The Mater Medical Research Institute proposes to undertake a Phase I clinical trial using CMRF-56 immunoselected blood dendritic cells (BDC) loaded with control and myeloma-associated tumour peptide antigens for the treatment of multiple myeloma (MM) patients with minimal residual disease. This thesis describes some of the fundamental pre-clinical in vitro experiments undertaken in preparation for this trial so as to maximise the potential of this vaccine to induce myeloma-specific immune responses. These experiments involved determining the parameters for optimal activation of the CMRF-56 immunoselected cell preparation and exploring the potential of novel myeloma peptide antigens to induce anti-myeloma cytotoxic T lymphocyte (CTL) responses. CMRF-56 immunoselected cell preparations, containing predominately myeloid BDC, monocytes and B cells, were prepared from both healthy donors and myeloma patients. Activation of this preparation with granulocyte macrophage colony stimulating factor (GM-CSF) was found to increase co-stimulatory molecule expression by and survival of BDC, improve peptide- and lysate-specific CTL induction, and, in combination with prostaglandin E2 (PGE2), improve chemokine-specific migration of BDC. Following optimisation of in vitro CTL generation protocols, GM-CSF activated CMRF-56 immunoselected cells were examined for their ability to induce myeloma-specific immunity. Using lysate from myeloma cell line U266 as an antigen source, a polyclonal T cell pool was generated within which peptide specific CTL recognising myeloma antigens Muc1, HM1.24/BST2, DKK-1 and CT-7/MAGE-C1 could be identified. Furthermore, GM-CSF activated CMRF-56 immunoselected cells pulsed with HLA-A*201 restricted peptides derived from Muc1, HM1.24/BST2 and CT-7/MAGE-C1 could induce CTL capable of lysing both peptide- and myeloma cell line targets in both healthy donors and myeloma patients. These results provide the first evidence of immunogenic HLA-A*201 restricted epitopes of novel myeloma antigen CT-7/MAGE-C1. The data collected in this study supports the application of GM-CSF activated CMRF-56 immunoselected cells loaded with defined myeloma peptide antigens for the therapeutic vaccination of MM patients with minimal residual disease.

The Mater Medical Research Institute proposes to undertake a Phase I clinical trial using CMRF-56 immunoselected blood dendritic cells (BDC) loaded with control and myeloma-associated tumour peptide antigens for the treatment of multiple myeloma (MM) patients with minimal residual disease. This thesis describes some of the fundamental pre-clinical in vitro experiments undertaken in preparation for this trial so as to maximise the potential of this vaccine to induce myeloma-specific immune responses. These experiments involved determining the parameters for optimal activation of the CMRF-56 immunoselected cell preparation and exploring the potential of novel myeloma peptide antigens to induce anti-myeloma cytotoxic T lymphocyte (CTL) responses. CMRF-56 immunoselected cell preparations, containing predominately myeloid BDC, monocytes and B cells, were prepared from both healthy donors and myeloma patients. Activation of this preparation with granulocyte macrophage colony stimulating factor (GM-CSF) was found to increase co-stimulatory molecule expression by and survival of BDC, improve peptide- and lysate-specific CTL induction, and, in combination with prostaglandin E2 (PGE2), improve chemokine-specific migration of BDC. Following optimisation of in vitro CTL generation protocols, GM-CSF activated CMRF-56 immunoselected cells were examined for their ability to induce myeloma-specific immunity. Using lysate from myeloma cell line U266 as an antigen source, a polyclonal T cell pool was generated within which peptide specific CTL recognising myeloma antigens Muc1, HM1.24/BST2, DKK-1 and CT-7/MAGE-C1 could be identified. Furthermore, GM-CSF activated CMRF-56 immunoselected cells pulsed with HLA-A*201 restricted peptides derived from Muc1, HM1.24/BST2 and CT-7/MAGE-C1 could induce CTL capable of lysing both peptide- and myeloma cell line targets in both healthy donors and myeloma patients. These results provide the first evidence of immunogenic HLA-A*201 restricted epitopes of novel myeloma antigen CT-7/MAGE-C1. The data collected in this study supports the application of GM-CSF activated CMRF-56 immunoselected cells loaded with defined myeloma peptide antigens for the therapeutic vaccination of MM patients with minimal residual disease.

L’objectif principal de cette étude est de déterminer la valeur pronostique de l’infiltrat lymphocytaire dans l’adénocarcinome du pancréas. Les densités des lymphocytes T CD3+, CD4+, CD8+, FOXP3+ et CD45RO+ intratumoraux (T) et péritumoraux (PT) de 111 spécimens ont été mesurées avec des micromatrices tissulaires. Un Index Lymphocytaire (IL) a été créé basé sur les valeurs des CD4+ T, CD8+ PT et le ratio CD3+ T/PT regroupant les patients selon que les tumeurs présentaient aucune (IL---), 1 à 2 (IL+/-) ou les 3 caractéristiques immunitaires favorables (IL+++). La survie médiane des patients atteints d’un cancer du pancréas est significativement différente selon la catégorie d’index lymphocytaire; elle était de 14 mois pour IL---, de 19 mois pour IL +/- et de 29 mois pour IL+++ (p=0,01). L’IL est un facteur indépendant de survie en analyse multivariée ainsi que la différenciation tumorale et l’utilisation d’un traitement adjuvant. L’IL est un facteur pronostique de survie des adénocarcinomes du pancréas réséqués et devrait pouvoir permettre une meilleure classification des patients. / The main objective of this project was to determine the prognostic significance of T-lymphocytes densities in pancreatic adenocarcinoma. Using tissue microarrays, CD3+, CD4+, CD8+, CD45RO+, and FOXP3 T-cells were quantified by immunohistochemistry in the intratumoral (T) and peritumoral (PT) compartments of 111 specimens. An immune score (IS) based on T CD4+ and PT CD8+ counts and T/PT CD3+ ratio grouped patients into IS---, IS+/- and IS+++ if none, 1 or 2, or all 3 of the favorable immune features were present, respectively. Patients have different overall survival (OS) depending on their IS status. Patients IS--- have a median OS of 14 months and of 19 months and 29 months for those IS+/- and IS+++ respectively (log-rank p=0.01). By multivariate analysis, IS was independently associated with survival as were the histological grade and adjuvant therapy. An immune score that combines specific T-cell location and density may have prognostic value in patients with resected pancreatic adenocarcinoma, independently from current pathologic features.