The lymphoma vaccines are being tested as post-chemotherapy options for treating patients with low-grade follicular lymphomas. The vaccine idea comes from recent developments in immunotherapy and is described as a "magic bullet" for cancer treatment because it targets cancer cells without harming healthy cells. Preliminary results indicate that a combination of chemotherapy and immunotherapy could be more effective than chemotherapy alone.
Patients eligible for the study must test positive for low-grade follicular small, mixed, or large cell lymphoma. Once diagnosed, patients undergo a second tumor biopsy to acquire the cells from which a vaccine is developed specifically for that patient's tumor. Those cells are sent to developers at Genitope, Inc., in Redwood City, Calif., where protein from the cells is extracted to identify unique characteristics of each patient's tumor. Using that information and a "rescue fusion" method, a vaccine is manufactured to fight that patient's tumor exclusively. The entire process can take up to six months. While the vaccine is being developed, patients undergo 26-30 weeks of chemotherapy. Following that, patients have a 26-week recovery period with no chemotherapy, which allows their immune system to recover. During the treatment, patients will inject the vaccine into their thigh once a month for four months. Then, they will rest for three months before giving the final booster vaccine at six months.
"Preliminary data on this vaccine was exciting because it was benign, did not cause the low-blood counts resulting from some chemotherapy treatments, and was free of any long term side effects," says Gregory. However, patients may experience a local reaction characterized by redness of the skin and slight discomfort at the site of the injection.
Non- Hodgkin's lymphoma is the fifth most common cancer today, with approximately 57,000 new cases diagnosed each year. Approximately 35 percent of these cases are low-grade follicular lymphomas, and although life expectancies vary, most low-grade patients are expected to live six to ten years after diagnosis. This cancer of the immune system usually affects the whole body, as opposed to a particular organ. Similar to AIDS, it eliminates the body's ability to fight off diseases from normal bacteria and certain viruses. There are 40 or more different types of non-Hodgkin's lymphoma (classified as low, intermediate, or high grade), many requiring different treatments, making it difficult for doctors to develop or adopt standard treatment for these heterogeneous tumors.
Recently, the use of monoclonal antibodies, the most common type of immuotherapy, has increased. These antibodies "target specific cancer cells and certain markers of the surface of lymphoma cells," says Gregory. Rituximab is the first monoclonal antibody approved by the FDA for treating patients with relapsed low-grade lymphomas.
Doctors at Rush are currently seeking patients with low-grade follicular small, mixed, and large cell lymphomas to participate in this research study. Persons interested should call Terri O'Brien (312-942-5689) at the Lymphoma Research Program in the Section of Hematology, Rush Cancer Institute.
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