Vaccination therapy for cutaneous T-cell lymphoma

Primary cutaneous T-cell lymphomas (CTCL) are defined as clonal proliferation of skin-infiltrating T lymphocytes. Despite their heterogeneity, CTCL are generally incurable, which has led to the development of various treatment strategies including vaccination. Here, the attempts to vaccinate against lymphoma will be reviewed with special emphasis on CTCL. Because an universal tumour antigen is not available so far, different targets - including whole tumour cells, idiotypes, cancer/testis antigens, proteins derived from tumour-associated mutations, and mimotopes - have been investigated for their applicability in CTCL vaccination. The antigenic information can be delivered in different ways. So far, tumour cells fused to dendritic cells, idiotypic proteins/peptides and DNA/RNA preparations have been applied in lymphoma. As most targets are weak immunogens, adjuvants and other helpers - including dendritic cells, immunogenic peptides and oligonucleotides, cytokines, and viral vectors - are required to enable proper presentation of the antigens and sufficient activation of the immune system. Although first data from CTCL patients prove the suitability of vaccination in CTCL therapy, the number of available antigens, carriers, adjuvants and application schemes creates a multitude of vaccine formulations; identification of the best-suited approach remains nearly impossible. Furthermore, the relationship between lymphoma and the host immune system is complex and incompletely understood. As a result, CTCL vaccination still requires a lot of research.