Pre-diagnostic blood immune markers, incidence and progression of B-cell lymphoma and multiple myeloma: Univariate and functionally informed multivariate analyses

Recent prospective studies have shown that dysregulation of the immune system may precede the development of B‐cell lymphomas (BCL) in immunocompetent individuals. However, to date, the studies were restricted to a few immune markers, which were considered separately. Using a nested case–control study within two European prospective cohorts, we measured plasma levels of 28 immune markers in samples collected a median of 6 years before diagnosis (range 2.01–15.97) in 268 incident cases of BCL (including multiple myeloma [MM]) and matched controls. Linear mixed models and partial least square analyses were used to analyze the association between levels of immune marker and the incidence of BCL and its main histological subtypes and to investigate potential biomarkers predictive of the time to diagnosis. Linear mixed model analyses identified associations linking lower levels of fibroblast growth factor‐2 (FGF‐2 p = 7.2 × 10⁻⁴) and transforming growth factor alpha (TGF‐α, p = 6.5 × 10⁻⁵) and BCL incidence. Analyses stratified by histological subtypes identified inverse associations for MM subtype including FGF‐2 (p = 7.8 × 10⁻⁷), TGF‐α (p = 4.08 × 10⁻⁵), fractalkine (p = 1.12 × 10⁻³), monocyte chemotactic protein‐3 (p = 1.36 × 10⁻⁴), macrophage inflammatory protein 1‐alpha (p = 4.6 × 10⁻⁴) and vascular endothelial growth factor (p = 4.23 × 10⁻⁵). Our results also provided marginal support for already reported associations between chemokines and diffuse large BCL (DLBCL) and cytokines and chronic lymphocytic leukemia (CLL). Case‐only analyses showed that Granulocyte‐macrophage colony stimulating factor levels were consistently higher closer to diagnosis, which provides further evidence of its role in tumor progression. In conclusion, our study suggests a role of growth‐factors in the incidence of MM and of chemokine and cytokine regulation in DLBCL and CLL.

What's new?

B‐cell lymphomas (BCL) are frequent in immunocompromised individuals, but most BCL cases are thought to occur as a consequence of minor immune perturbations in otherwise immunocompetent individuals. Here the authors prospectively examined a panel of immune markers in the blood from 268 patients afflicted with BCL and paired controls. The data uncover a functional role for growth factors (i.e. FGF‐2, TGF‐alpha) in the incidence and progression of multiple myeloma, a BCL subtype, and underscore the importance of chemokine and cytokine regulation in diffuse large B‐cell lymphoma and chronic lymphocytic leukemia.

Provision of dental general anaesthesia for extractions in child patients at two centres

AIM

To two contrasting centres, to describe the provision of dental general anaesthesia (DGA) for simple non-surgical extractions in terms of the type of treatment provided, including the number of primary and permanent teeth extracted, and the characteristics of child patients attending in terms of their age group and gender.

DESIGN

Retrospective analysis of hospital records.

METHOD

Data were drawn from records of services over a 12-month period in 1996/97 at: a) a London dental hospital (Centre 1), and b) in the community dental services in Rochdale, Lancashire (Centre 2). Information was collated and analysed using the SPSS statistical software package.

RESULTS

The majority of patients at both centres were aged less than 9 years. Almost one third (31%) of those seen at Centre 1 were below 5 years of age, but fewer of this age group were treated at Centre 2. Children aged 9 years or less had an average of 5.4 (SD = 3.0) primary teeth extracted at Centre 1 and 3.0 (SD = 2.0) at Centre 2. For permanent teeth, an average of 3.2 (SD = 1.2) and 2.7 (SD = 1.4) were extracted at Centres 1 and 2 respectively.

CONCLUSIONS

Both services were used primarily for the extraction of primary teeth although the services differed in the ages of patients who used them and in the numbers of teeth extracted. Numbers of patients attending the service at Centre 1 had declined over time but numbers of teeth extracted per child had increased.

Interphase nucleolar organiser regions and survival in squamous cell carcinoma of the bronchus: a 10 year follow up study of 138 cases

BACKGROUND

Good prognostic indicators for patients with squamous cell carcinoma of the lung would help to determine the most appropriate treatment for individual patients.

METHODS

A silver colloid technique that shows interphase nucleolar organiser regions (AgNORs) has been applied to representative paraffin sections from 138 cases of squamous cell carcinoma of the bronchus treated by surgical resection of the primary tumour at East Birmingham Hospital in 1977. Of the 138 patients, 23 (17%) were alive 10 years after their operation.

RESULTS

The mean (SD) AgNOR count per cell was significantly higher for all grades of malignancy (well differentiated 10.5 (2.6), moderately differentiated 10.7 (3.2), and poorly differentiated 12.7 (4.5)) than for normal pseudostratified columnar epithelium from non-affected areas (2.3 (0.78)). There was a trend for AgNOR counts to be higher in poorly differentiated tumours, but a wide range of AgNOR counts was observed in all histological grades. AgNOR counts did not predict clinical outcome, irrespective of the stage of the disease, and did not relate to DNA ploidy or the percentage of cells in the proliferation phase of the cell cycle. Nine of 47 patients (19%) with tumours classified as DNA diploid and eight of 63 patients (13%) with DNA aneuploid tumours were alive 10 years after operation. Principal component analysis identified the clinicopathological stage of disease as the variable best related to survival. The percentage of patients surviving 10 years was 30% for stage I, 20% for stage II, 10% for stage IIIa, 9% for stage IIIb, and none for stage IV.

CONCLUSION

The AgNOR technique is not of prognostic value in postoperative patients with squamous cell carcinoma of the bronchus.