Idiotype vaccination following ABMT can stimulate specific anti-idiotype immune responses in patients with B-cell lymphoma

Vaccination with the idiotype (Id) protein derived from B-cell malignancies can produce Id-specific immune responses that correlate with improved remi ssion duration and survival rates in patients with follicular non-Hodgkin's lymphoma (NHL). A state of minimal or no residual disease correlates stron gly with the laboratory detection of a cellular or humoral immune response. High-dose cytotoxic therapy (HDCT) with autologous stem cell support (auto logous bone marrow transplantation [ABMT]) can provide profound cytoreducti on of B-cell NHL, but the potential immune suppression associated with myel oablative therapy may compromise a patient's ability to mount a specific im mune response. To determine whether patients with NHL could mount detectabl e immune responses following ABMT, Id vaccines were administered at 2 to 12 months following myeloablative therapy to a series of patients with relaps ed or resistant B-cell NHL. Two different vaccination strategies produced r obust immune responses against KLH in all patients, supporting the capacity of the reconstituted immune system following HDCT to react against a stron g antigen. Combining the results from both vaccination strategies, 10 of 12 patients mounted Id-specific humoral or cellular responses. Vaccinations w ere consistently well tolerated. Of the 12 patients, 7 have experienced pro longed remissions with a follow-up from HDCT ranging from 3 to more than 11 years. Our experience serves to document the ability of the recovering imm une system to react against both self and xenotypic antigens and supports t he feasibility and safety of antigen-specific vaccination following myeloab lative therapy in patients with B-cell NHL.