Neutrophil function in cured cancer patients

Defective Function of Granulocytes in Patients with Cancer

Mobilization of granulocytes into a serum-filled chamber, histochemical nitroblue tetrazolium (NBT) reduction tests, and phagocytosis were performed in 11 patients with solid tumors treated with surgical excision and chemotherapy and in 22 untreated or surgically treated patients. The results revealed a decreased mobilization (p < 0.001) and an impaired capability of neutrophils to reduce NBT after stimulation (p < 0.05) in both groups of patients. The decrease in the values in the stimulated reduction of NBT was more pronounced in untreated patients than in treated ones. At the same time the phagocytic activity of neutrophils on Candida albicans, which was decreased (p < 0.01) in untreated patients, was normal in those who had been treated with chemotherapy. There were no distinctive correlations between circulating immune complexes and granulocyte function. We propose that this newly demostrated defect in neutrophil mobilization and low median C. albicans-stimulated NBT reduction contributes more in the evolution of the tumor than in the pathogenesis of infections and that chemotherapy seems to restore a better granulocyte function.

Polymorphonuclear neutrophils and cancer: intense and sustained neutrophilia as a treatment against solid tumors

Polymorphonuclear neutrophils (PMN) are the most abundant circulating immune cells and represent the first line of immune defense against infection. This review of the biomedical literature of the last 40 years shows that they also have a powerful antitumoral effect under certain circumstances. Typically, the microenvironment surrounding a solid tumor possesses many of the characteristics of chronic inflammation, a condition considered very favorable for tumor growth and spread. However, there are many circumstances that shift the chronic inflammatory state toward an acute inflammatory response around a tumor. This shift seems to convert PMN into very efficient anticancer effector cells. Clinical reports of unexpected antitumoral effects linked to the prolonged use of granulocyte colony-stimulating factor, which stimulates an intense and sustained neutrophilia, suggest that an easy way to fight solid tumors would be to encourage the development of intense peritumoral PMN infiltrates. Specifically designed clinical trials are urgently needed to evaluate the safety and efficacy of such drug-induced neutrophilia in patients with solid tumors. This antitumoral role of neutrophils may provide new avenues for the clinical treatment of cancer.

Deficiency of N-acetyl-beta-D-glucosaminidase in neutrophils of cancer patients

It has been suggested that intracellular enzymatic deficiencies of neutrophils may represent another cancer risk factor. This concept is based on data indicating the cytotoxic effects of neutrophils on tumor cells. In 196 patients with various malignancies, precancerous states and states predisposing to malignancies, N-acetyl-beta-D-glucosaminidase activity has been determined in peripheral blood neutrophils using a semiquantitative cytochemical method. A statistically significant deficiency of this enzyme in neutrophils has been reported in patients with uterine, breast and lung cancer and uterine myoma. A tendency towards lower levels of activity of the enzyme within neutrophils has also been noted in patients with carcinoma of the stomach and precancerous states of the larynx, although without statistical significance; patients with endometriosis showed elevated activity of the enzyme.

Neutrophil Function during Cyclic Chemotherapy for Cancer Disease

A study of some aspects of granulocyte function was carried out before, during, and after cyclic chemotherapy in 9 patients surgically treated for carcinoma and in 6 patients with very advanced and inoperable cancer. In most patients, total leukocyte mobilization, Candida-stimulated nitroblue tetrazolium dye reduction, and phagocytosis increased after chemotherapy. Furthermore, delayed hypersensitivity skin reactions to PPD and above all to Varidase increased in the same cases. A significant correlation between accumulation of polymorphonuclear leukocytes into skin chambers and skin tests was found in both groups of patients (p < 0.001). In some instances, fluctuations in the levels of circulating immune complexes without a distinct correlation between these complexes and granulocyte function were found. The data support the hypothesis that depressed granulocyte function may contribute to an increased susceptibility to infections and may be considered an additional factor that favors tumor dissemination. Chemotherapy seems to restore polymorphonuclear function and delayed hypersensitivity skin reactions.

Polymorphonuclear leukocyte function in cancer patients treated with total body hyperthermia

This study was performed to determine if the ingestive and bactericidal capacity of peripheral blood polymorphonuclear leukocytes (PMN) was altered in cancer patients treated with total body hyperthermia (TBH). TBH of either 41.5 or 42.0 C was induced and maintained for periods up to 6 hours by extracorporeal circulation of the patient's blood through a very sensitive temperature regulating device via a shunt in the patient's leg. In vitro studies performed at 37 C showed that the bactericidal capacity of the PMN from cancer patients was initially generally lower than values obtained from control individuals, but most of the patients' PMN exhibited an increased bactericidal capacity following TBH. Function was not diminished by multiple hyperthermia treatments. Similar studies performed in vitro at 42 C showed that the bactericidal capacity of PMN from both control individuals and cancer patients was significantly less than those obtained at 37 C. These data indicate that the bactericidal capacity of peripheral blood PMN may be transiently increased after TBH, but during the period of elevated temperature, the phagocytic process may be retarded.

Bacteremic infection and malnutrition in patients with solid tumors: investigation of host defense mechanisms

Eighty-five patients with solid tumors without neutropenia were studied in order to determine host characteristics associated with bacteremic infection. Twenty patients without neoplastic disease who had bacteremia served as controls. Bacteremia frequently occurred in patients with tumors of the gastrointestinal and urinary tract, who were over 51 years of age, and had evidence of malnutrition. Peripheral blood lymphocyte dysfunction in vitro was commonly noted in infected patients with cancer. Polymorphonuclear leukocyte (PMNL) dysfunction was common in older bacteremic patients with and without cancer. The PMNL abnormality appeared to be cellular, it was not corrected with use of pooled normal serum, and was manifested by poor uptake of the assay organisms.

Comparative study of the endotoxin-stimulated nitroblue tetrazolium test in disease and health

Endotoxin-stimulated nitroblue tetrazolium (NBT) reduction was evaluated in 853 individuals: 270 healthy controls, 334 with various non-neoplastic conditions, 220 with solid non-lymphomatous tumours, and 29 with lymphoma. Each of the above groups was divided into three age subgroups: less than 60, 60-69, and greater than or equal to 70 years. In the controls and in patients with nonmalignant diseases, significantly lower values were recorded for elderly subjects (greater than or equal to 60 years) compared with younger subjects of the same group, whereas in cancer patients the results were independent of age. Under the age of 60, stimulated values for both patient groups were significantly lower than the control values, and in patients with solid non-lymphomatous tumours significantly lower values were attained than in the other patients. NBT reduction in lymphoma patients was comparable to that of the controls. In the elderly (age greater than or equal to 70) no significant differences were noted between patients and controls. It is suggested that stimulated NBT reduction declines with advancing age. While this test clearly demonstrates some leucocyte dysfunction in solid cancer, its value in investigating neutrophil behaviour in elderly subjects is questioned.