Follow-up studies on the immune status of patients with Hodgkin's disease after splenectomy and treatment, in relapse and remission

Abstract

Summary.-Sixty-two patients with Hodgkin's disease have been followed for one year from the start of treatment. Immunological assessments were repeated after intensive treatment, in patients relapsing and in those in remission at one year. In patients achieving remission, overall cellular immunity, after deteriorating with therapy, particularly cytotoxic chemotherapy, returned to pre-treatment levels in remission when there was little evidence of cellular immune disturbance. Serum IgG and IgM levels fell with intensive chemotherapy in splenectomized patients. IgA and IgM levels were lower (irrespective of splenectomy or therapy status) in remission than at presentation or after treatment. Relapse or non-response was usually associated with deteriorating cellular immunity. Herpes zoster/varicella and candida infections (seen in 6 patients) were preceded by, or associated with, deterioration of cellular immunity.

Immunity in Hodgkin's disease: status after 5 years' remission

“…Splenectomy has been claimed to have "protective" effects on peripheral leucocyte counts during therapy and our earlier study (Hancock et al, 1977) confirmed this. At 5 years, however, the neutrophil count was unchanged only in the radiotherapy/splenectomy group compared with the decreased level in other patients.…”

“…However, leucocyte-migrationOther inhibition and lymphocyte-transformation asssessments were significantly lower at 5 years than at presentation, when responses were already subnormal. Since all these patients were in clinical remission when retested, these findings invalidate our previous suggestion (Hancock et al, 1977) that deteriorating cellular immunity may be a useful indicator of relapse. Our patients also showed falls in all the immunoglobulin classes (G, A and M) monitored over the period of study.…”

“…Impaired humoral immunity has been observed in treated Hodgkin's disease (Weitzman et al, 1977); however, other reports (Fisher et al, 1980;Kun & Johnson 1975) suggest that in the longterm humoral immunity is not depressed. In 1977 we reported our early follow-up studies on the immune status of patients with Hodgkin's disease after splenectomy and treatment (Hancock et al, 1977). Cellular immunity as judged by skin tests and leucocyte migration inhibition showed little evidence of disturbance after one year but serum IgG and IgM levels fell with intensive chemotherapy in splenectomized patients; and IgA and IgM levels were lower, irrespective of splenectomy or therapy status, after 1 year's remission than either at presentation or after treatment.…”

A prospective study on antibody response to repeated vaccinations with pneumococcal capsular polysaccharide in splenectomized individuals with special reference to Hodgkin's lymphoma

“…In addition, despite efforts to educate patients and physicians to suspect the diagnosis and initiate adequate treatment promptly if disease occurs the annual mortality rate remains high (1.0–3.8%) [7]. Splenectomized individuals, in particular, patients with Hodgkin's lymphoma (HL) who have received chemotherapy, often show decreased serum immunoglobulin (Ig) levels of the IgM class [8–11]. As previously assumed by Kobel et al, if a young HL patient survives for 50 years after initial treatment, he/she runs a risk of 13.5 and 6.5% to develop and die from OPSI, respectively [12].…”

Systemic varicella-zoster virus infection in two critically ill patients in an intensive care unit

“…These conditions were considered being related to the onset of systemic VZV infection. Additionally, in Case 1, the relatively small spleen found by CT (spleen dysfunction is associated with reduction of humoral immunity [13]), the substantial blood transfusions, and the quadruple amputation were considered the other possible risk factors.…”