Exclusion criteria 1. Subjects cannot be simultaneously enrolled on other treatment studies. 2. Any contraindication to receiving GM -CSF based vaccine products. 3. Cardiac disease , specifically restrictive cardiomyopathy , unstable angina within the last 6 months prior to enrollment, New York Heart Association functional class III -IV heart failure on active treatment with normalized LVEF on therapy , and symptomatic pericardial effusion. 4.