Safety and efficacy of autologous whole cell vaccines in hematologic malignancies: A systematic review and meta-analysis.

Autor: Bastin DJ; Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.; Schulich School of Medicine, Western University, London, ON, Canada., Khan ST; Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada., Montroy J; Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada., Kennedy MA; Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada., Forbes N; Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada., Martel AB; Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.; Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.; Faculty of Medicine, University of Ottawa, Ottawa, Canada.; Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada., Baker L; Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada., Gresham L; Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada., Boucher DM; Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.; Faculty of Medicine, University of Ottawa, Ottawa, Canada.; Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada., Wong B; Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.; Faculty of Medicine, University of Ottawa, Ottawa, Canada.; Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada., Shorr R; Learning Services, The Ottawa Hospital, Ottawa, ON, Canada., Diallo JS; Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.; Faculty of Medicine, University of Ottawa, Ottawa, Canada.; Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada., Fergusson DA; Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada.; Faculty of Medicine, University of Ottawa, Ottawa, Canada.; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada., Lalu MM; Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada.; Faculty of Medicine, University of Ottawa, Ottawa, Canada.; Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.; Regenerative Medicine Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Auer RC; Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.; Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.; Faculty of Medicine, University of Ottawa, Ottawa, Canada.; Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada., Kekre N; Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.; Faculty of Medicine, University of Ottawa, Ottawa, Canada.; Department of Medicine and The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
Jazyk: angličtina
Zdroj: Hematological oncology [Hematol Oncol] 2021 Oct; Vol. 39 (4), pp. 448-464. Date of Electronic Publication: 2021 May 08.
DOI: 10.1002/hon.2875
Abstrakt: Autologous cell vaccines use a patient's tumor cells to stimulate a broad antitumor response in vivo. This approach shows promise for treating hematologic cancers in early phase clinical trials, but overall safety and efficacy remain poorly described. We conducted a systematic review assessing the use of autologous cell vaccination in treating hematologic cancers. Primary outcomes of interest were safety and clinical response, with secondary outcomes including survival, relapse rate, correlative immune assays and health-quality related metrics. We performed a search of MEDLINE, Embase and the Cochrane Register of Controlled Trials including any interventional trial employing an autologous, whole cell product in any hematologic malignancy. Risk of bias was assessed using a modified Institute of Health Economics tool. Across 20 single arm studies, only 341 of 592 enrolled participants received one or more vaccinations. Primary reasons for not receiving vaccination included rapid disease progression/death and manufacturing challenges. Overall, few high-grade adverse events were observed. One death was reported and attributed to a GM-CSF producing allogeneic cell line co-administered with the autologous vaccine. Of 58 evaluable patients, the complete response rate was 21.0% [95% CI, 10.4%-37.8%)] and overall response rate was 35.8% (95% CI, 24.4%-49.0%). Of 97 evaluable patients for survival, the 5-years overall survival rate was 64.9% (95% CI, 52.6%-77.2%) and disease-free survival was 59.7% (95% CI, 47.7%-71.7%). We conclude that, in hematologic malignancies, based on limited available data, autologous cell vaccines are safe and display a trend towards efficacy but that challenges exist in vaccine manufacture and administration.
(© 2021 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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