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Immunological responses in a patient with glioblastoma multiforme treated with sequential courses of temozolomide and immunotherapy: case study. 2008
Amy B Heimberger, and
Wei Sun, and
S Farzana Hussain, and
Mahua Dey, and
Lamonne Crutcher, and
Ken Aldape, and
Mark Gilbert, and
Samuel J Hassenbusch, and
Raymond Sawaya, and
Bob Schmittling, and
Gary E Archer, and
Duane A Mitchell, and
Darell D Bigner, and
John H Sampson
Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA. aheimber@mdanderson.org
Cytotoxic chemotherapy that induces lymphopenia is predicted to ablate the benefits of active antitumor immunization. Temozolomide is an effective chemotherapeutic agent for patients with glioblastoma multiforme, but it induces significant lymphopenia. Although there is monthly fluctuation of the white blood cell count, specifically the CD4 and CD8 counts, there was no cumulative decline in the patient described in this case report. Depriving patients of this agent, in order to treat with immunotherapy, is controversial. Despite conventional dogma, we demonstrated that chemotherapy and immunotherapy can be delivered concurrently without negating the effects of immunotherapy. In fact, the temozolomide-induced lymphopenia may prove to be synergistic with a peptide vaccine secondary to inhibition of regulatory T cells or their delayed recovery.
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