Changes in cell-mediated cytotoxicity during the clinical course of patients with bladder carcinoma

Lymphocyte-dose response relationship in spontaneous lymphocyte mediated cytotoxicity (SLMC) measured by microcytotoxicity assay

Titrations of spontaneous lymphocyte-mediated cytotoxicity (SLMC) in a 44-hour microcytotoxicity assay (MA) by serial dilutions of effector lymphocytes were performed to characterize the lymphocyte-dose response relationship, and to investigate the methodological basis for comparative cytotoxicity studies. The following lymphocyte fractions were used: unseparated, E rosetting, non-E rosetting, EA rosetting, and non-EA rosetting. Assays were performed against target cell lines from normal and malignant urothelium with high or low sensitivity to SLMC in allogeneic and autologous combinations, and against an osteosarcoma cell line. Analysis of SLMC titration curves showed that two different mathematical models could be used to describe the relationship between lymphocyte concentration and SLMC, I: linear relationship (log lymphocytes, CI) with exclusion of both high and low CI values, and II: sigmoid relationship (log lymphocytes, CI) which was transformed to linear relationship (log lymphocytes, log CI/100 - CI), including also high and low values. It is pointed out that perfect quantitative comparisons of SLMC in different combinations were complicated by statistically significant differences between the curve slopes. However, estimations based on experimental results in a range close to 50% cytotoxicity index (CI) may be acceptable, as the differences between slopes were small.

Sequential in vitro reactivity of lymphocytes from patients with cervical squamous malignancy in a cytotoxicity assay

The in vitro reactivity of peripheral blood lymphocytes from patients with cervical squamous malignancy was prospectively followed over a relatively long period of time. In 12 of 14 patients with preinvasive cervical lesions, reactivity was present at the time of initial diagnosis. Three months after treatment, reactivity was still present in only one of 12 (8%). Six months after the treatment, no significantly reactivity could be detected in any of them. In the group with invasive squamous cell carcinoma, four patients developed recurrence in the course of follow-up. Reactivity was present in all at the time of initial diagnosis. In three of them, cytotoxic reactivity was retained up to the time of death, in spite of clinical deterioration. One lost the reactivity after the third course of chemotherapy. Fourteen patients with invasive squamous cell carcinoma were followed up to 24 months without any evidence of recurrence. In all of this group, the cell-mediated cytotoxicity was nonreactive at 9 months. We conclude that: (1) patients with squamous cell carcinoma of the cervix demonstrated cell-mediated immune responses which disappeared 3 to 9 months after effective treatment (apparent cure) and (2) with persistent disease, in spite of marked clinical deterioration and inanition, cell-mediated cytotoxicity was demonstrable until the time of death.

Does cyclophosphamide induce bladder cancer?

An increasing incidence of bladder neoplasms temporally associated with chemotherapy, usually cyclophosphamide, is being reported. These secondary primary bladder malignancies are characteristically found in two groups of patients: those with lymphoproliferative or myeloproliferative tumors, and those with immunosuppression after organ transplantation. A case of adenocarcinoma of the bladder associated with malignant lymphoma is reported, and the known cases of second primary bladder malignancies after cyclophosphamide therapy as reported in the literature are reviewed. Studies relating to the enhanced occurrence of second primary cancers in lymphoproliferative disorders are presented. The recognized urologic toxicities of cyclophosphamide, including cytopathologic changes in animals and humans, are discussed. The observed association between immunosuppression and second primary malignancies is explored, as supported by studies on congenital immunodeficiency in humans, viral oncogenesis in experimental animals, and neoplasia after organ transplantation. Possible mechanisms of carcinogenesis associated with cyclophosphamide are reviewed, including suppression of humoral and cell-mediated immune defense mechanisms, direct carcinogenesis, or cocarcinogenesis. A plea is made for the orderly reporting and careful documentation of bladder tumors in patients receiving cyclophosphamide. It is suggested that prospective studies in these patients and in patients receiving cyclophosphamide for nonmalignant disorders would be of value in assessing the culpability of cyclophosphamide as a carcinogen.

The specificity of the microcytotoxicity assay for cell-mediated immunity in human bladder cancer

Cytotoxicity of lymphocytes from T1 or T2 bladder cancer patients and patients with other diseases was tested in 44-hour microcytotoxicity assay against 3 different target cell lines: 1) HU 456, derived from human bladder carcinoma and established in our laboratory, 2) HU 609, a line derived from normal human bladder tissue and established in our laboratory and 3) SAOS-2, a human osteosarcoma cell line from the Memorial Sloan-Kettering Cancer Institute. Lymphocyte concentrations ranging from 7.8 time 10(4) to 2.5 times 10(6) lymphocytes per ml. were tested against each cell line. Lymphocytes from both groups of patients demonstrated a cytotoxicity against all 3 target cell lines, proportional to the lymphocyte concentration used. There was no difference in reactivity to HU 609 or to SAOS-2 between bladder cancer and control patients but the lymphocytes of bladder cancer patients showed a statistically greater cytotoxicity for HU 456, demonstrating a tumor type-specific cellular immune reaction superimposed on a background of non-specific cytotoxicity.

Adenosine deaminase activity in patients with carcinoma of the bladder

Adenosine deaminase is an important enzyme in purine metabolism, and patients with abnormal lymphocyte and erythrocyte adenosine deaminase levels have been shown to have impaired immune competence. Since immune factors have been shown to be important in patients with transitional cell carcinoma of the bladder we studied adenosine deaminase activity in the hemic cells of 48 patients with this tumor. Lymphocyte adenosine deaminase levels were elevated in patients with transitional cell carcinoma and correlated with stage, activity, clinical course and tumor resection but not with tumor grade. Erythrocyte adenosine deaminase levels also were elevated in patients with transitional cell carcinoma but did not correlate with other disease parameters. Lymphocyte adenosine deaminase activity in patients with transitional cell carcinoma may be a sensitive indicator of disease activity and further studies may provide insight into the host-tumor relationship at the enzyme level.