Abstract
Multiple myeloma (MM) is characterized by a malignant proliferation of plasma cells in the bone marrow with associated organ damage. Although the prognosis of MM has improved recently, the disease remains incurable for the large majority of patients. The eradication of residual disease in the bone marrow is a main target on the road toward cure. Immune cells play a role in the control of cancer and can be tools to attack residual MM cells. However, the myeloma-associated immune deficiency is a major hurdle to immunotherapy. We evaluated ex vivo the effects of low doses of the immunomodulatory drugs (IMiDs) lenalidomide and pomalidomide on several immune cell types from MM patients after autologous stem cell transplantation and with low tumor burden. We observed that these drugs increased CD4+ and CD8+ T-cell proliferation and cytokine production, enhanced the lytic capacity of cytotoxic T lymphocytes and reduced the suppressive effects of regulatory T cells on CD8+ T-cell responses. In addition, we found that functional dendritic cells (DCs) can be generated from mononuclear cells from MM patients. The presence of IMiDs improved the quality of antigen-specific T cells induced or expanded by these DCs as evidenced by a higher degree of T-cell polyfunctionality. Our results provide a rationale for the design of early phase clinical studies to assess the efficacy of DC-based immunotherapy in combination with posttransplant maintenance treatment with IMiDs in MM.
Similar content being viewed by others
Abbreviations
- 4-1BBL:
-
4-1BB ligand
- ASCT:
-
Autologous stem cell transplantation
- caTLR4:
-
Constitutively active Toll-like receptor 4
- CD40L:
-
CD40 ligand
- CM-DC:
-
Cytokine cocktail matured dendritic cell
- CR:
-
Complete response
- DC:
-
Dendritic cell
- Flu-NP:
-
Influenza nuclear protein
- iDC:
-
Immature dendritic cell
- IDO:
-
Indoleamine 2,3-dioxygenase
- IMiD:
-
Immunomodulatory drug
- MDSC:
-
Myeloid-derived suppressor cell
- MM:
-
Multiple myeloma
- NAC:
-
Non-adherent cell
- NK:
-
Natural killer
- PBMC:
-
Peripheral blood mononuclear cell
- Teff:
-
Effector T cell
- Treg:
-
Regulatory T cell
- VGPR:
-
Very good partial remission
References
Schots R (2011) Recent advances in myeloma treatment. Transfus Apheresis Sci 44:223–229
Munshi NC, Anderson KC (2013) New strategies in the treatment of multiple myeloma. Clin Cancer Res 19:3337–3344
Munshi NC, Anderson KC, Bergsagel PL et al (2011) Consensus recommendations for risk stratification in multiple myeloma: report of the International Myeloma Workshop Consensus Panel 2. Blood 117:4696–4700
Brenner H, Gondos A, Pulte D (2008) Recent major improvement in long-term survival of younger patients with multiple myeloma. Blood 111:2521–2526
Reichardt VL, Okada CY, Liso A et al (1999) Idiotype vaccination using dendritic cells after autologous peripheral blood stem cell transplantation for multiple myeloma—a feasibility study. Blood 93:2411–2419
Liso A, Stockerl-Goldstein KE, Auffermann-Gretzinger S et al (2000) Idiotype vaccination using dendritic cells after autologous peripheral blood progenitor cell transplantation for multiple myeloma. Biol Blood Marrow Transplant 6:621–627
Rosenblatt J, Avivi I, Vasir B et al (2013) Vaccination with dendritic cell/tumor fusions following autologous stem cell transplant induces immunologic and clinical responses in multiple myeloma patients. Clin Cancer Res 19:3640–3648
Hobo W, Strobbe L, Maas F et al (2013) Immunogenicity of dendritic cells pulsed with MAGE3, Survivin and B-cell maturation antigen mRNA for vaccination of multiple myeloma patients. Cancer Immunol Immunother 62:1381–1392
Meehan KR, Wu J, Bengtson E et al (2007) Early recovery of aggressive cytotoxic cells and improved immune resurgence with post-transplant immunotherapy for multiple myeloma. Bone Marrow Transplant 39:695–703
Rapoport AP, Aqui NA, Stadtmauer EA et al (2011) Combination immunotherapy using adoptive T-cell transfer and tumor antigen vaccination on the basis of hTERT and survivin after ASCT for myeloma. Blood 117:788–797
Meehan KR, Talebian L, Tosteson TD et al (2013) Adoptive cellular therapy using cells enriched for NKG2D+ CD3+ CD8+ T cells after autologous transplantation for myeloma. Biol Blood Marrow Transplant 19:129–137
Nair JR, Carlson LM, Koorella C et al (2011) CD28 expressed on malignant plasma cells induces a prosurvival and immunosuppressive microenvironment. J Immunol 187:1243–1253
Okunishi K, Dohi M, Nakagome K et al (2005) A novel role of hepatocyte growth factor as an immune regulator through suppressing dendritic cell function. J Immunol 175:4745–4753
Beyer M, Kochanek M, Giese T et al (2006) In vivo peripheral expansion of naive CD4+ CD25high FoxP3+ regulatory T cells in patients with multiple myeloma. Blood 107:3940–3949
Brimnes MK, Vangsted AJ, Knudsen LM et al (2010) Increased level of both CD4+ FOXP3+ regulatory T cells and CD14+ HLA-DR−/low myeloid-derived suppressor cells and decreased level of dendritic cells in patients with multiple myeloma. Scand J Immunol 72:540–547
Feyler S, von Lilienfeld-Toal M, Jarmin S et al (2009) CD4(+)CD25(+)FoxP3(+) regulatory T cells are increased whilst CD3(+)CD4(−)CD8(−)alphabetaTCR(+) double negative T cells are decreased in the peripheral blood of patients with multiple myeloma which correlates with disease burden. Br J Haematol 144:686–695
Van Valckenborgh E, Schouppe E, Movahedi K et al (2012) Multiple myeloma induces the immunosuppressive capacity of distinct myeloid-derived suppressor cell subpopulations in the bone marrow. Leukemia 26:2424–2428
Görgün GT, Whitehill G, Anderson JL et al (2013) Tumor promoting immune suppressive myeloid derived suppressor cells in multiple myeloma microenvironment. Blood 121:2975–2987
Ramachandran IR, Martner A, Pisklakova A et al (2013) Myeloid-derived suppressor cells regulate growth of multiple myeloma by inhibiting T cells in bone marrow. J Immunol 190:3815–3823
Lu L, Payvandi F, Wu L et al (2009) The anti-cancer drug lenalidomide inhibits angiogenesis and metastasis via multiple inhibitory effects on endothelial cell function in normoxic and hypoxic conditions. Microvasc Res 77:78–86
Mitsiades N (2002) Apoptotic signaling induced by immunomodulatory thalidomide analogs in human multiple myeloma cells: therapeutic implications. Blood 99:4525–4530
LeBlanc R, Hideshima T, Catley LP et al (2004) Immunomodulatory drug costimulates T cells via the B7-CD28 pathway. Blood 103:1787–1790
Xu Y, Li J, Ferguson GD et al (2009) Immunomodulatory drugs reorganize cytoskeleton by modulating Rho GTPases. Blood 114:338–345
Lu G, Middleton RE, Sun H et al (2014) The myeloma drug lenalidomide promotes the cereblon-dependent destruction of Ikaros proteins. Science 343:305–309
Lopez-Girona A, Mendy D, Ito T et al (2012) Cereblon is a direct protein target for immunomodulatory and antiproliferative activities of lenalidomide and pomalidomide. Leukemia 26:2326–2335
Wilgenhof S, Van Nuffel AMT, Corthals J et al (2011) Therapeutic vaccination with an autologous mRNA electroporated dendritic cell vaccine in patients with advanced melanoma. J Immunother 34:448–456
Van Nuffel AMT, Benteyn D, Wilgenhof S et al (2012) Intravenous and intradermal TriMix-dendritic cell therapy results in a broad T-cell response and durable tumor response in a chemorefractory stage IV-M1c melanoma patient. Cancer Immunol Immunother 61:1033–1043
Bonehill A, Van Nuffel AMT, Corthals J et al (2009) Single-step antigen loading and activation of dendritic cells by mRNA electroporation for the purpose of therapeutic vaccination in melanoma patients. Clin Cancer Res 15:3366–3375
Wilgenhof S, Pierret L, Corthals J et al (2011) Restoration of tumor equilibrium after immunotherapy for advanced melanoma: three illustrative cases. Melanoma Res 21:152–159
De Keersmaecker B, Heirman C, Corthals J et al (2011) The combination of 4-1BBL and CD40L strongly enhances the capacity of dendritic cells to stimulate HIV-specific T cell responses. J Leukoc Biol 89:989–999
Zhang L, Götz M, Hofmann S, Greiner J (2012) Immunogenic targets for specific immunotherapy in multiple myeloma. Clin Dev Immunol 2012:820394
De Keersmaecker B, Allard SD, Lacor P et al (2012) Expansion of polyfunctional HIV-specific T cells upon stimulation with mRNA electroporated dendritic cells in the presence of immunomodulatory drugs. J Virol 86:9351–9360
Yuan J, Gnjatic S, Li H et al (2008) CTLA-4 blockade enhances polyfunctional NY-ESO-1 specific T cell responses in metastatic melanoma patients with clinical benefit. Proc Natl Acad Sci USA 105:20410–20415
Aranda F, Llopiz D, Díaz-Valdés N et al (2011) Adjuvant combination and antigen targeting as a strategy to induce polyfunctional and high-avidity T-cell responses against poorly immunogenic tumors. Cancer Res 71:3214–3224
Ding Z-C, Huang L, Blazar BR et al (2012) Polyfunctional CD4+ T cells are essential for eradicating advanced B-cell lymphoma after chemotherapy. Blood 120:2229–2239
Galustian C, Meyer B, Labarthe M-C et al (2009) The anti-cancer agents lenalidomide and pomalidomide inhibit the proliferation and function of T regulatory cells. Cancer Immunol Immunother 58:1033–1045
Vasquez-Dunddel D, Pan F, Zeng Q et al (2013) STAT3 regulates arginase-I in myeloid-derived suppressor cells from cancer patients. J Clin Invest 123:1580–1589
Qin A, Cai W, Pan T et al (2013) Expansion of monocytic myeloid-derived suppressor cells dampens T cell function in HIV-1-seropositive individuals. J Virol 87:1477–1490
Mougiakakos D, Jitschin R, von Bahr L et al (2012) Immunosuppressive CD14+ HLA-DRlow/neg IDO+ myeloid cells in patients following allogeneic hematopoietic stem cell transplantation. Leukemia 27:377–388
Poschke I, Mougiakakos D, Hansson J et al (2010) Immature immunosuppressive CD14+ HLA-DR−/low cells in melanoma patients are Stat3hi and overexpress CD80, CD83, and DC-sign. Cancer Res 70:4335–4345
Kotsakis A, Harasymczuk M, Schilling B et al (2012) Myeloid-derived suppressor cell measurements in fresh and cryopreserved blood samples. J Immunol Methods 381:14–22
Schilling B, Sucker A, Griewank K et al (2013) Vemurafenib reverses immunosuppression by myeloid derived suppressor cells. Int J Cancer 133:1653–1663
Duffy A, Zhao F, Haile L et al (2013) Comparative analysis of monocytic and granulocytic myeloid-derived suppressor cell subsets in patients with gastrointestinal malignancies. Cancer Immunol Immunother 62:299–307
Serafini P, Meckel K, Kelso M et al (2006) Phosphodiesterase-5 inhibition augments endogenous antitumor immunity by reducing myeloid-derived suppressor cell function. J Exp Med 203:2691–2702
Bonehill A, Tuyaerts S, Van Nuffel AMT et al (2008) Enhancing the T-cell stimulatory capacity of human dendritic cells by co-electroporation with CD40L, CD70 and constitutively active TLR4 encoding mRNA. Mol Ther 16:1170–1180
Wilgenhof S, Van Nuffel AMT, Benteyn D et al (2013) A phase IB study on intravenous synthetic mRNA electroporated dendritic cell immunotherapy in pretreated advanced melanoma patients. Ann Oncol 24:2686–2693
Maecker B, Anderson KS, von Bergwelt-Baildon MS et al (2003) Viral antigen-specific CD8+ T-cell responses are impaired in multiple myeloma. Br J Haematol 121:842–848
Sakamaki I, Kwak LW, Cha S-C et al (2014) Lenalidomide enhances the protective effect of a therapeutic vaccine and reverses immune suppression in mice bearing established lymphomas. Leukemia 28:329–337
Chen N, Lau H, Kong L et al (2007) Pharmacokinetics of lenalidomide in subjects with various degrees of renal impairment and in subjects on hemodialysis. J Clin Pharmacol 47:1466–1475
Richter J, Neparidze N, Zhang L et al (2013) Clinical regressions and broad immune activation following combination therapy targeting human NKT cells in myeloma. Blood 121:423–430
Acknowledgments
The authors would like to thank Bilal Khan, Chiraz Mahmoud, Steven Heynderickx, Angelo Willems, Elsy Vaeremans, Petra Roman and Xavier Debaere for excellent technical assistance and Sarah Maenhout for her advice regarding the MDSC suppression assays. This study was supported by the Stichting Tegen Kanker, the International Myeloma Foundation (Brian D Novis junior research award), the King Baudouin Foundation (Fund Catharina Weekers) and the Wetenschappelijk Fonds Willy Gepts (Universitair Ziekenhuis Brussel). Parts of this work were realized with a research grant Emmanuel van de Schueren of the Vlaamse Liga Tegen Kanker.
Conflict of interest
TriMix DCs are the topic of a current patent application (WO2009/034172). Kris Thielemans is mentioned as inventor of this application. None of the authors involved in this study receives any form of support or remuneration related to this platform.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
De Keersmaecker, B., Fostier, K., Corthals, J. et al. Immunomodulatory drugs improve the immune environment for dendritic cell-based immunotherapy in multiple myeloma patients after autologous stem cell transplantation. Cancer Immunol Immunother 63, 1023–1036 (2014). https://doi.org/10.1007/s00262-014-1571-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00262-014-1571-6