Direct endolymphatic instillation (ELI) of BCG-Tumor cell mixture

Summary A method of active immunization by direct Endolymphatic Instillation (ELI) of a mixture of BCG and Autologous Irradiated Tumor Cells (AITC) is described. ELI was performed in 36 patients with advanced breast cancer, melanoma and some other solid tumors. The procedure was well tolerated and was not associated with any untoward systemic side effects other than those often encountered in conventional BCG immunotherapy. Exposure of patients to AITC by the direct endolymphatic route proved to be superior to immunization by the intradermal route as judged by the subsequent induction of cutaneous Delayed Hypersensitivity Reaction (DHR) toward AITC. When employed as the first immunization attempt ELI was effective in 5 of 6 patients. It led to invigoration of preexisting weak DHR in 6 of 8 patients. In 15 of 22 patients conversion to a strongly positive cutaneous DHR to AITC was achieved by ELI, where previous attempts of immunization by the intradermal route had failed to elicit a positive response. Acquisition of positive cutaneous response to AITC following ELI was found to correlate with favourable prognosis in terms of longer median survival. The effect of ELI was particularly notable with respect to enhancement of in vitro lymphocyte stimulation by PPD antigen, but was not followed by increased reactivity of other in vitro parameters of cell-mediated immunity such as peripheral lymphocyte count, proportion of E-rosette forming cells, and PHA lymphocyte stimulation.Abbreviations used: ELI — Endolymphatic Instillation; AITC — Autologous Irradiated Tumor Cells; BCG — Bacillus Calmette-Guérin; DHR — Delayed Hypersensitivity Reaction; PPD — Purified Protein Derivative (tuberculin); PHA — Phytohemagglutinin; SI — Stimulation Index; E-RFC — E-Rosette Forming Cells; PBL — Peripheral Blood Lymphocytes.