Immunomonitoring in GD2-positive Wilms tumor immunotherapy. A case report

Over the past decades, survival rate for patients with refractory tumors have been increasing at a very slow. The success of the last decade has been the formation of new classes of drugs – targeting, created to affect certain intracellular molecular targets, as well as immuno-oncological, aimed at surface receptor targets. This article presents a clinical case of a patient with a GD2-positive Wilms tumor who received chemoimmunotherapy using anti-GD2 monoclonal antibodies as reinduction treatment. Within the framework of peripheral blood immunomonitoring, the picture of the main parameters of cellular immunity, as well as their dynamics during treatment, was assessed. During the analysis of the immune status dynamics, all observed parameters associated with an unfavorable outcome, namely the number of regulatory T cells and myeloid suppressor cells, were at low levels. The exception was the absolute neutrophils to lymphocytes ratio, which exceeded the norm by 3–4 times. In addition, after 2 courses of chemoimmunotherapy, the number of NK (CD3^–CD16⁺CD56⁺) and activated HLA^–DR⁺CD8⁺ cells, which are also present in the immunosuppressive lymphocyte cluster, increased. Subsequently, despite an increase in the levels of immunoactivating subpopulations of cells by 1.5–3.0 times (with the exception of γδ T cells), the immunosuppressive pattern of lymphocytes also reacted upward, but the increase in its indicators was not so significant. Again, the exception was regulatory T cells, the number of which tripled. These changes were associated with the progression of the malignant disease. A combination of immuno-oncology agents may need to be considered in the future to enhance T cell effector functions and/or inhibit immunosuppressive pathways. In this context, analyzed systemic immunomarkers in peripheral blood can be used to optimize the combination of chemoimmunotherapy.

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