Summary:A 48-year-old patient with IgA k multiple myeloma received a BMT from his HLA-matched sibling. After transplantation, the disease relapsed. Melphalan therapy followed by reinfusion of haemopoietic blood stem cells collected from the patient led to the improvement of the clinical status, although mixed chimerism and an elevated serum IgA persisted. Successful donor immunisation against an immunogenic preparation of the recipient monoclonal protein was performed before the infusion of donor T lymphocytes (DLI) into the patient. Ten weeks after the lymphocyte infusions, no monoclonal band was evidenced and donor complete chimerism was detected. The patient did not develop GVHD. Once complete remission was achieved, the idiotype vaccine was administered to the patient. Nineteen months after DLI, the patient remains in remission. Bone Marrow Transplantation (2000) 25, 1105-1108. Keywords: multiple myeloma; idiotype vaccination; donor lymphocyte infusions Intensive treatment with stem cell transplantation has been widely used in multiple myeloma (MM) patients in recent years. 1 Following allogeneic bone marrow transplant (BMT), there is a high transplant-related mortality, partially related to graft-versus-host disease (GVHD) and a high rate of relapse.Treatment of relapse is not well established. The antitumour effect of donor lymphocyte infusions (DLI) is mediated by alloreactive T cells and is well documented in leukaemia. Moreover, incidental reports of remissions after DLI in small numbers of MM patients have indicated the existence of a graft-versus-myeloma (GVM) effect. [2][3][4][5][6] However, this technique has some disadvantages. On the one hand, the success of DLI has been limited to some extent by the morbidity and mortality associated with GVHD. 2,4,6 On the other hand, although a high response rate to DLI has been reported, 3,4 it is not always complete or durable, and long-term survival in complete remission is infrequent. 3,4 An alternative strategy for treating relapsed MM patients after allogeneic BMT is to induce a specific immune response against tumour cells. Vaccine trials using malignant B cell idiotypes as tumour-specific antigens have yielded some promising results in patients with NHL. 7 In a similar way, the idiotype of the myeloma paraprotein can be used as a unique tumour-specific antigen. Kwak et al 8 immunised an allogeneic BMT donor against the recipient's idiotype protein and were able to transfer this donor immunity to the patient at the time of allografting. In a variation of this technique, immunisation of the donor before collecting cells for DLI could selectively boost GVM.We present a case of relapsed MM after BMT in which complete remission was obtained after DLI from the histocompatible donor immunised with a myeloma idiotype (Id) vaccine.
Case reportA 48-year-old man who had been diagnosed as having an IgA kappa MM (IgA 7280 mg/dl, 36% plasma cells in bone marrow and vertebral compression fractures) had been treated at the age of 34 with allogeneic T cell-depleted (Cam...
The contribution of the liver to plasma ABO glycosyltransferase activity has been studied in a group O individual transplanted with a liver from a group B donor. The B transferase activity present in the post-transplantation plasma was negligible. However, a potent B transferase inhibitor, absent from the pretransplantation plasma, was present after transplantation. The inhibitor was present in the excluded fraction following Sephadex G-25 gel filtration, but was retained by a protein A-Sepharose column, suggesting that it was an IgG antibody. This inhibitor was also effective in reducing A transferase activity.
Over 50% of plasmas from plasmapheresis donors hyperimmunized for Rh antibodies were found to contain antibodies to low frequency red cell antigens (LFA). The majority of these plasmas contained antibodies to more than one LFA. On the other hand, the incidence of these antibodies in immune plasma from control plasmapheresis donors was markedly lower. The significance of the high incidence of these antibodies in grouping reagents is discussed.
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