Upfront immunization with autologous recombinant idiotype Fab fragment without prior cytoreduction in indolent B-cell lymphoma.
Idiotype vaccination for follicular lymphoma is primarily being developed as remission consolidation after chemotherapy. We investigated idiotype vaccination as primary intervention for treatment-naive indolent B-cell lymphoma and in a separate cohort as remission consolidation after chemotherapy to assess immunization-induced immune responses in relation to progression-free survival (German Clinical Trials Register, DRKS00000227). Twenty-one patients in each cohort received 6 intradermal injections of adjuvanted recombinant idiotype Fab fragment (Fab(Id)); 76% of patients in both groups developed anti-idiotype antibodies and/or cellular immunity as measured by enzyme-linked immunosorbent assay and interferon-γ ELISpot. In treatment-naive patients, only cellular responses correlated with superior progression-free survival (P < .002) and durable objective remissions (P = .04). Immunization-induced T cells recognized hypermutated or complementarity-determining region 3 epitopes. After remission consolidation immunization, induction of anti-idiotype antibodies correlated with progression-free survival. Low B-cell counts after rituximab therapy predicted for failure to develop anti-idiotype antibodies. These results are similar to published trials showing an association of humoral immunity with control of residual lymphoma. In contrast, effective immunity against untreated lymphoma appears to be dependent on idiotype-specific T cells. Sustained remissions in patients with vaccination-induced cellular immunity suggest clinical benefit and warrant a randomized comparison of this vaccine with expectant management for asymptomatic follicular lymphoma.
Department of Hematology/Oncology, University Medical Center Freiburg, Freiburg, Germany;
Marcelo A
MA
Navarrete
Kristina
K
Heining-Mikesch
Frank
F
Schüler
Cristina
C
Bertinetti-Lapatki
Gabriele
G
Ihorst
Andrea
A
Keppler-Hafkemeyer
Gottfried
G
Dölken
Hendrik
H
Veelken
D000328:Adult; D000368:Aged; D001402:B-Lymphocytes / Q000276:immunology; D019496:Cancer Vaccines / Q000627:therapeutic use*; D018984:Epitopes, T-Lymphocyte / Q000276:immunology; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000276:immunology*; D007130:Immunoglobulin Idiotypes / Q000276:immunology*; D016393:Lymphoma, B-Cell / Q000276:immunology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011994:Recombinant Proteins / Q000276:immunology*; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome; D014611:Vaccination
D019496:Cancer Vaccines; D018984:Epitopes, T-Lymphocyte; D007140:Immunoglobulin Fab Fragments; D007130:Immunoglobulin Idiotypes; D011994:Recombinant Proteins