Inclusion Criteria

Inclusion criteria:

- Patients with clinically and histological or cytological confirmed newly diagnosed
MM, that can be measured in two dimensions by a radiologic imaging study.

- Patients must be at least 18 years old and must be able to give written informed
consent.

- Patients must be ambulatory (Karnofsky scale > 70, or WHO-ECOG performance status
0,1, or 2) and in stable medical condition. The expected survival must be at least 4
months.

- Patients must have normal organ function and adequate bone marrow reserve: absolute
neutrophil count > 1.5 x 109/l, platelet count > 100 x 109/l, and Hb > 6.0 mmol/l.

- Positive DTH skin test (induration > 2mm after 48 hrs) against at least one positive
control antigen tetanus toxoid.

- Stable disease or response after chemotherapy.

- Availability of sufficient tumor material of the patient.

- Ability to return to the Erasmus MC for adequate follow-up as required by this
protocol.

- Able to tolerate oral therapy

- No impairment of gastrointestinal (GI) function or GI disease that may affect or
alter absorption of CTX (e.g., mal-absorption syndrome, history of total
gastrectomy/significant small bowel resection)

- No history of allergic reactions (≥ grade 3 or 4) to compounds of similar chemical or
biologic composition to CTX (i.e., alkylating agents)

- No known intolerance or hypersensitivity reaction to CTX

Exclusion criteria:

- Conditions that make the patient unfit for chemotherapy or progressive disease after
4 cycles of chemotherapy.

- Pleurodesis at the affected side before the pleural fluid is obtained.

- Medical or psychological impediment to probable compliance with the protocol.

- Patients on steroid (or other immunosuppressive agents) are excluded on the basis of
potential immune suppression. Patients must have had 6 weeks of discontinuation and
must stop of any such treatment during the time of the study.

- No prior malignancy is allowed except for adequately treated basal cell or squamous
cell skin cancer, superficial or in-situ cancer of the bladder or other cancer for
which the patient has been disease-free for five years.

- Serious concomitant disease, no active infections. Patients with a history of
autoimmune disease or organ allografts, or with active acute or chronic infection,
including HIV (as determined by ELISA and confirmed by Western Blot) and viral
hepatitis (as determined by HBsAg and Hepatitis C serology).

- Patients with serious intercurrent chronic or acute illness such as pulmonary (asthma
or COPD) or cardiac (NYHA class III or IV) or hepatic disease or other illness
considered by the study coordinator to constitute an unwarranted high risk for
investigational DC treatment.

- Patients with a known allergy to shell fish (may contain KLH).

- Pregnant or lactating women.

- Patients with inadequate peripheral vein access to perform leukapheresis

- Concomitant participation in another clinical trial

- An organic brain syndrome or other significant psychiatric abnormality which would
comprise the ability to give informed consent, and preclude participation in the full
protocol and follow-up.

- Absence of assurance of compliance with the protocol. Lack of availability for
follow-up assessment.