title: Adoptive immunotherapy in patients with recurrent malignant glioma: preliminary results of using autologous whole-tumor vaccine plus granulocyte-macrophage colony-stimulating factor and adoptive transfer of anti-CD3-activated lymphocytes.
abstract: OBJECTIVE
  This trial was designed to determine the ability of autologous whole-tumor cell vaccines to induce cell mediated immune responses in patients with recurrent malignant glioma, as well as to determine whether combining such vaccination with adoptive transfer of in vitro activated T lymphocytes prolongs patient survival.
  
  
  METHODS
  Nineteen patients with recurrent malignant glioma, in whom previous external beam radiotherapy and at least one course of chemotherapy had failed were vaccinated twice with irradiated autologous whole tumor cells by using granulocyte-marcrophage colony-stimulating factor as an adjuvant. Patients then underwent leukapheresis followed by adoptive transfer of peripheral blood lymphocytes activated in vitro with anti-CD3 and interleukin-2. In vivo immune response, radiological response, clinical outcome, and survival were monitored. Seventeen patients developed a delayed-type hypersensitivity (DTH) response to vaccination that appeared to be directed against the autologous tumor. In eight patients there was radiological evidence of a response and in five there was evidence of clinical improvement. Median survival was 12 months (range 6-28 months), and both the presence of a DTH response and the radiological response correlated with survival (p < 0.02 and p < 0.04, respectively).
  
  
  CONCLUSIONS
  These preliminary results suggest that autologous whole-tumor cell vaccines induce a cell-mediated immune response, which appears to be tumor specific in most patients. Furthermore, vaccination combined with adoptive immunotherapy with in vitro activated cells may induce a radiologically demonstrated tumor response and improved survival despite a condition of advanced disease and immunosuppression resulting from previous treatment or tumor burden. Further studies of immunotherapy are warranted.
authors.affiliation: Department of Neurosurgery, Karmanos Cancer Institute, Detroit, Michigan, USA. asloan@neurosurgery.wayne.edu
authors.forename: A E
authors.initials: AE
authors.lastname: Sloan
authors.forename: R
authors.initials: R
authors.lastname: Dansey
authors.forename: L
authors.initials: L
authors.lastname: Zamorano
authors.forename: G
authors.initials: G
authors.lastname: Barger
authors.forename: C
authors.initials: C
authors.lastname: Hamm
authors.forename: F
authors.initials: F
authors.lastname: Diaz
authors.forename: R
authors.initials: R
authors.lastname: Baynes
authors.forename: G
authors.initials: G
authors.lastname: Wood
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D017252:CD3 Complex / Q000276:immunology*; D019496:Cancer Vaccines / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005910:Glioma / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage*; D006801:Humans; D016219:Immunotherapy, Adoptive / Q000009:adverse effects / Q000379:methods*; D007937:Leukapheresis; D008213:Lymphocyte Activation / Q000276:immunology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000276:immunology / Q000473:pathology / Q000628:therapy; D015996:Survival Rate; D013601:T-Lymphocytes / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000276:Adjuvants, Immunologic; D017252:CD3 Complex; D019496:Cancer Vaccines; D016178:Granulocyte-Macrophage Colony-Stimulating Factor