Intravesical instillation of cytotoxic T-lymphocytes induced by soluble tumor antigen in the prophylaxis of recurrence of bladder cancer

Objective: To explore a new method for preventing the recurrence of bladder cancer.

Methods: With the adjuvant of BCG, cytotoxic T-lymphocytes (CTLs) were induced from human peripheral blood mononuclear cells (PBMC) by bladder tumor soluble antigen which was extracted through salt-infiltrating biochemical procedures from autologous bladder tumor. Intravesical instillation of CTLs together with their supernatants after culture for 8 to 10 days was performed in 37 patients with superficial bladder cancer after surgery. The effects of the treatment were evaluated by endocytoscopy, pathological examinations and ELISA assays for the levels of cytokines IL-2, TNF-alpha and IFN-gamma in the patients' serum and urine. The distribution of T-lymphocyte subpopulations was also monitored by SAP immuno-histochemical techniques.

Results: The proportion of CD3+ and CD4+ T-lymphocyte subpopulations increased significantly while CD8+ T-lymphocyte subpopulation was stable. The ratio of CD4+ to CD8+ increased to 1.60 +/- 0.29. The levels of cytokines IL-2, TNF-alpha and IFN-gamma in serum and urine increased significantly, especially the level of TNF-alpha in urine. Pathological studies revealed that non-specific inflammation is the major change in the bladder mucosa after therapy. Follow-up for 6-26 months showed that 1 patient havd moderate heterogeneity in bladder mucosa. The recurrence rate was 2.7%. Side effects were not found except transient lower fever or hematuria.

Conclusions: Intravesical insitillation of CTLs could effectively prevent the recurrence of superficial bladder cancer after the improvement of immunological reactivity in the whole body.