Cell mediated and humoral immune response to acute leukemia cells and soluble leukemia antigen: relationship to immunocompetence and prognosis

Concurrent studies of lymphocyte blastogenic response to autologous leukemia cells, of general immunocompetence, and direct membrane immunofluorescence with anti immunoglobulin serum were carried out in 35 adults with acute leukemia. In addition, lymphocyte blastogenic response of autologous and allogeneic lymphocytes to soluble leukemia antigen was studied. Of 35 patients, 25 (72%) had positive blastogenic response to their own leukemia cells. Patients with acute myelogenous leukemia (AML) tended to have a greater blastogenic response to their leukemia cells than patients with acute lymphoblastic leukemia (ALL). Eight of nineteen patients with AML and one of the five with ALL had complete or partial abrogation of this positive blastogenesis when the lymphocytes were cultured in autologous serum rather than allogeneic serum. Direct membrane immunofluorescence with anti immunoglobulin serum showed bound IgG on the cells of 7 of 8 AML patients with the serum inhibitory effect and 1 AML patient without the serum inhibitory effect. There was facilitation of blastogenic response in autologous serum compared to allogeneic serum in 5 instances. A good prognosis was correlated with a vigorous blastogenic response, its inhibition or facilitation by autologous serum, and IgG bound to the cell surface. Of 7 patients, 6 had positive blastogenic response to autologous soluble antigen. Of these 6 patients, 5 also responded to autologous leukemia cells. Although allogeneic normal donor lymphocytes responded vigorously to leukemia cells in 6 of 7 instances, only 1 of 7 allogeneic lymphocytes responded to soluble antigen. Thus, presensitization apparently is required for in vitro blastogenic response to soluble leukemia antigen.