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Prognosis of disseminated melanoma remains gloomy as neither chemotherapeutic nor unspecific immune modulatory approaches were able to improve the overall survival of these patients. Hence, specific immunotherapy has received increasing attention. Disappointing clinical results, however, indicate that the choice of suitable antigens is of special importance. To this end, the inhibitor of apoptosis (IAP) protein survivin, which is over-expressed in several tumours but is largely undetectable in adult tissues, appears to be a promising target for vaccination purposes, since down-regulation or loss of expression is associated with impaired tumour progression. Consequently, five heavily pretreated stage IV melanoma patients were vaccinated with the HLA-A2 restricted survivin96–104 epitope presented by autologous dendritic cells (DCs) in a compassionate use setting. Four of these patients mounted strong T cell responses to this epitope as measured by ELISPOT assay. Furthermore, in situ peptide/HLA-A2 multimer staining confirmed that these survivin reactive cells infiltrated both visceral and soft tissue metastases.

A 64-year-old woman was referred to our department due to first clinical symptoms of autoimmune hemolytic anemia. For 1 week the patient had been suffering from flu with joint pain and fatigue. Medical history showed chronic obstructive lung disease and status post hysterectomy. Physical examination revealed a patient in good general condition. There was slight icterus of the skin and sclera, and ankle edema. There was also a lymph node (1.5 cm) in the right groin. All other clinical findings were normal. Laboratory parameters revealed anemia with a hemoglobin of 6.7 g/dl, MCV 112.0 fl, MCH 42.7 pg, hematocrit 17.5%, and reticulocytes 124%. Total bilirubin was elevated to 4.33 mg/dl, lactate dehydrogenase 669 U/l, and haptoglobin