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新诊断的多形性胶质母细胞瘤患者在放化疗后接受淋巴结内自体肿瘤裂解物-树突状细胞疫苗接种的免疫反应。

Immune response in patients with newly diagnosed glioblastoma multiforme treated with intranodal autologous tumor lysate-dendritic cell vaccination after radiation chemotherapy.

机构信息

Section of Hematology/Oncology-Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.

出版信息

J Immunother. 2011 May;34(4):382-9. doi: 10.1097/CJI.0b013e318215e300.

Abstract

Patients with glioblastoma multiforme (GBM) are profoundly immunosuppressed and may benefit from restoration of an antitumor immune response in combination with conventional radiation therapy and temozolomide (TMZ). The optimal strategies to evaluate clinically relevant immune responses to treatment have yet to be determined. The primary objective of our study was to determine immunologic response to cervical intranodal vaccination with autologous tumor lysate-loaded dendritic cells (DCs) in patients with GBM after radiation therapy and TMZ. We used a novel hierarchical clustering analysis of immune parameters measured before and after vaccination. Secondary objectives were to assess treatment feasibility and to correlate immune response with progression-free survival (PFS) and overall survival. Ten eligible patients received vaccination. Tumor-specific cytotoxic T-cell response measured after vaccination was enhanced for the precursor frequency of CD4+ T and CD4+ interferon γ-producing cells. Hierarchical clustering analysis of multiple functional outcomes discerned 2 groups of patients according to their immune response, and additionally showed that patients in the top quintile for at least one immune function parameter had improved survival. There were no serious adverse events related to DC vaccination. All patients were alive at 6 months after diagnosis and the 6-month PFS was 90%. The median PFS was 9.5 months and overall survival was 28 months. In patients with GBM, immune therapy with DC vaccination after radiation and TMZ resulted in tumor-specific immune responses that were associated with prolonged survival. Our data suggest that DC vaccination in combination with radiation and chemotherapy in patients with GBM is feasible, safe, and may induce tumor-specific immune responses.

摘要

多形性胶质母细胞瘤(GBM)患者的免疫功能严重受到抑制,可能受益于恢复抗肿瘤免疫反应,与常规放射治疗和替莫唑胺(TMZ)联合治疗。目前尚未确定评估治疗中临床相关免疫反应的最佳策略。我们研究的主要目的是确定在接受放射治疗和 TMZ 后,颈淋巴结内自体肿瘤裂解物负载树突状细胞(DC)接种对 GBM 患者的免疫反应。我们使用一种新的免疫参数分层聚类分析方法,在接种前后进行测量。次要目标是评估治疗的可行性,并将免疫反应与无进展生存期(PFS)和总生存期(OS)相关联。10 名符合条件的患者接受了接种。接种后测量的肿瘤特异性细胞毒性 T 细胞反应增强了 CD4+T 和 CD4+干扰素γ产生细胞的前体频率。对多个功能结果的分层聚类分析根据免疫反应将患者分为 2 组,此外还表明至少有一个免疫功能参数处于前 5 位的患者的生存时间得到了改善。与 DC 接种相关的严重不良事件为零。诊断后 6 个月时所有患者均存活,6 个月 PFS 为 90%。中位 PFS 为 9.5 个月,总生存期为 28 个月。在 GBM 患者中,放射治疗和 TMZ 后免疫治疗联合 DC 接种可诱导肿瘤特异性免疫反应,延长生存期。我们的数据表明,在 GBM 患者中,DC 接种联合放射和化疗是可行的、安全的,并且可能诱导肿瘤特异性免疫反应。

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