From the Department of Lymphoma and Myeloma, The University of Texas M. D. Anderson Cancer Center, Houston, TX
Authors’ disclosures of potential conflicts of interest are found at the end of this article.
Address reprint requests to Larry W. Kwak, MD, PhD, Professor, Chairman, Department of Lymphoma and Myeloma, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 429, Houston, TX 77030; e-mail: lkwak{at}mdanderson.org
Overview: Vaccination with the autologous clonal tumor immunoglobulin idiotype (Id) has been performed in follicular lymphoma (FL) to elicit tumor-specific immune responses and to prevent or delay relapse or progression. Early studies demonstrated that tumor-specific humoral and cellular immune responses could be induced after Id vaccination. Molecular remission and durable clinical responses were observed for patients vaccinated in first clinical remission with granulocyte-monocyte colony-stimulating factor as adjuvant. Id vaccination was also demonstrated to induce tumor-specific T cell immunity in the absence of B cells after prior administration of rituximab. Three randomized double-blind placebo-controlled multicenter clinical trials were performed to formally determine the clinical efficacy of therapeutic vaccination in FL. BiovaxID significantly prolonged time to relapse compared with control vaccine for patients with advanced stage FL in complete remission after standard induction chemotherapy. However, MyVax and Mitumprotimub-t showed no improvement in time to progression compared with control arm. Results from these trials suggest that requirement of a minimal residual disease state may be necessary for the vaccine induced immune responses to be effective. Although additional studies are needed to test the efficacy of BiovaxID for patients pretreated with rituximab, further optimization of antilymphoma vaccines may require concurrent blockade of negative regulatory pathways.
