Ronald Levy1, Kristen N Ganjoo1, John P Leonard1, Julie M Vose1, Ian W Flinn1, Richard F Ambinder1, Joseph M Connors1, Neil L Berinstein1, Andrew R Belch1, Nancy L Bartlett1, Craig Nichols1, Christos E Emmanouilides1, John M Timmerman1, Stephanie A Gregory1, Brian K Link1, David J Inwards1, Arnold S Freedman1, Jeffrey V Matous1, Michael J Robertson1, Lori A Kunkel1, Diane E Ingolia1, Andrew J Gentles1, Chih Long Liu1, Robert Tibshirani1, Ash A Alizadeh2, Dan W Denney1. 1. Ronald Levy, Andrew J. Gentles, Chih Long Liu, Robert Tibshirani, and Ash A. Alizadeh, Stanford University Medical Center, Palo Alto; Christos E. Emmanouilides and John M. Timmerman, University of California Los Angeles Medical Center, Los Angeles; Lori A. Kunkel, Diane E. Ingolia, and Dan W. Denney Jr, Genitope, Fremont, CA; Kristen N. Ganjoo and Michael J. Robertson, Indiana University Medical Center, Indianapolis, IN; John P. Leonard, Weill Medical College of Cornell University, New York, NY; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Ian W. Flinn and Richard F. Ambinder, Johns Hopkins University Oncology Center, Baltimore, MD; Joseph M. Connors, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, British Columbia; Neil L. Berinstein, Toronto-Sunnybrook Regional Cancer Centre, Toronto, Ontario; Andrew R. Belch, Cross Cancer Institute, Edmonton, Alberta, Canada; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; Craig Nichols, Oregon Health Science University, Portland, OR; Stephanie A. Gregory, Rush University Medical Center, Chicago, IL; Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA; David J. Inwards, Mayo Clinic, Rochester, MN; Arnold S. Freedman, Dana-Farber Cancer Institute, Boston, MA; and Jeffrey V. Matous, Rocky Mountain Cancer Centers, Denver, CO. 2. Ronald Levy, Andrew J. Gentles, Chih Long Liu, Robert Tibshirani, and Ash A. Alizadeh, Stanford University Medical Center, Palo Alto; Christos E. Emmanouilides and John M. Timmerman, University of California Los Angeles Medical Center, Los Angeles; Lori A. Kunkel, Diane E. Ingolia, and Dan W. Denney Jr, Genitope, Fremont, CA; Kristen N. Ganjoo and Michael J. Robertson, Indiana University Medical Center, Indianapolis, IN; John P. Leonard, Weill Medical College of Cornell University, New York, NY; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Ian W. Flinn and Richard F. Ambinder, Johns Hopkins University Oncology Center, Baltimore, MD; Joseph M. Connors, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, British Columbia; Neil L. Berinstein, Toronto-Sunnybrook Regional Cancer Centre, Toronto, Ontario; Andrew R. Belch, Cross Cancer Institute, Edmonton, Alberta, Canada; Nancy L. Bartlett, Washington University School of Medicine, St Louis, MO; Craig Nichols, Oregon Health Science University, Portland, OR; Stephanie A. Gregory, Rush University Medical Center, Chicago, IL; Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA; David J. Inwards, Mayo Clinic, Rochester, MN; Arnold S. Freedman, Dana-Farber Cancer Institute, Boston, MA; and Jeffrey V. Matous, Rocky Mountain Cancer Centers, Denver, CO. arasha@stanford.edu.
Abstract
PURPOSE: Idiotypes (Ids), the unique portions of tumor immunoglobulins, can serve as targets for passive and active immunotherapies for lymphoma. We performed a multicenter, randomized trial comparing a specific vaccine (MyVax), comprising Id chemically coupled to keyhole limpet hemocyanin (KLH) plusgranulocyte macrophage colony-stimulating factor (GM-CSF) to a control immunotherapy with KLH plus GM-CSF. PATIENTS AND METHODS: Patients with previously untreated advanced-stage follicular lymphoma (FL) received eight cycles of chemotherapy with cyclophosphamide, vincristine, and prednisone. Those achieving sustained partial or complete remission (n=287 [44%]) were randomly assigned at a ratio of 2:1 to receive one injection per month for 7 months of MyVax or control immunotherapy. Anti-Id antibody responses (humoral immune responses [IRs]) were measured before each immunization. The primary end point was progression-free survival (PFS). Secondary end points included IR and time to subsequent antilymphoma therapy. RESULTS: At a median follow-up of 58 months, no significant difference was observed in either PFS or time to next therapy between the two arms. In the MyVax group (n=195), anti-Id IRs were observed in 41% of patients, with a median PFS of 40 months, significantly exceeding the median PFS observed in patients without such Id-induced IRs and in those receiving control immunotherapy. CONCLUSION: This trial failed to demonstrate clinical benefit of specific immunotherapy. The subset of vaccinated patients mounting specific anti-Id responses had superior outcomes. Whether this reflects a therapeutic benefit or is a marker for more favorable underlying prognosis requires further study.
RCT Entities:
PURPOSE: Idiotypes (Ids), the unique portions of tumor immunoglobulins, can serve as targets for passive and active immunotherapies for lymphoma. We performed a multicenter, randomized trial comparing a specific vaccine (MyVax), comprising Id chemically coupled to keyhole limpet hemocyanin (KLH) plus granulocyte macrophage colony-stimulating factor (GM-CSF) to a control immunotherapy with KLH plus GM-CSF. PATIENTS AND METHODS: Patients with previously untreated advanced-stage follicular lymphoma (FL) received eight cycles of chemotherapy with cyclophosphamide, vincristine, and prednisone. Those achieving sustained partial or complete remission (n=287 [44%]) were randomly assigned at a ratio of 2:1 to receive one injection per month for 7 months of MyVax or control immunotherapy. Anti-Id antibody responses (humoral immune responses [IRs]) were measured before each immunization. The primary end point was progression-free survival (PFS). Secondary end points included IR and time to subsequent antilymphoma therapy. RESULTS: At a median follow-up of 58 months, no significant difference was observed in either PFS or time to next therapy between the two arms. In the MyVax group (n=195), anti-Id IRs were observed in 41% of patients, with a median PFS of 40 months, significantly exceeding the median PFS observed in patients without such Id-induced IRs and in those receiving control immunotherapy. CONCLUSION: This trial failed to demonstrate clinical benefit of specific immunotherapy. The subset of vaccinated patients mounting specific anti-Id responses had superior outcomes. Whether this reflects a therapeutic benefit or is a marker for more favorable underlying prognosis requires further study.
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