Vaccine Therapy for Lymphoma
Dear OncoLink "Ask The Experts,"
I am a 53-year-old female, newly diagnosed with follicular Non-Hodgkin's lymphoma. I am taking Rituxan, and then will begin a vaccine made from my own cells and an immunity booster. This is a clinical trial. Please explain to me how the injection of my cells will help fight this cancer.
Babis (Charalambos) Andreadis, MD, Assistant Professor in Medicine in the Division of Hematology/Oncology at the Abramson Cancer Center and an Associate Scholar in the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania, responds:
Follicular lymphoma is an indolent (which means slow-growing) form of Non-Hodgkin's Lymphoma. The cancer cells that make up this lymphoma are B-lymphocytes (cells that are part of the normal immune system) that tend to abnormally accumulate over time and produce enlarged lymph nodes and/or infiltrate organs. These cells have a surface marker (the so-called idiotype) that is only present on these cells, as opposed to any other cells in a given patient. Each patient also has a unique B-lymphocyte idiotype compared to the B-cells from other patients. Given the indolent nature of this lymphoma, and the ability to distinguish between benign and malignant cells using this marker, several approaches have been made to produce a vaccine targeted against the particular idiotype.
These approaches start with biopsy material from each patient and utilize different technologies to produce the idiotype protein in large quantities. They then combine this protein with an adjuvant (which is a substance added to a vaccine to enhance the immune response so that less vaccine is needed, such as KLH) and a direct immune booster (like GM-CSF) before administering the combination to a patient over several visits. So far, vaccination has been tried either in first- or second- line treatment of follicular lymphoma, (meaning without or with a history of prior chemotherapy, respectively). There are several promising studies in print that suggest the successful generation of a cellular and humoral (antibody-mediated) immune response against lymphoma cells after receiving the vaccine. This is usually accompanied by a clinical response, though most of the studies do not allow us to make direct comparisons between treated and untreated patients. The ones that do will require longer follow-up to be able to show a difference in remission duration and survival in this disease.
Overall, vaccines are relatively safe to give, with few expected or observed side-effects, and appear promising in the treatment of follicular as well as potentially other types of lymphomas.