title: Systemic T cell adoptive immunotherapy of malignant gliomas.
abstract: OBJECTIVE
  To determine the feasibility, toxicity, and potential therapeutic benefits of systemic adoptive immunotherapy, 10 patients with progressive primary or recurrent malignant glioma received this treatment. Adoptive immunotherapy, the transfer of immune T lymphocytes, is capable of mediating the regression of experimental brain tumors in animal models. In animal models, lymph nodes (LNs) that drain the tumor vaccine site are a rich source of tumor-immune T cells.
  
  
  METHODS
  In this clinical study, patients were inoculated intradermally with irradiated autologous tumor cells and granulocyte macrophage-colony stimulating factor as an adjuvant. Cells from draining inguinal LNs, surgically resected 7 days after vaccination, were stimulated sequentially with staphylococcal enterotoxin A and anti-CD3, and a low dose of interleukin-2 (60 IU/ml) was used to expand the stimulated cells. The maximum cell proliferation was 350-fold over 10 days of culture. The activated cells were virtually all T cells consisting of various proportions of CD4 and CD8 cells. These cells were given to patients by intravenous infusion at doses ranging from 9 x 10(8) to 1.5 x 10(11). There were no Grade 3 or 4 toxicities associated with the treatment. Following T-cell transfer therapy, radiographic regression that lasted at least 6 months was demonstrated in two patients with recurrent tumors. One patient demonstrated stable disease that has lasted for more than 17 months. The remaining patients had progressive disease; however, four of the eight patients with recurrent tumor remain alive more than 1 year after surgery for recurrence. Three patients required intervention with corticosteroid agents or additional surgery approximately 1 month following cell transfer.
  
  
  CONCLUSIONS
  These intriguing clinical observations warrant further trials to determine whether this approach can provide therapeutic benefits and improve survival.
authors.affiliation: Department of Neurological Surgery, Center for Surgery Research, The Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: G E
authors.initials: GE
authors.lastname: Plautz
authors.forename: G H
authors.initials: GH
authors.lastname: Barnett
authors.forename: D W
authors.initials: DW
authors.lastname: Miller
authors.forename: B H
authors.initials: BH
authors.lastname: Cohen
authors.forename: R A
authors.initials: RA
authors.lastname: Prayson
authors.forename: J C
authors.initials: JC
authors.lastname: Krauss
authors.forename: M
authors.initials: M
authors.lastname: Luciano
authors.forename: D B
authors.initials: DB
authors.lastname: Kangisser
authors.forename: S
authors.initials: S
authors.lastname: Shu
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D004195:Disease Models, Animal; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D005910:Glioma / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D016219:Immunotherapy, Adoptive; D007262:Infusions, Intravenous; D007271:Injections, Intradermal; D008198:Lymph Nodes / Q000276:immunology; D008213:Lymphocyte Activation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D012074:Remission Induction; D012086:Reoperation; D015996:Survival Rate; D013601:T-Lymphocytes / Q000276:immunology*
chemical_list: D000276:Adjuvants, Immunologic; D016178:Granulocyte-Macrophage Colony-Stimulating Factor