Tuberculin reaction in cancer patients, "Mantoux release," and lymphosuppressive-stimulatory factors

Long-term changes in blood counts after intraoperative radiotherapy for breast cancer-single center experience and review of the literature

Background

Intraoperative radiotherapy (IORT) for breast cancer is used as an upfront boost or as accelerated partial breast irradiation (APBI). To date, no description of blood count changes after IORT are available. Our analysis shows blood count changes in breast cancer patients up to 5 years after IORT ± whole breast radiotherapy (WBRT).

Methods

IORT was given as APBI in 58 patients (IORT/APBI-group) and as a boost in 198 patients (IORT/WBRT-group). A median dose of 20 Gy was given intraoperatively with low energy X-rays [INTRABEAM (TM) System] and additionally 46 Gy/2 Gy per fraction to the whole breast, if WBRT was added. Blood counts were collected preoperatively, after 90 days and through year 1–5 of follow-up. Dunnett’s tests were used to calculate changes in blood counts over time. Additionally, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and derived neutrophil-to-lymphocyte ratio (dNLR) were calculated for each time point.

Results

Significantly decreases in the IORT/WBRT-group were seen for erythrocytes, hemoglobin, platelets and leucocytes and an increase for lymphocytes for the total follow-up period. In the IORT/APBI-group significantly decreases were seen for erythrocytes and hemoglobin for the total follow-up period. Regarding changes during follow-up compared to the preoperative value, much more significant changes were seen in the IORT/WBRT-group compared to IORT/APBI-group without any relevant impact of chemotherapy. Regarding PLR-, NLR- and dNLR-values the rate of patients over the range improved over time in both groups.

Conclusions

IORT/APBI seems to have a smaller effect on blood counts compared to IORT/WBRT. Furthermore, PLR-, NLR- and dNLR-values improved over time, suggesting a positive effect on outcome after IORT in general.

Multidisciplinary treatment of head and neck cancer using BCG, OK-432, and GE-132 as biologic response modifiers

Since 1979, we have performed multidisciplinary treatment using intensive immunotherapy with biologic response modifiers (BRM) in combination with surgical treatment of oral cancer. Chemotherapy and radiotherapy were also included as part of the therapy. A historic control study was performed. Adjuvant therapy was administered by standardized methods, and the distribution of patients at various stages was similar between groups. The immunotherapy group showed a shorter treatment period, lower rates of recurrence, metastases, and side effects, greater histologic effects at the end of the first treatment, and a higher survival rate than the nonimmunotherapy group. Immunologically, immunotherapy tended to promote positive immune reactions and inhibit negative immune reactions.

In vitro changes in cell mediated immunity following tuberculin skin testing in humans

Tuberculin skin testing with purified protein derivative (PPD) was found to induce alterations of in vitro measures of cell mediated immunity. T lymphopenia with proportionate decreases of TM and TG cell numbers were observed two days after skin testing. A relative augmentation of TM cells was demonstrated after one week. Peripheral blood mononuclear cells from negative skin responders had normal in vitro reactivity to PPD stimulation suggesting a cutaneous abberation in these individuals. Macrophage dependent depressed PHA reactivity of mononuclear cells was demonstrated two days after skin testing. No change in natural killer cell cytotoxicity was observed. Cytotoxicity was positively correlated to the number of TG cells in the assay.

The immune response to prostate cancer: an evaluation and a review

The effects of stage and therapy of prostate cancer on the immune response were evaluated in 193 patients with an histologic diagnosis of prostatic malignancy. There was little or no effect, as measured by these generally non-specific tests, on the immune response. The host-tumor immune interaction is difficult to evaluate in prostate cancer. The complexities of measuring prostate tumor immunity are discussed and the literature is reviewed.

The modulation of tumour-versus-host response in lung, colon, and breast cancer patients: implications for adjuvant immunochemotherapy

Major advances in the understanding of clinical tumour biology occurred with the appreciation that tumour-associated substances circulated in the blood of cancer patients. In this study their origin and immunogenic function have been investigated. Whole tumour cells (WTC) and cancer cell membrane fractions (CMF) of 24 patients with lung, colon, and breast cancer were investigated for their antigenic effect upon the patients' own lymphocytes and upon healthy allogeneic ones. The antigenicity of whole lung and breast cancer cells to stimulate lymphocyte DNA synthesis, and the ineffectiveness of colon cells were confirmed. CMF had little stimulating effect upon autologous lymphocytes; however, they were able to augment lymphocyte response to PPD and PHA in high dilution and to suppress it in high concentration. The serum of cancer patients exerted similar biphasic activity upon PPD and PHA stimulated lymphocytes ("lymphosuppressive-stimulatory factors", or LSSF). Sephadex studies confirmed that LSSF activity in cancer serum correlated with circulating CMF. These substances modulate lymphocyte nucleic acid synthesis in vitro; it is likely that they similarly modulate the patient tumour-host cell relationship.

Depressed responder and stimulator capacities of peripheral lymphocytes from patients with advanced breast cancer in the mixed lymphocyte culture

Peripheral lymphoid cells of patients with carcinoma of the breast were examined for reactivity (responders) against allogeneic lymphoid cells in the one-way mixed lymphocyte culture. The latter cells were also tested for response against the patients' lymphocytes (stimulators). The responder and stimulator capacities of lymphoid cells of patients with advanced cancer were found to be significantly reduced compared to cells from healthy subjects. Such defects were not observed in disease-free women previously treated for primary carcinoma of the breast. The results support the view that there is an abnormality of the lymphocyte-monocyte pool of cells in patients with advanced cancer.

Role of B cells in the expression of the PPD response of human lymphocytes in vitro

Human blood lymphocytes were tested for their proliferative response to purified protein derivative (PPD) in vitro. Purified T cells showed a lower response than the orginial purified lymphocyte suspension. Purified B cells were unresponsive to PPD. Mixtures of preparations of T and B cells were stimulated to a greater extent by this antigen than anticipated by adding the responses of the two cell types tested separately. This cell synergy could largely be explained by soluble factors released by PPD-stimulated T cells, which were found to be mitogenic for B cells.

Capacity of sera from patients with mammary carcinoma to promote PHA-stimulation of human lymphocytes

Lymphocytes from patients with carcinoma have been reported to exhibit impaired immunologic reactivity and responsiveness to non-specific stimuli both in vivo and in vitro due to inhibitory serum factors. In the present investigation it is tested whether sera from patients with mammary carcinoma may inhibit the response of lymphocytes from normal donors to phytohaemagglutinin (PHA) in vitro. Neither sera from patients with newly diagnosed breast malignancy nor patients with wide spread disease differed from control patients with benign breast lesions. Serum activity did not change within 3 weeks after radical mastectomy or local irradiation but increased slightly after 6 weeks. It is suggested that the impaired PHA-responsiveness of lymphocytes in patients with mammary carcinoma is not due to blocking serum factors but to intrinsic cellular abnormality.

Serial studies of immunocompetence of patients undergoing chemotherapy for acute leukemia

Immunocompetence was followed serially for 1 yr from the onset of treatment in 55 adult patients with acute leukemia. The tests used were delayed hypersensitivity responses to a battery of five recall antigens (dermatophytin, dermatophytin 0, candida, streptokinase-streptodornase, and mumps) and in vitro lymphocyte blastogenic responses to phytohemagglutinin and streptolysin 0. There was a strong correlation between immunocompetence at the start of treatment and a good prognosis; 32/39 patients who subsequently entered remission were initially immunocompetent compared to 4/15 who failed to enter remission. In the complete remission group there was a decline in competence starting from 2 to 5 mo after the onset of treatment. In those who remained in remission for 1 yr, competence recovered at 6 mo and remained vigorous thereafter. In those who relapsed before 1 yr, the decline in competence occurred 1 mo before relapse and competence continued to decline progressively during the 1 yr follow-up period. These studies suggest that therapeutic approaches which restore immunocompetence or prevent its decline will improve both the remission rate and the remission duration of patients with acute leukemia.