title: T-cell therapy for EBV-associated nasopharyngeal carcinoma: preparative lymphodepleting chemotherapy does not improve clinical results.
abstract: BACKGROUND
  We and others have demonstrated that adoptive cell therapy with Epstein-Barr virus (EBV)-specific autologous cytotoxic T lymphocytes (CTLs) may control disease progression in patients with EBV-associated nasopharyngeal carcinoma (NPC). With the aim of favoring in vivo T-cell expansion, we optimized our cell therapy approach by administering higher doses of EBV-specific CTLs, following lymphodepleting chemotherapy.
  
  
  METHODS
  Eleven patients with EBV-related NPC in whom conventional treatment failed have been enrolled. Patients received nonmyeloablative lymphodepleting chemotherapy consisting of cyclophosphamide and fludarabine. Two doses of autologous EBV-specific CTLs were subsequently infused, 2 weeks apart. Study end points were feasibility and clinical outcome.
  
  
  RESULTS
  All patients enrolled completed the treatment and were assessable for analysis. The median dose of CTLs per infusion was 3.7 × 10(8). Therapy was well tolerated, with no severe adverse events ascribable to either chemotherapy or cell therapy. Disease control (defined as either tumor regression or disease stabilization lasting >4 months) was obtained in 6 of 11 patients, in keeping with previously published results.
  
  
  CONCLUSIONS
  Our data confirm that EBV-specific CTL therapy is safe and associated with antitumor activity in patients with advanced NPC. The use of lymphodepleting chemotherapy before high-dose CTL infusion did not enhance the clinical benefit observed in our previous series.
authors.affiliation: Falck Medical Oncology, Niguarda Ca' Granda Hospital, Milano, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Secondino
authors.forename: M
authors.initials: M
authors.lastname: Zecca
authors.forename: L
authors.initials: L
authors.lastname: Licitra
authors.forename: A
authors.initials: A
authors.lastname: Gurrado
authors.forename: I
authors.initials: I
authors.lastname: Schiavetto
authors.forename: P
authors.initials: P
authors.lastname: Bossi
authors.forename: L
authors.initials: L
authors.lastname: Locati
authors.forename: R
authors.initials: R
authors.lastname: Schiavo
authors.forename: S
authors.initials: S
authors.lastname: Basso
authors.forename: F
authors.initials: F
authors.lastname: Baldanti
authors.forename: R
authors.initials: R
authors.lastname: Maccario
authors.forename: F
authors.initials: F
authors.lastname: Locatelli
authors.forename: S
authors.initials: S
authors.lastname: Siena
authors.forename: P
authors.initials: P
authors.lastname: Pedrazzoli
authors.forename: P
authors.initials: P
authors.lastname: Comoli
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma; D064987:Cell- and Tissue-Based Therapy; D018450:Disease Progression; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005260:Female; D006801:Humans; D016219:Immunotherapy, Adoptive; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000276:immunology / Q000628:therapy* / Q000821:virology*; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology*; D055815:Young Adult