Systemic T cell adoptive immunotherapy of malignant gliomas

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Object. To determine the feasibility, toxicity, and potential therapeutic benefits of systemic adoptive immunotherapy, 10 patients with progressive primary or recurrent malignant glioma received this treatment. Adoptive immunotherapy, the transfer of immune T lymphocytes, is capable of mediating the regression of experimental brain tumors in animal models. In animal models, lymph nodes (LNs) that drain the tumor vaccine site are a rich source of tumor-immune T cells.

Methods. In this clinical study, patients were inoculated intradermally with irradiated autologous tumor cells and granulocyte macrophage-colony stimulating factor as an adjuvant. Cells from draining inguinal LNs, surgically resected 7 days after vaccination, were stimulated sequentially with staphylococcal enterotoxin A and anti-CD3, and a low dose of interleukin-2 (60 IU/ml) was used to expand the stimulated cells. The maximum cell proliferation was 350-fold over 10 days of culture. The activated cells were virtually all T cells consisting of various proportions of CD4 and CD8 cells. These cells were given to patients by intravenous infusion at doses ranging from 9 × 108 to 1.5 × 1011. There were no Grade 3 or 4 toxicities associated with the treatment. Following T-cell transfer therapy, radiographic regression that lasted at least 6 months was demonstrated in two patients with recurrent tumors. One patient demonstrated stable disease that has lasted for more than 17 months. The remaining patients had progressive disease; however, four of the eight patients with recurrent tumor remain alive more than 1 year after surgery for recurrence. Three patients required intervention with corticosteroid agents or additional surgery approximately 1 month following cell transfer.

Conclusions. These intriguing clinical observations warrant further trials to determine whether this approach can provide therapeutic benefits and improve survival.

Article Information

Address reprint requests to: Suyu Shu, Ph.D., Center for Surgery Research FF5, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195.

© AANS, except where prohibited by US copyright law.

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    Case 3. Serial MR images obtained following surgery for tumor recurrence (A), prior to immunotherapy (B), and following T-cell transfer, at 1 month (C), 2 months (D), 4 months (E), and 6 months (F).

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    Case 7. Serial MR images obtained following surgery for tumor recurrence (A), prior to immunotherapy (B), and following T-cell transfer, at 1 month (C), 3 months (D), 5 months (E), and 7 months (F).

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    Case 9. Serial MR images obtained following surgery for tumor recurrence (A), prior to immunotherapy (B), and following T-cell transfer, at 1 month (C ), 3 months (D), 5 months (E), and 7 months (F).

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