The long-term effect of radiotherapy on the immune status of patients cured of a gynecologic malignancy

Evaluation of thymic output by measurement of T-cell-receptor gene rearrangement excisional circles (TREC) in patients who have received fludarabine

The role of the thymus in immune reconstitution in adults receiving chemotherapy is controversial. Detection of T-cell-receptor gene rearrangement excisional circles (TREC) in peripheral blood T cells has been shown to estimate thymic output. Therefore, we measured TREC levels to assess the contribution of the thymus to immune recovery following treatment with fludarabine. Patients who had received fludarabine alone or a fludarabine containing regimen were identified. Cryopreserved peripheral-blood mononuclear cells were obtained and analyzed by four-color flow cytometry utilizing fluorochrome-conjugated antibodies against CD4, CD8, CD45RO and CD27. Proportions of naïve T cells in each CD4+ and CD8+ subset were measured by gating on CD45RO-negative, CD27+ cells. Quantification of TREC in sorted naïve CD4+ and CD8+ T cells was performed by real-time PCR. Thirteen patients received a mean of 3.8 +/- 0.4 courses of fludarabine and samples were obtained at a average of 18.8 (range 3.6-40.3) months after completing chemotherapy. Ten (77%) had detectable TREC levels. There was a positive correlation (Spearman's rank correlation) between the degree of TREC expression and the percentage of naïve T cells (r = 0.6, p = 0.03), naïve CD4+ (r = 0.6, p = 0.03) and naïve CD8+ (r = 0.66, p = 0.01) cells. We conclude that increased thymic output as demonstrated by an increase in TREC levels correlated with, and was predictive ofincreased numbers of naive T cell following fludarabine administration. The thymus appears to play a role in immune recovery in adults after receiving chemotherapy.

Immune reactive proteins as prognostic and clinical markers in malignant cervical neoplasia

The significance of immune reactive proteins in malignant cervical neoplasia, with particular reference to its prognostic and clinical relevance, was studied in 229 patients. All stages of the disease showed elevated levels of circulating immune complexes (CIC). Patients with stages I/IIA showed elevated levels of IgG, whereas those with stages III and IV showed depressed IgM levels. In the case of IgA, the situation was reversed: patients with advanced disease showed increased levels. Radiotherapy resulted in highly elevated levels of CIC, IgG, and IgA. However, in patients who remained disease-free after radiation treatment, levels of these proteins came down, often falling below pretreatment levels. On the other hand, patients developing recurrent disease showed sustained, high levels of CIC and IgA, with IgG as an isolated case in stage I/IIA. The present study therefore shows that although these increases were non-tumour-specific, patients with persistent elevation of CIC and IgA levels were at much greater risk of developing recurrent disease, thereby proving the merit of these substances as markers in prognosticating the course of disease in malignant cervical neoplasia.

The effects of radiotherapy on immunity in patients with cured localized carcinoma of the cervix uteri

The effects of radiotherapy on immune status in patients with localized carcinoma of the cervix have been assessed serially up to 5 years remission by a wide range of methods. Neutrophil function and serum immunoglobulins were essentially normal throughout. Peripheral blood neutrophil and lymphocyte counts and the proportions of T and B-cells fell with treatment but were all normal at 5 years, with the exception of B-cell proportions which remained significantly low. Marked deterioration was seen in in vivo cellular immune responses and this persisted even at 5 years remission. Reduced in vitro immunoreactivity is not therefore a reliable marker of disease recurrence and persisting defects in cellular immunity after radiotherapy do not seem to adversely affect the host tumor response. However, in three of the six patients who subsequently relapsed after therapy, subnormal PHA lymphocyte transformation responses were observed at presentation; all patients achieving sustained remission had normal pretreatment responses.

Effects of radiochemotherapy and splenectomy on cellular immunity in long-term survivors of Hodgkin's disease and non-Hodgkin's lymphoma

Thirty-six patients treated for Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL) who had been in complete remission and off all therapy for greater than two years were examined for evidence of immunosuppression. All patients were found to have marked depression of their lymphocyte blastogenic response to phytohemagglutinin (PHA) and of their skin test responses. No abnormalities of serum protein or immunoglobulins were found. T cells were significantly lower than normal in patients who had had Hodgkin's disease, but not in those who had had NHL. B cells, on the other hand, were significantly elevated in both groups. Splenectomy elevated the total lymphocyte count, while those who had not had a splenectomy had lower than normal lymphocyte counts. B cells were elevated while T cells tended to be lower in both splenectomy and nonsplenectomy groups, though only in the nonsplenectomized patients did this reach statistical significance. PHA response tended to be higher in patients with less advanced disease and less extensive treatment than in those with more advanced disease and more extensive treatment, although there was no statistically significant difference. Skin test response though, was shown to correlate well with both stage of disease at diagnosis and extent of treatment.

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.