology / Q000637:transplantation; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007130:Immunoglobulin Idiotypes / Q000008:administration & dosage* / Q000276:immunology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D014182:Transplantation, Autologous
D019496:Cancer Vaccines; D007130:Immunoglobulin Idiotypes