Oncoquest-L Vaccine in Patients With Previously Untreated Stage III or IV, Asymptomatic, Non-bulky Follicular Lymphoma

This is a single-arm open-label pilot Phase II study. Following informed consent, eligible
subjects will undergo excisional biopsy of a lymphoma-containing lymph node for diagnosis and
for generation of the Oncoquest-L vaccine. Patients will receive subcutaneous injections
consisting of their autologous tumor-derived Oncoquest-L vaccine starting at approximately 4
to 8 weeks after the biopsy. The first two doses will be given at a 2-week interval and the
remaining 3 doses at monthly intervals. Patients will be monitored for response by performing
imaging studies at baseline and 1 month after the fifth vaccination (Week 19). Additional
imaging studies will be performed every 3 months for the first year and every 6 months during
the second year until relapse or disease progression whichever occurs sooner.

Inclusion Criteria:

1. Follicular lymphoma (FL) grade 1, 2, or 3a diagnosed within 12 months of study
enrollment

2. Age ≥ 18 years

3. Previously untreated Stage III or IV FL

4. A single peripheral lymph node of at least 1 x 1 cm in size accessible for excisional
biopsy

5. Measurable or evaluable disease after obtaining tissue for vaccine production

6. Performance status (ECOG) of 0 or 1

7. Asymptomatic disease without B symptoms or severe pruritus

8. Low tumor burden as defined by the following criteria:

- Normal lactic dehydrogenase

- Largest tumor mass < 7 cm

- Involvement of < 3 nodal sites with a diameter ≥ 3 cm

- No clinically significant pleural effusion or ascites

- Spleen size of ≤ 16 cm by CT scan

- Circulating tumor cells < 5.0 x 109/L

- No clinically significant organ compression

9. Adequate hematopoietic parameters:

- Absolute neutrophil count ≥ 1.5 x 109/L

- Platelet count ≥ 100 x 109/L

- Hemoglobin ≥ 10 g/dL

10. Serum creatinine ≤ 2 x upper limit of normal (ULN)

11. Total bilirubin ≤ 2 x ULN unless considered secondary to Gilbert's syndrome. Aspartate
aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase ≤ 2 x ULN

12. Fertile patients must use effective contraception during and for 12 months after
completion of therapy

13. For fertile female patients, a negative pregnancy test result at enrollment

Exclusion Criteria:

1. Active HIV, hepatitis B, hepatitis C or other active infectious process

2. Pregnant or nursing women

3. Patients with previous history of malignancy within the past 2 years except curatively
treated squamous or basal cell carcinoma of the skin or curatively treated carcinoma
in situ of the cervix.

4. Any medical or psychiatric condition that in the opinion of the principal investigator
would compromise the patient's ability to tolerate this treatment

5. Concurrent treatment with immunosuppressive therapy