Frequently Asked Questions

For many people, the word "dendritic cells" does not mean anything or very little. But the dendritic cells are an important part of our immune system and every human being and every vertebrate normally has this type of cell. Their task is to recognise foreign structures (such as tumour cells) and to stimulate their destruction by the body's own immune system. Tumours can grow when degenerated tumour cells are no longer recognised as abnormal by the dendritic cells in the body. The in vitro cultivation of dendritic cells from cells of the patient's blood in the laboratory can dissolve this immune deficiency.

If your animal develops a tumour, then the immune system, including the dendritic cells in your animal, no longer works properly. They do not recognise the tumour cells as foreign and do not stimulate their destruction, but instead tolerate the tumour cells and their further growth.

In the clean room laboratory, the dendritic cells are allowed to develop in their natural form again without the effects of the tumour and can thus perform their important tasks in the immune system as intended by nature. These are: to recognize all foreign and degenerate cells in the body and to immediately start a proper immune reaction against them.

In principle, any tumour can be treated. This also applies if the tumour has already grown very strongly or has already formed metastases. In principle, the use of dendritic cell therapy should be considered in the treatment of tumour patients, regardless of the type of tumour and the organ affected. As the animal's own immune system is used and increased, a positive reaction can be seen or diagnosed in a lot of treatments.

For the planned treatment with dendritic cells we always need fresh whole blood (not centrifuged and not frozen). This is the basis of dendritic cell therapy. We separate the so-called precursor cells (monocytes) from the whole blood. These develop further with the addition of various cytokines (growth-regulating proteins) to the dendritic cells.

No, this is not necessary. There are several reasons against the basic use of tumour lysate. In the case of inoperable tumours, no tumour material can be obtained (e.g. lung tumour). The tumour tissue is often inserted in formalin. Or the tumor material is contaminated by (small amounts of) germs.

For the dendritic cell therapy we only need fresh whole blood from the patient.

1. Your veterinarian will receive a starter kit with all materials and information for the first blood sample (required amount of blood is approx. 1 ml per kg body weight). Your veterinarian will also be provided with a transport box in which the samples can be transported protected and refrigerated.
2. You arrange a blood collection appointment with your veterinarian and inform us as early as possible so that we can assign an express courier to collect the blood samples on the day of collection.
3. As soon as we receive the samples, they are immediately checked for completeness, minimum quantity and visible contamination. The processing of the cells can already begin and takes place within a fixed time frame.
4. The finished vaccination will be delivered to your veterinarian by express courier 8 days after blood collection (for cats) or 9 days after blood collection (for dogs and horses) and must be vaccinated on the day of arrival.

With many animals for different reasons, e.g.

• Your wish as a patient owner
• Size of the tumor
• formation of metastases in other organs
• Age or condition (disease of other organs, e.g. heart, liver, kidney in addition)

no more surgical procedures are performed. In these cases, the dendritic cell therapy can also be used palliatively. The strengthening of the immune system through the treatment often leads to a reduction in the size of the tumour and thus to a significant improvement in the patient's quality of life. This is especially true for unresectable tumours in the thorax and abdominal region. On the other hand, a surgical intervention to remove the tumour is occasionally possible again by reducing the size of the tumour tissue.

Please have all removed tumours examined in the laboratory, even if you and your vet are sure it is a benign tumour. Only the examination in the specialised laboratory can give you final certainty.

Even small changes can have a big impact on your medical history later on, which is why it is so important to gather a lot of information.

In many cases, you as the patient owner will receive the histological report, i.e. the laboratory examination of the tumour a few days after the surgery, explained by your veterinarian. It is often stated in these findings that the tumour could not be removed "in clean tissue" or that the edges of the tumour were "not clean". This means that it cannot be ensured that the entire tumour has been removed, i.e. that the tumour has been removed incompletely or very close to healthy tissue.

The incomplete removal can have different causes:

• The tumour was so large that a complete removal would have put too much strain on your patient, for example because complications in wound healing (too large wound or a wound surface that is difficult to control) could be expected.
• The tumour is located on an organ in your patient that does not have sufficient tissue to completely remove the tumour with sufficient "safety distance". This is often the case, for example, if a tumour occurs in the facial area or on the legs. Comprehensive removal may also be possible for internal organs.
• Metastases are already present which cannot be detected or removed during the examination.

Often we are asked how to proceed when

• the tumour tissue could not be removed with clean margins or
• if only a size reduction of the tumour mass was possible.

In these cases, dendritic cell therapy is a suitable treatment option as it draws the immune system's attention to the tumour cells remaining in the patient's body and specifically combats them. Contact us if you are unsure what the laboratory findings of your patient tell you exactly and how you can deal with them.

Due to many years of experience with dendritic cell therapy in the treatment of dogs, cats and horses suffering from tumours, a first application is recommended very quickly after surgery or tumour diagnosis. After a short time, the first success of the treatment can be assessed. In most cases there is an improvement of the general condition, a shrinkage of the residual tumour tissue and/or a good healing of the surgical wound. In order to further strengthen the immune reaction of the body, three treatments in a monthly interval have generally proved successful. This stimulates a sufficient immune reaction that builds up.

Especially in the case of tumours with a strong tendency to recurrence, we recommend regular repetition of dendritic cell therapy at intervals of three to six months.

In the case of sarcoids of horses, further applications must be decided on the basis of the degree of healing. If you, as the owner, notice a slight reduction in the general quality of life of your animals after a few months, then post-treatment with dendritic cells would also be advisable in this case.

Dr. Thomas Grammel will also advise you and your veterinarian between applications at any time if you have any questions about the effect of the treatment.

Depending on the localisation of the tumour, the application is preferably carried out near the nearest lymph nodes, since the dendritic cells after which they have recognised the tumour cells migrate to the nearest lymph node and initiate an immune reaction. The application is very gentle, typically your patient does not need to be anaesthetised or sober.

Your veterinarian will receive specific instructions from Dr. Thomas Grammel on how to apply the cells. The type of application is individually adapted to each patient.

The dendritic cells should be applied shortly after their production in the laboratory. An express transport company is used to get the cells to your veterinarian as quickly as possible. During transport and until use, the cells are stored in a cool place. You should therefore make an appointment with your veterinarian for the day the cells arrive. The date of arrival of the cells is coordinated with your veterinarian.

Dendritic cell therapy can be very well combined with homeopathy, dietary supplements and painkillers. For some types of tumours, irradiation is an effective support to fight the tumour. This influences the surface of the tumour cells to such an extent that they become more vulnerable to the immune cells.

Please discuss individual treatment steps and forms with your veterinarian. Immunological therapy with dendritic cells may inhibit alternative treatment concepts. In cooperation with your veterinarian, we will be happy to clarify further information on other supportive therapy options; he has the appropriate scientific documentation. Of course, we are at your disposal for further consultation in order to achieve the optimal care of your four-legged friend.

We have compiled further information here: https://www.immune-therapy.vet/en/vet/accompanying-therapies

A reaction to the applied dendritic cells can occur within a few days (in rare cases even within hours). Immune stimulation by the cells can manifest itself in the form of increased body temperature or noticeably more agility on the part of the patients.

Within 3 weeks after the application it can be observed that solid tumors shrink or separate from the surrounding tissue. In addition, it can be observed that the consistency becomes softer and the tumour tissue detaches from the body or tumour debris is expelled through the skin (fistula formation).

The nutrition of the tumour-stricken animal and good intestinal health also play an important role in achieving an optimal immunological response of the patient. Tumour patients are dependent on a strong immune system and therefore need a high-quality nutrient supply. We have compiled information on this topic under the heading "Nutrition of tumour patients".

The expected therapeutic success depends on the type of tumour and the stage of the tumour in which dendritic cell therapy is initiated. Compared to conventional treatment methods, we can achieve an improvement in the quality of life for your animal with an early diagnosis of the tumour and no to few metastasis, with an increased lifetime.

In a very late tumour stage, dendritic cell therapy as palliative accompanying therapy is a beneficial support in order to be able to say goodbye to your darling in peace with some time gain and less pain and, above all, to achieve quality of life.

In order to give you a realistic assessment, we would like to get to know your patient and his medical history better. Dr. Thomas Grammel is always available to consult and answer your questions about immunological treatment.

As with all seriously ill living beings, a protective vaccination (for example against rabies, distemper or influenza) should also be carefully considered when diagnosing a tumour. During dendritic cell therapy, these can under certain circumstances jeopardize the success of the treatment. Since these vaccinations involve an intervention in the immune system, the immunological effect of dendritic cell therapy can be reduced or destroyed. Therefore, please discuss necessary vaccinations against infectious diseases with your veterinarian. During the treatment period with dendritic cell therapy, we recommend postponing the planned vaccinations.

However, treatments against endo- or ectoparasites (worms) can and must be carried out to the necessary extent.

Please note that the purpose of chemotherapy is the suppression of rapidly dividing cells (tumour cells). However, the treatment also affects other fast-dividing tissues of the animal body (e.g. blood cells, intestinal cells). However, we need the white blood cells for the preparation of our dendritic cell therapy. Therefore, it is always necessary to wait until the blood count (white blood cells) has normalized before starting dendritic cell therapy. Please contact us in any case if your animal is under chemotherapeutic treatment to compensate for the immunosuppressive effect of chemotherapy before starting dendritic cell therapy.

Yes, dendritic cell therapy may be covered by your veterinary insurance.

Just get in touch with us. We will be happy to provide you with a non-binding offer to submit to your health insurance company to check whether the costs will be covered.

After the cells have been cultivated in the clean room laboratory for 6 or 7 days, the cells are harvested. The cells are transferred into a sterile liquid on the day of the cell harvest. This is 2 ml for dogs and cats and 5 ml for horses. The complete cell suspension is applied to your patient so that as many cells as possible can develop their immunostimulating effect.

After the cell harvest, the cells are transferred into a transparent sterile liquid. Since the cells are also relatively colourless (for the naked eye), the cell suspension is transparent or slightly pink.

Fatigue and mild fever may occur in the first few hours after injection. This is the positive sign for your animal: it means that your animal's immune system reacts to the injection.

Approximately between the 10th and 14th day after the treatment there can be a clear reaction in the tumor area, because the immune system attacks tumor cells more intensively. Therefore, a stronger swelling and inflammatory reactions is possible and a sign that the immune system attacks purposefully.

In all cases an anti-inflammatory and analgesic treatment is possible and reduces the symptoms.

You will often find the term "infiltrative" in the pathohistlogical laboratory report for your dog, cat or horse. In the case of a tumour, infiltrative means that the tumour is able to infiltrate surrounding tissue, i.e. to grow into it. In plain language, this means that the tumour overcomes the tissue barriers and spreads into surrounding tissue (muscles, nerves, tendons, bones).

Although these terms sound very similar, in practice they mean something very different:

• Median survival means the time in days when half the animals suffering from the disease died.
• In contrast, the mean survival time is the value in days that the diseased animals lived on average. Here, an animal can have only a few days, other long-term survival.

Please note these two different terms when comparing survival times.

A tumour can form so-called metastases. Metastases are other tumor metastases that occur in addition to the main tumor (also called primary tumor). The different tumour types in dogs, cats and horses form metastases at different speeds. There are tumours that develop mainly locally (e.g. fibrosarcomas). Other types of tumours form metastases first in the lungs, but they can also occur in other internal organs, such as the spleen, liver or heart.

When tumours form metastases, cells migrate from the main tumour to other organs via the bloodstream. There they form new cell islands (micrometastases) and from them a new tumor mass. A biopsy of neighbouring lymph nodes is often used to search for metastases. Unfortunately, metastases only become visible when they have reached a relative size, in an X-ray or ultrasound examination. The tissue type of the main tumor and metastases is often not cell identical. It is therefore therapeutically interesting that the immunological treatment with dendritic cells normally reaches different cell types.

Similarly, if metastases have not yet been found in your animal, the prognosis is better and the chances of a good course of the disease increase with timely treatment.

Recurrence is the recurrence of a tumour. Different types of tumours have different probabilities of recurrence, for example after complete removal. This is also referred to as the "recurrence rate", i.e. the probability that the tumour will recur.

Remission in medicine means the temporary or permanent reduction of disease symptoms. Tumor diseases are divided into the categories:

• minimum/low remission
• partial remission
• total remission

The aim of tumour treatment is to achieve the greatest possible remission of the disease over the longest possible period of time. In publications, the three remission categories together with the number of affected animals and the average duration of the remission are therefore mentioned.

We will work with you to ensure that your animal stays as well as possible for as long as possible. Quality of life is therefore our most important asset. Because only good days are really worth living for the whole family. But how can I clarify for myself whether my animal really has a good quality of life? You can and must discuss this with your family.

Yes, if your veterinarian has no experience with dendritic cell therapy, we offer consultations and training (webinars). In addition, your veterinarian will receive extensive information material for each patient.