Thymus-dependent lymphocyte levels in bronchogenic carcinoma: correlations with histology, clinical stage, and clinical course after surgical treatment

Immunologic dysfunction in cancer

The interactions between the tumor and its host are complex, and many aspects of the immune system appear to be adversely affected directly or indirectly by the presence of the tumor. Virtually all of the processes involved in immune induction and action have been implicated in the observed deficient response in tumor-bearing patients. Improved understanding and molecular analysis of the mechanisms underlying the escape of tumors from immune surveillance may lead to the development of novel strategies for the prevention of T-cell immunosuppression in cancer patients, the development of novel immunotherapeutic strategies, and potentially prevention of tumor progression or development.

Splenectomy before tumor inoculation prolongs the survival time of cachectic mice

The effects of splenectomy on the development of cachexia, tumor growth and animal survival were studied in tumor-bearing CDF1 mice. Mice were inoculated with two subclones of colon 26 adenocarcinoma, clone 20 (with a potent capacity to induce cachexia) and clone 5 (without such activity), and underwent splenectomy before or after tumor inoculation. Splenectomy significantly prolonged the survival of mice bearing clone 20 when it was performed prior to tumor inoculation, although the progression of cachexia and tumor growth were not affected. The survival rate was higher in splenectomized than it was in nonsplenectomized mice 20-40 days after tumor inoculation. Such effects on survival were not observed, however, in mice splenectomized after inoculation with clone 20 or in mice that underwent splenectomy either before or after inoculation with clone 5. The decrease of peripheral blood lymphocyte count observed in mice bearing clone 20 was magnified when splenectomy was performed before tumor inoculation, but the serum levels of tumor necrosis factor and interleukin-6 were comparable. These results indicate that cancer death from cachexia is not directly attributable to enhanced catabolism. The mechanism by which splenectomy ameliorates the survival of cachectic mice remains to be studied, although several changes observed in the splenectomized mice after inoculation, including decreases in the peripheral blood L3T4+ cells and Lyt-2+ cells on the 9th day and 15th day respectively, and increase in the L3T4+/Lyt-2+ cell ratio on the 15th day suggest the involvement of the modified host's immune response.

Peripheral blood lymphocyte subsets and survival in small-cell lung cancer

Measurement of lymphocyte subsets in peripheral blood is likely to reflect immune response of patients and therefore may be linked to survival in small-cell lung cancer (SCLC). Forty patients with SCLC (14 with limited and 26 with extensive disease at study entry) were included and followed for up to 23 months. Peripheral blood lymphocytes were determined by flow cytometry and levels for total-, T-, B-, helper-, suppressor-, activated T-cells and natural killer cells established and the T-helper-suppressor ratio (H-S ratio) calculated. Quartiles of lymphocyte subset cell counts at the start of follow-up and for the change over follow-up were investigated. Cox regression models indicated that H-S ratio was a significant predictor (p = 0.02) of survival. The risk ratio, after adjustment for competing risk factors, sex, age and stage of disease, was found to be 0.66 (95 percent confidence intervals, 0.46 to 0.95) and predicted that for each quartile of greater H-S ratio, the risk of death decreased by 34 percent. For change in cell counts over follow-up, total lymphocytes (p = 0.02) demonstrated a significant association with survival. Although our observation is limited by the fact that 13 patients were unavailable for follow-up, we conclude that H-S ratio can serve as an easily accessible marker of immune function and possible prognostic value in SCLC.

Assessment of local cellular immunity in lung cancer by bronchoalveolar lavage

Small cell lung cancer (SCLC) is the most malignant of the pulmonary neoplasms and is associated with a poor local cellular immune response. 16 patients with non small cell lung cancer (NSCLC) and 11 patients with SCLC underwent bronchoalveolar lavage (BAL) in the lung which harbored the tumor in order to investigate the lymphocyte surface antigens utilizing the immunoperoxidase technique. Analysis of blood lymphocytes was performed in parallel. 8 patients with previous sarcoidosis in complete remission who underwent BAL and 10 normal blood donors served as controls. Among blood lymphocytes the CD3+, CD4+ and CD16+ cell populations were elevated significantly and the T4/T8 ratio was elevated in NSCLC patients, but only CD16+ were augmented in SCLC. Cell populations expressing the activation markers transferrin (TF) receptor, interleukin-2 (IL-2) receptor and the very late antigen VAL-1 were also increased in NSCLC, while SCLC was associated with antigen distributions similar to controls. No differences between the cohorts were seen in the expression of human leukocyte antigen (HLA)-DR. In BAL the population of CD3+ and CD4+ cells were reduced in SCLC and the T4/T8 ratio was diminished in contrast to controls and NSCLC patients, whereas these two latter groups did not differ from each other. The distribution pattern of CD16, TF receptor and IL-2 receptor in the study groups resembled that of cells of the blood stream, but CD16+ natural killer cells were additionally down regulated to control values in SCLC. No differences were seen in the distribution of VLA-1. HLA-DR+ cells were clearly elevated in both cancer groups.(ABSTRACT TRUNCATED AT 250 WORDS)

E-rosettes in aging: meta-analysis of the literature

In this meta-analysis of the literature, it is affirmed that aging is associated with a small but significant decline in peripheral E-rosette-forming cells while high affinity E-rosettes (active or early rosettes) increase. The author speculates that this differential age effect may reflect the abnormal capping behaviour of E-rosettes or a change in the cell surface charge properties. A type II error is a common trait of the reviewed studies and could well explain the great number of reports concluding that E-rosette-forming cells are unaltered in the elderly.

[Immune status of patients with bronchial cancer]

The proliferation of lymphocytes, the cell-surface markers of mononuclear cells, and the capacity of T lymphocytes to bind sheep red blood cells were studied in 61 healthy volunteers and 72 patients with small-cell carcinoma, adenocarcinoma, and squamous-cell carcinoma of the lung. The mitogen-stimulated proliferation of the lymphocytes against phytohemagglutinin (PHA) was significantly reduced in patients with small-cell carcinoma. The number of T lymphocytes with T3, T4, T8, and T11 receptors was also reduced, to a degree similar to the E-rosetting rates of patients with small-cell carcinoma. The behavior of the lymphocytes of patients with either adeno- or squamous-cell carcinoma was similar to the normal persons. With regard to prognosis, we could not find significant differences between patients with "limited" and those with "extensive disease".

The doubtful relevance of nonspecific immune reactivity in patients with squamous cell carcinoma of the head and neck region

Nonspecific immune reactivity (lymphocyte stimulation with PHA, PWM; % T-cells; absolute T-cell levels; skin reactivity to DNCB) was determined in 30 patients with squamous cell carcinoma of the head and neck region and in 30 age- and sex-matched healthy controls. The tests were carried out in each patient at 4-week intervals for at least 1 year. The tumor patients were regularly controlled over a period of 5 years. A reduced nonspecific immune reactivity was detected for tumor patients as compared with healthy controls. However, there was no correlation between the follow-up tests on unspecific immune reactivity and the clinical course of the disease. Moreover it was not possible--on the basis of pretherapeutic unspecific immune reactivity and 5 years' clinical follow-up--to make any prognostic statement for the tumor patients tested.

Effect of postoperative total parenteral nutrition (TPN) as an adjunct to gastrectomy for advanced gastric carcinoma

Clinical staging and immune reactivity were correlated in 39 patients who underwent gastrectomy for primary gastric cancer. Cellular immunity was depressed as the stage of cancer advanced, whereas humoral immunity was unaffected. Gastrectomy for advanced cancer in stage 3 and 4 suppressed cellular immunity. The cellular and humoral immune systems in relation to total parenteral nutrition (TPN) versus non-TPN were evaluated in 57 patients who underwent gastrectomy for stage 3 and 4 advanced cancer. Cell-mediated immunocompetence was restored in all 29 patients who received postoperative TPN, while serum immunoglobulins were unaffected by TPN. Improvement of impaired cell-mediated immunity was also obtained in patients treated with a TPN-5-FU combination as an adjunct to surgery. Treatment with TPN during 5-FU administration restored immunocompetence, increased tolerance for 5-FU and gave a satisfactory 3-year survival rate. There were significant differences in the 3-year survival rates of patients who underwent non-curative gastrectomy (54 per cent for TPN-5-FU v. 0 per cent for non-TPN-5-FU; P less than 0.05). It is concluded that TPN during chemotherapy as an adjunct to surgery leads to diminished morbidity, and possibly to prolonged survival time, in patients undergoing gastrectomy for gastric cancer. A possible mechanism responsible for the gratifying results of TPN treatment may be the increased tolerance for 5-FU resulting from improved nutrition and increased cell-mediated immunity.

Immunobiologic staging of patients with carcinoma of the head and neck

For decades immunologic deficiencies have been documented in patients with carcinoma, and many investigators have attempted to utilize this information in determining prognosis more accurately. Determining prognosis more accurately would be most helpful with Stage III patients, since at present there are no useful guidelines as to which Stage III patients would benefit from aggressive surgery and/or radiation therapy and which would not. Assays of cellular immunity--such as skin testing, determining peripheral T-lymphocyte counts, and assessing lymphocyte reactivity--have achieved extremely limited clinical application. These assays are too expensive and/or too difficult to perform in the routine clinical setting. Total lymphocyte counts, however, are readily available in the clinical setting and can be helpful in determining prognosis. Other readily available clinical information, such as age and pretreatment serum immunoglobulin levels, can also be of value in determining prognosis. In this study, logistic regression was utilized to determine the prognostic implications of stage, age, and pretreatment total lymphocyte counts in 132 patients with carcinoma of the head and neck. Although each variable determined prognosis accurately less than 70% of the time, the stage, age, lymphocyte prognostic index (SALPI) accurately predicted outcome at 3 year follow-up 80% of the time (Pr. less than .0001). Discriminant function analysis was utilized to determine the prognostic implications of pretreatment serum immunoglobulins in 243 patients with head and neck carcinoma. A serum immunoglobulin prognostic index (SIPI) was derived which was based on the observations that elevated levels of immunoglobulin A (IgA) indicated a poor prognosis, while elevated levels of immunoglobulin E (IgE) and immunoglobulin D (IgD) indicated a favorable prognosis (Pr. less than .009). The SIPI was not as accurate as the SALPI in determining prognosis; however, when the indices were used simultaneously, concurring indices predicted the outcome of Stage III patients correctly 86% of the time.

Serial immune testing in surgically resected lung cancer patients

Immunoregulation of phytohemagglutinin (PHA) responsiveness by glass-adherent cells and prostaglandin-synthesizing cells was serially monitored in the peripheral blood mononuclear cells (PBMC) of surgically resected stage I and stage II lung cancer patients entered on a trial of adjuvant immunotherapy. The relationship between immunoregulatory cell function, immunocompetence, and disease relapse was determined. Immunoregulatory activity was measured in PHA-stimulated cultures in the presence and absence of 2 micrograms/ml indomethacin and in the presence and absence of glass-adherent cells. In each instance of disease relapse seen, an increase in immunoregulatory cell function to a level significantly different from normal was observed 3 months prior to or coincident with clinical confirmation of disease recurrence. This was usually associated with a decline in PHA responsiveness. In the patients who did not relapse, the levels of PHA responsiveness and immunoregulatory function persisted within normal limits throughout the course of study. Percentages and numbers of leukocytes and leukocyte subsets and delayed cutaneous hypersensitivity were also monitored in this study, but could not be consistently correlated with early changes in clinical disease status. These data suggest that the development of indomethacin-sensitive and glass-adherent suppressor cells may precede and predict for tumor recurrence in surgically resected lung cancer patients.

Prognostic significance of lymphocyte proliferative responses to mitogens in gastric cancer patients

In 501 Japanese patients with gastric cancer, the relationships between preoperative lymphocyte proliferative (LP) responses to mitogens and prognosis of patients were evaluated. Peripheral blood lymphocytes were cultured in the presence of either autologous or allogeneic serum and their LP responses to phytohemagglutinin (PHA) and pokeweed mitogen were investigated. An apparent inverse relationship between LP responses and stage of the disease was found in LP responses to PHA in the presence of autologous serum. The survival rate of patients with higher responses was significantly greater than those with lower responses, when LP responses to PHA in the presence of autologous serum served as the criterion. Probabilities of staging which were computed on the basis of LP response to PHA affirmed the reciprocal relationship between LP responses and stage of the disease. From these results, it is concluded that evaluation of LP responses may be a valuable tool in the assessment of the clinical stage and in the prediction of prognosis.

Biological markers and breast cancer. A multiparametric study. II. Depressed immune competence

Immune functions were evaluated in 207 carefully staged breast cancer patients, 54 patients with benign breast diseases and 152 normal controls. All patients were followed for at least five years and the prognostic significance of immune competence determined at diagnosis was established. The parameters employed were dermal hypersensitivity to four skin test antigens and to 2,4-dinitrochlorobenzene (DNCB), blastogenic responses to PHA (phytohemagglutinin), ConA (Concanavalin A), and PW (Pokeweed mitogen) mitogens and percentage of T- and B-lymphocytes. A significant degree of impairment of immune functions was found in breast cancer patients when compared to controls; this was illustrated by depressed T-cell counts and low responses to PHA, ConA and PW mitogens and by depressed responses to recall antigens. However, only lymphocyte stimulation with PHA, percentage of T-cells and dermal hypersensitivity tests showed a continued decrease with advancing stages of the disease. Moreover, among cancer patients with low responses to recall antigens, 61% died before five years, 16% showed progressive disease and only 22% were disease-free after five years of follow-up; compared to 30, 18 and 52%, respectively, in patients with normal responses to recall Ags (overall P value less than or equal to 0.005). A similar relation could be illustrated in patents with low PHA responses as 42% of these patients died before five years, 19% showed progressive disease and 39% were disease-free compared to 26, 19, and 54%, respectively. In patients with normal PHA responses (overall P value less than or equal to .05). It is concluded that initial immunocompetence, determined by parameters of cell-mediated immunity, could be significantly depressed in patients with localized or even premalignant breast disease as well as in advanced cancer. Depressed responses to PHA and dermal hypersensitivity to recall antigens seem to indicate a poorer prognosis. There is no single ideal biological marker as yet. Combined with our previous results on serum proteins, this current study may help us, at the time of initial treatment, in the identification of a subset of Stage I breast cancer patients likely to do poorly.

Rosette forming T-lymphocyte levels in the peripheral blood of cattle affected with squamous cell carcinoma of horn

The level of thymus-derived lymphocytes was assessed by determining the per cent of cells which formed non-immune rosettes with 2-Aminoethyl isothiouronium bromide treated sheep erythrocytes in the peripheral blood of 20 (14 bullocks and 6 cows) histopathologically confirmed cases of bovine squamous cell carcinoma of horn (horn cancer) and an equal number of age-matched control animals. A significantly marked (P less than 0.01) depression in the per cent erythrocyte-rosette forming cell count was observed in horn cancer affected bullocks and cows as compared to the values in unaffected control animals. The decrease in the level of these cells was comparatively more marked in animals which were clinically in advanced stages of the disease.

Bronchogenic carcinoma: survival after surgical treatment according to stage, histologic type and immunomorphologic changes in regional lymph nodes

The survival rates of 90 patients who underwent operation for bronchogenic carcinoma were analyzed statistically according to sex, age, tumor stage and histologic type, types of surgical procedures (lobectomy or pneumonectomy), and to immunomorphologic parameters of immunologic activity in peribronchial and hilar lymph nodes. The Stage I group survived significantly longer than did the Stage II and III groups, the lobectomized patients survived significantly longer than the pneumonectomized patients. The absence or presence of lymph node metastases was one of the major determinants of survival. The mean values (percent of total node cut surface) of lymph node sinus histiocytosis and of paracortical area could be correlated directly to survival in each of the histologic tumor-type groups, while the development of follicular cortex and germinal centers correlated inversely with survival. Increased survival might be associated with changes concomitant with immune reactivity in lymph node T-cell areas and with the sinus histiocytosis pattern, the latter representing probably a tumor--host reaction of the delayed hypersensitivity type. By contrast, increased activity of lymph node B-cell areas tended to correlate with poor prognosis of lung cancer patients. Moreover, patterns showing germinal center hyperplasia were statistically associated with lymph node neoplastic invasion, while the pattern with sinus histiocytosis and expanded paracortical areas was statistically associated with tumor-free lymph nodes.

Immunobiology of primary intracranial tumors. Part 5: Correlation of a lymphocyte index and clinical status

Long-term assessment of general host immunocompetence of patients with primary malignant brain tumors indicates that although isolated determinations of nonspecific responsiveness are not clinically useful, sequential analyses utilizing a linear combination of in vitro lymphocyte probes are capable of predicting tumor recurrence prior to clinical deterioration.

Circulating IgE levels in patients with bronchial carcinoma

Serum IgE measurements in 107 patients with bronchial carcinoma revealed statistically significant elevations when compared to a control population. Serum IgE elevation was seen in 21.5% of the sample (23 of 107) and in all histological types at all clinical stages of the disease. It appears to occur early in the disease or possibly before the development of the carcinoma.

[Investigations of unspecific immune reactivity in patients with head and neck carcinoma (author's transl)]

Unspecific cellular immune reactivity in 30 patients with squamous cell carcinoma of the head and neck was compared with those in 30 healthy controls. Assays were performed in vitro to evaluate the blastogenic response of lymphocytes to the mitogens PHA (phytohemagglutinin), Con A (Concanavalin A) and PWM (pokeweed mitogen) and to quantify T-rosette-forming lymphocytes. The in vivo assay used was the delayed cutaneous hypersensitivity reaction to DNCB (dinitro-chlor-benzene). Tests were performed in all patients every 4 weeks either for a total of 1 year or until death. Tumor patients were followed up to 5 years. Compared to healthy controls tumor patients demonstrated significant impairment of unspecific immune reactivity. Surgery, chemotherapy, and radiotherapy led temporarily to a further decrease of immune reactivity. There was no correlation between unspecific immune reactivity and tumor stage, course of the disease, and prognosis. It was not possible to give any useful statement for patients with squamous cell carcinoma of the head and neck by determining their unspecific immune reactivity.

Small cell carcinoma of the lung

Prospects for the patient with small cell carcinoma of the lung have been partially turned around during the past decade. This dramatic achievement remains very incomplete, but it continues to gather momentum and seems to carry promise of greater advance in the future. An essential feature of the new approach to treatment is that it depends on cooperative and interdisciplinary effort; in all probability, increasing cooperation will be necessary for future progress. We will attempt to review here the current approaches to the understanding and management of this disease, as they may be of concern to surgeons, and to try to define the areas of failure and controversy.

Persistent lymphocytopenia as a diagnostic feature of bronchogenic carcinoma

Patients with abnormalities due to bronchogenic carcinoma, noted on chest films, have decreased peripheral blood lymphocytes and increased total white cells compared to patients with benign lesions. Precision studies of 40 patients revealed that a low percentage of lymphocytes averaged over a three-week period distinguished bronchogenic carcinoma patients from patients with benign lesions with 95 percent overall accuracy. Lesions as small as 1.0 cm were correctly predicted to be malignant. Mean 8 AM plasma cortisol levels were elevated in patients with bronchogenic carcinoma and there was a negative correlation of 8 AM plasma cortisol levels with precentage of lymphocytes. Increased levels of endogenous cortisol may account for lymphocytopenia in bronchogenic carcinoma patients.

Immunological state of patients with carcinoma of the bronchus before and after radiotherapy

The immunological state of 30 patients with carcinoma of the bronchus was assessed before and after radiotherapy by lymphocyte response to PHA and E and EAC rosette formation. The results were compared with those from age-matched patients with benign chest disease and a group of healthy control subjects. Differences were found between the three groups and decreased immunological responses were found to correlate with shorter survival times for patients with cancer of the bronchus. These differences were not associated with the extent of the disease, or with the smoking habits of the patients. Significant differences in percentage EAC cell rosetting were demonstrated between lymphocytes from patients with malignant disease (31.3 +/- 2.0) and those for control groups (21.5 +/- 1.9 and 24.0 +/- 2.2). Cancer patients and benign chest disease patients both had significantly decreased mean E rosetting values (59.3% and 55.6%) compared with healthy control subjects (69.7%). The group of cancer patients with a normal percentage of T lymphocytes and total number of lymphocytes after radiotherapy, or those with low percentage EAC cell rosettes, had a greater than 80% survival after seven months compared with less than 50% for the rest of the patients with carcinoma of the bronchus.

Harmful effects of i.v. Corynebacterium Parvum given at the same time as cyclophosphamide in patients with squamous-cell carcinoma of the bronchus

The effects are reported of a combination therapy of i.v. C. parvum and cyclophosphamide on the survival time and immune responses of patients with inoperable squamous-cell carcinoma of the bronchus. The immune status of the patients was evaluated by determining the antibody response to C. parvum, the E and EAC rosettes, the PHA response of blood lymphocytes, the skin-test reactivity to Candida and PPD, the response to DNCB and the chemotaxis and NBT-dye reduction capacity of neutrophil leucocytes. The survival time of patients treated with the combination therapy was found to be significantly shorter than that of untreated patients and of those receiving cyclophosphamide only. Severe side effects were observed after C. parvum infusions, with no decrease on repeated administration. The effect of C. parvum on the different immune parameters of cyclophosphamide-treated patients was negligible, though there was a normal antibody response to C. parvum.

Serum-mediated immunosuppression in lung cancer

Immunosuppression in 45 patients with lung cancer was studied by examining delayed cutaneous hypersensitivity reactions to DNCB and by analyzing the effect of the patient's serum on the proliferative response of normal donor lymphocytes. Both diminution of DNCB reactivity and inhibition of the proliferative response of normal donor lymphocytes to mitogens were associated with the stage of the disease and the presence of unresected tumor. Suppressive sera were associated with poor prognosis. The suppressive effects of patients' sera on lymphocytes from a normal donor suggest that the immunosuppression seen in lung cancer may be mediated by serum factors. The significant association of clinically evident tumor with this serum-mediated immunosuppression further suggests that the tumor itself could account for the appearance of these factors in the host. The clinical implications of these findings may be useful for designing new clinical trials.

Cell-mediated immunity in operable bronchial carcinoma: the effect of injecting irradiated autologous tumour cells and BCG

In 52 patients undergoing tests of cell-mediated immunity before surgical resection of bronchial carcinoma a positive tuberculin test result was found in 71% compared with 68% of age- and sex-matched controls. Sensitisation to DNCB occurred in 52% of 37 patients but in 78% of controls. There was depression of lymphocyte transformation by PPD in 19 patients compared with controls (P=0.001), but there was no difference in lymphocyte transformation by PHA or pokeweed mitogen between 34 patients and controls. In a pilot study patients were randomly allocated to autograft (eight) or non-autograft (seven) groups. The autograft group were given an intradermal injection of a suspension of irradiated autologous tumour-cells mixed with intradermal BCG on the day of operation. Tests of cell-mediated immunity were repeated two weeks after operation. Five patients in each group received a course of radiotherapy to the mediastinum three weeks after operation. There was a rise in cutaneous tuberculin reactivity (P=0.08) and total leucocyte count (P=0.09) in the autograft group postoperatively with a fall in total lymphocyte and T lymphocyte counts in the non-autograft group (P less 0.05). These differences, however, were not followed by any difference in the frequency of tumour recurrence or the survival rate two years after operation. The results show that the immunological surveillance mechanism is impaired even in patients with early bronchial carcinoma and that it is possible to overcome postoperative immunological depression with specific immunotherapy combined with BCG. This treatment did not produce any clinical advantage in this small number of patients and the skin lesions caused the patients considerable discomfort.

Prognostic value of pre-treatment lymphocyte count and T cell levels in localized bronchogenic carcinoma

In the patient with clinically localized bronchogenic carcinoma, the pre-treatment peripheral blood lymphocyte count and the thymus-dependent lymphocyte (T cell) level correlated with the prognosis of the tumor histology was either squamous cell, oat cell, or undifferentiated carcinoma. Patients whose pre-treatment lymphocyte count was less than 1,000/ml or whose T cell level was less than 750/ml either died or developed distant metastases by nine months after treatment of their localized tumor. By contrast, 55% of patients whose pre-treatment T cell level was greater than 750/ml were alive and without evidence of metastases nine months after treatment (P less than 0.02). Analysis of survival of these patients by the life-table method through the first post-treatment year further demonstrates the prognostic value of a low pre-treatment lymphocyte count or T cell level. The pre-treatment lymphocyte count and T cell level in patients with adenocarcinoma did not correlate with prognosis.

The effect of anticancer therapy on peripheral blood T and B lymphocyte counts and function

Patients categorized according to tumor type were compared to a control non-tumor population. Comparison of relative T cell values among the groups showed no significant differences; however, when absolute numbers of T cells/mm3 were compared, all cancer patients, whether from treated or untreated groups, had significantly depressed T cell values. No significant differences were observed in the relative or absolute numbers of B cells. Comparison of the total lymphocyte response to PHA showed no significant differences among the various cancer groups; however, response in all cancer groups whether from treated or untreated patients, was depressed by comparison to the control group. Patients categorized according to the type of treatment received showed significant depression in the white blood count, lymphocyte count, relative and absolute T cell counts and the absolute B cell count in the postsurgery, postadjunctive therapy group. The pretherapy group also showed significant depression in the absolute number of T cells/mm3 when compared to the controls. Response to PHA correlated with the absolute T cells values.

Comparison of the effects of single versus multiple agent chemotherapy on lymphocytes assayed by the rosette technique

The percentage of peripheral blood Total T, Active T and B-Rosette Forming Cells (RFC) were determined serially (Day 0, 1, 2, 7, and 21) following administration of single (SAT) versus multiple (MAT) agent chemotherapy. SAT caused essentially a decrease in the percentage of B-RFC. MAT resulted in profound decrease of Active T and B-RFC and to a lesser degree of Total T-RFC percentages with nadirs being reached in 48 hours. The most striking decrease involved the percentage of Active T-RFC which remained 15% below pretreatment level 7th posttreatment day. The posttreatment changes in the absolute numbers of Total T, Active T and B-RFCs following MAT were similar to that noted on the RFC percentage. Effects of the two most commonly used multiple agent treatments (COBAM and DOMF) were comparable. MAT causes a more profound decrease in the percentage of various RFCs than SAT. The differences between the nadirs of various RFC reached Day 1 and 2 with MAT versus SAT are statistically significant (p less than .001). We conclude that the effects of chemotherapy on peripheral RFC may be best evidenced by serial determination of their percentage rather than their absolute numbers. Subpopulation of the T-RFC which has been labeled Active T-RFC appears to be the best indicator of the chemotherapy effects on the lymphocyte population since they demonstrate the most profound and persistent changes.

Overview on new immunologic markers for diagnosis of cancer

There is a large and increasing number of tumor-associated markers which can be detected immunologically and which may be useful for detection, diagnosis and monitoring of cancer. These include cell surface antigens and other components specifically associated with tumor cells, ectopic hormones, and normal materials which are produced in increased amounts by or in response to the tumors. Some of these markers are only antigenic in heterologous species, whereas others are reacted to by the tumor-bearing host. The major current problem is to determine which of these markers may be applied to practical problems of immunodiagnosis.

Unspecific cellular immunity before therapy in patients with squamous cell carcinoma of head and neck

An introduction to the role of lymphocytes in immunological reactions is given. Two fundamental categories of immunological response are described which are mediated by two distinct subpopulations of lymphocytes: B-lymphocytes are responsible for humoral immune reactions and T-lymphocytes are involved in cell-mediated immunity. Information is given on the role of the immune system in generation of anti-tumour activities and of mechanisms leading to an acceleration of tumour growth. Several pathways of cytotoxic and blocking reactions against target cells are mentioned. Furthermore, methods are described for monitoring the non-specific immune reactivity of the host. These nonspecific cellular immune responses in 30 patients with squamous cell carcinoma of the head and neck were compared with those in 30 healthy controls. Assays were performed in vitro to evaluate the blastogenic response of lymphocytes to the mitogens PHA (phytohaemagglutinin) and PWM (pokeweed mitogen) and to quantify T-rosetteforming lymphocytes in the peripheral blood. The in vivo assays used were the delayed cutaneous hypersensitivity reaction to the primary stimulus of DNCB (dinitro-chloro-benzene) and the recall reaction to PPD (purified protein derivate). The carcinoma patients demonstrated significant impairment of lymphocyte blastogenesis reactions to PHA but not to PWM. The percentage and absolute counts of T-rosettes was significantly reduced in cancer patients compared with normal controls. Skin test reactivity to de-novo sensitation with DNCB was significantly abnormal in patients with head and neck cancer. However, delayed type hypersensitivity evaluated with PPD (recall antigen) was not significantly reduced. After subdividing the cancer patients according to their clinical stage of disease and subsequent analysis, they showed no correlation between clinical stage and immune reactivity. These data indicate that PHA induced lymphocyte blastogenesis, enumeration of T-rosette levels and evaluation of delayed hypersensitivity reaction to DNCB are potentially useful for the study of squamous cell carcinoma of head and neck to monitor effects of tumour treatment and perhaps to evaluate a correlation between immunocompetence and prognosis.

Effect of radiation on cell-mediated cytotoxicity and lymphocyte subpopulations in patients with ovarian carcinoma

Lymphocyte subpopulations and cell-mediated cytotoxicity (CMI) were studied during radiation therapy in 16 patients with ovarian carcinoma. The total lymphocyte count became depressed in all patients. The depression was more marked among T cells, while the proportion of B cells remained unaffected. In patients with Stage I and II ovarian cancer, CMI was depressed significantly by radiotherapy after 7 days of treatment, remained low at 14 days but recovered despite continuation of radiation. This depression of CMI occurred at a delivered dose of 1,000 rads with subsequent recovery. Patients with Stage III ovarian cancer given pelvic and abdominal radiation were found to have no consistent depression of CMI, a finding similar to that in Stage III ovarian carcinoma patients given chemotherapy.

Changes in cell-mediated immunity in patients undergoing radiotherapy

The cell-mediated immune status of 147 patients who received radiotherapy was evaluated using in vitro tests (PHA, E-rosette and spontaneous blastogenesis) both before and 6 weeks after the end of radiation. All patients had verified malignancies, involving the bronchus in 29 cases, breast in 28, female genital system in 26, head and neck in 20 and bladder in 15. Patients suffering from bronchogenic carcinomas or malignancies of the head and neck showed a relative high degree of immune suppression. Our findings indicate a trend towards some improvement in PHA reactivity, as well as in as the percentage of E-rosette-forming cells after treatment, which is more noticeable in patients with pelvic or breast tumors. A relationship seems to exist between the tumor load and the immune status, which reverts to a normal pattern when the former is extinguished. Moreover, patients with poor clinical response display a profoundly depressed level of immune status without any improvement after treatment.

Abnormal lymphocyte protein synthesis in bronchogenic carcinoma

Phytohemagglutinin (PHA) stimulated lymphocyte protein synthesis was measured in vitro in 21 patients with recently diagnosed, untreated bronchogenic carcinoma and 11 control subjects. In the cancer group absolute protein synthesis was significantly decreased in both baseline and stimulated cultures. The abnormality in protein synthesis was observed despite the fact that there were no differences in vitro DNA synthesis between the two groups. In order to investigate the possibility that a decrease in the number of T-cells was the cause of the impaired protein synthesis in the lung cancer patients, the percentage of circulating E-rosetting forming cells was measured. The mean percentage of rosette forming cells in the cancer patients was 66.8 +/- 2.2 and in the control population was 68.3 +/- 2.6. Our results demonstrate that lymphocyte protein synthesis is abnormal in patients with bronchogenic carcinoma and that the abnormality in protein synthesis is not due to decreased numbers of T-cells. In addition our results suggest that measurement of protein synthesis is a more sensitive assay of lymphocyte function than other standard parameters of cellular immunity.