The Stanford experience with high-dose etoposide cytoreductive regimens and autologous bone marrow transplantation in Hodgkin's disease and non-Hodgkin's lymphoma: preliminary data

Seventy-seven Hodgkin's disease and non-Hodgkin's lymphoma (NHL) patients received high-dose etoposide in combination with cyclophosphamide and either fractionated total body irradiation (TBI) (n = 28) or carmustine (n = 49) prior to autologous bone marrow transplantation. Marrow from NHL patients was purged in vitro with a panel of monoclonal B- and T-cell antibodies and complement. Six toxic deaths (8%) occurred, all in patients who received carmustine. With a median follow-up of 1 year, 57 patients are alive and free from progressive disease. The 1-year actuarial survival and freedom from progression are 85 and 73% in fractionated TBI/etoposide/cyclophosphamide-treated patients and 79 and 72% in carmustine/etoposide/cyclophosphamide-treated patients. Forty-five of these patients participated in prospective trials for which eligibility criteria were (1) less than 25% curability with conventional therapy; (2) achievement of minimal disease state with conventional therapy; and (3) transplantation early in the course of disease. One-year actuarial survival for 18 patients with relapsed Hodgkin's disease is 80% and for 21 relapsed intermediate and high-grade NHL patients, 70%. One NHL Burkitt's patient was transplanted on a protocol for high-risk intermediate and high-grade NHL in first remission. Five patients with follicular mixed or small cleaved NHL were also transplanted in first remission.

Combined syngeneic bone marrow transplantation and immunotherapy of a murine B-cell lymphoma: active immunization with tumor-derived idiotypic immunoglobulin

Recurrence of the underlying malignancy remains a major cause of treatment failure after autologous bone marrow transplantation (BMT) for patients with lymphoma. In this regard, we have developed an immunotherapeutic approach designed to induce resistance against residual tumor cells persisting after BMT. Previous studies in the model system of 38C13, a lethal B-cell lymphoma of C3H origin, have shown that active immunization with purified tumor-derived surface immunoglobulin (Id), as a tumor-associated antigen, produces resistance to tumor growth. Id immunization of lethally irradiated mice at 3 or 5 weeks after reconstitution with syngeneic bone marrow resulted in significantly prolonged survival after tumor challenge compared with nonspecifically immunized controls. Low levels of idiotype-specific antibody were also demonstrated in the sera of specifically immunized mice at this early time, when other functional studies in the literature of immunocompetence after syngeneic reconstitution might have predicted incomplete recovery. Immunization of mice before lethal irradiation and syngeneic marrow reconstitution also induced significant resistance to tumor challenge, suggesting the persistence of established host antitumor immunity through total body irradiation. These studies demonstrate the feasibility of id immunization in conjunction with bone marrow transplantation.

Prognostic significance of actual dose intensity in diffuse large-cell lymphoma: results of a tree-structured survival analysis

While diffuse large-cell lymphoma (DLCL) is considered to be highly curable with current therapy, treatment failures are observed even with intensive combination chemotherapy regimens. In order to study the prognostic significance of actual dose intensity of chemotherapy in DLCL, we retrospectively analyzed 115 previously untreated patients treated as Stanford between 1975 and 1986 with cyclophosphamide, Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), vincristine, and prednisone (CHOP), methotrexate, bleomycin, Adriamycin, cyclophosphamide, vincristine, and dexamethasone ([M]BACOD), or methotrexate, Adriamycin, cyclosphosphamide, vincristine, prednisone, and bleomycin (MACOP-B). The actual relative dose intensity (RDI), the amount of drug actually administered to each patient during the first 12 weeks of therapy, was calculated as standardized to CHOP and analyzed in addition to clinical factors prognostic for survival by univariate analysis. Multivariate recursive partitioning (tree-structured) survival analysis identified the actual RDI of Adriamycin greater than 75% as the single most important predictor of survival. A model incorporating the actual RDI of Adriamycin and performance status, in combination with serum lactate dehydrogenase (LDH) and extranodal disease, defined three overall prognostic groups of patients with respective 3-year survival rates of 89%, 63%, and 18%. The three prognostic groups remained distinct, even when restricted to complete responders. This model was also predictive of survival when dose intensity was analyzed relative to the optimum dose defined for each of the three regimens and when applied to a subgroup of patients aged 50 years or younger. We conclude that actual RDI is an important prognostic factor for survival in DLCL and that analysis of RDI early in the course of treatment may allow modification of the treatment plan.

Immune response to the H-X antigen on P815-X2. I. Recombinant inbred strain analysis and lack of effect of castration

In a preceding report, the detection of an H-2-linked immune response to the H-Xd antigen on the P815-X2 mastocytoma was demonstrated by the significantly increased survival of (C57BL/6 X DBA/2)F1 (B6D2F1) male hybrids (H-Xb) compared with female siblings (H-Xb/H-Xd) after injection with the histocompatible tumor (H-Xd). This interpretation was supported by the absence of this sex effect in reciprocal D2B6F1 hybrids (H-Xd and H-Xd/H-Xb). Additional findings presented in this paper support the conclusion that this sex effect is due to a true immunological response to H-Xd: (a) Reciprocal (DBA/2 X C57BL/6 H-2 mutant)F1 hybrids, as well as D2B6F1, failed to exhibit the sex effect: (b) the demonstration of the sex effect in (BALB/c X DBA/2)F1 and (BALB/c-H-2dm2 X DBA/2)F1 hybrids and in (C57BL/10 X DBA/2)F1 hybrids was consistent with the known H-X incompatibilities between the strains BALB/c and DBA/2 and C57BL/10 and DBA/2, respectively, previously demonstrated by skin grafting; and (c) the sex effect was not abrogated by castration of male B6D2F1 hybrids. Variability in the presence or absence of the sex effect was observed in various [recombinant inbred (RI) X DBA/2]F1 hybrids and may be attributed to the influence of a regulatory non-H-2 gene which is closely linked to the gene coding for mouse kidney-androgen-regulated protein (KAP) but androgen-independent, or to variability in inheritance of the H-Xb allele among the RI lines. It is proposed that the P815-X2 model may be utilized to type RI lines derived from a cross between C57BL/6 and DBA/2 for their H-X genotypes.

H-2 gene control of resistance to P815-X2 mastocytoma

Some, but not all, mutations at H-2 loci can alter, in either direction, histocompatible tumor resistance in the model system of P815-X2 mastocytoma (DBA/2 origin) transplanted into DBA/2J or (C57BL/6 X DBA/2J)F1 mice. This hybrid effect has been shown previously to depend on the immune system. We have examined eight mutants at H-2Kb (bm1, bm4, bm6, bm7, bm8, bm10, bm11, and bm16, two at H-2Db (bm13 and bm14), and one I-Ab mutant (bm12). When one parent is an H-2b mutant (C57BL/6 mutant), the hybrid progeny (C57BL/6 mutant X DBA/2J)F1 may have increased (bm7 and bm8) or decreased (bm10, bm11, bm12, and bm16) survival times when compared to C57BL/6 X DBA/2J)F1 controls. Hybrids from bm1, bm4, bm6 (all H-2Kb), and bm13 and bm14 (both H-2Db) mutants showed no differences in survival. Several of the mutant molecules differ from those of the parental strain by only one or two amino acids. Apparently, these small changes in H-2 antigens are capable of altering resistance to a histocompatible tumor to produce an immune response gene-like effect. The availability of H-2 mutant strains and detailed data on the molecular nature of the gene products make the model presented in this report a particularly useful system to study.

H-2-linked resistance to mastocytoma in male mice: immune response to a histocompatibility antigen on the X chromosome

Male hybrids from a cross between female mice of strain C57BL/6Kh and males of strain DBA/2J lived longer after injection of P815 mastocytoma cells of DBA/2 origin than did their female siblings. Responses to the histocompatibility antigen on the X chromosome of the DBA/2 strain may be involved in resistance to the tumor. When the female parent was replaced with a C57BL/6Kh carrying one of several mutations in the H-2 region, this sex effect disappeared in some of the hybrid combinations. Thus, the H-2 complex appears to be involved in the regulation of the immune response to the X-linked histocompatibility antigen in this tumor model.