A prospective study of the changes in the immune status before, during, and after multiple-agent chemotherapy for Hodgkin's disease.

In a prospective study, immune status was measured in 20 previously untreated patients with Stage III and IV Hodgkin's disease. Assessments of immunologic capacity were performed at diagnosis and repeated after eventual staging laparotomy and after multiple-agent chemotherapy. The immune status was measured using delayed-type hypersensitivity tests to common recall-antigens and in vitro lymphocyte responsiveness to mitogens, antigens, and allogeneic lymphocytes. Immunoglobulin levels were determined on each point of assessment. In untreated patients, the disturbances in the cell-mediated immunity had no predictive value with respect to the chance to achieve a complete remission. During chemotherapy the mean value of the unstimulated culture in responders increased, whereas it decreased in nonresponders (P less than 0.05 between both groups). After treatment, the proliferative capacity of lymphocytes in vitro was severely affected, while the reactivity to skin tests improved. Chemotherapy also reduced the IgM level, irrespective of the performance of splenectomy. Thirteen patients achieved a complete remission after chemotherapy. In this group, measurements of immunologic capacity were continued. The patients showing a relapse did so despite gradual improvement of delayed-type hypersensitivity and the lymphocyte responsiveness to phytohemagglutinin in vitro.