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Prepublished online as a Blood First Edition Paper on March 6, 2003; DOI 10.1182/blood-2002-12-3665.

Submitted December 4, 2002
Accepted February 20, 2003
 T cells for immune therapy of patients with lymphoid malignancies
Martin Wilhelm, Volker Kunzmann*, Susanne Eckstein, Peter Reimer, Florian Weissinger, Thomas Ruediger, and Hans-Peter Tony
Medizinische Poliklinik, University of Wuerzburg, Wuerzburg, Germany
Lehrstuhl fuer Lebensmittelchemie, University of Wuerzburg, Wuerzburg, Germany
Institute of Pathology, University of Wuerzburg, Wuerzburg, Germany
* Corresponding author; email: kunzmann_v{at}medizin.uni-wuerzburg.de.
There is increasing evidence that  T cells have potent innate anti-tumor activity. We described previously that synthetic aminobisphosphonates are potent gd T cell stimulatory compounds which induce cytokine secretion (i. e. IFN- ) and cell-mediated cytotoxicity against lymphoma and myeloma cell lines in vitro. To evaluate the anti-tumor activity of  T cells in vivo, we initiated a pilot study of low dose IL-2 in combination with pamidronate in 19 patients with relapsed/refractory low-grade Non-Hodgkin lymphoma (NHL) or Multiple Myeloma (MM). The objectives of this trial were to determine toxicity, the most effective dose for in vivo activation/proliferation of  T cells, and anti-lymphoma efficacy of the combination of pamidronate and IL-2. The first ten patients (cohort A) who entered the study received 90mg pamidronate intravenously (IV) on day 1 followed by increasing dose levels of continuous 24-hour IV infusions of IL-2 (0.25 - 3 x 106 IU/m2) from day 3-8. Even at the highest IL-2 dose level in vivo  T cell activation/proliferation and response to treatment were disappointing with only 1 patient achieving stable disease. Therefore, the next nine patients were selected by positive in vitro proliferation of  T cells in response to pamidronate/IL-2 and received a modified treatment schedule (6-hour bolus IV IL-2 infusions from day 1-6). In this patient group (cohort B) significant in vivo activation/proliferation of  T cells was observed in 5 patients (55%) and objective responses (PR) were achieved in 3 patients (33%). Only patients with significant in vivo proliferation of  T cells responded to treatment indicating that  T cells might contribute to this anti-lymphoma effect. Overall, administration of pamidronate and low dose IL-2 was well tolerated. In conclusion, this clinical trial demonstrates, for the first time, that  T cell-mediated immunotherapy is feasible and can induce objective tumor responses.

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