Accomplishments and perspectives of immunological interventions in lymphoproliferative disorders

The purpose of this review is to consider evidences accumulated in the last few years which might lead to a new therapeutic strategy for lymphoproliferative disorders. Tumor-targeted and immunologically designed therapy has already started. Clinical effectiveness also includes the primary and secondary prevention of these malignancies. The fortifying of body's defense through vaccination as primary prevention with tumor-specific cell surface antigen, has been seen over the past few years, and will lead to health patient's improvement. Data collected from clinical trials and in vitro analysis indicated that the immune system of patients could recognize and eliminate neoplastic cells while sparing normal cells. In B-cell lymphomas and myelomas, the tumor-idiotype (Id) produced by a single B-cell clone, has been used for vaccination. Therapeutic Id vaccination used two types of antigen-presenting cells as natural adjuvants for the induction of antigen-specific T cell response. Dendritic cells (DCs)--based vaccines are under active investigation and are entering clinical evaluation. Current research focuses on optimization of DCs source, choice and loading of antigen, mode of injection, as well as immune monitoring. Some preliminary results were obtained and no significant side effects of dendritic cells vaccination of lymphoma and myeloma patients have so far been reported. The over-estimation of clinical effectiveness, at this moment, is still limited by the small number of patients included in this kind of treatment. The challenge for the future will be to extend these early results to reproducible vaccination strategy according to current standards of good clinical practice (GCP).