Immunologic competence was evaluated in 25 patients with acute myelogenous leukemia before and after intensive combination chemotherapy for induction of remission. Cell-mediated immunity correlated with the response to chemotherapy; 86 per cent of patients with normal delayed hypersensitivity to a battery of antigens achieved remission as compared to 25 to 50 per cent of anergic patients. In vitro lymphocyte responses to phytohemagglutinin before and after therapy showed 41,000 and 42,000 counts per minute in patients achieving remission and of 15,000 and 9000 counts per minute in patients not achieving remission. Sixty per cent of patients showing delayed hypersensitivity after immunization entered complete remission as compared to only 37 per cent of those without this reactivity. Patients converting from immunoincompetence to immunocompetence during therapy achieved remission, whereas those converting from immunocompetence to immunoincompetence did not. Prior treatment had no effect on immune competence. Serial immunologic evaluation may predict prognosis in acute leukemia.
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