The failure of
chemotherapy to cure a significant proportion of
multiple myeloma (MM) patients and increasing knowledge of
tumor immunology and MM biology have generated considerable interest in
immunotherapy for this lethal disease.
Immunotherapy for MM can be divided into three broad categories: passive antibody-mediated immunotherapy, active specific immunization (vaccination), and adoptive T-cell
immunotherapy. Early clinical trials using anti-CD20
monoclonal antibodies (mAbs) have met with limited success so far but have also suggested that selected patient subgroups may benefit from this treatment. The availability of a truly
tumor-specific
antigen such as
immunoglobulin idiotype, the recent demonstration that MM cells process and present idiotype to T lymphocytes, and formal evidence of an antitumor effect of idiotypic vaccination in
follicular lymphoma provide the framework for applying idiotypic vaccination in MM. The ability to generate ex vivo functional dendritic cells has made it possible to fuse them with patients' MM cells, thus producing a different type of customized
vaccine. Dendritic cells are also a pivotal
reagent to generate ex vivo MM-specific cytotoxic T lymphocytes (CTLs) to be reinfused into the patient for adoptive immunotherapy. This review summarizes achievements in MM
immunotherapy based on data reported since 1998.