Safety and efficacy of autologous whole cell vaccines in hematologic malignancies: A systematic review and meta‐analysis. Issue 4 (8th May 2021)

• Record Type: Journal Article
• Authors: Bastin, Donald J.; Khan, Sarwat T.; Montroy, Joshua; Kennedy, Michael A.; Forbes, Nicole; Martel, Andre B; Baker, Laura; Gresham, Louise; Boucher, Dominique M.; Wong, Boaz; Shorr, Risa; Diallo, Jean‐Simon; Fergusson, Dean A.; Lalu, Manoj M.; Auer, Rebecca C.; Kekre, Natasha
• Is Part Of: Hematological oncology. Volume 39:Issue 4(2021)
• Page Start: 448
• Page End: 464
• Publication Date: 2021-05-08
• Subjects: active specific immunotherapy -- autologous cancer vaccines -- cancer immunotherapy -- hematologic cancers -- systematic review -- whole cell cancer vaccines; Hematological oncology -- Periodicals; Hematology; Medical Oncology; 616.99418005
• DOI: 10.1002/hon.2875
• Languages: English
• ISSNs: 0278-0232

Abstract

Abstract: 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. Key points: Autologous whole cell cancer vaccines appear to be safe for the treatment of hematologic malignancies. Heterogeneity of the limited number of early phase clinical studies limited the ability to determine efficacy of these vaccines.