The antileukemic effect of systemic non-specific BCG-immunostimulation vs systemic specific immunostimulation with irradiated isogeneic leukemic cells.
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Biomedical subjects
Publications and source records attributed to G Mathé.
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Because of the experimental and clinical studies which have been extensively conducted with bacillus Calmette-Guérin (BCG) as a systemic adjuvant in cancer immunotherapy, we have analyzed the main factors and conditions which determine its beneficial action and have underlined some of these (eg, the dose factor which controls the amplification of suppressor cells which is probably responsible for failures and even the possible tumor-enhancing effect of immunotherapy). Knowing those factors and conditions, we have been able to establish a systematic immunopharmacologic study of systemic immunity adjuvants, which has resulted in the discovery of agents whose actions are more rapid than that of BCG on one or a few populations of cells involved in immunity and which, unlike BCG, do not induce suppressor cell amplification. This amplification may explain the difference in the results obtained with this mycobacterium in various clinical immunotherapy trials in which it was applied differently. It is proposed to combine these mono- or pauc-functional adjuvants in order to try to obtain all of the beneficial effects of BCG without the amplification of suppressor cells.
Vindesine, an analog of vinblastine and vincristine, has been submitted to a phase II trial, the results of which are judged in terms of remission induction. A high proportion of remissions were obtained in acute lymphoid leukemia and blastic crisis of chronic myeloid leukemia, and a few responses have been registered in lymphosarcoma and Hodgkin's disease. A continuous 48-hour iv infusion may induce a remission where an iv push of the same dose has failed. The most remarkable characteristic of vindesine is the absence of cross-resistance with vincristine as documented in acute lymphoid leukemia.
Amino acid analysis of the culture medium was carried out in a human leukemic lymphoblastoid cell line (REH) established from the lymphoblasts of a patient with acute lymphoid leukemia. The results are compared with those of a reference cell line (LHN13) established from normal human lymphocytes. The most striking difference between these two cell lines concerns proline. In LHN13 the concentration of this amino acid in the culture medium increases by 40 microgram/ml/10(6) cells during a 72-hr incubation. In REH there is a decrease under the same culture conditions. In both cell lines proline is derived from glutamic acid and from arginine, as found with the use of 14C-labeled precursors. Synthesis of proline in the REH line represents approximately 26% of the value measured in LHN13 when the precursor is glutamic acid and 15% when the precursor is arginine. The radioisotopic assay for delta1-pyrroline-5-carboxylate reductase showed that there is a deficiency of this enzyme in the REH cells. The defect in proline synthesis of REH was found at the establishment of this line and constitutes a metabolic marker that has persisted for more than 2 years.
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It is demonstrated that, under experimental conditions resembling those used for bone marrow grafting in man, disparity for minor histocompatibility antigens alone (i.e., antigens coded for by genes not included in the major histocompatibility complex) is in fact sufficient for the induction of severe lethal graft-versus-host disease in adult (DBA/2 X B10.D2)F1 recipients of normal B10.D2 myeloid and lymphoid cells.
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A total alkaloid and two purified alkaloid extracts of Alangium vitiense were found to be oncostatic for L1210 leukemia; the total alkaloid exerted a noticeable activity, and the purified extracts exerted a borderline activity. These two purified extracts are noticeably oncostatic for two other lymphoid neoplasias in mice, P388 leukemia and Gardner lymphosarcoma. These compounds are not active on Warner myelomonocytic leukemia WEH13 or on B16 melanoma.
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The immunomodulating effects of bacillus Calmette-Guérin (BCG) and levamisole were tested in young adult mice after a single administration and in 12-month-old mice after continuous administration. In young mice, BCG was shown to activate macrophages, to potentiate antibody responses and delayed hypersensitivity reaction, to increase antibody-dependent cell-mediated cytotoxicity, and to induce nonspecific suppressor cells. Levamisole was not able to modify any of these immune responses in young mice. The action of these adjuvants differed markedly when tested in age-immunodepressed mice. BCG was found to be strongly immunosuppressive on antibody formation and induced suppressor cell activity in the spleen. Moreover, the survival of immunodepressed mice continuously treated with BCG was shortened in comparison to untreated aged mice. In contrast, levamisole acted as an immunorestoring agent because it strongly stimulated the antibody response compared to aged controls and did not induce suppressor cell population. The survival of levamisole-treated mice was prolonged when compared to untreated aged mice. When the surviving mice were killed and autopsied at the age of 24 months, the incidence of spontaneous tumors was significantly lower in the group of mice treated by levamisole.
A total alkaloid and two purified alkaloid extracts of Alangium Vitiense were revealed by our experimental screening to be oncostatic on L1210 leukemia and two other lymphoid neoplasias in Mice. They are not active on myelomonocytoid leukemia WEHI3 nor on B16 melanoma.
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50 cases of primary acute lymphoid leukaemia (A.L.L.) were analysed for the presence of T and B membrane markers on bone-marrow and/or peripheral-blood cells. 26% of cases were predominantly T-cell in type, 4% were B, the remaining 70%, without detectable membrane markers, were classified as "null" cell A.L.L. Of particular interest is the correlation between this immunological classification and the prognosis, since T-cell and B-cell A.L.L. were associated with a poorer prognosis than null-cell A.L.L. in terms of both median length of first complete remission and median survival. With one exception the T-cell cases were, according to the W.H.O. classification, of either the prolymphocytic or macrolymphoblastic type of A.L.L. and were more extensive than the comparable null-cell A.L.L. In contrast, cases of the W.H.O. prolymphoblastic and microlymphoblastic types were all found to be null-cell A.L.L. and were associated with the worst and best prognosis respectively. The correlation found between the immunological classification of A.L.L. and the prognosis means that patients with a poor prognosis can be selected for more intensive therapy.
The discovery of B or T markers on neoplastic cells in acute lymphoid leukemia (ALL) is correlated with a poor prognosis, while a cure expectancy of 50% can be expected for null cell ALL patients of all ages. In the case of Non Hodgkin's malignant lymphoma the patients with the T cell types carry a poor prognosis, while the patients with a B cell type present an 85% cure expectancy, and those with the null cell type a 65% cure expectancy. The correlation between immune markers on the one hand, and WHO cyto-histological typing and clinical presentation on the other, is reported.
The therapeutic value of interspersing cyclophosphamide (CPM) chemotherapy and BCG immunotherapy was investigated in two tumor models: L1210 leukemia and Lewis solid tumor (LLT). In the case of L1210 leukemia, the antileukemic effect of CPM was enhanced by subsequent BCG administration where a single cycle of combined treatment was applied; treatment by repeated doses of CPM interspersed with BCG was no more effective than CPM chemotherapy alone. In the case of LLT tumor, the effect of one cycle of combined CPM-BCG treatment was not different from CPM administered alone but treatment by repeated doses of CPM interspersed with BCG immunotherapy was less effective than CPM chemotherapy alone. These results indicate that, while the effect of BCG immunotherapy may be favorable or nil when BCG is applied after cell-reducing chemotherapy, it may be nil or unfavorable when applied repeatedly in interspersed chemoimmunotherapy treatments.
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