Immunological Status May Predict Clinical Outcome in BCG Treated Melanoma

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Abstract
Patients (27) with surgically resected stage II or III malignant melanoma were treated with BCG and followed prospectively to determine whether relapse could be predicted. Peripheral blood mononuclear (lymphocyte plus monocyte) counts (PBM), T [thymus derived] and B [bone marrow derived] cell counts, phytohemagglutinin (PHA) cytotoxicity, PHA transformation, antibody-dependent cell-mediated cytotoxicity (ADCC) and serum immunoglobulin concentrations were studied before and during therapy. Patients ultimately classified as having a poor clinical outcome (inoperable recurrence) were compared with those with a more favorable outcome. Prior to therapy, poor outcome patients had lower PBM and T cell counts but there was some overlap. After 3 mo. these differences were more pronounced. Low PHA cytotoxicity was associated with poor outcome; the differences were more apparent at 3 mo. than prior to therapy. PBM, T cell counts and PHA cytotoxicity may predict poor outcome some months before inoperable recurrence is apparent clinically.