Chemoimmunotherapy of disseminated malignant melanoma with DTIC-BCG, transfer factor + melphalan

[Transfer factors in medical therapy]

Transfer factor (TF) consists of messenger peptides produced by activated T lymphocytes as part of cellular immunity, and it acts in virgin lymphocytes through TF inducers, suppressors and specific antigens. TF is not immunogenic because it is not species-specific, since it contains a consensus sequence of amino acids LLYAQDL/VEDN. TF extracted from leukocytes can transfer immunity from a human to another species. TF extracts are complex, containing more than 200 molecules with molecular weights ranging from 1 to 20 kDa. The antigen specific transfer factors (STF) have molecular weights between 3,5 and 5 kDa. TF is easy to prepare and well tolerated. It does not contain HL-A antigens against potential receptors and it can used as adjuvant therapy in several diseases.

The natural history of resectable metastatic melanoma (Stage IVA melanoma)

One-hundred-two patients with malignant melanoma who had distant metastases surgically resected and were judged to be clinically free of disease (M. D. Anderson Stage IVA melanoma) were studied. The median survival for all the patients from time of diagnosis of stage IVA disease was 18 months. The site of the resected metastases did not appear to influence survival, being approximately the same for the brain (15 months), lung (16 months), intraabdominal (18 months), and skin and/or lymph nodes (23 months). The site of the resected metastases also did not influence the median disease-free interval. Patients who had metastases resected from several organs at the same time had a median survival of 15 months, which was similar to that of patients with one resected site. Patients who were rendered Stage IVA on several occasions by surgical excisions had a median survival of 36 months. Thirty-five patients received surgery only and 67 patients received adjuvant chemotherapy, immunotherapy, or combined chemoimmunotherapy after surgery. For the group treated with surgery only, the median disease-free interval and survival from diagnosis of stage IVA disease were 6 months and 16 months, respectively, and for the adjuvant group 6 months and 21 months, respectively. Specifically, by the type of adjuvant therapy, the median disease-free interval and survival from stage IVA for 23 patients receiving Corynebacterium parvum were 6.9 and 19 months; for 39 patients receiving BCG, eight months and 26 months; for 24 patients receiving BCG + DTIC, eight and 17.4 months; and for all 51 DTIC treated patients 6.3 and 17.8 months, respectively. Patients receiving BCG had a median survival superior to the surgery only group (P = 0.02). An increase in survival was seen predominantly in patients who achieved IVA status more than once and received BCG. Patients with recurrent soft-tissue metastases appeared to benefit most from BCG in prolonging the disease-free interval. Only 1/10 treated by surgery alone had a disease-free interval longer than 1 year, compared with 9/16 who received BCG (P = 0.01). Stage IVA melanoma appears to be distinctly different in prognosis from Stage IVB melanoma and should be classified separately. Patients with recurrent soft-tissue disease may benefit significantly from treatment with BCG.

Resynthesis of trypsinized sheep red blood cell receptors on human lymphocytes: comparison of the effects of immunopotentiators of biological and synthetic origin in vitro

Five immunostimulants--thymosin, dialyzable leukocyte extracts containing transfer factor (DLE), isoprinosine, BM 12 531 (azimexon), and levamisole--were compared separately and in various combinations for their ability to increase the binding of sheep erythrocytes by trypsinized human peripheral blood lymphocytes in vitro. Levamisole produced the greatest enhancement when used alone, DLE produced a smaller increase, and isoprinosine, thymosin, and BM 12 531 were less effective. When combining two of these agents, the greatest increase was seen when one of the components was thymosin and the other either DLE, isoprinosine, or BM 12 531. These results indicate possible synergistic mechanisms and the possible advantage of combined therapeutic use of selected combinations of immunostimulants. In the majority of the combinations, however, inhibition rather than stimulation of rosette formation was observed.