Evaluation of Cellular and Humoral Immunity Against Myel

尽管大剂量放化疗联合自体干细胞移植在PTS的治疗中显示出一些希望。对于多发性骨髓瘤，潜在疾病的复发仍然是治疗失败的主要原因。这是一项试验性研究，旨在探索主动特异性免疫疗法在消除大剂量治疗后残留的微小残留疾病方面可能有效的可能性。PTS中的实验研究。已经证明了免疫球蛋白独特型作为肿瘤特异性抗原用于开发针对B细胞恶性肿瘤的治疗性疫苗的可行性。PTS。将在大剂量治疗前后的几个时间点用骨髓瘤独特型蛋白免疫，该蛋白通过与载体(KLH)结合而产生免疫原性，并使用GM-CSF作为免疫佐剂。这项研究的目的是测试是否可以诱导细胞和体液免疫，以对抗患者骨髓瘤移植前和移植后表达的独特独特型。PTS。将接受一系列3次骨髓瘤ID-KLH(0.5 mg)皮下注射疫苗接种。在大剂量马法兰/全脑损伤或马法兰/环磷酰胺治疗后自体外周血单个核细胞移植后，联合GM-CSF(250g/mg2)，连续4d、2、3、6个月。18分。已经在这项研究中接受了治疗。所有人员注意。已经显示出对KLH的反应，这表明骨髓移植调节方案产生的免疫抑制不是骨髓移植后主动免疫的障碍。此外，50%的PTS。已经证明了T细胞对独特型的反应，正如体内自体独特型特异性细胞因子的产生和/或独特型特异性皮试反应所证明的那样。

Although high-dose chemoradiotherapy with autologous stem cell transplantation has shown some promise in the management of pts. with multiple myeloma, relapse of the underlying disease remains the primary cause of treatment failure. This is a pilot study to explore the possibility that active-specific immunotherapy may be effective in eliminating minimal residual disease remaining after high-dose therapy. Experimental studies in pts. with lymphoma have demonstrated the feasibility of immunoglobulin idiotype as a tumor-specific antigen for development of therapeutic vaccines against B-cell malignancies. Pts. will be immunized with myeloma idiotype protein, made immunogenic by conjugation to a carrier (KLH) and administration with GM-CSF as an immunological adjuvant, at several timepoints before and after high-dose therapy. The objective of this study is to test whether cellular and humoral immunity can be induced against the unique idiotype expressed on the patient's myeloma pre- and post-transplantation. Pts. will receive a series of 3 vaccinations with myeloma Id-KLH (0.5 mg) administered s.c. together with GM-CSF (250 ?g/mg2) for 4 consecutive days 2,3,and 6 months after high-dose therapy with either melphalan/TBI or melphalan/cytoxan followed by autologous peripheral mononuclear stem cell transplantation. 18 pts. have been treated on this study. All pts. have demonstrated responses to KLH, suggesting that immune suppression produced by the BMT conditioning regimen is not an obstacle to active immunization post-BMT. Furthermore, 50% of the pts. have demonstrated T-cell responses to idiotype, as demonstrated by autologous idiotype-specific production of cytokines and/or idiotype-specific skin test reactivity in vivo.