RHAMM/CD168-R3 Peptide Vaccination of Patients with Acute Myeloid Leukemia (AML), Myelodysplastic Syndrome (MDS) and Multiple Myeloma (MM) Elicits Immunological and Clinical Responses.
Authors: Schmitt Michael , Schmitt Anita , Giannopoulos Krzysztof , Li Li , Liebisch Peter , Chen Jinfei , Ringhoffer Mark , Guillaume Phillipe , Ritter Gerd , Rojewski Markus , Gnjatic Sascha , Dohner Hartmut , Jochen Jochen 
Published: April 2020

Abstract
Most patients with AML, MDS, MM and chronic lymphatic leukemia (CLL) express the receptor for hyaluronic acid mediated motility (RHAMM/CD168) on their tumor cells. We characterized RHAMM/CD168 as a leukemia-associated antigen (LAA) eliciting both humoral and cellular immune responses in patients with different hematological malignancies. CD8 positive T cells primed with the RHAMM/CD168-derived peptide R3 (ILSLELMKL) were able to lyse autologous AML blasts expressing this LAA. Therefore, we initiated a phase I/II R3 peptide vaccination to induce immunological and hematological responses for patients with AML, MDS or MM overexpressing RHAMM/CD168. Patients were included with positive RHAMM/CD168 expression but with a limited tumor load. At a biweekly interval, RHAMM R3 peptide (300 mcg for the first 12 patients and 1000 mcg for patients 13–24) emulsified with the incomplete Freund’s adjuvant (day 3) and GM-CSF (100 mcg, days 1–5) was administrated four times subcutaneously. The primary aim of the study is safety and feasibility of this peptide vaccination, secondary aims the evaluation of a specific T cell immune response to RHAMM/CD168 R3 peptide and the assessment of the influence of the R3 peptide vaccination on the remission status. Since January 2005, 14 patients have been enrolled in the study. The first ten patients (2 AML, 4 MDS, 4 MM) have completed the course of four vaccinations and have been completely evaluated. Therapy related adverse events observed under R3-peptide vaccination were erythema and induration of the skin at the site of injection (CTC I°). In 5/10 patients, we detected in the peripheral blood a significant increase of specific CD8+ T cells recognizing the R3 peptide in ELISPOT analysis and seven-color flow cytometry including tetramer staining. As expected, after vaccination with the HLA class I peptide R3 no significant increase of IgG titers against the antigen RHAMM could be detected. Clinical responses have been assessed by the examination of peripheral blood and bone-marrow samples before and after vaccination. Patients showed a reduction of the tumor-specific expressed antigen RHAMM/CD168 in real-time RT-PCR analysis after vaccination. 3/6 patients with myeloid disorders (1 AML, 2 MDS/RAEB1) showed a reduction of CD33+ cells in FACS analysis of the bone-marrow after four vaccinations from 10 and 7 % to 1–2 and &lt;1%, respectively. One patient with MDS did not need further erythrocyte substitution. Two patients with MM showed a reduction of plasma cells in the bone-marrow as by FACS analysis and of free light chains. One patient with AML and one patient with MM showed a progressive disease. Taken together, RHAMM/CD168 induced both immunological and clinical results and therefore constitutes a promising target antigen for immunotherapies in patients with hematological malignancies. Further entities with RHAMM/CD168 expression such as CLL might also be eligible for immunotherapeutic approaches using RHAMM/CD168.