Local and systemic immunologic effects of perfusion therapy for malignant melanoma

The effects on the in vitro lymphocyte blastogenic response to phytohemagglutinin and streptolysin O were studied in 10 patients. All patients had melanoma of the extremities and were treated with a combination of phenylalanine mustard, actinomycin D, and nitrogen mustard. Profound local effects of the perfusion were noted. Lymphocyte blastogenic responses of cells collected during therapy were markedly impaired. This was true whether the cells were cultured in patient serum or normal serum. In general, at least statistically, no systemic effects of the perfusion therapy were noted. However, in several of the 10 patients there was a significant decline in the postperfusion lymphocyte blastogenic responses, even in normal serum. This suggests that either stress of the procedure or leakage of the perfused drug suppressed blastogenic responses of the general circulating lymphocytes. There was no correlation of the suppressed responses after perfusion with the degree of leakage and, therefore, stress seems a more reasonable explanation. In 6 persons, the preperfusion lymphocyte responses were significantly higher in normal serum. These patients who had only localized disease had a serum inhibitory factor which previously has been noted only in patients with metastatic disease.