Expression of oncofetal antigens by murine and human normal cells in tissue culture

Normal mouse tissues in tissue culture express fetal antigens that are not expressed on these same tissues in vivo. The fetal antigens expressed on normal mouse cells in vitro are also expressed on at least two murine sarcomas, and account for the cross-reactive antibodies between these tumors. The fetal antigens are distinct from unique tumor-specific antigens found on these neoplasms. Normal human cells in tissue culture also express antigens found in human fetuses during the first trimester of pregnancy. Many human sera contain natural antibodies directed against the fetal antigens appearing in vitro. The expression of oncofetal antigens by normal cells in tissue culture must be taken into account in the interpretation of results of studies in tumor immunology in which tissue-cultured cells are utilized.

Hematologic neoplasia in patients treated for Hodgkin's disease

We studied 680 patients with Hodgkin's disease, treated at Stanford University Medical Center from July 1, 1968, through December 31, 1975, to determine the risk of development of hematologic neoplasia. Six cases of leukemia occurred in patients in clinical remission, one 7 1/2 years after diagnosis. Two additional cases occurred in patients with active Hodgkin's disease. No cases were seen in 320 patients treated with radiotherapy alone or in 30 treated with chemotherapy alone. A single case of subacute leukemia occurred in a patient treated initially with radiation therapy and colloidal gold. The actuarial probability of development of leukemia at five and seven years is 1.5 and 2.0 per cent for the entire group and 2.9 and 3.9 per cent for the 330 patients treated with combined radiation and chemotherapy. The medium survival after diagnosis is four months, with no patient living beyond six months.

Prognostic factors in patients undergoing lymphadenectomy for malignant melanoma

Review of a 19 year experience in melanoma patients undergoinglymphadenectomy at the National Cancer Institute revealedthat the preoperative assessment of the status of theregional lymph nodes was accurate 91% of the time when thesurgeon felt the nodes were clinically positive, and accurate79% of the time when the nodes were judged clinically negative. The 10-year survival in patients with one to three histologicallypositive nodes or no positive nodes was 50-55%, compared to a25% 8-year survival in patients with four or more histologicallypositive nodes. Stepwise multivariate evaluation of prognosticfactors indicated that the most important factor for predictingprognosis is the number of nodes histologically involved. Nodepalpability was the second most important factor because of itshigh correlation with number of nodes histologically involved. Site of melanoma was the third most important factor, aspatients with extremity (upper or lower) melanoma had a bettersurvival (P = 0.002) than patients with axial melanoma (trunkor head and neck). Five years following lymphadenectomythere appeared to be substantial differences in survivalaccording to differences in the level of invasion of the primarylesion, however, these differences were not nearly aspronounced 10 years following node dissection.B The division of melanoma thicknesses into <1.50 mm and>1.50 mm provided some prognostic discrimination at fiveyears but again the differences were not pronounced 10 yearsfollowing node dissection. The thickness measurements wereeasier to determine than the level of invasion, and more reproduceableon resubmission to the same pathologist. Fourpatients with melanoma less than 0.76 mm had subsequentmetastases, but these may represent inadequate sampling of theprimary melanoma both in our series and in the four similarpatients previously reported with such thin metastasizingmelanomas.

Clinical course and management of accidental adriamycin extravasation

Adriamycin infiltration into subcutaneous tissues during intravenous administration results in an intense inflammatory response, which may progress to full-thickness skin ioss and irreversible damage to underlying tendons and neurovascular structures. An analysis of 10 patients seen with Adriamycin in filtration indicated that healing of ulcerated lesions is often prolnged and associated with significant morbidity. Seven patients suffered skin ulcerations and three had severe functional impairment due to joint contractures. Adriamycin should not be infused near joints if possible . Surgical excision of ulcers is advocated if healing is prolonged. Proper local therapy, as well as early attention to proper splinting and physical therapy, can help reduce ultimate functional disability.

Comparison of multiple assays for detecting human antibodies directed against surface antigens on normal and malignant human tissue culture cells

Four separate assays of human antibody reactivity to four separate normal and malignant human tissue culture cell lines from two patients have been evaluated using a single highly-reactive allogeneic serum. The visual and end-point cytolysis assay and the 51Chromium release assay were equally sensitive in measuring complement mediated antibody cytoxicity and both were far more sensitive than a trypan blue dye exclusion assay. The assay of antibody reactivity by hemadsorption technique was about 10 times more sensitive than any of the cytotoxicity assays. This latter assay measures only IgG antibody however. These assays showed that cell lines from different patients may differ greatly in 'reactivity' to an allogeneic serum and emphasized the importance of utilizing tumor and normal cells from the same patient when using tissue culture cells to search for tumor specific reactivity. These observations emphasize the importance of utilizing multiple assays against paired normal and malignant cells from the same patient to be certain of the specificity and magnitude of the measured antibody.

Use of plasma pharmacokinetics to predict and prevent methotrexate toxicity

To correlate the pharmacokinetics and toxicity of methotrexate, we measured the drug's clearance from plasma after 395 high-dose, six-hour infusions given to 78 patients. After 375 infusions, 48 hour methotrexate levels fell within 2 standard deviations of the mean for nontoxic infusions, and myelosuppression did not occur. Methotrexate concentrations exceeded the range for nontoxic patients (mean +/- 2 standard deviations) after 20 infusions. Serious myelosuppression occurred after six of these 20 infusions, including five of 12 infusions associated with 48-hour drug concentrations above 9 X 10(-7) M. In seven patients with 48-hour concentrations above 9 X 10(-7) M, the absence of toxicity could be attributed to subsequent rapid clearance of the drug; four of these patients also received large doses of supplemental leucovorin (50 to 100 mg per square meter every six hours). Determination of methotrexate concentration in plasma thus identified patients at high risk of toxicity, a group that may benefit from supplemental leucovorin rescue.

Clinical and surgical (laparotomy) evaluation of patients with non-Hodgkin's lymphomas

A consecutive unselected series of 423 patients with non-Hodgkin's lymphomas was staged prospectively at the Stanford Medical Center between June 1971 and June 1976. The histopathologic classification of Rappaport was used exclusively. Staging laparotomies were performed in 197 of the patients, but another 226 patients were excluded from the staging procedure for a variety of reasons, including stage IV involvement, poor surgical risk, and diagnostic celiotomy before referral to Stanford. Gastrointestinal, splenic, bone marrow, hepatic, and mesenteric lymph node involvement was very common in these patients, whereas systemic symptoms and mediastinal sites of disease were less frequently noted. After staging laparotomy, 15 patients (8%) were downstaged to a lesser extent of involvement while 62 (31%) were upstaged, primarily from clinical stage III to pathologic stage IV. Correlations were made between clinical and pathologic staging and the sites of involvement were compared between those with nodular and those with diffuse lymphomas. The accuracy of diagnostic radiologic procedures was also assessed. Although it is valuable in sequentially determining the extent of subdiaphragmatic involvement by lymphomas, we believe that staging laparotomy should still be regarded as a research procedure which will be undertaken only as indicated in centers of clinical research.

Combined modality therapy in malignant lymphomas

The treatment of patients with non-Hodgkin's lymphomas remains controversial. The Rappaport classification system has established its clinical value in distinguishing relatively favorable disease (ie, nodular or follicular lymphoma) from relatively unfavorable disease (ie, diffuse lymphoma). Despite the problems of multiple histologies in a given patient posed by the existence of composite lymphomas and by a spectrum of nodularity in a given node, no newer classification has yet proved superior to the Rappaport system. The relative roles of radiotherapy and chemotherapy are reviewed. The primary role of radiation appears to be the control of detectable disease, when adequate doses and volumes are employed. The primary role of chemotherapy appears to be the eradication of microfoci of tumor. Randomized studies of combined modality approaches have produced no definitive evidence of benefit from adjuvant chemotherapy in stage I and II disease of unfavorable histology. The addition of adjuvant radiotherapy in stage III and IV disease of unfavorable histologic types appears to produce some improvement. Aggressive treatment regimes have yet to show any significant advantage over more conservative treatment in patients with favorable histologic types of stage IV extent. This paper emphasizes the need for expert hematopathologic interpretation in every study of non-Hodgkin's lymphoma.

Expression of fetal antigens by normal human skin cells grown in tissue culture

Normal human sera are capable of causing complement-mediated lysis of normal human skin cells grown in tissue culture. This lytic reactivity can be completely removed by absorption with first trimester fetal tissue. Absorption with a variety of normal adult human tissues including lymphocytes, decidua, skin, and muscle are incapable of absorbing reactivity. Absorption of reactivity by fetal tissue is specific and not due to the introduction of anti-complementary or other nonspecific factors, as evidenced by the inability of simultaneous fetal absorption to remove reactivity from antisera with specificity for HLA antigens. Similarly, absorption of lytic sera with fetal calf serum proteins was incapable of removing reactivity against normal cells in tissue culture. It thus appears that normal human cells in tissue culture express antigens shared by the first trimester human fetus, but not present on a variety of adult human tissues. This "neoantigen" present on normal human cells when grown in tissue culture is a potential source of confusion and must be accounted for in searching for human tumor-specific antigens utilizing tissue culture cells.

Validity of the Ann Arbor staging classification for the non-Hodgkin's lymphomas

The Ann Arbor staging classification has proved to be valuable for Hodgkin's disease. When proposed in 1971 it was thought that it could also be applied to the non-Hodgkin's lymphomas. The diversity of the non-Hodgkin's groups, the continued evolution of histopathologic classifications, and the great frequency of advanced disease in the lymphocytic subgroups make the Ann Arbor classification of only limited value for the non-Hodgkin's lymphomas.

Cross-reacting antigens in chemically induced sarcomas are fetal determinants

Serologic cross-reactivity has been demonstrated among three MCA-induced sarcomas in C57BL/6N female mice (MCA-2, MCA-3, and MCA-12) with a microcytotoxicity assay. Serum from mice bearing MCA-3 tumor was cytotoxic to both MCA-2 and MCA-3 tumor cells at a titer of 1:8. Sequential absorptions of this serum with syngeneic embryo cells completely eliminate cytotoxicity against MCA-2 cells without affecting the cytotoxic titer against MCA-3 cells. Serum hyperimmune to the MCA-3 tumor reacted with MCA-3, MCA-2, and MCA-12 tumors. Absorption of this serum with embryo cells eliminated cytotoxicity against MCA-2 and MCA-12 cells, but was incapable of lowering the titer against MCA-3 cells below 1:40. Similarly, serum hyperimmune to MCA-2 tumor was lytic to MCA-2, MCA-3, and MCA-12 before absorption, but was lytic only to MCA-2 cells after absorption with sygeneic embryo cells. Thus, the in vitro cross-reactivity between MCA-induced sarcomas is due to a common fetal antigen(s), which is distinct from the individual tumor-specific antigens of each tumor. Since these tumors do not exhibit cross-reactivity in in vivo challenge experiments, it appears that this fetal antigen is not responsible for in vivo immune protection.

Lysis of human normal and sarcoma cells in tissue culture by normal human serum: implications for experiments in human tumor immunology

Sera from 8 of 9 patients with osteogenic sarcoma equally lysed autologous tissue-cultured cells of both skin and osteosarcoma in the presence of complement. Of 155 normal human sera tested, 103 (66%) lysed allogeneic normal ksin in tissue culture. These antibodies appeared more prevalent in younger (96% in ages 11-20 yr) than older (33% in ages 41-50 yr) humans. The presence of these "natural" antibodies against normal and malignant cells growing in tissue culture was possibly directed against components adsorbed to the cells during tissue culture or to "new" cell-surface antigens expressed by these cells grown in tissue culture. These non-tumor-related neoantigens on normal and malignant cells in tissue culture represented a potential source of confusion in studies of the serologic response of humans to tumors.

Serologic identification of multiple tumor-associated antigens on murine sarcomas

The humoral immune response to two transplanted chemically induced murine sarcomas (MCA-2 and MCA-3) was studied in C57BL/6N mice. These tumors were immunogenic as evidenced by tumor amputation and rechallenge experiments, and no cross-reactivity between them was observed in in vivo challenge experiments. Utilizing a complement-dependent microcytotoxicity assay, we detected antibody to both MCA-2 and MCA-3 in the sera of animals bearing MCA-3 as well as after tumor removal. The sera of animals hyperimmunized to MCA-3 (MCA-3HI) was also cytotoxic in high titer to both MCA-2 and MCA-3 (50% cytotoxicity titers of 1:80 and 1:320, respectively). Sequential absorptions of sera from animals bearing MCA-3 and MCA-3HI sera with fresh MCA-2 cells completely removed activity against MCA-2 but retained reactivity to MCA-3. Sequential absorptions with fresh MCA-3 cells produced stepwise reductions of activity against both tumors, whereas absorption with normal cells produced no loss of activity against either tumor. Thus both specific and cross-reactive antigens were expressed on the surfaces of MCA-3 cells. Only the specific tumor antigen appeared to be involved in in vivo protection against tumor challenge.

Transplantation in miniature swine. II. In vitro parameters of histocompatibility in MSLA homozygous minipigs

A selective breeding program based on serological techniques was used to establish three herds of miniature swine, each homozygous for a different allele at the major histocompatibility complex, termed MSLA. By selective immunization of these swine, high-titered antisera detecting the products of individual MSLA alleles were raised and used to confirm the genotype of offspring in these herds. Techniques for performing one-way mixed leukocyte cultures in these pigs were developed and demonstrated the presence of a strong mixed leukocyte culture locus (or loci) closely linked to the serologically defined MSLA locus. Cell-mediated cytotoxicity assays based on 51Cr release were developed to monitor the course of cellular immunity following allotransplantation and exhibited specificity identical to that predicted by the serological typing.

Advantages of cryoperserved lymphocytes for sequential evaluation of human immune competence. I. Mitogen stimulation

Human lymphocytes were harvested from normal volunteer donors and cryopreserved. Various concentrations of dimethyl sulfoxide and human serum in the cryoprotective media were evaluated to optimize the recovery and function of viable cells. Multiple samples were then drawn from volunteers over a number of days, processed individually, and used in mitogen stimulation assays. These cells were also cryopreserved, immediately thawed, and cultured simultaneously with the fresh cells. In all instances fresh and cryopreserved lymphocytes exhibited similar levels of stimulation by mitogens. Cryopreserved cells from these sequential bleedings were then recovered and cultured simultaneously in mitogen stimulation assays. The results obtained in these assays with cryopreserved cell had less day-to-day variagion than those with cells cultured individually. Coefficients of variance of individual cultures of mitogen stimulation assays were reduced from 26-59% to 5-17% by use of cryopreserved cells. The findings suggested that use of cryopreservation techniques decreases the variability of cellular immune assays and thus alows more accurate longitudinal study of the immune competence of patients.

Prednisone in MOPP chemotherapy for Hodgkin's disease

High remission rates have been produced by MOPP (mustine, vincristine, procarbazine, and prednisone) chemotherapy in patients with advanced Hodgkin's disease, but the prednisone component has caused adverse effects in patients who have undergone radiotherapy. The remission rates and length of remission were reviewed in 211 patients with Hodgkin's disease who received chemotherapy either with or without prednisone. In contrast to the findings of a British study, there were no significant differences in remission rates or length of remission between patients who had received prednisone and patients who had not. There were differences between the British prospective study and this retrospective one, but it is difficult to know what accounted for the substantial differences in the findings.

Initial relapses in previously treated Hodgkin's disease. I. Results of second treatment

Two hundred forty-three consecutive patients with Hodgkin's disease who relapsed after an initial course of treatment at the Stanford University Division of Radiation Therapy underwent subsequent systematic evaluation and retreatment. An analysis of the influence of numerous parameters, including sex, histopathology, original stage, relapse site, and original and second therapy, on actuarial survival and on relapse-free survival was undertaken. Most relapses (87%) occurred within 3 years of the initial treatment course. The 5-year relapse-free survival measured from the time of second treatment increased from 14% before to 39% after the introduction of multiple agent chemotherapy (MOPP) for relapsing disease. Patients treated with MOPP chemotherapy for nodal relapses showed increased subsequent relapse-free survival (61%) when compared with patients treated only with radiotherapy for nodal relapses. Based on the combined findings of this analysis, recommendations are made regarding the management of patients with Hodgkin's disease who have suffered a relapse.

Intralesional immunotherapy of melanoma with BCG

Treatment of recurrent cutaneous melanoma nodules with BCG is an effective and relatively nonmorbid method for eliminating these tumor nodules. Injected nodules can be made to disappear about 90 per cent of the time and in about 20 per cent of patients non-injected nodules in the same drainage area may also regress. Subcutaneous melanoma nodules are far more resistant to melanoma injection. Although cutaneous nodules can be made to regress there is no evidence that a systemic effect against disseminated melanoma exists and no responses of distant visceral disease have been seen following intralesional therapy of cutaneous nodules. The regression of cutaneous nodules following BCG injection appears to be an immunologic phenomenon and is related to the immunocompetence of the patient. The molecular mechanisms of this tumor regression are unknown and are the subject of intensive study. Several new approaches such as the use of BCG for the treatment of poor prognosis primary malignant melanomas, as well as the use of nonviable, nonbacteriologic agents for intralesional treatment are under investigation.