Blood groups and the response to immunotherapy

Abstract

Summary. After resection, lung cancer patients treated with levamisole who were blood group 0 and~or Rhesus (D)-negative showed poorer survival than all other patients, both in the post-operative period and in later follow-up. Palliative Rh-negative patients showed a similar effect. Differential response to immunotherapy by blood group could have implications for the interpretation of immunotherapy trials.We have reported that excess post-operative deaths in levamisole-treated lung cancer patients were more frequent in patients who were blood group 0 and/or Rh (D)-negative [3]. The excess deaths were due to cardiorespiratory failure and were associated (in the only cases where serum samples were available for testing) with the presence of antimyocardial antibodies that were not detected in any patient without the syndrome. Autoimmune disease is more common in group 0 individuals [7]; it was concluded that pre-treatment with levamisole before handling of the heart and great vessels had induced cardiac autoimmunity with unwontedly serious effects because of the alterations in the pulmonary vascular bed resulting from lung resection.It now appears that the poorer survival of group 0 and Rh-negative patients receiving levamisole was not limited to the post-operatiw~ period. The survival of all resected patients (217) by ABO blood group (0 and not 0) and by Rhesus blood group, with levamisole or placebo therapy is shown on Fig. 1. Patients who had blood group 0 or were Rh-negative showed significantly poorer survival if treated with levamisole. The difference was unaffected by controlling for the extent of disease at operation (Table 1), and was still present when the patients who died in the 6 weeks after operation were excluded by starting the analysis at the seventh week (Table 1). The effects of the two blood group factors were largely independent, only three levamisole-treated patients being both group 0 and Rh-negative.Recurrent tumour had been detected or suspected in most of the patients who died after the post-operative period, but there were five unexpected deaths among levamisole-treated patients, all cardiac in type. Four of these patients were group 0, Rh-positive and the fifth group A, Rh-negative.Ninety-eight other patients had palliative or exploratory operations only. Among these, levamisole-treated Rh-negative patients showed poorer survival than placebo-treated and Rh-positive patients (O/E 2.3 Z 2 7.4 P < 0.02). However, the survival of levamisole-treated group 0 patients did not differ from that of the rest of the palliative group.Harris et al. [5] have recently reported that genetic factors influenced the response of patients with acute myeloid leukaemia (AML) to immunotherapy with BCG and allogeneic cells after cytoreduction. Immunotherapy preferentially improved the length of first remission and the length of survival of patients who were blood group A, Rh (D)-positive or HLA B12 compared, in each case, with all the rest of the patients.In each of these studies immunotherapy showed interaction...

Predictive and Prognostic Value of ABO Blood Group in Patients Using Immune Checkpoint Inhibitor for Advanced Renal Cell Carcinoma

“…The first study on this subject was performed in 1981. 13 In that study, the relationship between levamisole, which is used as an immunostimulant in patients with lung cancer, and blood types was investigated. Levamisole was hypothesized to provide this effect by increasing the Thelper (Th) 1-related immune response and decreasing Th2.…”