Complete remission of mantle-cell non-Hodgkin lymphoma with a dendritic cell vaccine

Abstract

Hematol Oncol Stem Cell Ther 2(1) First Quarter 2009 hemoncstem.edmgr.com 302 Non-Hodgkin lymphomas (NHL) include more than 20 different histologic subtypes. The number of cases has doubled in the last 25 years, particularly in elderly patients. In Brazil, NHL represents the fifth most common cancer form with incidence of 55 000 cases a year and the cause of more than 26 000 deaths.1 A rare and aggressive form of NHL is mantle-cell lymphoma (MCL), which is believed to originate from naive B-cells in the mantle zone of lymph nodes and accounts for about 5% to 10% of adult NHL.2 This type of cancer is frequently associated with a t(11;14) translocation3 resulting in overexpression of the cyclin D1 gene, routinely used as a diagnostic marker. Common chemotherapy approaches include rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by stem cell transplantation or rituximab-HyperCVAD (cyclophosphamide, vincristine, doxorubicin, decadron, cytarabine, and methotrexate) followed by observation.4,5 Recent studies in patients with relapsed MCL have shown substantial antitumor activity with single-agent bortezomib, single-agent temsirolimus, and the combination of thalidomide and rituximab. Unfortunately these approaches are not able to cure patients or even promote long-lasting responses without severe toxicity.6-8 We present a case with MCL disease that obtained complete remission following therapy with dendritic cell tumor cell vaccine without the major adverse reactions common in traditional therapies.