Abstract
BackgroundThe effectiveness of immunotherapy for high-grade glioma (HGG) patients remains controversial. To evaluate the therapeutic efficacy of dendritic cells (DCs) alone in the treatment of HGG, we performed a systematic review and meta-analysis in terms of patient survival with relevant published clinical studies.Materials and methodsA total of 409 patients, including historical cohorts, nonrandomized and randomized controls with HGG, were selected for the meta-analysis.ResultsThe treatment of HGG with DCs was associated with a significantly improved one-year survival (OS) (p<0.001) and 1.5-, 2-, 3-, 4-, and 5-year OS (p<0.001) compared with the non-DC group. A meta-analysis of the patient outcome data revealed that DC immunotherapy has a significant influence on progression-free survival (PFS) in HGG patients, who showed significantly improved 1-,1.5-, 2-, 3- and 4-year PFS (p<0.001). The analysis of Karnofsky performance status (KPS) demonstrated no favorable results for DC cell therapy arm (p = 0.23).The percentages of CD3+CD8+ and CD3+CD4+ T cells and CD16+ lymphocyte subset were not significantly increased in the DC group compared with the baseline levels observed before treatment (p>0.05), whereas CD56+ lymphocyte subset were significantly increased after DC treatment (p = 0.0001). Furthermore, the levels of IFN-γ in the peripheral blood of HGG patients, which reflect the immune function of the patients, were significantly increased after DC immunotherapy (p<0.001).ConclusionsThus, our meta-analysis showed that DC immunotherapy markedly prolongs survival rates and progression-free time, enhances immune function, and improves the efficacy of the treatment of HGG patients.
Highlights
High-grade gliomas (HGGs) have an incidence currently estimated at 14,000 new diagnoses per year, according to the 2007 World Health Organization (WHO) classification, which includes patients with anaplastic astrocytomas (WHO grade III) and with glioblastoma multiforme (GBM, WHO grade IV) [1]
The analysis showed that the proportions of CD3+CD8+ and CD3+CD4+ cells were not significantly increased in the dendritic cells (DCs) group compared with the baseline levels observed before treatment, as reflected by pooled MD values of 21.21 and 20.46 [21,22,24]
The percentages of CD3+CD8+ and CD3+CD4+ T cells and CD16+ lymphocyte cells were not significantly increased in the DC group compared with the baseline levels observed before treatment (p.0.05), but CD56+ lymphocyte cells were significantly increased after DC treatment (p,0.001)
Summary
High-grade gliomas (HGGs) have an incidence currently estimated at 14,000 new diagnoses per year, according to the 2007 World Health Organization (WHO) classification, which includes patients with anaplastic astrocytomas (WHO grade III) and with glioblastoma multiforme (GBM, WHO grade IV) [1]. Several studies have clarified that lymphocytes and antigen-presenting cells (APCs), including macrophages and dendritic cells (DCs), are able to cross the bloodbrain barrier and migrate to a tumor within the brain parenchyma [5]. In phase I and phase II trials, adoptive immunotherapy including lymphokine-activated killer cells (LAK), cytotoxic T lymphocytes (CTLs) and tumor-infiltrating T lymphocytes (TILs) and active immunotherapy using autologous tumor cells (ATCs) and DCs have demonstrated clinical efficacy, suggesting that immunotherapy may be a useful strategy to combat HGGs [6]. To evaluate the therapeutic efficacy of dendritic cells (DCs) alone in the treatment of HGG, we performed a systematic review and metaanalysis in terms of patient survival with relevant published clinical studies
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