Immunosuppression in Burkitt's lymphoma. I. Cutaneous reactivity to recall antigens: Alterations induced by a tumour burden and by BCG administration

Abstract

Patients with Burkitt's lymphoma have impaired delayed hypersensitivity to recall antigens (mumps, streptokinase‐streptodornase candidin and PPD) in the presence of a tumour load. The degree of impairment at presentation (which may reach total anergia) is dependent upon the clinical stage and correlates significantly with survival rate (p < 0.02), sustained remission rate (p < 0.05) and remission duration (p < 0.01). Cutaneous reactivity 3 months after chemotherapy is significantly improved overall in spite of the potentially immunosuppressant effects of cyclophosphamide but immuno‐suppression recurs in patients who relapse. BCG, applied by dermal scarification resulted, after 4 weeks, in significant improvement of cutaneous reactivity (p < 0.001), but no improvement in prognosis. The most probable explanation of these findings is that the impairment in delayed hypersensitivity correlates with the tumour volume, which in turn governs prognosis. The level of general immunological responsiveness at presentation seems unlikely to be a crucial factor per se in governing the response to chemotherapy.

Sera from patients with undifferentiated nasopharyngeal carcinoma contain a factor which abrogates specific epstein‐barr virus antigen‐induced lymphocyte response

“…The in vivo significance of LSI remains to be defined; it is however important to note that, as in the case of many viral infections, a depression of cellmediated immunity can also be found in IM, BL and NPC patients (Fass et af., 1970;Bluming et af., 1971;Nkrumah et al, 1972;Notkins et al, 1973;Lai el al., 1974;Magrath, 1974;Woodruff and Woodruff, 1975;Ho et al, 1978;Wainwright et al 1979). Since the mechanism of such impaired cell-mediated immunity is not understood at present, the possibility that factors such as SBF and LSI are the principal (or sole?)…”

Sequential evaluation of cutaneous delayed hypersensitivity responses to recall and to lymphoid cell line antigens in Burkitt's lymphoma

“…Previous reports of cell-mediated immune responses (CMI) in BL as studied in vivo by delayed hypersensitivity reactions to extracts of autologous tumor cells (Fass et al, 1970;Bluming et al, 1971) and to bacterial and viral recall antigens (Magrath, 1974) have all documented initial impairment of CMI in many patients with BL. In these studies, positive responses to tumor extract were almost exclusively obtained in patients in remission and the responses to recall antigens were found to correlate with tumor extent, remission duration and survival.…”

“…One patient died from causes unrelated to BL has been reported from Uganda (Magrath, 1974), and most likely is a reflection of the extent of tumor burden at presentation. Pretreatment reactivity to the standard antigens showed a closer correlation with clinical course (relapse and survival) than responses to the Raji antigen.…”

“…Impaired delayed hypersensitivity to standard recall antigens in the presence of tumor load has also been documented in BL patients. The degree of impairment was found to correlate with survival and remission duration (Magrath, 1974). Positive DCH reactions to crude membrane extracts of autologous tumors have been reported in some BL patients achieving remission after chemotherapy (Bluming et al, 1971), and this has been found to correlate with long-term sustainep remissions (Fass et al, 1970).…”

Antibody and complement levels in patients with Burkitt's lymphoma

“…6,7,8 . Clinical trials of immunotherapy were started in the early 1970's based on Burkitt's hypothesis of immunosurveilance using sera from patients who had undergone complete tumour regression, and immunostimulators like Bacillus Calmette Guerin (BCG) 9 . Depressed host immunity measured by mitogen stimulation and delayed type hypersentivity in BL patients bear direct and indirect relationship to the tumour burden 10,11 .…”