Transimmunization for cutaneous T cell lymphoma: A phase I study

Extracorporeal photochemotherapy ( ECP) is a widely used immunotherapy for cutaneous T cell lymphoma ( CTCL). It involves four sequential steps: conversion of blood monocytes into dendritic antigen presenting cells ( DC) by repetitive adherence and disadherence to plastic surface; reinfusion of the new DC; presumed in vivo loading of the new DC with apoptotic malignant leukocytes; and expansion of the anti-tumor CD8 T cell pool. To assess the safety of a methodology designed to increase ex vivo contact between the apoptotic malignant cells and new DC prior to reinfusion, a single- center, open- label Phase I clinical study of a revised procedure - referred to as "Transimmunization'' - was conducted in CTCL patients. Twenty-seven subjects were treated monthly for 3 to 5 months, alone or in combination with electron beam therapy. For those receiving Transimmunization alone, there was an overall diminution in infiltrative lesions in eleven ( 55%) of twenty patients. In the twelve leukemic CTCL patients, there was a significant mean reduction of 50.1% in the circulating malignant cells, as determined with family- specific anti- T cell receptor V beta monoclonal antibodies (P <= 0.021). Because this therapy permits the synchronous induction and tumor loading of DC, with minimal toxicity, Transimmunization may merit further investigation in CTCL and other malignancies.