To the Editor.–Vetto and co-workers (Arch Surg 108:558, 1974) have emphasized the importance of evaluating the immune status of tumor patients. We have observed that, while there are accepted systems for clinically staging and pathologically grading tumors, no accepted classification exists to immunologically stage a patient who has cancer. We are presently emphasizing the need for such an "immunostaging" system,1,2 and offer it for your consideration.
After an immunologic evaluation, including humoral and cellular aspects of immunologic responsiveness, has been completed, the patient's immunologic status may be assessed and staged immunologically. A possible immunostaging system might consist of four immunostages, ranging from a strong immune response (stage 1) to anergic unresponsiveness (stage 4): immunostage 1: patients with a high lymphocyte blastogenic index and high levels of IgM associated with tumor cytotoxic antibody; immunostage 2: patients with a high lymphocyte blastogenic index with high IgG levels; immunostage 3: patients