Immunization of Stem Cell Transplant Donors to Enhance Graft-versus-Tumor Effect

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DESCRIPTION (provided by applicant): The central hypothesis of this proposal is that breaking tolerance to tumor antigens is more easily accomplished by immunizing healthy donors compared with cancer patients, who may be immunocompromised from the underlying disease or prior treatment. We propose testing a novel therapeutic strategy combining cancer vaccine therapy with reduced-intensity conditioning, allogeneic stem cell transplantation (SCT), with the goal of transferring tumor antigen-specific immunity from stem cell donors to patients with myeloma to reduce the risk of relapse. This strategy is based on our previous preclinical and clinical studies demonstrating proof of principle in patients with multiple myeloma. Specifically, under an approved FDA Investigational New Drug application, SCT donors were immunized with a safe, well-defined tumor vaccine, consisting of highly purified myeloma-derived idiotype protein. Direct transfer of myeloma idiotype-specific T-cell immunity from donor to recipient was observed after myeloablative bone marrow transplantation and was associated with favorable long-term survival. In this project, we will determine whether antigen-specific immunity, induced in the stem cell donor, can be passively transferred to the allogeneic SCT recipient (Specific aim 1) and determine the fine specificity, frequency, phenotype, and effector function of adoptively transferred, idiotype-specific T cells (Specific aim 2). The higher T-cell content in the peripheral blood stem cell grafts is likely to enhance the transfer of idiotype-specific T cells following donor immunization. Furthermore, non-myeloablative conditioning may reduce the transplant- related mortality, improving the overall success of this novel treatment. The long-term goal of this project is to transfer highly enriched populations of idiotype-specific T cells from donor to recipient (i.e., educated donor lymphocyte infusions), which may enhance the antitumor effect of the allograft without exacerbating graft-versus-host disease and thereby reduce the risk of relapse of myeloma. The current studies will further optimize this novel vaccination strategy for future clinical studies. Myeloma Id- specific T-cell immunity over time will be measured, characterized, and correlated to anti-myeloma responses. The long-term goal of this project is to transfer highly enriched populations of specific T cells from donor to recipient (e.g., educated DLI). Following completion of this proposal, we anticipate the initiation of a subsequent randomized, controlled trial using DLI from immune versus non-immune donors in non- myeloablative PBSCT to definitively test the hypothesis that transfer of myeloma Id-specific T-cell immunity produces favorable clinical outcome. Multiple myeloma patients who have persistent or relapsing disease at least three months post HLA-matched related allo-transplant will be included in the future study.