Dr. David Avigan, MD Beth Israel Deaconess Medical Center Interview Date: March 11, 2016 

"Minimal Residual Disease" is the trace amount of myeloma that can be left even after treatment is over. Dr. David Avigan of the Beth Israel Medical Center is intent on eliminating the rest of any remaining myeloma using a dendritic cell vaccine after autologous stem cell transplant. Myeloma cells can tell the immune system to shut down and dendritic cells are powerful immune system stimulants so they are a good target for practical use in boosting one's own system to go after the myeloma. To make the personalized vaccine, a patient's white blood cells are removed during a standard bone marrow biopsy and are taking these "teacher" dendritic cells and fusing them to tumor cells that it can then show to the immune system. An autologous stem cell transplant is performed and the vaccine is given to the patient with the hope that the T-Cells or fighter cells will now be turned back on to target the myeloma cells. The hope is also that the vaccine provides memory, so that if additional myeloma cells are generated, they are killed via with T cell surveillance. Dr. Avigan tells us that stem cell transplant can do more than just kill the myeloma cells. One of the goals of transplant is to debulk the tumor because vaccines don't work well when there is high tumor burden. But additionally, the stem cell transplant can help resent the immune system to get it working properly again to go after myeloma cells on its own. 

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