Relationship between T lymphocyte levels and lymphoproliferative responses to mitogens and alloantigens in lung and breast cancer patients

The functional deficiency of B lymphocytes in patients with lung cancer is due to inadequate T-cell help and excessive suppression by T and non-T cells

The proliferative and plaque-forming cell (PFC) responses of unseparated mononuclear cells (MNC) and B- and T-cell-enriched populations of cells were analyzed in 15 patients with lung cancer to determine the mechanisms involved in the functional abnormality of their B cells. The PFC responses of the MNC of the patient group were significantly lower than those of normal controls. In addition, the enriched B cells of several patients showed a further decrease in their PFC responses after coculture with autologous T cells compared with their respective MNC responses. The proliferative response against phytohemagglutinin (PHA) was also lower in many of the patients after similar cocultures. Cocultures of patients' B cells with T cells from normal controls significantly enhanced the PFC responses in 7 patients. In most of the normal controls, B lymphocytes showed a significant decrease in their PFC responses after coculture with the patients' T cells. Although the percentages of total T cells, T-helper, and B cells were within the normal range, the number of suppressor T cells was significantly higher in the patient group. These results indicate that a combination of insufficient T-cell help, excessive suppression by both T and non-T cells, and a possible intrinsic B-cell abnormality are responsible for the B-cell functional deficiency observed in patients with lung cancer.

The effects of indomethacin and interleukin-2 on the proliferation of lymphocytes from patients with lung cancer

The effects of the addition of indomethacin and interleukin-2 (IL-2) to phytohemagglutinin (PHA)-stimulated lymphocytes from patients with untreated squamous-cell carcinoma of the lung and with chronic obstructive pulmonary disease and from normal individuals were studied. In 13 of 21 patients with lung carcinoma, the response of lymphocytes to PHA stimulation was significantly augmented by indomethacin. In these 13 patients, the nonaugmented PHA response was also significantly depressed, with only 1 patient falling in the normal range. In the other 8 patients, the average PHA reactivity was normal, as was the degree of augmentation by indomethacin. In additional studies, IL-2 was added to PHA-stimulated lymphocytes with and without the addition of indomethacin. In the normal group, IL-2 further increased PHA reactivity by an average of 46.0%. The addition of indomethacin to these cultures increased the PHA reactivity by only 8.8%, which is similar to the indomethacin effect for the PHA-stimulated cells without the addition of IL-2. In the cancer group, the PHA reactivity of 13 of 19 patients was significantly increased by the addition of IL-2. When indomethacin was added simultaneously with IL-2, the proliferative response for 12 of 19 patients was increased significantly more than for the normal controls. Thus, this study indicates that the PHA reactivity of lymphocytes from many lung carcinoma patients is augmented to a greater extent than for normal individuals by inhibiting prostaglandin synthesis. Also, the addition of IL-2 to these PHA-stimulated cultures did not mimic the addition of indomethacin, but instead the effects were usually additive.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunologically defined prognostic subgroups as predictors of response to BCG immunotherapy

Fifty-two stage I and II patients with nonsmall cell lung cancer were randomized after resection to no further therapy, BCG, or BCG plus allogeneic tumor cells. Patients have been observed for 16-65 months (mean 39.5). When the two immunotherapy arms were combined and plotted against controls, trend analysis suggested (P = 0.088) an increase in disease-free interval (DFI) only for stage I patients. The one-way mixed lymphocyte culture (MLC) values were depressed in some patients prior to any immune stimulation. Immunotherapy significantly benefited DFI among patients with a depressed MLC.

In vitro monocyte maturation as a prediction of survival in squamous cell carcinoma of the lung

In vitro monocyte maturation was studied in patients with squamous cell carcinoma of the lung--limited to the ipsilateral hemithorax in 30 and more extensive in 40. The patients were studied prospectively and initial monocyte maturation was correlated with survival. Monocyte maturation in patients with limited disease before treatment ranged from 3.1 to 57.6% with a median value of 21.4%. The survival of those patients in whom monocyte maturation was less than the normal range (less than 30.4%) was significantly shorter than the survival in those with normal maturation ( p less than 0.05). Four of the five patients whose initial maturation was less than 10% proved to be inoperable at surgery. Patients with extensive disease had monocyte maturation ranging from 2.4 to 52.9% with a median value of 13.2%, significantly lower than in those with limited disease (p less than 0.025). Patients with extensive disease and low monocyte maturation survived a significantly shorter time than those with normal maturation ( p less than 0.005). The depression of monocyte development may explain the finding of negative delayed hypersensitivity skin reactions in many patients with lung carcinoma and may prove useful as an index of prognosis.

Role of adherent suppressor cells in the depression of cell-mediated immunity in Hodgkin's disease and lung carcinoma

The mechanism of the depression of cell-mediated immunity (CMI) in patients with Hodgkin's disease (HD) and lung carcinoma (LC) was investigated before any treatment. In 9 patients out of 14 with HD and in 4 patients out of 14 with LD, a depressed lymphocyte reactivity to phytohaemagglutinin (PHA) was observed. In 3 out of 9 patients with HD and in 2 out of 4 patients with LC who exhibited a depressed lymphocyte response to PHA, suppression caused by adherent cells and mediated by prostaglandins was evidenced. No relationship was found between this mechanism of suppression and depression of CMI in vivo as judged by skin tests to common recall antigens.

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.

Antibody-dependent cellular cytotoxicity in cancer patients: lack of prognostic value

Antibody-dependent cellular cytotoxicity ("killer" (K) cell activity) of peripheral-blood lymphomononuclear (LMN) cells was determined in patients with early and advanced cancer, and the results compared with those in healthy individuals, those with benign diseases and critically ill septic patients. The effect of operation and local radiotherapy was determined on K cells. The initial values were compared in those who subsequently lived or died to test their prognostic value.K-cell activity was the same in women of all ages and was half that in men. It was lower in men over 65 years than in younger men. In patients with early cancer, K-cell activity was the same as in healthy individuals and those with benign diseases, and was of no prognostic value. It was decreased by 42% in those with advanced cancer but to the same extent as in the septic patients. Operation had no effect in those who had normal activity before operation, but caused an 84% decrease in those who had low preoperative values. The decrease was maximal at 5 days and recovery occurred by 15 days. Radiotherapy caused a 72% decrease in K-cell activity, maximal at 5 weeks after starting treatment, with recovery by 16 weeks in those who had complete tumour regression. The values remained low in those with persistent tumour or metastases. The values during treatment did not help in identifying those who subsequently lived or died.

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.

Circulating breast tumour antigen-sensitive T lymphocytes in early breast cancer and high risk benign breast disease

Levels of circulating T lymphocytes sensitized to breast tumour associated antigens (BTA) were correlated with pathological tumour stage or benign histopathology in preoperative studies of 180 patients by the antigen-stimulated active rosette-forming T cell (AgARFC) assay. Incubation of lymphocytes with allogeneic BTA extracts produced increased AgARFC compared with incubation without BTA. Significant levels of BTA-sensitive T cells were found in 78 per cent of breast cancer patients compared with 23 per cent of patients with benign disease (P less than 0.0005, by X2). Over 93 per cent of stage I cancer patients responded to BTA, compared with 69 per cent of stage II patients (P less than 0.025) and 59 per cent of stages III-IV patients (P less than 0.005). Twenty-nine per cent of 42 patients with fibrocystic disease were positive to BTA in contrast to 8 per cent of 25 patients with fibroadenomas. This was a 3.6-fold higher incidence of BTA-sensitive T cells associated with fibrocystic disease than with fibroadenomas, which was in agreement with the increased breast cancer risk rate associated with fibrocystic disease. These findings suggest that the AgARFC assay may detect early malignant change in fibrocystic disease. The AgARFC assay was found to reliably detect early invasive carcinoma.

Cancer-specific density changes in lymphocytes after stimulation with phytohaemagglutinin

A fluorescence polarisation technique ("S.C.M. test") for detecting responses to phytohaemagglutinin revealed that the responsive lymphocytes from patients with malignant disease had an abnormal distribution after centrifugation through lymphocyte separation medium. In a small blind series the technique accurately distinguished patients with histologically proven malignancies from those with nonmalignant disease and normal people.