DeNardo S J, Kroger L A, MacKenzie M R, Mirick G R, Shen S, DeNardo G L
Department of Internal Medicine, University of California Davis, School of Medicine, Sacramento, USA.
Cancer Biother Radiopharm. 1998 Feb;13(1):1-12. doi: 10.1089/cbr.1998.13.1.
A patient with aggressive, chemotherapy-resistant non-Hodgkins lymphoma (NHL) was treated with 131I-Lym-1, a mouse antibody, on a protocol designed for serial therapy. Human anti-mouse antibody (HAMA) developed within 1 month of initial therapy. The patient also developed an antibody to the hypervariable region of the Lym-1 antibody (Lym-1 specific). Because the patient was responding to therapy, plasmaphoresis was used to reduce the level of HAMA followed by unlabeled Lym-1 calculated to be sufficient to block residual HAMA. This allowed additional therapy on three subsequent occasions over 5 months. Despite very high HAMA levels, no untoward effects from administrations of Lym-1 were observed. The HAMA response of the patient included anti-Lym-1 specific antibodies containing anti-idiotypic antibodies. The anti-Lym-1 antibody level has been sustained over the 9 year interval since 131I-Lym-1 therapy and has been associated with a uniquely long remission of the patient's disease. These observations demonstrate that, under certain circumstances, radioimmunotherapy (RIT) can be given safely and effectively despite HAMA. Anti-idiotypic antibodies could have induced an immune cascade that contributed to the prolonged disease-free survival of the patient.
一名患有侵袭性、化疗耐药性非霍奇金淋巴瘤（NHL）的患者，按照系列治疗方案接受了鼠源抗体131I-Lym-1治疗。在初始治疗后1个月内产生了人抗鼠抗体（HAMA）。该患者还产生了针对Lym-1抗体高变区的抗体（Lym-1特异性抗体）。由于患者对治疗有反应，采用了血浆置换来降低HAMA水平，随后给予未标记的Lym-1，其剂量经计算足以阻断残留的HAMA。这使得在接下来的5个月内又进行了三次额外治疗。尽管HAMA水平非常高，但未观察到Lym-1给药产生的不良影响。该患者的HAMA反应包括含有抗独特型抗体的抗Lym-1特异性抗体。自131I-Lym-1治疗以来的9年期间，抗Lym-1抗体水平一直维持，且与患者疾病的超长缓解期相关。这些观察结果表明，在某些情况下，尽管存在HAMA，放射免疫治疗（RIT）仍可安全有效地进行。抗独特型抗体可能引发了一种免疫级联反应，有助于患者延长无病生存期。
