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626 Chapter 12: Gene Therapy envision a clinical plan as outlined in Fig. 2. Patients will possess the diagnosis of acute myeloid leukemia, established by peripheral blood and/or bone marrow morphologic and flow cytometric analysis, and be of poor prognosis as determined by adverse cytogenetics. Patients will be entered on study at the time of an initial presentation of a new hematologic malignancy or at the time of presentation with an untreated relapse. A volume of peripheral blood will be obtained, not exceeding 250 mL, which should allow for isolation of approximately 1-10X10 9 blast cells. Blood will be depleted of erythrocytes, and the mononuclear cell component, including the malignant population, will be isolated. Cells will be infected with a VPC comprising a replication incompetent adenoviral vector carrying the CD80 (B7.1) and/or GM-CSF genes. After infection, a sample of the product will be assayed to assess gene transfer efficiency, the ability to stimulate CTLs in vitro, and sterility. The resulting infected tumor cell product will be irradiated and cryopreserved in aliquots, in anticipation of later use as a leukemia vaccine. After standard induction and consolidation chemotherapy, patients whose infected tumor cells generated CTLs in vitro would then begin vaccine therapy. Cryopreserved cells will be thawed and administered using a dose escalation design. Part of the dosing strategy will be to explore the optimal time interval for administration of the vaccine. Objective response to the vaccine will be assessed by assays for cytolytic T cell populations specific for the tumor clone. Overall and disease-free survival will be calculated from the date of accrual. Major endpoints of this clinical trial include safety to patients, monitoring qualitative and quantitative immune function, inducing tumor-specific CTLs, and assessing time to relapse. Clinical Implementation Plan AML patient 1 — Standard Therapy 1 Immune Reconstitution 1 Vaccinate I • Safety •CTL induction •Time to relapse ==- 250 mis Blood VPC infect Recovery Irradiate Cryopreserve 12-24 hour processing In vitro testing: •Gene transfer •Immunology •safety Figure 2. Clinical implementation plan for the use ofVPCs to generate gene-modified tumor cell vaccines.
Jordan et al. In preclinical studies, the only apparent shortcoming of this approach was that permanent cures were limited to instances in which tumor burden was relatively low. Thus, this strategy appears ideal in the context of an adjuvant setting, where tumor remission has already been induced by standard chemotherapy. In this scenario, the tumor-specific CTLs that are induced by the vaccine are only required to maintain a state of remission rather than attack an advanced malignancy. Furthermore, because tumor cells that do regrow in a relapsed leukemia patient are more likely to be drug resistant than cells that occur at presentation, 21 an induced CTL response may be particularly useful in this context. Finally, leukemia is also a potentially good general model for immunotherapy because, as a liquid tumor, it allows easy access to large numbers of tumor cells and lymphocytes. This feature allows for a variety of ex vivo manipulations. REFERENCES 1. Rosenberg SA: Kamofsky Memorial Lecture. The immunotherapy and gene therapy of cancer. J Clin Oncol 10:180-199,1992. 2. Schwartzentruber DJ, Horn SS, Dadmarz R, White DE, Yannelli JR, Steinberg SM, Rosenberg SA, Topalian SL: In vitro predictors of therapeutic response in melanoma patients receiving tumor-infiltrating lymphocytes and interleukin-2. J Clin Oncol 12:1475-1483,1994. 3. Rosenberg SA, Yannelli JR, Yang JC, Topalian SL, Schwartzentruber DJ, Weber JS, Parkinson DR, Seipp CA, Einhorn JH, White DE: Treatment of patients with metastatic melanoma with autologous tumor-infiltrating lymphocytes and interleukin 2. J Nad Cancer Inst 86:1159-1166, 1994. 4. Mitchell MS: Active specific immunotherapy of melanoma. Br Med Bull 51:631-646, 1995. 5. Baskar S: Gene-modified tumor cells as cellular vaccine. Cancer Immunol Immunother 43:165-173, 1996. 6. Roth JA, Cristiano RJ: Gene therapy for cancer: What have we done and where are we going? J Natl Cancer Inst 89:21-39, 1997. 7. Dunussi-Joannopoulos K, Weinstein HJ, Arceci RJ, Croop JM: Gene therapy with B7.1 and GM-CSF vaccines in a murine AML model. / Pediatr Hematol Oncol 19:536-540, 1997. 8. Hirano N, Takahashi T, Takahashi T, Azuma M, Yazaki Y, Yagita H, Hirai H: Protective and therapeutic immunity against leukemia induced by irradiated B7-1 (CD80)-transduced leukemic cells. Leukemia 11 (Suppl 3):577-581,1997. 9. Yannelli JR, Hyatt C, Johnson S, Hwu P, Rosenberg SA: Characterization of human tumor cell lines transduced with the cDNA encoding either tumor necrosis factor alpha (TNF- a) or interleukin-2 (IL-2). J Immunol Methods 161:77-90, 1993. 10. Hwu P, Yannelli J, Kriegler M, Anderson WF, Perez C, Chiang Y, Schwarz S, Cowherd R, Delgado C, Mule J: Functional and molecular characterization of tumor-infiltrating lym phocytes transduced with tumor necrosis factor-alpha cDNA for the gene therapy of can- 627
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AUTOLOGOUS BLOOD AND MARROW TRANSPL
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AUTOLOGOUS BLOOD AND MARROW TRANSPL
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ACKNOWLEDGMENTS We wish to thank Wi
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THE VAN BEKKUM STEM CELL AWARD Prof
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xii Table of Contents CHAPTER 2: AL
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xiv Table of Contents Late Non-Rela
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xvi Table of Contents Pretreatment
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xviii Table of Contents CHAPTER 7:
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XX Table of Contents Long-Term Obse
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xxii Table of Contents CHAPTER 13:
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0-9 LIST OF ABBREVIATIONS 2CDA 2-ch
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List of Abbreviations xxvii EFS eve
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List of Abbreviations MOPP mechlore
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VOD veno-occlusive disease VPC viru
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4HC-Purged Autologous Stem Cell Tra
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1.0-1 + 0.2 Miller et al. 5 Event F
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Miller et al. Adjusted probability
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Who Benefits From Autograft in AML
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Burnett 11 which to set the transpl
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Table 1. Outcome after relapse in M
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Immunotherapy in AML: No Positive E
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Simonsson et al. inhibit IL-2 induc
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Autologous Bone Marrow Transplantat
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Ball et al. 21 CD15) and AML-2-23 (
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Ball et al. 23 The ex vivo treatmen
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Ball et al. 25 Table 2. Factors inv
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Ball et al. Overall Survival for Pa
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Ball et al. Overall Survival for Pa
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Ball et al. 31 Overall Survival for
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Ball et al. Table 4. Actuarial over
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Ball et al. myeloid leukemia. The G
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Ball et al. 1993. 38. Mehta J, Powl
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Can Autologous Stem Cell Transplant
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De Witte et al. 41 novo AML. Auer r
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De Witte et al. hematopoietic engra
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De Witte et al. 23. Fenaux P, Laï
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Stein et al. and fever. No patient
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Stein et al. after doses 1, 3, and
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Stein et al. early after the transp
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autologous stem-cell rescue. / Clin
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Bone Marrow Transplantation for Acu
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Table 2. Autologous BMT in ALL in f
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Rowe 61 or adult patients with acut
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Hoelzer and Gôkbuget minitransplan
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Hoelzer and Gdkbuget 65 blood, earl
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Table 3. Risk factors for the defin
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Hoelzer and Gôkbuget treatment opt
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Hoeker and Gökbuget tical sibling
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Sierra et al. INTRODUCTION Two-thir
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Sierra et al. Table 2. Adverse char
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1,0 0,0 J Sierra et al. 0 20 40 60
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Sierra et al. Months Figure 4 < 30,
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Sierra et al. No adverse factors (n
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1994. Sierra et al. 83 10. Canals C
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Martin, Atta, and Hoelzer 85 adult
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Martin, Atta, and Hoelzer 87 Single
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100. Martin, Atta, and Hoelzer 89 P
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Martin, Atta, and Hoelzer 91 chromo
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Autologous vs. Unrelated Allogeneic
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Boyer and Yeager 95 outcomes after
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Boyer and Y eager 97 Table 2. Hypot
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Boyer and Y eager SUMMARY Most of t
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CHAPTER 3 CML
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Autograft Followed by Allograft Wit
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106 Chapter 3: CML (one low-grade a
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108 Chapter 3: CML DISCUSSION Myelo
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110 Chapter 3: CML Philadelphia-neg
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The Case for Manipulation of CML Au
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Toward a Cure by Drug Treatment? Th
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116 Chapter 3 :CML Table 1. Prolong
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118 Chapter 3: CML Table 3. German
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120 Chapter 3: CML Table 5. Normal
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122 Chapter 3: CML Table 8. Surviva
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124 Chapter 3: CML 88:3118-3122, 19
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126 Chapter 3: CML RK, Klingemann H
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The Tyrphostin AG957 Inhibits the I
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130 Chapter 3: CML mobilization. Al
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132 Chapter 3: CML A B 100 n 0 1 5
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134 Chapter 3: CML The in vitro sel
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136 Chapter 3: CML detecting leukem
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Progressive Hodglcin's Lymphoma Fol
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Reece et al. survival is observed i
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0.2 -I 0.0 0 Reece et al. 143 ii i
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Reece et al. Table 3. Causes of non
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Reece et al. carmustine, etoposide
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CD34 + Selection of Hematopoietic B
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Lazarus et al. 151 significantly de
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Lazarus et al. 153 (Sigma, St Louis
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Lazarus et al. 155 Table 2. Effect
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Lazarus et al. 157 difference. Furt
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Lazarus et al. 159 cells after myel
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The European CUP/UP Trial: A Prelim
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Table 1. Patient characteristics at
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Schouten et al. licular non-Hodgkin
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Sweetenham et al. vs. autologous pe
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Table 1. Patient characteristics, g
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Table 2. Patient characteristics, g
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Table 3. Sites of relapse, group A
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Table 4. Patterns of relapse, group
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A 100 80 %OS 60 40 20 B 100 %OS | S
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Sweetenham et al. new sites, and fi
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Sweetenham et al. Treatment options
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Molecular Remission: A Worthwhile A
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Early or Late Autotransplant in Hig
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Schenkein et al. 187 PATIENTS AND M
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Schenkein et al. 189 Toxicity Toxic
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Schenkein et al. 191 16. Glick JH,
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Santini et al. 193 to evaluate the
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Table 1. Continued Santini et al. 1
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Santini et al. 197 cytosine arabino
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1 0 0 1 90- 80- 70- (0 u. 60' o so-
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Hodgkin's lymphoma. N EnglJ Med 333
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CHAPTER 5 MYELOMA
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206 Chapter 5: Myeloma independent
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208 Chapter 5: Myeloma disease (MRD
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210 Chapter 5: Myeloma Scandinavia,
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212 Chapter 5: Myeloma (0 n o B co
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214 Chapter 5: Myeloma B cq d ? o c
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216 Chapter 5: Myeloma patients wit
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218 Chapter 5: Myeloma PBSC transpl
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220 Chapter 5: Myeloma 25. Seiden M
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Autologous Transplantation in Multi
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224 Chapter 5: Myeloma 0 52 44 U §
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226 Chapter 5: Myeloma BM ^ (CD34±
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228 Chapter 5: Myeloma IFM 94 : OS
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230 Chapter 5: Myeloma two groups a
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232 Chapter 5: Myeloma increase bot
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234 Chapter 5: Myeloma REFERENCES 1
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236 Chapter 5: Myeloma Intensified
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238 Chapter 5: Myeloma of CD34 + ce
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Chapter 5: Myeloma Table 2. Descrip
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242 Chapter 5: Myeloma o 8H 0 2 4 6
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244 Chapter 5: Myeloma ated with sh
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The Presence of Micrometastases in
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Kvalheim et al. 249 Table 1. Immuno
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Kvalheim et al. 251 Figure 1. Sixty
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Kvalheim et al. 253 DISCUSSION In t
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Kvalheim et al. 255 Bastert G: Micr
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Hood et al. 257 In an effort to inc
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#CD34 + cells in blood = Hood et al
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Hood et al. 261 Table 3. Frequency
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Hood et al. 263 REFERENCES 1. Rill
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The Clinical Significance of Breast
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Moss et al. tests, and bilateral po
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Moss et al. 269 0 15 70 143 200 400
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Moss et al. 271 0 3 6 12 18 24 30 3
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Moss et al. 273 8. Passos-Coelho J,
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Autotransplantation for Men With Br
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McCarthy et al. 277 radiation, two
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High Dose Sequential Chemotherapy W
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Viens et al. 281 3 g/m 2 and doxoru
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Table 1. Tumor characteristics Exte
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Table 4. Response Viens et al. 285
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Viens et al. 287 Table 5. Pathologi
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Viens et al. 289 apy for inoperable
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Gliick et al. 291 INTRODUCTION The
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Gluck et al. 293 RESULTS Patient de
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Glück et al. 295 Table 3. Response
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Gluck et al. 297 Overall Survival O
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Gluck et al. 299 Sudbury patients w
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Gluck et al. 301 anthracycline or t
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Repetitive High-Dose Therapy With P
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Prince et al. paramagnetic separati
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Prince et al. Table 1. High-dose re
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Table 2. Patient characteristics (n
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Table 4. Hematopoietic recovery fol
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1.0- M C .S 0.8- a c *fe o o> 0.6-
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M 1.0 I 0.8H s? VI o.6H S 0.2 0.0 P
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a Prince et al. days to platelets >
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Table 5. Results of Isolex 300i CD3
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Prince et al. 321 Figure 5, continu
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Prince et al. 323 months after tran
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Prince et al. 325 excessive to be u
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Prince et al. 327 eight patients ha
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Prince et al. 329 marrow transplant
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Prince et al. intensive chemotherap
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-Q CO .Q O 1.0 0.9 0.8 0.7 0.6 0.5
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.Q CD .Q O 1.0 0.9 0.8 0.7 0.6 0.5
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oba Q. 1.0 0.9 Dicke et al. Stage I
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Vahdat with peripheral blood progen
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Evaluation of Prognostic Factors fo
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Fields et al. 343 PATIENTS AND METH
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Table 1. Chemotherapy regimens. Fie
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Fields et al. Stage II; 4-9 Pos LN
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U U Fields et al.
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Fields et al. 351 between 1 and 2 y
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European Trends and the EBMT Databa
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25% % 22% / 17% \ Rosti et al. 355
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Rosti et al. 357 The new Italian St
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Rosti et al. 6. Haas R, Schmid H, H
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Bewick et al. 363 INTRODUCTION The
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Bewick et al. 365 Blood samples obt
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Bewick et al. 367 HDCT with ABSC su
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Bewick et al. Progression Free Surv
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Bewick et al. pression in MBC, i.e.
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Bewick et al. 14. Kandl HL, Seymour
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CHAPTER 7 OTHER SOLID TUMORS
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378 Chapter 7: Solid Tumors INTRODU
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380 Chapter 7: Solid Tumors Prepara
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382 Chapter 7: Solid Tumors Surviva
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384 Chapter 7: Solid Tumors months
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386 Chapter 7: Solid Tumors have be
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High-Dose Chemotherapy in the Manag
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390 Chapter 7: Solid Tumors followe
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392 Chapter 7: Solid Tumors Table 1
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394 Chapter 7: Solid Tumors (mucosi
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Three-Fold Intensification by Seque
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High-Dose Therapy for Small Cell Lu
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404 Chapter 7: Solid Tumors chemoth
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406 Chapter 7: Solid Tumors SCLC ha
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408 Chapter 7: Solid Tumors relapse
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410 Chapter 7: Solid Tumors 69:585-
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412 Chapter 7: Solid Tumors ogous b
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414 Chapter 7: Solid Tumors 64. Bru
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416 Chapter 7: Solid Tumors Prignot
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418 Chapter 7: Solid Tumors CO > CO
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420 Chapter 7: Solid Tumors TANDEM
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Multiple Courses of Cyclophosphamid
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424 Chapter 7: Solid Tumors and the
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426 Chapter 7: Solid Tumors Thiotep
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430 Chapter 7: Solid Tumors E 100 0
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432 Chapter 7: Solid Tumors course
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434 Chapter 7: Solid Tumors boplati
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436 Chapter 7: Solid Tumors INTRODU
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438 - Chapter 7: Solid Tumors Table
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440 Chapter 7: Solid Tumors seeded
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442 Chapter 7: Solid Tumors DISCUSS
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444 Chapter 7: Solid Tumors 10. Di
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446 Chapter 7: Solid Tumors plasma
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Autologous Stem Cell Transplantatio
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Keystone 451 hypertension, anemia,
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Fassas et al. 453 INTRODUCTION Mult
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Fassas et al. Table 2. Stem cell mo
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Table 3. Toxicity after stem cell i
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Fassas et al. Table 5. Trial 1: cha
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Fassas et al. MS PROGRESSION FREE S
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Fassas et al. ic or autologous bone
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1 2 1 6 EAE. Burt et al. 465 Becaus
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Burt et al. Since cyclophosphamide
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Burt et al. 469 toxicity study, we
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Burt et dl. All 23. Mor F, Cohen IR
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Hasler, Gratwohl, and Tyndall an ev
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Hasler, Gratwohl, and Tyndall 475 B
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Kuis, Wulffraat, and Sanders 477 st
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Kuis, Wulffraat, and Sanders neousl
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CHAPTER 9 LONG-TERM EFFECTS
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484 Chapter 9: Long-Term Effects po
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486 Chapter 9: Long-Term Effects Ta
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488 Chapter 9: Long-Term Effects ml
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490 Chapter 9: Long-Term Effects 4.
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492 Chapter 9: Long-Term Effects us
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494 Chapter 9: Long-Term Effects AB
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498 Chapter 9: Long-Term Effects En
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500 Chapter 9: Long-Term Effects Rl
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502 Chapter 9: Long-Term Effects RE
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504 Chapter 9: Long-Term Effects A,
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Long-Term Follow-Up of Autologous T
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CHAPTER 10 GRAFT MANIPULATION
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514 Chapter 10: Graft Manipulation
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Stem Cell Reinfusion Over Two Conse
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Page 610 and 611: 576 Chapter 10: Graft Manipulation
Page 614 and 615: Final Report of the First Prospecti
Page 635 and 636: Canine Hematopoietic Stem Allograft
Page 637 and 638: Sandmaier et al. 603 The resultant
Page 639 and 640: Sandmaier et al. 605 synthesis path
Page 641 and 642: Sandmaier et al. 607 interactions o
Page 643 and 644: Sandmaier et al. 1991. 2. Burchenal
Page 645 and 646: 87:3508-3513,1996. Sandmaier et al.
Page 647 and 648: Giralt, Khouri, and Champlin Table
Page 649 and 650: Giralt, Khouri, and Champlin seven
Page 651 and 652: 1.0 3 0.2 Giralt, Khouri, and Champ
Page 653: CHAPTER 12 GENE THERAPY
Page 656 and 657: 622 Chapter 12: Gene Therapy INTROD
Page 658 and 659: 624 Chapter 12: Gene Therapy RESULT
Page 662 and 663: 628 Chapter 12: Gene Therapy cer in
Page 664 and 665: A Vaccine of Melanoma Peptide Loade
Page 667 and 668: B43(anti-CD 19)-Gen i stein Immunot
Page 669 and 670: Targeting Immunotherapy for the Tre
Page 671 and 672: McGuinness andArceci 637 modified m
Page 673 and 674: McGuinness andArceci 639 leukemic c
Page 675 and 676: McGuinness and Arced 641 in G418. T
Page 677 and 678: McGuinness andArceci 643 Figure 2
Page 679 and 680: mRNA for hB7-1 (1491 bp) mRNA for C
Page 681 and 682: McGuinness and Arced CD80PE C080PE
Page 683 and 684: McGuinness andArceci 649 8. Robert
Page 685 and 686: McGuinness andArceci immune respons
Page 687 and 688: McGuinness andArceci 75. Jubinsky F
Page 689 and 690: Slavin et al. 655 up suggests, as p
Page 691 and 692: Slavin et al. 657 was a phase lib c
Page 693 and 694: Slavin et al. presented, appears to
Page 695 and 696: Antitumor Immunotherapy in Autologo
Page 697 and 698: Klingemann et al. 663 Table 3. Meth
Page 699: CHAPTER 14 RADIOIMMUNOTHERAPY
Page 702 and 703: 668 Chapter 14: Radioimmunotherapy
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676 Chapter 14: Radioimmunotherapy
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Selection of Radioisotopes, Chelate
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Radioimmunotherapy of Common Epithe
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CHAPTER 15 NEW AVENUES
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698 Chapter 15: New Avenues Table 1
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700 Chapter 15: New Avenues An alte
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702 Chapter 15: New Avenues who can
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704 Chapter 15: New Avenues myeloid
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706 Chapter 15: New Avenues 48. Gir
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Emerging Viral Infections in Blood
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710 Chapter 15: New Avenues influen
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712 Chapter 15: New Avenues Among a
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714 Chapter 15: New Avenues physica
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716 Chapter 15: New Avenues respira
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Minimal Therapy Models of Transplan
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CHAPTER 16 SUMMARIES
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724 Chapter 16: Summaries although
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726 Chapter 16: Summaries use of po
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728 Chapter 16: Summaries Table 1.
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736 Chapter 16: Summaries IL-15. Th
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738 Chapter 16: Summaries Patterns
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740 List of Participants Thomas L.
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742 List of Participants Sergio A.
Page 778 and 779:
744 List of Participants Hans Marti
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746 List of Participants David P. S
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748 List of Participants AUTHOR IND
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750 Author Index Hurd, D.D. 483 Kui
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752 Author Index Stiff, Patrick J.
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754 Key Word Index Hematologic mali
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ISBN 1-891524-04-6
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