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A 2011 dendritic cell-idiotype myeloma vaccination study…Part 1

Posted Apr 21 2011 7:44am

In January, I came across a study in “Blood” ( http://goo.gl/oaNjM ), a study that I had posted about when it was first published in November 2010. It reminded me of a draft that I hadn’t finished (=a sequel to that initial November post), which frequently happens, I hate to say…

In the past few days I have been revising and rewriting my draft, mainly because I would like to discuss a new vaccine study that I have read and that should be of particular interest to early stage myeloma folks. I will discuss it in the second part of this post to be published tomorrow…or the day after tomorrow…

Let’s start with my November 2010 post, the published one, I mean, in which I discussed the Phase I anti-MM dendritic vaccine study you can find at the above “Blood” link. The link to my post is: http://margaret.healthblogs.org/2010/11/13/an-anti-myeloma-vaccine-the-full-study/ . Please read it before diving into the rest of this post…

Okay, now that that is done, we can move on to some of the research I did for my and recently-revised November draft. Basically, back then I found out that vaccines had already been tested on MM patients. I found three different studies but am almost positive that there are more out there. At any rate, the first study I found dates to 1999 ( http://goo.gl/3fZxy ). Here a group of six IgG myeloma patients were vaccinated with a DC-based formula (where “DC” means “dendritic cell”). All these patients remained stable for a period, and one actually had a 25% paraprotein reduction. The authors admit they don’t know what this modest reduction means in terms of overall survival (see the Discussion part of the study)…

The second study I found was an Italian one. It tested an idiotype vaccination on 15 myeloma patients, began in 1995 and lasted for three years: http://goo.gl/DspW6 Again, the full study is online, so I don’t have to say much about it. As in the previous study, the idea here was to use vaccination as maintenance therapy after high-dose chemo. When comparing the survival rate in the control versus vaccine group, however, The difference was not statistically significant. Not very encouraging, eh…

A member of the MMA patient support list brought a third study to my attention some time ago. As luck would have it, the full study, published in 2009, is available for free online, so, again, all I have to do is give you the link: http://goo.gl/kDQCx I wasn’t as interested in this study, though, mainly because it was carried out on mice, not human beings…

And now, finally, we get to the new study on Stage 1 myeloma patients, published in the “Journal of Immunotherapy” in January 2011: http://goo.gl/KHCQh The abstract tells us that until now vaccines have been tested mainly on patients with advanced myeloma. This study instead focuses on a group of folks in an early stage–stage I.

Before reading the full study, though, I wanted to have a closer look at idiotype vaccines…Unfortunately, my brain shut down after a little while. This stuff is not easy to digest! Zzzzz. Here is the little I was able to grasp before the, er, shutdown: we myeloma folks “secrete” our own type of (monoclonal) immunoglobulins, also called idiotype proteins. These are patient-specific proteinsmine are different from Beth’s, Beth’s are different from John’s and Scott’s, and so forthwhich sit on the surface of our myeloma cells. They can also be found swimming around in our blood, conveniently ready to be collected and used in vaccines. Indeed, the fact that they are typical only of myeloma cells, healthy cells, makes them perfect candidates for the development of vaccines. In this study, each patient’s idiotype proteins were stuck onto dendritic cells, or DCs, which I have written about before (just do a “search” of my blog)…In a nutshell, though, DCs are the guardians of our immune system…

The abstract tells us that nine IgG patients with stage I myeloma participated in this vaccination study…and also that the M-protein levels of three patients decreased to some extent. In the full study, we can read that this decrease was, on average, 2.6 g/L, and also that the remaining six patients experienced light to moderate increases in their paraprotein levels (an average of a 2.2 g/L increase). Furthermore, eight months after the vaccinations ended, one patient had to resort to conventional treatment after progressing to stage III. Not too reassuring, eh?

The authors themselves list some of the problems faced by this study, namely, the restricted number of patients involved AND the fact that there was no control group. Therefore, they write, the results were difficult to interpret, even though they ultimately believe that their findings show that Id-specific immune responses might be activated in stage I myeloma patients via immunotherapy. Note the use of the conditional tense…

Okay, I think I have provided enough fodder for thought for today…Back to my reading…

Written by Margaret

April 21st, 2011 at 4:44 am

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