Barrios Yvelise, Cabrera Rafael, Yáñez Rosa, Briz Montserrat, Plaza Aresio, Forés Rafael, Fernández Manuel-Nicolás, Díaz-Espada Fernando
Departments of Immunology, Clínica Puerta de Hierro, Madrid, Spain.
Haematologica. 2002 Apr;87(4):400-7.
Patients with B-cell lymphoma can be induced to mount a specific immune response against the individual idiotypic determinants expressed in their tumor cells. This form of active immunotherapy is now under evaluation in the clinical setting. We evaluated the feasibility and effectiveness of this kind of immunotherapy in a group of patients with low-grade lymphoma, which included two cases of bi/triclonal lymphoma.
Nine patients with a histopathologic diagnosis of follicular non-Hodgkin's (NHL) low-grade B-cell lymphoma were initially selected for this disease-free survival study. Idiotypic proteins were recovered by somatic fusion of the tumor cells and their identity with the tumor idiotype determined by molecular methods. The patients received the vaccine consisting of their tumor Ig protein coupled to keyhole limpet hemocyanine and were observed for toxicity, anti-idiotypic immune response, clinical outcome and circulating t(14;18)+ tumor cells.
The median duration of follow-up was 40 (10-64) months from the initiation of immunotherapy. Tumor regression was detected in two patients. No tumor progression was observed in the other patients. Eight patients generated specific anti-idiotypic antibodies and 3 out of five were cleared of circulating t(14;18)+ cells.
Induction of tumor-specific anti-idiotypic immune responses may be of benefit to patients affected by low-grade B-cell NHL. Our results are in line with those previously reported and call attention to the issue of tumor clonality in this kind of treatment.
B细胞淋巴瘤患者可被诱导产生针对其肿瘤细胞中表达的个体独特型决定簇的特异性免疫反应。这种主动免疫疗法目前正在临床环境中进行评估。我们评估了这种免疫疗法在一组低度淋巴瘤患者中的可行性和有效性，其中包括两例双/三克隆淋巴瘤。
最初选择9例经组织病理学诊断为滤泡性非霍奇金（NHL）低度B细胞淋巴瘤的患者进行无病生存研究。通过肿瘤细胞的体细胞融合回收独特型蛋白，并通过分子方法确定其与肿瘤独特型的一致性。患者接受由其肿瘤Ig蛋白与钥孔戚血蓝蛋白偶联而成的疫苗，并观察其毒性、抗独特型免疫反应、临床结局和循环t(14;18)+肿瘤细胞。
从免疫疗法开始计算，中位随访时间为40（10 - 64）个月。两名患者出现肿瘤消退。其他患者未观察到肿瘤进展。8名患者产生了特异性抗独特型抗体，5名患者中有3名清除了循环t(14;18)+细胞。
诱导肿瘤特异性抗独特型免疫反应可能对受低度B细胞NHL影响的患者有益。我们的结果与先前报道的结果一致，并提请注意这种治疗中肿瘤克隆性的问题。
