Frenkel J K, Amare M, Larsen W
Infection. 1978;6(2):84-91. doi: 10.1007/BF01642165.
A 40 year old woman with Hodgkin's disease twice developed signs of encephalitis while being treated with prednisone and cyclophosphamide for 10 months. Since on both occasions her Toxoplasma dye test titer was 1 : 8000 or higher, she was treated on suspicion of toxoplasmosis with sulfadizine and pyrimethamine. Her tumor therapy was changed to bleomycin with lower doses of prednisone for 12 months. After death from central pontine myelinolysis, Toxoplasma and cytomegalovirus could be isolated, but no lesions attributable to these infectious agents were present. Maintenance of the patient's immune competence suggested an inquiry into the effects of the chemotherapeutic agents and of tumor infiltration for their respective interference with immunity. Using hamsters with chronic latent toxoplasmosis, it was found that both cortisone and cyclophosphamide caused recrudescence of chronic inapparent infection, that vinblastine and bleomycin interfered only slightly with the development of immunity, whereas in infiltrating lymphoma permitted immunity to develop normally. It is concluded that greater attention should be directed to the immunosuppressive effects of tumor treatment. By choice of an effective tumor therapy which is least immunosuppressive, and if necessary under cover of antimicrobial therapy, a patient with Hodgkin's disease can be aided in developing immunities which he may subsequently be able to maintain.
一名40岁患有霍奇金病的女性，在接受泼尼松和环磷酰胺治疗10个月期间两次出现脑炎症状。由于两次她的弓形虫染色试验滴度均为1:8000或更高，她因疑似弓形虫病而接受磺胺嘧啶和乙胺嘧啶治疗。她的肿瘤治疗改为使用博来霉素并降低泼尼松剂量，持续12个月。在因中枢性桥脑髓鞘溶解症死亡后，可分离出弓形虫和巨细胞病毒，但未发现可归因于这些感染因子的病变。维持患者的免疫能力提示应探究化疗药物和肿瘤浸润对免疫的各自干扰作用。使用患有慢性潜伏性弓形虫病的仓鼠发现，可的松和环磷酰胺都会导致慢性隐性感染复发，长春碱和博来霉素对免疫发育的干扰很小，而在浸润性淋巴瘤中免疫可正常发育。结论是应更加关注肿瘤治疗的免疫抑制作用。通过选择免疫抑制作用最小的有效肿瘤治疗方法，如有必要在抗菌治疗的掩护下，可帮助霍奇金病患者发展免疫力，使其随后能够维持。
