Phase I/II clinical trial of sequential subcutaneous and intravenous delivery of dendritic cell vaccination for refractory multiple myeloma using patient-specific tumour idiotype protein or idiotype (VDJ)-derived class I-restricted peptides

Br J Haematol. 2007 Nov;139(3):415-24. doi: 10.1111/j.1365-2141.2007.06832.x.


Fifteen multiple myeloma (MM) patients who had failed maintenance therapy after tandem autologous stem cell transplantation underwent anti-idiotype (Id) vaccination with dendritic cells (DCs). CD14(+)-derived DCs were loaded with the autologous Id as whole protein (=6) or Id-derived class I-restricted peptides (=9) and keyhole limpet hemocyanin (KLH). Vaccination consisted of three subcutaneous (sc) and two intravenous injections of increasing DC doses at 2 weeks interval. DC therapy was well tolerated. Most patients developed both humoral and T-cell responses to KLH, suggesting immunocompetence. Eight of 15 patients developed an Id-specific T-cell proliferative response, 8/15 increased interferon-gamma-secreting T cells and 4/15 showed an Id-positive delayed-type hypersensitivity test. Anti-Id cytotoxic T-lymphocyte precursors increased after DC vaccination in 2/2 evaluable patients. A more robust T-cell response was observed after sc DC injections and increased Id-specific T-cell proliferation was found up to 1 year after vaccination. VDJ-derived peptides were as effective as the whole protein in stimulating T-cell responses. Clinically, 7/15 patients have stable disease after a median follow-up of 26 months, one patient achieved durable partial remission after 40 months, and seven patients progressed. In conclusion, sc injections of cryopreserved Id-pulsed DCs were safe and, in contrast with intravenous administrations, induced anti-MM T-cell responses.

Publication types

  • Clinical Trial, Phase I
  • Clinical Trial, Phase II
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antibodies, Neoplasm / biosynthesis
  • Antigens, Neoplasm / immunology
  • Cancer Vaccines / administration & dosage
  • Cancer Vaccines / therapeutic use*
  • Dendritic Cells / transplantation*
  • Female
  • Hemocyanins / immunology
  • Humans
  • Immunity, Cellular
  • Immunoglobulin Idiotypes / immunology*
  • Immunoglobulin Joining Region / immunology
  • Immunoglobulin Variable Region / immunology
  • Injections, Intravenous
  • Injections, Subcutaneous
  • Male
  • Middle Aged
  • Multiple Myeloma / immunology
  • Multiple Myeloma / therapy*
  • Peptide Fragments / immunology
  • Treatment Outcome
  • Vaccination / adverse effects
  • Vaccination / methods


  • Antibodies, Neoplasm
  • Antigens, Neoplasm
  • Cancer Vaccines
  • Immunoglobulin Idiotypes
  • Immunoglobulin Joining Region
  • Immunoglobulin Variable Region
  • Peptide Fragments
  • Hemocyanins
  • keyhole-limpet hemocyanin