Primary and secondary immune responses in the evaluation of immunocompetence and prognosis in cancer patients

These studies clearly indicate that immunocompetence is related to prognosis in patients with malignant disease. Patients with a good prognosis generally have better immunocompetence and immune responsiveness (measured by in vitro lymphocyte blastogenesis, established delayed hypersensitivity and primary immune response) than patients with a poor prognosis. As important, or perhaps more important than a pretherapy evaluation of the immune response is an evaluation done after therapy. Some patients who are immunologically incompetent before thepy become immunocompetent after therapy; these have a good prognosis. Conversely, patients who are immunocompetent before therapy but who have prolonged and profound suppression of immune respinsiveness after therapy have a poor prognosis. This is true, both for patients with acute leukemia and for those with a variety of solid tumors. There are several things which are indicated for continuing immunological research in cancer therapy. Serial studies of the immunocompetence of treated cancer patients must be made to identify those who are immunologically incompetent. Identification of the etiology of the immunological deficiency must be attempted so that it can be attacked specifically. Characterization and identification of the immunosuppressive effects of the conventional therapies used to control cancer, such as radiotherapy, chemotherapy, and surgery, must be attempted. Finally a reversal of the immunological deficiencies detected by either specific or nonspecific immunotherapy must be attempted.