Article
Pseudoprogression after dendritic cell vaccination and radiochemotherapy of a GBM patient
Search Medline for
Authors
-
Ann Kristin Schmitz
- Klinik für Neurochirurgie, Heinrich-Heine-Universität, Düsseldorf
-
Karl-Josef Langen
- Institut für Neurowissenschaften und Medizin, Forschungszentrum Jülich, Jülich
-
Oliver M. Grauer
- Klinik für Neurologie, Westfälische Wilhelms-Universität Münster, Münster
-
Michael Sabel
- Klinik für Neurochirurgie, Heinrich-Heine-Universität, Düsseldorf
-
Rüdiger V. Sorg
- Institut für Transplantationsdiagnostik und Zelltherapie, Heinrich-Heine-Universität, Düsseldorf
-
Marion Rapp
- Klinik für Neurochirurgie, Heinrich-Heine-Universität, Düsseldorf
| Published: | June 2, 2015 |
|---|
Outline
Text
Objective: Glioblastoma (GBM) is a high-grade glial tumor with an aggressive clinical course. Despite multimodal treatment approaches, the clinical outcome is dismal and further therapeutic concepts are needed. Vaccination therapy using autologous dendritic cells (DC) has become a promising approach. Here, we present the case of a patient treated with standard radiochemotherapy and DC vaccinations.
Method: After nearly complete tumor resection and concomitant radiochemotherapy with temozolomide, a newly diagnosed 38-year-old bifrontal GBM patient (MGMT promotor methylated) was vaccinated by weekly intradermal injections of 1.5x107 mature DC (81.8 ± 2.7% CD83+) loaded with autologous tumor lysate between concomitant radio/-chemotherapy and intermittent chemotherapy (weeks 6 - 10). Clinical follow-up was performed on a regular basis and contrast MRI and 18F-FET-PET scans were used for monitoring treatment response. Informed consent was given by the patient for this individual treatment scheme.
Results: The post radiation follow-up MRI scan at week 10 was suspicious for a rapid tumor progression according to the RANO criteria, whereas 18-F-FET-PET revealed a reduced tracer uptake, consistent with reactive post-therapeutic alterations. MRI and 18-F-FET-PET diagnostics were repeated after 4 and 8 weeks with similar results. Because of these incongruent findings, surgery was performed, and histopathology identified massive (radio)necrosis with reactive changes. Moreover, activated infiltrating T cells (CD3+,CD4+,CD8+) were observed, suggesting a response to vaccination therapy.
Conclusions: In this case we could demonstrate pseudoprogression with histologically proven (radio)necrosis and infiltrating activated T cells after DC vaccination therapy integrated into standard radiochemotherapy. This case underlines the importance of additional treatment monitoring e.g. by 18F-FET PET for better differention of tumor progression and unspecific postherapeutic changes after immunotherapeutic interventions in GBM patients.
