Serial immunologic assessment during a randomized trial of chemoimmunotherapy in acute myelogenous leukemia

Summary

Thirty-one adults who had acute myelogenous leukemia and in whom remission had been induced and consolidated with chemotherapy were randomized to receive one of three maintenance schedules: (A) BCG + chemotherapy [1, 3-bis-(2-chlorethyl)-1-nitrosourea (BCNU) and cytosine arabinoside]; (B) splenectomy, followed 1 week later with BCG and chemotherapy; or (C) allogeneic leukemic cells, BCG, and chemotherapy. Serial immunologic assessments were performed at the onset of maintenance and every 3 months.

No differences were found in duration of remission (median 209 days) or survival (median 454 days) among the three schedules. Six patients remain in remission after from 2−4 + years. Skin test responses, mitogen responses, mixed lymphocyte culture responses, antibody responses, and T and B lymphocyte numbers were depressed at the onset of maintenance therapy. Therapy clearly improved the state of anergy as defined by recall antigen responsiveness, and induced in vivo and in vitro PPD reactivity. However, immunotherapy resulted in a reduction of the number of T or B cells and of the in vitro lymphocyte response to mitogens and allogeneic cells. Serum obtained at diagnosis and during remission inhibited in vitro blastogenic responses in more than half the patients. These data indicate that chemoimmunotherapy given as described tended to be more immunosuppressive than stimulatory.