Idiotypic vaccination in B-cell malignancies.

Immunoglobulins contain unique portions, collectively termed idiotypes, that can be recognized by the immune system. Idiotypes expressed by tumor cells in B-cell malignancies can be regarded as tumor-specific antigens and targets for vaccine immunotherapy. Haptens and adjuvants, including cytokines, have been used in several animal models to increase idiotype immunogenicity and establish protective anti-idiotype immunity. These results have been extended by the use of DNA technology, and this has led to the development of a new generation of immunogens, namely fusion proteins and naked-DNA vaccines. The central role of antigen-presenting cells as initiators of anti-idiotype immune responses has also been recognized. Guided by the experimental data, idiotypic vaccination has come into medical use in patients with lymphoma and multiple myeloma.