[Comparison of the leukaemia incidence in two cohorts of farmers and traders in the Vercelli province of Italy, 2002-2009]

This study aims to investigate the incidence of leukaemia between 2002 and 2009 (ICDIX 204-208) among farmers active in the Vercelli province (North West Italy), during the period: 1962-1991. The farmer cohort (14397 subjects, 78 cases) was compared with a retail trader cohort (4565 subjects, 11 cases) who were Vercelli province residents as well, but not exposed to the risk factors associated with professional farming. A proportional hazard Cox model shows among the farmers, an approximately double leukaemia incidence with respect to traders (Hazard Ratio = 1,90 P-value 0,043 IC95% 1,00-3,60). Moreover men's incidence appears approximately to double that of women (Hazard Ratio = 1,92 P-value 0,003 IC95% 1,25-2,95).

Bayesian semiparametric modeling for stochastic precedence, with applications in epidemiology and survival analysis

We propose a prior probability model for two distributions that are ordered according to a stochastic precedence constraint, a weaker restriction than the more commonly utilized stochastic order constraint. The modeling approach is based on structured Dirichlet process mixtures of normal distributions. Full inference for functionals of the stochastic precedence constrained mixture distributions is obtained through a Markov chain Monte Carlo posterior simulation method. A motivating application involves study of the discriminatory ability of continuous diagnostic tests in epidemiologic research. Here, stochastic precedence provides a natural restriction for the distributions of test scores corresponding to the non-infected and infected groups. Inference under the model is illustrated with data from a diagnostic test for Johne's disease in dairy cattle. We also apply the methodology to the comparison of survival distributions associated with two distinct conditions, and illustrate with analysis of data on survival time after bone marrow transplantation for treatment of leukemia.

Analysis of the relationship between leukemia mortality and soil trace elements using chemometrics

The relationship between the mortality of leukemia and the contents of trace elements in the soils of 29 regions of China was investigated. A total of 27 elements were determined for each region. Considering that an efficient variable selection can be highly beneficial both to improve the predictive ability of the model and to greatly reduce its complexity, genetic algorithm-partial least squares was used to screen out 13 qualified elements. As a result, only 13 elements, i.e., As, Hg, Mn, Sr, Ba, Cu, Ti, Co, K, Ca, Rb, Zn, and Mg, were picked out and, a partial least squares model with three latent variables was obtained, whose prediction exhibited a correlative coefficient of 0.874 with actual mortality. Especially, it showed a high negative correlation between the content of soil As and the mortality of leukemia. Such a fact can be explained by the apoptotic effect of cancerous cells by trace-amount arsenic trioxide. Furthermore, according to whether the mortality was larger than two out of 100,000 (2 × 10⁻⁵), all the 29 regions were divided into 21 high-mortality regions and eight low-mortality regions and were assigned the label -1 or 1, respectively. Using the same 13 elements, a Fisher's discriminant analysis model was developed, which can successfully discriminate low- and high-mortality groups.

Reduced mortality after allogeneic hematopoietic-cell transplantation

BACKGROUND

Over the past decade, advances have been made in the care of patients undergoing transplantation. We conducted a study to determine whether these advances have improved the outcomes of transplantation.

METHODS

We analyzed overall mortality, mortality not preceded by relapse, recurrent malignant conditions, and the frequency and severity of major complications of transplantation, including graft-versus-host disease (GVHD) and hepatic, renal, pulmonary, and infectious complications, among 1418 patients who received their first allogeneic transplants at our center in Seattle in the period from 1993 through 1997 and among 1148 patients who received their first allogeneic transplants in the period from 2003 through 2007. Components of the Pretransplant Assessment of Mortality (PAM) score were used in regression models to adjust for the severity of illness at the time of transplantation.

RESULTS

In the 2003-2007 period, as compared with the 1993-1997 period, we observed significant decreases in mortality not preceded by relapse, both at day 200 (by 60%) and overall (by 52%), the rate of relapse or progression of a malignant condition (by 21%), and overall mortality (by 41%), after adjustment for components of the PAM score. The results were similar when the analyses were limited to patients who received myeloablative conditioning therapy. We also found significant decreases in the risk of severe GVHD; disease caused by viral, bacterial, and fungal infections; and damage to the liver, kidneys, and lungs.

CONCLUSIONS

We found a substantial reduction in the hazard of death related to allogeneic hematopoietic-cell transplantation, as well as increased long-term survival, over the past decade. Improved outcomes appear to be related to reductions in organ damage, infection, and severe acute GVHD. (Funded by the National Institutes of Health.).

Leukemia-related mortality in towns lying in the vicinity of metal production and processing installations

BACKGROUND

Releases to the environment of toxic substances stemming from industrial metal production and processing installations can pose a health problem to populations in their vicinity.

OBJECTIVES

To investigate whether there might be excess leukemia-related mortality in populations residing in towns in the vicinity of Spanish metal industries included in the European Pollutant Emission Register.

METHODS

Ecologic study designed to examine mortality due to leukemia at a municipal level, during the period 1994-2003. Population exposure to pollution was estimated on the basis of distance from town of residence to pollution source. Using Poisson regression models, we analyzed: risk of dying from leukemia in a 5-kilometer zone around installations which had become operational prior to 1990; effect of pollution discharge route and type of industrial activity; and risk gradient within a 50-kilometer radius of such installations.

RESULTS

Excess mortality (relative risk, 95% confidence interval) was detected in the vicinity of pre-1990 installations (1.07, 1.02-1.13 in men; 1.05, 1.00-1.11 in women), with this being more elevated in the case of installations that released pollution to air versus water. On stratifying by type of industrial activity, statistically significant associations were also observed among women residing in the vicinity of galvanizing installations (1.58, 1.09-2.29) and surface-treatment installations using an electrolytic or chemical process (1.34, 1.10-1.62), which released pollution to air. There was an effect whereby risk increased with proximity to certain installations.

CONCLUSIONS

The results suggest an association between risk of dying due to leukemia and proximity to Spanish metal industries.

Mechanism of regulation of bcl-2 mRNA by nucleolin and A+U-rich element-binding factor 1 (AUF1)

The antiapoptotic Bcl-2 protein is overexpressed in a variety of cancers, particularly leukemias. In some cell types this is the result of enhanced stability of bcl-2 mRNA, which is controlled by elements in its 3'-untranslated region. Nucleolin is one of the proteins that binds to bcl-2 mRNA, thereby increasing its half-life. Here, we examined the site on the bcl-2 3'-untranslated region that is bound by nucleolin as well as the protein binding domains important for bcl-2 mRNA recognition. RNase footprinting and RNA fragment binding assays demonstrated that nucleolin binds to a 40-nucleotide region at the 5' end of the 136-nucleotide bcl-2 AU-rich element (ARE(bcl-2)). The first two RNA binding domains of nucleolin were sufficient for high affinity binding to ARE(bcl-2). In RNA decay assays, ARE(bcl-2) transcripts were protected from exosomal decay by the addition of nucleolin. AUF1 has been shown to recruit the exosome to mRNAs. When MV-4-11 cell extracts were immunodepleted of AUF1, the rate of decay of ARE(bcl-2) transcripts was reduced, indicating that nucleolin and AUF1 have opposing roles in bcl-2 mRNA turnover. When the function of nucleolin in MV-4-11 cells was impaired by treatment with the nucleolin-targeting aptamer AS1411, association of AUF1 with bcl-2 mRNA was increased. This suggests that the degradation of bcl-2 mRNA induced by AS1411 results from both interference with nucleolin protection of bcl-2 mRNA and recruitment of the exosome by AUF1. Based on our findings, we propose a model that illustrates the opposing roles of nucleolin and AUF1 in regulating bcl-2 mRNA stability.

Leukemia incidence among people exposed to chronic radiation from the contaminated Techa River, 1953-2005

Beginning in 1950, people living on the banks of the Techa River received chronic low-dose-rate internal and external radiation exposures as a result of releases from the Mayak nuclear weapons plutonium production facility in the Southern Urals region of the Russian Federation. The Techa River cohort includes about 30,000 people who resided in riverside villages sometime between 1950 and 1960. Cumulative red bone marrow doses range up to 2 Gy with a mean of 0.3 Gy and a median of 0.2 Gy. Between 1953 and 2005, 93 first primary cases of leukemia, including 23 cases of chronic lymphatic leukemia (CLL), were ascertained among the cohort members. A significant linear dose-response relationship was seen for leukemias other than CLL (P < 0.001), but not for CLL. The estimated excess relative risk per Gy is 4.9 (95% confidence interval (CI): 1.6; 14.3) for leukemias other than CLL and less than 0 (95% upper bound 1.4) for CLL.

Can decreasing smoking prevalence reduce leukemia mortality?

Previous studies have demonstrated a modest association between smoking and leukemia particularly for myeloid disorders. Our objective was to examine whether changing trends in cigarette smoking prevalence nationally and within selected states parallel similar trends in mortality from leukemia. Trends in national smoking rates were correlated with trends in leukemia mortality rates obtained from the Centers for Disease Control and Prevention and the Surveillance Epidemiology and End Results registry, respectively. State-specific correlations were assessed from 1984 to 2004 using smoking prevalence data from the Behavioral Risk Factor Surveillance System and leukemia mortality data from National Vital Statistics System. Correlations were computed using the Spearman rank correlation coefficient. Leukemia mortality decreased overall in the United States in parallel with decreased smoking. Analyzed on a state-specific basis, leukemia mortality decreased in states where smoking rates declined markedly but remained unchanged where smoking prevalences were relatively stable. The findings suggest that declining rates of leukemia mortality are associated with changing patterns of smoking behavior.

The incidence and survival of acute de novo leukemias in Estonia and in a well-defined region of western Sweden during 1997-2001: a survey of patients aged >or=65 years

BACKGROUND

In a recently published retrospective population-based study over three 5-year periods (1982-1996) we investigated the outcome for de novo acute leukemia (AL) patients aged >or=65 years at diagnosis in Estonia (a country that had been occupied by the Soviet Union over 5 decades) and in the so-called Western Swedish Health Care Region. The age-standardized yearly incidence rates regarding the total number of de novo AL was 5.3/100000 inhabitant for Estonia and 8.0 for Sweden, this difference being statistically significant merely as regards acute myeloid leukemia (AML). The relative survival for the total cohort of de novo AL as well as for de novo AML was significantly longer (p<0.001) for Swedish as compared to Estonian patients.

METHODS

In view of the miserable outcome for the Estonian patients we decided to prospectively compare the results for incidence and outcome of de novo AL between the two countries.

RESULTS

The present report covers the first 5-year period comprising 1997-2001 and deals only with patients aged >or=65 years at diagnosis. The age-adjusted annual incidence rates for de novo AML were lower in Estonia (6.4/100000) than in Sweden (9.2/100000) but not significantly so. The present results also show that the outcome for the Estonian AML patients had improved considerably over the study period; thus, at no time point, i.e., at 1, 3 and 5 years did relative survival between the two countries differ significantly.

CONCLUSION

Yet, as compared to the Swedish cohort relative survival for the Estonian patients did still not reach an acceptable level.

Reanalysis of cancer mortality in Japanese A-bomb survivors exposed to low doses of radiation: bootstrap and simulation methods

BACKGROUND

The International Commission on Radiological Protection (ICRP) recommended annual occupational dose limit is 20 mSv. Cancer mortality in Japanese A-bomb survivors exposed to less than 20 mSv external radiation in 1945 was analysed previously, using a latency model with non-linear dose response. Questions were raised regarding statistical inference with this model.

METHODS

Cancers with over 100 deaths in the 0 - 20 mSv subcohort of the 1950-1990 Life Span Study are analysed with Poisson regression models incorporating latency, allowing linear and non-linear dose response. Bootstrap percentile and Bias-corrected accelerated (BCa) methods and simulation of the Likelihood Ratio Test lead to Confidence Intervals for Excess Relative Risk (ERR) and tests against the linear model.

RESULTS

The linear model shows significant large, positive values of ERR for liver and urinary cancers at latencies from 37 - 43 years. Dose response below 20 mSv is strongly non-linear at the optimal latencies for the stomach (11.89 years), liver (36.9), lung (13.6), leukaemia (23.66), and pancreas (11.86) and across broad latency ranges. Confidence Intervals for ERR are comparable using Bootstrap and Likelihood Ratio Test methods and BCa 95% Confidence Intervals are strictly positive across latency ranges for all 5 cancers. Similar risk estimates for 10 mSv (lagged dose) are obtained from the 0 - 20 mSv and 5 - 500 mSv data for the stomach, liver, lung and leukaemia. Dose response for the latter 3 cancers is significantly non-linear in the 5 - 500 mSv range.

CONCLUSION

Liver and urinary cancer mortality risk is significantly raised using a latency model with linear dose response. A non-linear model is strongly superior for the stomach, liver, lung, pancreas and leukaemia. Bootstrap and Likelihood-based confidence intervals are broadly comparable and ERR is strictly positive by bootstrap methods for all 5 cancers. Except for the pancreas, similar estimates of latency and risk from 10 mSv are obtained from the 0 - 20 mSv and 5 - 500 mSv subcohorts. Large and significant cancer risks for Japanese survivors exposed to less than 20 mSv external radiation from the atomic bombs in 1945 cast doubt on the ICRP recommended annual occupational dose limit.

Outcome of 93 patients with relapse or progression following allogeneic hematopoietic cell transplantation

Relapse/progression after allogeneic hematopoietic cell transplantation (allo-HCT) remains the major cause of treatment failure. In this study, the subsequent clinical outcome was overviewed in 292 patients with leukemia/myelodysplastic syndrome who received allo-HCT. Among them, 93 (32%) showed relapse/progression. Cohort 1 was chosen to receive no interventions with curative intent (n = 25). Cohort 2 received reinduction chemotherapy and/or donor lymphocyte infusion (n = 48), and Cohort 3 underwent a second allo-HCT (n = 20). Sixty-three patients received reinduction chemotherapy, and 27 (43%) achieved subsequent complete remission (CR). The incidence of nonrelapse mortality (NRM) was similar among the three cohorts (4, 15, and 5%). The 1-year overall survival (OS) after relapse was significantly better in patients with a second HCT (58%) than in others (14%, Cohorts 1 and 2; P <.001). However, the 2-year OS did not differ between the two groups, which suggests that it is difficult to maintain CR after the second HCT. Multivariate analysis showed that reinduction chemotherapy, CR after intervention, second HCT, and longer time to post-transplant relapse were associated with improved survival. In conclusion, for patients with relapse after allo-HCT, successful reinduction chemotherapy and a second HCT may be effective for prolonging survival without excessive NRM. However, effective measures to prevent disease progression after a second HCT clearly need to be developed.

Development of a unit risk factor for 1,3-butadiene based on an updated carcinogenic toxicity assessment

The Texas Commission on Environmental Quality (TCEQ) has developed an inhalation unit risk factor (URF) for 1,3-butadiene based on leukemia mortality in an updated epidemiological study on styrene-butadiene rubber production workers conducted by researchers at the University of Alabama at Birmingham. Exposure estimates were updated and an exposure estimate validation study as well as dose-response modeling were conducted by these researchers. This information was not available to the U.S. Environmental Protection Agency when it prepared its health assessment of 1,3-butadiene in 2002. An extensive analysis conducted by TCEQ discusses dose-response modeling, estimating risk for the general population from occupational workers, estimating risk for potentially sensitive subpopulations, effect of occupational exposure estimation error, and use of mortality rates to predict incidence. The URF is 5.0 x 10(-7) per microg/m(3) or 1.1 x 10(-6) per ppb and is based on a Cox regression dose-response model using restricted continuous data with age as a covariate, and a linear low-dose extrapolation default approach using the 95% lower confidence limit as the point of departure. Age-dependent adjustment factors were applied to account for possible increased susceptibility for early life exposure. The air concentration at 1 in 100,000 excess leukemia mortality, the no-significant-risk level, is 20 microg/m(3) (9.1 ppb), which is slightly lower than the TCEQ chronic reference value of 33 microg/m(3) (15 ppb) protective of ovarian atrophy. These values will be used to evaluate ambient air monitoring data so the general public is protected against adverse health effects from chronic exposure to 1,3-butadiene.

[Allogeneic hematopoietic stem cell transplantation from HLA one-locus-mismatched related donors]

Fourteen patients who received allogeneic hematopoietic stem cell transplantation (HSCT) from a serologically HLA one mismatched related donor (MMRD) between November 1987 and July 2003, were compared with HSCT from matched sibling donor (MSD) (n=142) or matched unrelated donor (MUD) (n=78). Cumulative incidence of acute graft-versus-host disease (GVHD) in patients with MMRD was significantly higher than in those with MSD, but was not different from that in those with MUD. There was no difference in the incidence of extensive type chronic GVHD in HSCT according to donor type. Overall survival (OS) at 5-years in patients with MMRD, MSD and MUD was 42.8%, 55.6% and 44.3%, respectively. The presence of acute GVHD and disease status at HSCT were identified as risk factors for overall survival by multivariate analysis. Acute GVHD was a risk factor for prognosis in patients with MSD and MUD, but not in those with MMRD. It was confirmed that the therapeutic results could be obtained in HSCT from MMRD as well as MUD.

The Incidence and Survival of AcuteDe NovoLeukaemias in Estonia and in a Well Defined Region of Western Sweden During 1982 – 1996: A Survey of Patients Aged 16 – 64 Years

In the present work the incidence and survival of acute de novo leukaemias in two neighbouring countries, were studied retrospectively over three 5-year periods, 1982-1996. The aim was to compare the above variables, particularly with respect to political/socio-economic and environmental factors, in a well defined area of Sweden, the so-called Western Swedish Health Care Region, with Estonia. Population-wise the Western Swedish Region and Estonia are very similar; area-wise they are also well comparable. The present report covers only patients diagnosed between the ages of 16-64 years. The number of acute de novo leukaemias in the two regions was quite similar (Western Sweden n = 282 and Estonia n = 237). The age standardized incidence rate regarding total acute de novo leukaemias was slightly lower in Estonia than in Western Sweden (1.49/100,000 inhabitants/year for Estonia and 1.76 for Sweden, respectively), the difference being not statistically significant. However, the survival data for the two countries were highly different (P < 0.001). Thus, the relative survival for the total group of patients aged 16-64 years in Estonia at 1 year was 20.7% and at 5 years 3.6%, respectively. The corresponding figures for the Swedish patients were considerably higher, 65.2 and 29.4%, respectively. Further, the 5 year survival significantly (P < 0.05) increased for the Swedish patients over the 3 consecutive 5-year periods. No such improvement was recorded for the Estonian patients.

Mifepristone treatment improves length and quality of survival of mice with spontaneous leukemia

BACKGROUND

Mifepristone was found to suppress expression of the progesterone-induced blocking factor (PIBF). Progesterone-induced blocking factor suppresses natural killer cell activity. The objective of the present study was to determine if treatment of mice with spontaneous murine lymphocyte leukemia with the progesterone receptor antagonist mifepristone could improve length and quality of life.

MATERIALS AND METHODS

Sixty-one mice were gavaged with mifepristone and 33 controls with olive oil. Quality of life was determined by body conditioning score (BCS). Treatment was initiated when the mice were 6 months old.

RESULTS

Within 2 weeks of therapy only 11.4% of the mifepristone treated mice died vs. about 50% of controls. The BCS was 5 (highest quality) in 82% of treated mice vs. 11% of controls after 2 weeks of therapy.

CONCLUSION

Mifepristone therapy should be further evaluated for treating leukemia and lymphoma.

[Cause-specific mortality in populations exposed and unexposed to outdoor emissions of formaldehyde and wood dust: the Viadana study]

AIM

to describe the mortality risk for all causes and chronic diseases among people living in the industrial district of Viadana (Mantua), where wooden furniture factories producing formaldehyde and wood dust are situated.

DESIGN

mortality for the years 1996-2005 among residents in the municipalities where the industrial plants are located (exposed areas) was compared with the mortality among people living in the areas without plants (non-exposed areas).

MAIN OUTCOMES

standardized mortality ratios (SMR), using as reference the total population of the Province of Mantua.

RESULTS

overall mortality risk was slightly higher in the non-exposed areas and in the district of Viadana than in the Province of Mantua. Mortality risk for all cancers in the exposed areas was lower than in the Province of Mantua (SMR=0.93; 95% IC 0.87-0.99). Mortality for prostate cancer was significantly increased in the exposed areas compared to non-exposed areas (RR=1.83; 95% IC 1.08-3.09) and to the Province of Mantua as a whole (SMR=1.39; 95% IC 1.06-1.79). Mortality maps suggest a higher mortality risk for prostate cancer, mainly among exposed areas. An excess of mortality for leukaemia (non-statistically significant) and for respiratory diseases (statistically significant) was found in Gazzuolo and Sabbioneta, both located in the exposed area.

CONCLUSION

no statistically significant excess risk of mortality for cancer of upper aerodigestive tract was found among residents in municipalities where wood dust and formaldehyde producing factories were active. The increased mortality risk for prostate cancer and leukaemia needs to be deeply analyzed.

A phase II multicenter study of troxacitabine in relapsed or refractory lymphoproliferative neoplasms or multiple myeloma

Options for patients with relapsed/refractory lymphoproliferative disorders and multiple myeloma are currently limited. Troxacitabine has shown promise in preclinical studies in a variety of malignancies; hence, the current study was conducted to evaluate the activity of troxacitabine in relapsed or refractory lymphoid malignancies. This was a phase II, open-label, multinational, multicenter study of patients with relapsed or refractory lymphoproliferative disorders or multiple myeloma. Thirty-four adults were enrolled in the study and received the study drug at either 5.4 mg/m2 (n = 16) or 4.3 mg/m2 (n = 18). The dose was decided in a phase I study, during which dose escalation was carried to reach a maximum tolerated dose with an acceptable toxicity profile. Two separate phase I studies were performed in Europe and the US. Troxacitabine was administered by intravenous infusion over 30 min daily for days 1 - 5 every 4 weeks. Treatment was continued to disease progression or until the subjects met criteria for withdrawal or unacceptable toxicities were evident as outlined in the protocol. Two patients had a partial response (PR) to treatment with troxacitabine to yield an overall response rate of 13%. There were no complete responses seen with the drug. Stable disease was achieved in 15 patients (44%). All patients had at least one treatment related adverse event, which led to six withdrawals from the study. Hematologic toxicity constituted the most common adverse events. Serious adverse effects were seen in 62% of patients. None of the 13 deaths were attributed directly to troxacitabine. As a single agent, troxacitabine has limited benefit in patients with advanced lymphoproliferative disorders or multiple myeloma. Future studies will be needed to address modified dosing according to emerging pharmacokinetic and pharmacodynamic data and combination therapy which may lead to improved clinical benefit for troxacitabine in hematologic malignancies.

Role of serum sodium in assessing hospital mortality in cancer patients with spontaneous tumour lysis syndrome inducing acute uric acid nephropathy

Spontaneous tumour lysis syndrome (STLS) inducing acute uric acid nephropathy, a rare and neglected disease, presents more insidiously than conventional post-treatment tumour lysis syndrome. Although STLS is a serious and potentially fatal complication in patients with neoplastic disorders, few investigations have addressed the relevance of clinical and laboratory features in assessing prognosis. A retrospective study was conducted, reviewing the records of all patients who developed acute renal failure (ARF) at Chang Gung memorial hospital between 1 July 1999 and 30 June 2003. STLS-induced acute uric acid nephropathy was identified in 12 of 1072 ARF patients (1.1%) during the study period. All patients had advanced stage tumours with large tumour burden, and 66.7% of cases had abdominal organ involvement. All 12 hyperuricemic patients became oliguric despite conservative therapy, and remained hyperuricemic (21.6 +/- 5.2 mg/dl) before dialysis therapy. Diuresis developed in eight patients (66.7%), with associated resolution of hyperuricemia, azotemia and metabolic derangements following dialysis initiation. Overall hospital mortality was 58.3%. Death in most patients was related to hyponatremia and hypoalbuminemia on admission. The serum sodium was found to have the best Youden index (0.86) and highest overall prediction accuracy (93%). Moreover, serum sodium and serum albumin for individual patients were significantly and positively correlated (r = 0.617, p = 0.032). This investigation confirms a grave prognosis for cancer patients with STLS inducing acute uric acid nephropathy. Hyponatremia and hypoalbuminemia on the first day of admission indicate poor prognosis in such patients.

Immune phenotype and prognosis in chronic B-lymphocytic leukaemia and leukaemic immunocytoma

Fifty-nine patients with a leukaemic B-lymphocytic malignancy ("CLL") were studied. According to the Kiel classification, 29 patients had chronic lymphocytic leukaemia (CLL) and 30 had immunocytoma (IC). Cell surface immunoglobulin staining showed mu heavy chain phenotype in 14 patients, mu in 35, gamma in 7; in cells from 3 patients the staining was too weak to permit identification. The light chain phenotype was kappa in 39 patients, lambda in 17, and unidentified in 3. The immunoglobulin isotypes differed between the diagnoses. The gamma chain phenotype was found only in IC patients (p less than 0.02), and more CLL than IC patients showed a lambda chain phenotype (p less than 0.04). Blood lymphocytes from IC patients contained more T cells than CLL cell samples (p less than 0.002). No prognostic difference was found between the CLL and IC group. Compared to the lambda phenotype, the kappa phenotype was associated with a poorer prognosis in the IC group, but with a better prognosis in the CLL group. IC patients with mu phenotype had a poorer prognosis than those with gamma phenotype. Low relative T cell numbers were associated with a poor survival (p less than 0.01).

Molecular specific and cell selective cytotoxicity induced by a novel synthetic HLA-DR antibody mimic for lymphoma and leukemia

Like rituximab, monoclonal antibodies reactive with human leukocyte antigen have potent antilymphoma activity. However, size limits their vascular and tissue penetration. To mimic monoclonal antibody binding, nanomolecules have been synthesized, shown specific for the beta subunit of HLA-DR10, and selective for cells expressing this protein. Selective high affinity ligands (SHALs) containing the 3-(2-([3-chloro-5-trifluoromethyl)-2-pyridinyl]oxy)-anilino)-3-oxopropanionic acid (Ct) ligand residualized and had antilymphoma activity against expressing cells. Herein, we show the extraordinary potency in mice with human lymphoma xenografts of a tridentate SHAL containing this ligand. After titrating antilymphoma activity in cell culture, a randomized preclinical study of a tridentate SHAL containing the Ct ligand was conducted in mice with established and aggressive human lymphoma xenografts. Mice having HLA-DR10 expressing Raji B- or Jurkat's T-lymphoma xenografts were randomly assigned to receive either treatment with SHAL at a dose of 100 ng i.p. weekly for 3 consecutive weeks, or to be untreated. Primary end-points were cure, overall response rates and survival. Toxicity was also evaluated in these mice, and a USFDA general safety study was conducted in healthy Balb/c mice. In Raji cell culture, the threshold and IC50 concentrations for cytotoxic activity were 0.7 and 2.5 nmol (pm/ml media), respectively. When compared to treated Jurkat's xenografts or untreated xenografts, Raji xenografts treated with the SHAL showed an 85% reduction in hazard of death (P=0.014; 95% confidence interval 32-95% reduction). There was no evidence for toxicity even after i.p. doses 2000 times greater than the treatment dose associated with cure of a majority of the mice with Raji xenografts. When compared with control groups, treatment selectively improved response rates and survival in mice with HLA-DR10 expressing human lymphoma xenografts at doses not associated with adverse events and readily achievable in patients.

[Historical epidemiology of leukaemia mortality in Salento (Italy) from 1902 to 2002]

The aim of this study is to investigate leukaemia mortality in Salento. Leukaemia mortality in Salento's population is compared to data for Apulia and Italy, for 1902 to 2002. With particular reference to the period from 1969 to 2002, the paper looks at leukaemia mortality in male and female populations. Data on all eligible leukaemia deaths was obtained from the National Institute of Statistics (ISTAT). An increase of leukaemia mortality was observed both in male and female populations. Leukaemia mortality in Salento's female population was greater than amongst males.