The National Cancer Institute (NCI) Extramural IL2/LAK Working Group treated 93 patients with 114 cycles of high-dose intravenous (IV) interleukin-2 (IL-2) and lymphokine-activated killer (LAK) cells in three phase II trials. Thirty-six patients had metastatic melanoma, 35 had metastatic renal cell cancer, and 22 had colorectal cancer. All patients had a Karnofsky performance status greater than or equal to 80% and normal laboratory tests and organ function, and had received no more than one prior form of immunotherapy or chemotherapy. Objective responders were eligible to receive up to two additional courses of therapy at 12-week intervals. The most frequent toxicities were a capillary leak syndrome resulting in marked extravascular fluid shifts, and hypotension requiring treatment with large volumes of IV fluids and vasopressor agents. Laboratory and clinical evidence of hepatic and renal dysfunction were virtually universal. Intensive care-level support was routinely provided and the toxicity observations confirmed the need for this level of care. The life-threatening toxicities were cardiac and pulmonary. Five of the 27 patients who experienced significant respiratory compromise required intubation and mechanical ventilatory support. Twenty patients developed cardiac arrhythmias, the majority of which were supraventricular. There was a single episode of ventricular tachycardia requiring cardioversion. Four patients had transient cardiac ischemia, and an additional four had myocardial infarctions, one of which was fatal. With these exceptions, all toxicities were rapidly reversible. The occurrence of only a single therapy-related death and a very low incidence of other irreversible or life-threatening events is comparable to the level of toxicities often observed in other phase II trials. Although the intensity of this regimen limits this approach to a subset of cancer patients with excellent performance status and adequate organ function, because of the frequency and apparent durability of complete responses, this treatment warrants further investigation.

Several approaches have provided evidence for the existence of distinct T lymphocyte subsets in man as defined by cell-surface markers. To a large extent, these studies have employed either differential Fc-receptor binding, or antisera reactive selectively with subpopulations of T cells. With the former method, it was shown that two human T cell subsets, T cells bearing receptors for the Fc portion of IgG (Ty) and T cells bearing receptors for the Fc portion of IgM (Tp.), could be isolated via surface receptors capable of binding the Fc portion of IgG or IgM, respectively (1, 2). Approximately 60-70% of T lymphocytes in peripheral blood were defined as T~, whereas a smaller portion representing <20% were T3' cells. Functionally, T'/and T/~ populations were distinct with respect to phytohemagglutinin responsiveness and capacity to effect help or suppression of B cell-immunoglobulin production in a pokeweed-mitogen-driven system (3, 4).Hetero-and autoimmune antisera and hybridomas that secrete monoclonal antibodies directed at subsets of human T cells have provided an alternative method for their identification (5-16). 20% of peripheral T cells were found to be reactive with THz heteroantisera (TH2 +) or a monoclonal antibody termed OKT5 (OKT5 +) and both defined the cytotoxic/suppressor populations (6,7,17). The remaining 80% of T cells were unreactive with both TH2 and OKT5 antisera and defined as THe-(OKT5-). A second monoclonal antibody, OKT4, reacted with 60% of the total T cell population and was restricted in its reactivity to the THe-(OKT5-) T cell subpopulation (12-16). Only the OKT4 + T cell population responded with proliferation to soluble antigen (12). More importantly, this population was the helper population because it was required for the optimal development of the THe + (OKT5 +) cytotoxic cell in cell-mediated lympholysis, induction of B cell differentiation, proliferation and immunoglobulin synthesis in a pokeweed-mitogen-driven system, and production of helper factors (13-16). Thus, the OKT4 ÷ and OKT5 + T cells belonged to reciprocal subsets, and defined the human inducer (helper), and suppressor, T cell subpopulations, respectively. Because of the importance of relating T lymphocyte *

Thirty-six patients with metastatic melanoma were entered into a study of the therapeutic efficacy of adoptive immunotherapy with high-dose interleukin-2 (IL-2) and lymphokine-activated killer (LAK) cells. Thirty-two patients who received all components of the therapy are evaluable for response, and all patients are evaluable for toxicity. Sites of disease included lung, liver, subcutaneous nodules, and intra-abdominal metastases. One complete response (CR) and five partial responses (PRs) resulted from treatment (19% response rate). The median response duration was 5 months, with the durable CR continuing at 31+ months and one durable PR continuing for 13 months. Sites of response included lung, liver, subcutaneous nodules, and lymph nodes. Response, response duration, or site of response did not correlate with the total dose of IL-2 administered, rebound lymphocytosis, or the number of LAK cells infused. Toxicity included hypotension, fluid retention with a "capillary leak syndrome" in most patients, and transient multiorgan dysfunction that resolved promptly after the completion of therapy. Adverse cardiac events occurred in 16% of patients, with one myocardial infarction leading to a death. This study confirms the activity of the initial IL-2/LAK cell regimen in metastatic melanoma reported by Rosenberg et al, supporting the concept of adoptive immunotherapy as an important new treatment approach for this disease.

The immunophenotypes of lymphoblasts from children with newly diagnosed T-cell acute lymphoid leukemia (T-ALL, n = 101) or T-cell non-Hodgkin lymphoma (T-NHL, n = 31) were analyzed to correlate stage of thymocyte differentiation with clinical features and outcome. The 67 boys and 34 girls with T-ALL were 1 month to 18 years old (median, 8 years) with leukocyte counts ranging from 2 to 810 x 10(9)/L (median, 55 x 10(9)/L). Eighteen of these patients were black, and 70 had a mediastinal mass. Twenty-six boys and five girls with a median age of 9 years (range, 1 to 20 years) had T-NHL. Seven of these patients were black, and 24 had a mediastinal mass. The distributions of thymocyte developmental stages (early [CD7+], intermediate [CD1+ and/or CD4+ and/or CD8+], and mature [CD3+]) in cases of T-ALL and T-NHL were significantly different: 34%, 43%, and 23% v 6%, 62%, and 32% (P = .02). A comparison of the patients' clinical features according to the maturational stage of thymocytes failed to disclose significant differences in the majority of characteristics studied. However, patients with mature-stage T-NHL, with or without the addition of subjects with mature-stage T-ALL, were less likely to have a mediastinal mass (P = .02 for both comparisons). Those with intermediate-stage T-cell malignancy (T-ALL and T-NHL combined) were the subgroup most likely to have a mediastinal mass (P = .01). Response to remission induction therapy was significantly worse in the T-ALL subgroup with an early-stage phenotype: a failure rate of 21% v 0% and 6% for the two more differentiated phenotypic subgroups (P = .007). Event-free survival was not affected by thymocyte maturational stage in cases of either T-ALL or T-NHL. Despite evidence of clinical heterogeneity among the maturational stages of T-cell malignancies in children, these developmental subdivisions do not appear to be critical determinants of outcome once remission is achieved. We conclude that such phenotypes need not be included in the stratification plans for clinical trials using common induction treatment.

Chromosome banding studies on 60 children with acute lymphocytic leukemia (ALL), including “null,” pre-B, B, and T cell phenotypes, were performed. In 4 of 17 patients with pre-B cell ALL, we noted a previously undescribed chromosome translocation, t(1;19)(q23;q13). This translocation was not found in patients with “null” cell, B cell, or T cell ALL. Since each patient with the 1;19 translocation experienced early treatment failure, t(1;19)(q23;q13) may mark a subgroup of patients with pre-B cell ALL who have an especially poor prognosis.