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