Novel antigenic targets for immunotherapy in myeloma

Multiple myeloma (MM) is the second most commonly diagnosed hematologic malignancy after non-Hodgkin lymphoma and remains incurable in most of patients despite advances in high-dose chemotherapy, stem cell transplantation, and the development of novel therapeutics. Strategies for posttransplantation immunomodulation are desirable for eradication of remaining tumor cells. However, active immunotherapies using idiotype protein vaccines have been explored in MM patients, and the results have been disappointing. This chapter will concentrate on novel antigenic targets that are being targeted or can be targeted for immunotherapies to treat patients with MM. I will review the results of targeting idiotype proteins in preclinical and clinical studies of immunotherapies in MM conducted in the past 14 years. Moreover, the potentials of novel antigenic targets for myeloma immunotherapies, either through active immunization or vaccination or by adoptive immunotherapy using antigen-specific monoclonal antibodies, will be discussed in detail. With a better understanding of the immune system and tumor microenvironment in myeloma patients, as well as identification and development of novel targets and methods for immune targeting, there is a realistic hope that immunotherapies will soon be a part of conventional treatment modalities in MM and help control or even cure the disease.