Multiple Myeloma Clinical Trial
Vaccine Therapy in Treating Patients With Multiple Myeloma Who Have Undergone Stem Cell Transplantation
Summary
The purpose of this trial is to test the safety and immune response to four immunizations with this vaccine made from a protein produced by the patient's tumor. There is no guarantee or promise that this procedure will be successful
Full Description
PRIMARY OBJECTIVES:
I. To determine the safety of multiple subcutaneous vaccinations with myeloma Id-KLH (idiotype-keyhole limpet hemocyanin) with GM-CSF (sargramostim) in post allogeneic transplant myeloma patients, or with GM-CSF +/- interleukin (IL)-2 (aldesleukin) in post autologous transplant myeloma patients.
II. To evaluate patients pre and post bone marrow transplantation (BMT) for evidence of endogenous idiotype specific immune response.
III. To characterize the time course, specificity and persistence of antibody and T cell immune response to myeloma idiotype and to KLH induced by myeloma Ig (Id) immunization.
IV. To clone, expand and characterize T cells specific for the tumor idiotype. V. Monitor myeloma involvement in bone marrow and serum paraprotein level following vaccination.
VI. Use stored patient samples to clone, expand, and characterize T cells specific for myeloma antigens other than idiotype and identify the antigens they recognize so that they can be used in future studies.
OUTLINE:
Patients receive autologous immunoglobulin idiotype-KLH conjugate vaccine combined with sargramostim subcutaneously (SC) in weeks 0, 2, 6, and 10 and sargramostim SC once daily (QD) for three days following each vaccine injection. Some patients also receive aldesleukin SC daily from weeks 2-14.
After completion of study treatment, patients are followed up every 3 months for 1 year and then every 6 months for 1 year.
Eligibility Criteria
Inclusion Criteria:
ELIGIBILITY FOR VACCINE PREPARATION:
Patients must have a diagnosis of multiple myeloma and be eligible for a Fred Hutchinson Cancer Research Center (FHCRC) treatment protocol using high dose therapy with syngeneic, allogeneic or autologous marrow or stem cell transplantation
Pretransplant sera available with immunoglobulin A (IgA), immunoglobulin D (IgD), immunoglobulin E (IgE), immunoglobulin G (IgG), or immunoglobulin M (IgM) monoclonal paraprotein with a level of 1.5 grams/dl or greater identifiable on serum protein electrophoresis; eligibility for patients with pretransplant paraprotein levels of less than 1.5 gm/dl will be evaluated on an individual basis to determine whether purification of idiotype is feasible
ELIGIBILITY FOR POST-TRANSPLANT IDIOTYPE VACCINATION:
Successful isolation and production of an autologous idiotype vaccine from pre-BMT sera
Greater than 60 days post BMT
Achievement of a partial remission or greater (more than 75% reduction in serum paraprotein) for patients transplanted in relapse
Stable absolute neutrophil count (ANC) > 1000
Platelet count > 50,000 not requiring transfusions or growth factors
Red blood cell (RBC) supportable to hematocrit (Hct) > 25 with less than 2 units of packed red blood cell (PRBC)/week
Treatment with a stable dose of Interferon is allowed
Karnofsky status > 60 percent
Immunosuppression:
Off all corticosteroids
Either off all immunosuppressive medications or on a stable/tapering dose of cyclosporin or FK506 only
Exclusion Criteria:
Graft-vs-host disease requiring treatment with corticosteroids
Serum creatinine > 3.0
Uncontrolled infection
Disease progression
Presence of medical complication that in the opinion of the investigators would result in inability to tolerate the vaccination protocol
Patients with a history of serious adverse reactions to GM-CSF
Patients with a history of serious adverse reactions to IL-2 will not receive concurrent IL-2 administration but may receive the Id-KLH vaccine with GM-CSF
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There is 1 Location for this study
Seattle Washington, 98109, United States
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