Changes in cell-mediated immunity in patients undergoing radiotherapy

Oral yeasts in patients with cancer of the mouth, before and during radiotherapy

The yeasts of patients with oral cancer has been studied before and during Xr-therapy. Gram and PAS smears revealed an increase of yeast-like structures, during treatment, from 56% to 66% of the cases. Before radiotherapy oral yeasts were isolated from 56% of the patients with cancer represented by Candida albicans (30%); C. tropicalis (12%); C. glabrata and C. krusei (4%), besides six other different species (2%). During radiotherapy yeasts were isolated in 72% of the cases, as follow: C. albicans (36%); C. tropicalis (16%); Rhodotorula rubra (6%); C. kefyr; C. krusei and Pichia farinosa (4%), besides other nine species (2%). C. albicans serotype A represented 93% of the isolated samples, before treatment and 88.8% during Xr-therapy.

Selection of optimal therapy for neuroblastoma: a study of the immunomodulatory effects of surgery and irradiation in the murine C1300 neuroblastoma model

Human neuroblastoma is an immunogenic tumor for which therapy directed in an immunologic context may offer some advantage over conventional treatment. This study examines the immunomodulatory effects of surgery and irradiation in the murine C1300 neuroblastoma model. In vivo studies of primary tumor growth characteristics after treatment demonstrated no superiority of either therapeutic modality in control of local tumor or prolongation of host survival. However, irradiated hosts showed an increased ability to reject a secondary tumor challenge, compared to their surgical counterparts. That this phenomenon may be immune-related is suggested by in vitro studies of T lymphocyte function utilizing mixed lymphocyte-tumor cell cultures and PHA lymphoblastogenesis.

The effect of surgery, radiation therapy, and combined radiation therapy and chemotherapy on immunocompetence in patients with lung carcinoma

The immunologic status of 59 patients with lung carcinoma was determined by analysis of peripheral venous blood samples. The following tests were performed: total leucocyte and lymphocyte counts, the number of acid alpha-naphthyl acetate esterase (ANAE) positive cells (T-cells), and phytohaemagglutinin (PHA) and tuberculin (PPD) transformation tests. The patients were divided into three treatment groups: a surgery group (S), a radiation therapy group (R), and a combined cytostatic and radiation therapy group (C). A follow-up was carried out 4 to 6 months after treatment. The therapeutic measures, resection, irradiation, and chemotherapy, produced a decrease in the total leucocyte and lymphocyte counts, in the number of T-cells, and in the leucocyte transformation response to PPD. In the surgically treated group the decrease was transient. In the groups treated with radiation therapy and combined cytostatic and radiation therapy the values remained low throughout the follow-up. The lymphocyte response to PHA was not altered in any of the groups during initial treatment or follow-up. The results did not suggest a correlation between the immunologic parameters used and the stage and histologic type of lung cancer. The tests were of no clinical value in the determination of the individual prognosis.

Rationale for a novel immunotherapy of cancer with allogeneic lymphocyte infusion

A simple method of cancer immunotherapy has been developed which achieves marked objective response in 20-30% of patients with disseminated disease. Each course consists of a low dose of chemotherapy followed two days later by intravenous infusion of allogeneic lymphocytes. Courses are repeated on a monthly basis as needed. The function of the chemotherapy--too mild to significantly influence tumor growth directly--appears to be depletion of suppressor T cells, which sensitizes the patient to the immunostimulant action ("allogeneic effect") of the subsequently infused lymphocytes. The rationale for this method is discussed in the context of a review of past attempts at lymphocyte immunotherapy. We are now attempting to improve response rates by combatting anergy with nutritional immunopotentiators, and by preventing prostaglandin-mediated or -dependent immunosuppression with prostaglandin synthetase inhibition. By understanding and counteracting the various specific and general means by which a growing tumor induces host tolerance, it should prove possible to achieve immune-mediated tumor regression in a high proportion of patients. Best results may be seen when allogeneic lymphocyte therapy is initiated at an earlier stage of the disease, and is used in conjunction with surgery, radiotherapy, short-course intensive chemotherapy, or hyperthermia-based methods.

T and B lymphocyte counts and blast transformation in patients with Stage I cervical cancer

In 57 patients with Stage I cervical cancer and in 25 healthy women, a determination was made of leukocytosis, counts of lymphocytes and monocytes per 1 mm3 of blood, counts of T and B lymphocytes, and PHA-induced lymphocyte ability of in vitro blast transformation. Patients with cervical cancer, as compared with controls, exhibited a decrease in lymphocytosis and in the counts and percentages of T and B lymphocytes, as well as an increase of lymphocyte reactivity to PHA. An increase in the PHA-induced lymphocyte ability of in vitro blast transformation occurred in patients with a clinical picture characterized by the presence of a large tumor of the cervix or of metastases to the lymph nodes of the pelvis. In the group of patients in Stage I with a small cervix the mean indices of blast transformation did not differ from those observed for the healthy control group; on the other hand, in the group of patients with a large cervix and metastases to the lymph nodes of the pelvis, these indices exceeded on the average by about 88% those in the control group.

Longitudinal studies of blood lymphocyte functions in non-Hodgkin's lymphoma

The study comprises 26 patients with non-Hodgkin's lymphoma who entered complete remission. Lymphocyte subsets and spontaneous and mitogen (ConA, PWM)-induced DNA synthesis were recorded in purified blood lymphocytes harvested before treatment, in remission and in relapse. The T and B lymphocytopenia noted in untreated patients persisted in complete remission. At diagnosis the spontaneous DNA synthesis was increased and the response to mitogen was decreased as compared to controls. Both functions became normalised during complete remission in most patients under 60 yr. The lymphocyte abnormalities reappeared during relapse. A low response to mitogen (ConA) in complete remission seemed to predict early relapse in patients younger than 60 yr. It is concluded that functional abnormalities of blood lymphocytes in non-Hodgkin's lymphoma are closely related to the presence of active disease.

Indomethacin sensitive suppressor cell activity in head and neck cancer patients pre- and postirradiation therapy

The effects of the addition of indomethacin to PHA or Con A stimulated lymphocytes from patients with untreated squamous cell carcinoma of the head and neck or from patients with the disease who have just finished irradiation therapy from the disease was quantitated and compared to those of the control group. Lymphocytes from eight of 26 patients with untreated carcinoma were significantly augmented by the addition of indomethacin. The remaining eighteen patients were equal to the controls. For all 17 patients who had just finished extensive field irradiation therapy, significant enhancement of PHA and Con A reactivity by indomethacin was found, which did not appear to be solely a function of low baseline mitogen reactivity. In additional studies, stimulated lymphocytes of irradiated patients were tested for their sensitivity to the inhibitory effect of PGE2. The mitogen treated lymphocytes from all patients that had just finished irradiation therapy were found to be significantly more sensitive to the inhibition by PGE2 as compared to the normal lymphocyte response. This effect was also found not to be related merely to a low PHA or Con A reactivity of the lymphocytes. In both patient groups there was a striking correlation between the percent augmentation of indomethacin and the percent inhibition of PGE2 in that when the percent augmentation values were low so were percent inhibition values and when the degree of augmentation by indomethacin was elevated so was the inhibition by PGE2. This data suggests that increase sensitivity of stimulated lymphocytes to PGE2 may be responsible, at least in part, for the depressed mitogen response and the significant augmentation of this immune response by indomethacin in about 1/3 of the untreated patients with advanced head and neck carcinoma and in those patients who have just finished irradiation therapy. The results of this study support the hypothesis that perhaps patients receiving irradiation therapy may benefit by the oral administration of indomethacin, an approach that needs further consideration.

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.

Immunologic reactivity in patients with nasopharyngeal carcinoma

Immunologic reactivity was measured in 344 patients with nasopharyngeal carcinoma (NPC), before treatment, and in 398 age-matched control subjects. The data recorded suggest that depressed cell-mediated immunity in patients with NPC is a consequence rather than a cause of the disease. In order to reduce tumor burden in patients with NPC, radiation therapy with chemotherapy or immunopotentiation or both is recommended.

Immunocompetence, immunosuppression, and human breast cancer. II. Further evidence of initial immune impairment by integrated assessment effect of nodal involvement (N) and of primary tumor size (T)

Comprehensive immune function by integrated score was assessed in 158 operable, 55 inoperable, and 52 metastatic breast cancer patients relative to 107 healthy controls. The score was derived from in vivo response to PPD and DNCB and in vitro lymphocyte stimulation by PPD and PHA. Proportion of E-RFC was significantly lower in patients than in controls but was not found to correlate directly with the above functional criteria. Fifty-one percent of the patients with early, operable tumors were shown to be at least partially immunosuppressed by integrated score achievement vs. 11% of controls. This proportion rises to 68% of inoperable and 89% of metastatic patients. Quantitative analysis by graded response revealed an additional, significant degree of immune impairment in the respective patient groups by all testing parameters. Depression of immune function in operable patients was not related to age nor influenced by surgery. Immunocompetence of patients with mammary dysplasia did not differ from controls. Increasing size of primary tumor (T) was not found to be matched by progressive degree of immunosuppression, excepting that associated with large T4 tumors. Patients with lymph node involvement (N+) were not significantly immunologically inferior to those without (N0) where the larger operable T2-3) tumors are concerned. In the smallest, T1 tumors, nodal involvement (N+) is accompanied by remarkable immunosuppression relative to T1N0 cases. This finding suggests a pre-existing immune defect inherent in T1N+ patients. It supports the hypothesis that the immunosuppression associated with early breast cancer is primary, patient related. Secondary tumor-induced depression of immune response characterizes advanced and metastatic human breast cancer.

Aryl hydrocarbon hydroxylase inducibility in lung cancer patients undergoing radiotherapy

Aryl hydrocarbon hydroxylase (AHH) inducibility was studied in cultured lymphocytes from 21 healthy control subjects and from 15 lung cancer patients selected for radiation therapy. AHH inducibility of the patients was measured prior to, during and at the end of radiation therapy. Four of 15 patients had values comparable to the healthy controls. Cellular DNA and protein measurements of cultured lymphocytes were the same for patients and healthy controls. There was no significant difference in the percentage of lymphoblast formation and percentage of cell survival between the two groups. Radiation therapy reduces the number of lymphocytes in vivo and the amount of lymphoblast formation in vitro. AHH inducibulity is signifcantly lowered by radiation in the patients who had very high inducibility at pre-treatment level. DNA and protein contents of cultured lymphocytes did not change during radiation therapy.

Aryl hydrocarbon hydroxylase inducibility and lymphoblast formation in lung cancer patients

Aryl hydrocarbon hydroxylase (AHH) inducibility and lymphoblast formation were studied in lymphocytes from healthy control subjects and from lung cancer patients undergoing radiotherapy. The relationship between AHH inducibility and percentage lymphoblasts was statistically significant only for the pre-treatment patients (r = 0.598; p less than 0.05). In the control group and in patients undergoing radiotherapy the correlation between AHH inducibility and lymphoblast formation was positive but statistically it was not significant. Our data do not suggest a linear relationship between AHH inducibility and lymphoblast formation.