The presence of a metaphase cytogenetic abnormality (CA) is the key negative predictor of outcome in patients with multiple myeloma (MM). Gene expression profiling (GEP) of such patients showed increased expression of NY-ESO-1 compared to patients with normal cytogenetics (60% versus 31%; P ؍ .004). NY-ESO-1 was also highly expressed in relapsing MM especially patients with CA (100% versus 60.7%; P < .001). GEP findings were confirmed at the protein level by immunostaining of marrow biopsies for NY-ESO-1. We detected spontaneous NY-ESO-1-specific antibodies by enzymelinked immunosorbent assay in 33% of patients with NY-ESO-1 ؉ MM, especially in CA patients (9 of 13; 70%), but in none of the NY-ESO-1 ؊ patients with MM (n ؍ 27) or healthy donors (n ؍ 21
IntroductionDuring the past 10 years, numerous human tumor-associated antigens (Ags) have been identified, either by screening cDNA libraries with sera derived from cancer patients containing an antibody (Ab) to a tumor-associated Ag (SEREX) or by using T lymphocytes specific for tumor peptides presented in the context of specific HLA alleles. [1][2][3][4][5][6][7][8][9][10][11] The most rapidly expanding group of tumor Ags are the cancer/testis (C/T) Ags, which are either not expressed or are present at very low levels in normal tissues except the testes and perhaps the placenta. 12,13 Because the testes are not patrolled by the immune system, expression of C/T Ags in this environment is not harmful.Of the C/T Ags described thus far, NY-ESO-1 is among the most immunogenic with not only well-documented spontaneous [14][15][16][17][18][19][20] and vaccine-induced immunity, but also clinical responses in a substantial percentage of chemorefractory cancers. 19,21 NY-ESO-1 mRNA is found in approximately 20% to 40% of tumors including melanoma, prostate, transitional cell bladder, breast, lung, medullary thyroid, squamous head and neck, and cervical carcinoma. 12,14,[22][23][24][25][26][27] Because it is expressed in such a wide variety of tumors, NY-ESO-1 offers a unique opportunity to develop a broad-spectrum tumor-specific cancer vaccine.High-dose chemotherapy with autologous peripheral blood stem cell transplantation (auto-PBSCT) has significantly improved the outcome of patients with multiple myeloma (MM). [28][29][30][31][32][33][34][35][36][37] We and others have shown that the presence of cytogenetic abnormalities (CAs) is the most powerful prognosticator for poor outcome. [38][39][40][41][42][43][44][45] Intensification of treatment in our Total Therapy II (TTII) protocol has resulted in additional improvement in event-free (EFS) and overall survival (OS) of patients without CAs (67% of patients). However, no such improvement has yet been observed for patients with CAs (33% of patients). 41,43,46 Fewer than 10% of patients treated with tandem auto-PBSCT protocols remain in long-term remission and are considered "operationally cured." 40 These data highlight the urgent need for new approaches to improve diseasefree survival in such patients.We analyzed ou...