Lisocabtagene maraleucel versus standard of care with salvage chemotherapy followed by autologous stem cell transplantation as second-line treatment in patients with relapsed or refractory large B-cell lymphoma (TRANSFORM): results from an interim analysis of an open-label, randomised, phase 3 trial

BACKGROUND

Patients with large B-cell lymphoma (LBCL) primary refractory to or relapsed within 12 months of first-line therapy are at high risk for poor outcomes with current standard of care, platinum-based salvage immunochemotherapy and autologous haematopoietic stem cell transplantation (HSCT). Lisocabtagene maraleucel (liso-cel), an autologous, CD19-directed chimeric antigen receptor (CAR) T-cell therapy, has previously demonstrated efficacy and manageable safety in third-line or later LBCL. In this Article, we report a prespecified interim analysis of liso-cel versus standard of care as second-line treatment for primary refractory or early relapsed (within 12 months after response to initial therapy) LBCL.

METHODS

TRANSFORM is a global, phase 3 study, conducted in 47 sites in the USA, Europe, and Japan, comparing liso-cel with standard of care as second-line therapy in patients with primary refractory or early (≤12 months) relapsed LBCL. Adults aged 18-75 years, Eastern Cooperative Oncology Group performance status score of 1 or less, adequate organ function, PET-positive disease per Lugano 2014 criteria, and candidates for autologous HSCT were randomly assigned (1:1), by use of interactive response technology, to liso-cel (100 × 10⁶ CAR⁺ T cells intravenously) or standard of care. Standard of care consisted of three cycles of salvage immunochemotherapy delivered intravenously-R-DHAP (rituximab 375 mg/m² on day 1, dexamethasone 40 mg on days 1-4, two infusions of cytarabine 2000 mg/m² on day 2, and cisplatin 100 mg/m² on day 1), R-ICE (rituximab 375 mg/m² on day 1, ifosfamide 5000 mg/m² on day 2, etoposide 100 mg/m² on days 1-3, and carboplatin area under the curve 5 [maximum dose of 800 mg] on day 2), or R-GDP (rituximab 375 mg/m² on day 1, dexamethasone 40 mg on days 1-4, gemcitabine 1000 mg/m² on days 1 and 8, and cisplatin 75 mg/m² on day 1)-followed by high-dose chemotherapy and autologous HSCT in responders. Primary endpoint was event-free survival, with response assessments by an independent review committee per Lugano 2014 criteria. Efficacy was assessed per intention-to-treat (ie, all randomly assigned patients) and safety in patients who received any treatment. This trial is registered with ClinicalTrials.gov, NCT03575351, and is ongoing.

FINDINGS

Between Oct 23, 2018, and Dec 8, 2020, 232 patients were screened and 184 were assigned to the liso-cel (n=92) or standard of care (n=92) groups. At the data cutoff for this interim analysis, March 8, 2021, the median follow-up was 6·2 months (IQR 4·4-11·5). Median event-free survival was significantly improved in the liso-cel group (10·1 months [95% CI 6·1-not reached]) compared with the standard-of-care group (2·3 months [2·2-4·3]; stratified hazard ratio 0·35; 95% CI 0·23-0·53; stratified Cox proportional hazards model one-sided p<0·0001). The most common grade 3 or worse adverse events were neutropenia (74 [80%] of 92 patients in the liso-cel group vs 46 [51%] of 91 patients in the standard-of-care group), anaemia (45 [49%] vs 45 [49%]), thrombocytopenia (45 [49%] vs 58 [64%]), and prolonged cytopenia (40 [43%] vs three [3%]). Grade 3 cytokine release syndrome and neurological events, which are associated with CAR T-cell therapy, occurred in one (1%) and four (4%) of 92 patients in the liso-cel group, respectively (no grade 4 or 5 events). Serious treatment-emergent adverse events were reported in 44 (48%) patients in the liso-cel group and 44 (48%) in the standard-of-care group. No new liso-cel safety concerns were identified in the second-line setting. There were no treatment-related deaths in the liso-cel group and one treatment-related death due to sepsis in the standard-of-care group.

INTERPRETATION

These results support liso-cel as a new second-line treatment recommendation in patients with early relapsed or refractory LBCL.

FUNDING

Celgene, a Bristol-Myers Squibb Company.

In Vivo Cellular Expansion of Lisocabtagene Maraleucel and Association With Efficacy and Safety in Relapsed/Refractory Large B-Cell Lymphoma

Lisocabtagene maraleucel (liso‐cel) is an autologous, CD19‐directed, chimeric antigen receptor T‐cell product for the treatment of adult patients with relapsed or refractory large B‐cell lymphoma (LBCL) after 2 or more lines of systemic therapy. In vivo cellular expansion after single‐dose administration of liso‐cel has been characterized. In this article, in vivo liso‐cel expansion in the pivotal study TRANSCEND NHL 001 (ClinicalTrials.gov identifier, NCT02631044) was further characterized to assess the relationship between in vivo cellular expansion after single‐dose administration of liso‐cel and efficacy or safety after adjusting for key baseline characteristics. Two bioanalytical methods, quantitative polymerase chain reaction and flow cytometry, were used for the assessment of cellular kinetics of liso‐cel, which showed high concordance for in vivo cellular expansion. Multivariable logistic regression analyses demonstrated that higher in vivo cellular expansion of liso‐cel was associated with a higher overall response and complete response rate, and a higher incidence of cytokine release syndrome and neurological events in patients with relapsed or refractory LBCL. Age and tumor burden (by sum of the product of perpendicular diameters) were likely to confound the relationship between in vivo cellular expansion and efficacy, where the association became stronger after controlling for these factors. Repeat dosing of liso‐cel was tested in the study; however, in vivo cellular expansion of liso‐cel was lower after repeat dosing than after the initial dose. These findings should enable a comprehensive understanding of the in vivo cellular kinetics of liso‐cel and the association with outcomes in relapsed/refractory LBCL.

"Ask me what I need": A call for shifting responsibility upwards and creating inclusive learning environments in clinical placement

BACKGROUND

Ontario's human-rights legislation and institutions' support for students with disabilities have influenced these students' increased enrolment in the postsecondary environment. Yet more attention is paid to in-classroom than to out-of-classroom experiences. Students with disabilities enrolled in nursing are least likely to be accommodated. This has significant implications for access and equity upon graduation, as clinical placements are a bridge between school and employment.

OBJECTIVES

To explore clinical instructors' and students who identify with disabilities' perspectives on nursing clinical placements.

METHOD

A descriptive case-report was used: interactive take-home diaries were completed and semi-structured interviews were conducted with clinical instructors (n-14) and nursing students with disabilities (n-14) in Ontario. An iterative inductive analysis was undertaken.

RESULTS

Three overarching themes were identified: (a) an immovable clinical environment in relation to technology and time, (b) a perceived conflict between nursing and disability identity, and (c) a need to shift responsibility upwards while listening to lived experience. The clinical environment is a highly contested space; different identity groups have distinct roles and differing degrees of power within it.

CONCLUSION

Our research calls for a shift in the nursing landscape to be led by education and medical institutions that can build supportive networks, develop clear policies and listen to nursing students with disabilities.

Strategies for Gaining Access to Deliver Sport Programs with Highly Vulnerable Youth

Sport programs have been widely studied for their efficacy in helping youth develop important social, psychological, and physical skills. Extensive research has explored the challenges related to design, implementation, and evaluation of sport programs with a developmental focus. However, when designing sport programs specifically tailored for youth from vulnerable backgrounds, the challenges become multiplied, particularly when accounting for barriers that exist before the program starts. The following article describes best practices for gaining access to non-traditional, hard-to-access environments, such as foster care systems, juvenile detention centers, youth residential mental health facilities, and programs situated in high-risk communities. Recommendations are provided for the initial phase of sport program development for vulnerable populations, including protecting youth, choosing appropriate sport content, and addressing barriers in the research process. Generally, these best practices are applicable for the development of any youth program. However, this article provides context-specific guidance and precautions that should be considered to protect and foster the well-being and welfare of youth from highly vulnerable populations.

Dielectric properties of complex magnetic field induced states in PbCuSO4(OH)2

Spin spirals, which coexist with collinear spin order in linarite PbCuSO₄(OH)₂, indicate electrical polarisation textures of spin-multipolar phases. We derive experimental evidence by a detailed investigation of the magnetic-field dependent dielectric and electric polarization properties at low temperatures. Linarite exhibits a quasi-one-dimensional frustrated S = ½ spin chain, which forms 3D spin-spiral order in zero magnetic field for T < 2.85 K. Recently, due to the monoclinic lattice of linarite with CuO₂ ribbon chains, complex magnetic field induced states were found. These spin-multipolar phases, which compete with spin-density waves at low magnetic fields, exist in close vicinity to the transition from the spin spiral into field induced spin polarized state. Via antisymmetric Dzyaloshinskii-Moriya interaction spin-driven ferroelectricity develops in the spin-spirals state. Via electric polarization measurements this allows to prove the transitions into complex magnetic field induced phases. Thorough analyses of the temperature and magnetic field dependent dielectric properties of a naturally grown single crystalline sample provide a detailed (T,H) phase diagrams for the three different crystallographic directions.

A pooled analysis of 10 case-control studies of melanoma and oral contraceptive use

Data regarding the effects of oral contraceptive use on women's risk of melanoma have been difficult to resolve. We undertook a pooled analysis of all case-control studies of melanoma in women completed as of July 1994 for which electronic data were available on oral contraceptive use along with other melanoma risk factors such as hair colour, sun sensitivity, family history of melanoma and sun exposure. Using the original data from each investigation (a total of 2391 cases and 3199 controls), we combined the study-specific odds ratios and standard errors to obtain a pooled estimate that incorporates inter-study heterogeneity. Overall, we observed no excess risk associated with oral contraceptive use for 1 year or longer compared to never use or use for less than 1 year (pooled odds ratio (pOR)=0.86; 95% CI=0.74-1.01), and there was no evidence of heterogeneity between studies. We found no relation between melanoma incidence and duration of oral contraceptive use, age began, year of use, years since first use or last use, or specifically current oral contraceptive use. In aggregate, our findings do not suggest a major role of oral contraceptive use on women's risk of melanoma.

Sites of phosphorylation in tau and factors affecting their regulation

The microtubule-associated protein, tau, is the principal component of paired helical filaments (PHFs) in Alzheimer's disease. PHF-tau is highly phosphorylated and a total of 25 sites of phosphorylation have so far been identified. Many of these sites are serine or threonine residues that are immediately followed in the sequence by proline residues, and hence are candidate phosphorylation sites for proline-directed kinases. In vitro, glycogen synthase kinase-3 (GSK-3), extracellular signal-related kinase-1 and -2, and mitogen-activated protein kinases, p38 kinase and c-jun N-terminal kinase, all phosphorylate many of these sites, although with different efficiencies for particular sites. Phosphorylation studies in transfected cells and neurons show that GSK-3 phosphorylates tau more extensively than do these other proline-directed kinases. Mutations in tau have been shown to affect in vitro phosphorylation of tau by GSK-3. The Arg406-->Trp (R406W) tau mutation also affects tau phosphorylation in cells.

Determinants of melanoma in a case-control study of twins (United States)

OBJECTIVES

To estimate the relative contribution of environmental and genetic factors disposing towards the development of melanoma.

METHODS

We investigated risk factors for melanoma in a case-control study conducted among 185 North American twin pairs in which one was diagnosed with melanoma and the other (the co-twin of the case) was not. We considered monozygous (MZ) and dyzygous (DZ) twins separately.

RESULTS

While greater risk of melanoma was associated with number of large nevi in DZ twins (adjusted OR = 26.6 (4.2-170.8) for three or more large moles), this was not the case for MZ twins (adjusted OR = 1.4 (0.6-3.2) for three or more large moles). Elevated risks of developing melanoma with site-specific sun exposures resulting in sunburn also appeared to be confined to DZ twins. Despite the number of identical twins reporting a difference in mole prevalence, we observed only a modest and inconsistent increase in melanoma risk attributable to that factor, whereas the increase within fraternal twin pairs was larger by an order of magnitude.

CONCLUSIONS

If confirmed, this indicates that the significance of mole prevalence as a risk factor for melanoma is largely as a genetic, rather than an environmental, factor. We noticed an increased risk of developing melanoma among DZ twins who drank moderate amounts of beer, but we believe this result may be due to the sun-exposure activities of those people most likely to drink moderate amounts of beer.

Recall bias in self-reported melanoma risk factors

The evidence implicating sun exposure in the etiology of melanoma derives largely from case-control studies in which the retrospective assessment of sun exposure suggests potential for significant recall bias. Previous attempts at characterizing and quantifying that bias have had significant methodological limitations. In the International Twin Study, a case-control study of melanoma risk factors in twins conducted from 1980 to 1991, the authors asked melanoma cases and their co-twins to quantify their own exposures and asked which twin had the greater exposure. Recall bias was investigated by assuming that, if bias had occurred, the odds ratio based on the case's response would differ significantly from the odds ratio based on the co-twin's response. Case-derived odds ratios were higher than the odds ratios for the controls for sunbathing in childhood and adulthood and for mole frequency and freckling in childhood, suggesting some recall bias. The odds ratios for ease of burning and tanning appeared unbiased. The belief that sunlight was a cause of melanoma appeared related to an increased odds ratio for sunbathing as a child. There is a continuing need to carefully assess recall bias in the study of melanoma risk factors.

Risk factors for penile cancer: results of a population-based case-control study in Los Angeles County (United States)

The etiology of penile cancer is poorly understood, with neonatal circumcision being one of the few recognized nondemographic risk factors. Multiple logistic regression was used to analyze interview data from 100 matched case-control pairs; cases of carcinoma in situ (CIS) and invasive carcinoma of the penis were analyzed separately as well as together. Phimosis was strongly associated with invasive carcinoma (adjusted odds ratio [OR] = 16; 95% confidence interval [CI] = 4.5-57) but not CIS (OR = 1.7; 95% CI = 0.32-7.8), and these associations persisted when the analyses were restricted to uncircumcised subjects. Neonatal circumcision was inversely associated with invasive carcinoma (OR = 0.41; 95% CI = 0.13-1.1) but not CIS, and the observed association with invasive carcinoma was weakened appreciably when the analysis was restricted to subjects with no history of phimosis (OR = 0.79; 95% CI = 0.29-2.6). Other factors positively associated with invasive carcinoma or CIS or both were injury to the penis, cigarette smoking, physical inactivity and, to a lesser extent, genital warts and other infections or inflammation of the penis.

CONCLUSIONS

Although many effects were imprecisely estimated in this study, the protective effect of circumcision on invasive penile cancer appears to be mediated in large part by phimosis; furthermore, the effects of certain factors such as phimosis and circumcision appear to differ for CIS and invasive carcinoma.

Skin characteristics and risk of superficial spreading and nodular melanoma (United States)

OBJECTIVE

To assess the risk for melanoma associated with moles and pigmentary characteristics.

METHODS

Representative melanoma cases (773) among non-Hispanic white residents under age 65 occurring between 1 June 1978 and I December 1983 in Los Angeles County were compared to controls (752) matched to cases by age, sex, race and neighborhood of residence. Factors considered include hair, eye, and skin color; numbers of freckles and moles; and propensity to burn and tan obtained during an in-person interview.

RESULTS

Five hundred and fifty-one cases were classified as superficial spreading melanoma (SSM) and 110 as nodular melanoma (NM). For SSM, the important risk determinants were hair and skin color, freckling, and mole prevalence. Light skin and more freckles were found to be more highly associated with SSM for younger compared to older subjects, whereas the associations between SSM and both hair color and moles remained independent of age. NM showed patterns of risk similar to SSM with the exception of skin color. NM showed no evidence of increasing risk with lighter skin, as compared to the strong association seen for SSM.

CONCLUSION

Hair and skin color, freckling and, especially, numbers and size of moles are important determinants of melanoma risk.

Impact of a mailed intervention on annual mammography and physician breast examinations among women at high risk of breast cancer

Only a few studies have examined repeat annual mammography rates, and most studies find that such regularity is low, ranging from < 5% in the general population to between 14 and 20% of first-degree relatives. The present study tested the effectiveness of a mailed intervention designed to improve compliance with breast cancer screening guidelines among women at elevated familial risk. The study used a pretest-posttest control group design; 369 twin sisters of breast cancer cases were assigned alternately to an intervention or a control group on the basis of sequential registration numbers. The intervention consisted of written materials, an audiotape, and mailed reminders. The posttest was mailed 2.5 years after the intervention in order to provide adequate time to assess the regularity of screening. The intervention and control groups were virtually identical with respect to demographic and baseline screening characteristics. Of those who returned the follow-up questionnaire, annual physician breast examinations were 12.8% higher and annual mammograms were 10.3% higher in the intervention group than in the control group. The probability of annual screening with physician breast examination and mammography was higher in the intervention group, and the probability of annual mammography continued to be higher for women over age 52 years after controlling for baseline screening, year of diagnosis, education, and status of the twin. This result is consistent with improvements found in other studies. Women who did not return follow-up questionnaires were more likely to have had fewer physician breast examinations and mammograms and more likely to be in the intervention group than those who stayed in the study. Additionally, those who dropped out of the intervention arm perceived themselves to be less susceptible and perceived screening to be less effective than did those who dropped out of the control arm. Although the intervention caused many women to be screened more regularly, those who had not been screened in the past and those who held opinions that were not conducive to screening were more likely to drop out. This mailed intervention for high-risk women increased their rate of screening. Characteristics of women resistant to such programs have been identified; alternative strategies need to be developed to reach this small percentage of high-risk women who ignore their elevated susceptibility.

Risk of cutaneous melanoma associated with a family history of the disease. The International Melanoma Analysis Group (IMAGE)

In a combined analysis of 2952 melanoma patients and 3618 controls from 8 case-control studies in white populations the risk of cutaneous melanoma was 2.24-fold higher (95% CI, 1.76-2.86) in subjects who reported at least one affected first-degree relative than in subjects who did not. There was no evidence for heterogeneity in the relative risk between the studies, which were from a wide range of latitudes and hence degrees of sun exposure. The effect of family history on melanoma risk was independent of age, naevus count, hair and eye colour, and freckling. There was no evidence for a relationship between family history and primary site of melanoma but there was some suggestion that the familial patients were more likely to have superficial spreading melanoma or lentigo maligna melanoma than acral lentiginous melanoma or nodular melanoma.

Risk of cutaneous melanoma associated with pigmentation characteristics and freckling: systematic overview of 10 case-control studies. The International Melanoma Analysis Group (IMAGE)

Using individual subject data from 10 case-control studies, comprising over 3000 cases and almost 4000 controls, we have estimated the relative risk of melanoma associated with aspects of complexion, namely, hair, eye and skin colour and freckling in adulthood, and have examined the relationships between these factors and naevus count in terms of melanoma risk. Compared with individuals with black or dark brown hair, the relative risks for developing melanoma in those with light brown, blonde and red hair were 1.49 (95% CI 1.31, 1.70), 1.84 (95% CI 1.54, 2.21) and 2.38 (95% CI 1.90, 2.97), respectively. Individuals with blue eyes had a risk 1.55 (95% CI 1.35, 1.78) times that for those with brown eyes, or 1.15 (95% CI 0.94, 1.40) after adjusting for hair colour and freckling in adulthood. The relative risks associated with hair and eye colour were independent of those for naevus count and skin colour. Light skin colour and high freckle density were also highly significant risk factors, independent of each other and of naevus count and hair and eye colour. The risks associated with these factors, while individually modest, are largely independent, and thus pigmentation characteristics and freckling tendency should be useful in identifying high risk groups to be targeted for prevention.

Adherence to screening examinations for colorectal cancer after diagnosis in a first-degree relative

Reports of colorectal cancer screening behavior were collected from 83 twin sisters of colorectal cancer cases and compared to the patterns found by national surveys. Prior to the diagnosis of colorectal cancer in a twin, the unaffected cotwins were being screened at rates close to those of the general population. In the years after diagnosis the annual frequency of each exam increased by approximately 15 to 20 percentage points. By the time of response nearly 89% of these cotwins had at least one fecal occult blood test, 90% had at least one digital rectal exam, and 69% had a sigmoidoscopy in comparison to 44, 63, and 27% of the general population, respectively. However, despite the evident familial risk, within the year prior to the report, 42.3% of colorectal cancer twins had had a fecal occult blood test, 44.3% had had a digital rectal exam, and 16% had had a sigmoidoscopy exam (the comparable figures from the general population sample are 14.5, 19.3, and 4%, respectively). The colorectal cotwins have a higher rate of sigmoidoscopy screening than either the National Health Interview Survey or the breast cotwins. Both colorectal and breast cancer cotwins have a higher rate of fecal occult blood test and digital rectal exam than the NHIS sample. This suggests that those at increased risk of cancer in general, are more likely to obtain routine screening including fecal occult blood test and digital rectal exam as part of the physical exam; however, the specialized sigmoidoscopy screening is more likely to be provided to those at most risk.

Photogrammetric accuracy measurements of head holder systems used for fractionated radiotherapy

PURPOSE

We describe how stereo photogrammetry can be used to determine immobilization and repositioning accuracies of head holder systems used for fractionated radiotherapy of intracranial lesions.

METHODS AND MATERIALS

The apparatus consists of two video cameras controlled by a personal computer and a bite block based landmark system. Position and spatial orientation of the landmarks are monitored by the cameras and processed for the real-time calculation of a target point's actual position relative to its initializing position. The target's position is assumed to be invariant with respect to the landmark system. We performed two series of 30 correlated head motion measurements on two test persons. One of the series was done with a thermoplastic device, the other one with a cast device developed for stereotactic treatment at the German Cancer Research Center. Immobilization and repositioning accuracies were determined with respect to a target point situated near the base of the skull. The repositioning accuracies were described in terms of the distributions of the mean displacements of the single motion measurements.

RESULTS

Movements of the target in the order of 0.05 mm caused by breathing could be detected with a maximum resolution in time of 12 ms. The data derived from the investigation of the two test persons indicated similar immobilization accuracies for the two devices, but the repositioning errors were larger for the thermoplastic device than for the cast device. Apart from this, we found that for the thermoplastic mask the lateral repositioning error depended on the order in which the mask was closed.

CONCLUSION

The photogrammetric apparatus is a versatile tool for accuracy measurements of head holder devices used for fractionated radiotherapy.

Mammography and physician breast exams after the diagnosis of breast cancer in a twin or non-twin sister

Reports of breast-cancer-screening behavior were collected from 591 twin sisters of women with breast cancer and 182 non-twin sisters of the same women, and compared with the patterns found by national surveys. Timeline plots indicate that prior to the diagnosis of breast cancer in a sister, these women were being screened at prevailing rates. In the year after diagnosis, the annual frequency of use by them of both mammograms and physician breast exams increased by approximately 25 percent, but in subsequent years these rates dropped to a plateau no more than 10 to 15 percent higher than the baseline. The sisters over age 60 were screened with unusually low frequency, as were those with no partner in the home, those with no regular source of medical care, and especially the siblings of cases that died soon after the diagnosis. The relatively infrequent adoption of a long-term, annual, screening pattern in the face of certain knowledge of personal high risk gives cause for concern about the effectiveness of any intervention program requiring recognition of personal high risk for effectiveness. One cause for optimism is that higher screening rates prevail among those with co-twins diagnosed since 1980, suggesting that the increase in publicity and public education in recent decades has had a beneficial impact.

Mechanism of antiinflammatory actions of curcumine and boswellic acids

Curcumine from Curcuma longa and the gum resin of Boswellia serrata, which were demonstrated to act as anti-inflammatories in in vivo animal models, were studied in a set of in vitro experiments in order to elucidate the mechanism of their beneficial effects. Curcumine inhibited the 5-lipoxygenase activity in rat peritoneal neutrophils as well as the 12-lipoxygenase and the cyclooxygenase activities in human platelets. In a cell free peroxidation system curcumine exerted strong antioxidative activity. Thus, its effects on the dioxygenases are probably due to its reducing capacity. Boswellic acids were isolated from the gum resin of Boswellia serrata and identified as the active principles. Boswellic acids inhibited the leukotriene synthesis via 5-lipoxygenase, but did not affect the 12-lipoxygenase and the cyclooxygenase activities. Additionally, boswellic acids did not impair the peroxidation of arachidonic acid by iron and ascorbate. The data suggest that boswellic acids are specific, non-redox inhibitors of leukotriene synthesis either interacting directly with 5-lipoxygenase or blocking its translocation.

Boswellic acids: novel, specific, nonredox inhibitors of 5-lipoxygenase

Isomers (alpha- and beta-) of boswellic acids (BAs), 11-keto-beta-BA and their acetyl derivatives were isolated from the gum resin of Boswellia serrata. BA and derivatives concentration dependently decreased the formation of leukotriene B4 from endogenous arachidonic acid in rat peritoneal neutrophils. Among the BAs, acetyl-11-keto-beta-BA induced the most pronounced inhibition of 5-lipoxygenase (5-LO) product formation with an IC50 of 1.5 microM. In contrast to the redox type 5-LO inhibitor nordihydroguaiaretic acid, BA in concentrations up to 400 microM did not impair the cyclooxygenase and 12-lipoxygenase in isolated human platelets and the peroxidation of arachidonic acid by Fe-ascorbate. The data strongly suggest that BAs are specific, nonreducing-type inhibitors of the 5-LO product formation either interacting directly with the 5-LO or blocking its translocation.

Inhibition of leukotriene B4 formation in rat peritoneal neutrophils by an ethanolic extract of the gum resin exudate of Boswellia serrata

Suspensions of rat peritoneal polymorphonuclear leukocytes (PMNL) elicited with glycogen were stimulated by calcium and ionophore to produce leukotrienes and 5-HETE from endogenous arachidonic acid (AA). We investigated the effect of ethanolic extracts of the gum resin exudate of Boswellia serrata. A concentration-dependent inhibition of LTB4 and 5-HETE production by different charges of exudate extracts were found. All products of the 5-lipoxygenase (5-LOx) from endogenous arachidonic acid (AA) in PMNL were reduced to the same extent by the extracts tested. The ethanolic extract of the gum resin also decreased 5-LOx mediated metabolisation of exogenously added AA to LTB4 and 5-HETE. Since steroidal-type anti-inflammatory drugs do not exert an immediate effect in the test system used, we conclude that the activity of the 5-LOx itself represents the side of inhibition by the gum resin extract. Therefore, an inhibition of 5-LOx catalysed mediator synthesis might be involved in the previously reported anti-inflammatory activity in vivo.

Kaposi's sarcoma in Los Angeles, California

The demographic characteristics of "classic" Kaposi's sarcoma (KS) and of "epidemic" KS in Los Angeles, CA, were compared with the use of data from the Cancer Surveillance Program, the population-based tumor registry in Los Angeles County. The data obtained document the magnitude of the excess risk of classic KS for Jewish men of European (especially Eastern and Southern European) origin. The data also show in a systematic way the magnitude of the increase in acquired immune deficiency syndrome-related KS in one large urban area of the United States. In addition, they demonstrate that the demographic risk factors of religion and birthplace for classic KS are unrelated to epidemic KS and that the clinical presentation in terms of stage and primary site of classic KS is distinct from that of the epidemic form of the disease.

Hepatitis, alcohol consumption, cigarette smoking, and hepatocellular carcinoma in Los Angeles

Seventy-eight black patients and white patients with primary hepatocellular carcinoma (PHC), 70 years or younger at diagnosis, and 78 age-, sex-, and race-matched neighborhood controls were interviewed. Information sought included usual dietary and drinking habits, cigarette smoking habits, prior medical conditions including a history of hepatitis, prior exposure to blood products, and occupational history. Cigarette smoking was a risk factor for PHC; the relative risk (RR) for current smokers of more than one pack/day compared to nonsmokers was 2.6. Alcohol consumption was also a significant risk factor for PHC; individuals who drank 80 g or more of ethanol per day had a RR of 4.2 compared to those drinking less than 10 g/day. In addition, a history of hepatitis (RR = 13.0) and a history of blood transfusions (RR = 7.0) were significant risk factors for PHC. Each of these factors remained significant after adjustment was made for the others.

The epidemiology of endometrial cancer in young women

A case-control study was conducted in Los Angeles County, California, of 127 endometrial cancer cases aged 45 years or less at diagnosis, to investigate the role of fertility, obesity and exogenous oestrogens in the development of the disease in young women. Use of sequential oral contraceptive (SOCs) or oestrogen replacement therapy (ERT) for greater than or equal to 2 years was strongly associated with increased risk of endometrial cancer. After excluding these cases, since the SOC or ERT use was probably the cause of their disease, we were left with 110 case-control pairs for further study. Among these remaining case-control pairs increasing parity was strongly associated with decreased risk (relative risk of 0.12 for women of parity 3 compared to nulliparous women, P less than 0.001). Current weight was associated with increased risk (relative risk of 17.7 for women weighing greater than or equal to 190 lbs compared to women weighing less than 130 lbs, P less than 0.001). Combination oral contraceptive (COC) use was associated with a decreased risk, which decreased with duration of COC use (relative risk of approximately 0.28 at 5 years of use, P less than 0.001), but the estimate of the protective effect was reduced and became statistically non-significant when allowance was made for weight and parity. The protective effect of COC use was only clearly evident in women who had less than 3 live-births and weighed less than 170 lbs. These results provide further support for the "unopposed" oestrogen hypothesis of the aetiology of endometrial cancer.

Risk factors for nodular sclerosis and other types of Hodgkin's disease

The age-adjusted incidence rates of nodular sclerosis in Los Angeles County from 1972 to 1975 were 58% lower in Mexican-Americans and 42% lower in blacks than in other whites. They were the same for each sex among other whites and the curve of age-specific incidence peaked in young adulthood. The incidence of nodular sclerosis was directly associated with social class. In contrast, the rates for other histological varieties of Hodgkin's disease (lymphocyte predominance, mixed cellularity, lymphocyte depletion) were only 12% lower in Mexican-Americans but 34% lower in blacks. In other whites, the rates were 92% higher in men and increased gradually with age while there were no clear trends with social class. These characteristics support the hypothesis that, at least for purposes of etiology, the nodular sclerosis form of this disease should be considered a distinct entity. Self-administered questionnaire were completed by 218 of the 1972 to 1973 Hodgkin's disease patients and 218 individually matched neighbourhood controls. Significantly high risk ratios for Hodgkin's disease were found for prior appendectomy (risk ratios = 1.9, p = 0.01) and for past amphetamine use (risk ratios = 3.0, p = 0.01). The elevated risk associated with amphetamine use had been found in a previous study.

[Purine nucleotide synthesis in human liver an its influence by benzbromarone (author's transl)]

5-Phosphoribosyl-1-pyrophosphate amidotransferase and the hypoxanthine-guanine phosphoribosyltransferases (H-PRT, A-PRT) were assayed in human liver cells and some of the properties of these enzymes were determined. The Michaelis-Menten constants of both H-PRT and A-PRT for phosphoribosylpyrophosphate are at least an order of magnitude lower than for human PP-ribose-P amidotransferase. At the enzyme level the higher specific activities of phosphoribosyltransferases would, in effect, give precedence to purine salvage in human liver. In addition, no effect of benzbromaronum on enzyme activities could be demonstrated.

Exogenous estrogens and breast cancer in women with natural menopause

Age, age at menopause, and calendar year at menopause were controlled as factors related to estrogen use. Data on 90 breast cancer patients and 83 conrols--all of whom had a natural menopause--showed no relationship between breast cancer and estrogen usage after the start of menopause symptoms.

Cancer incidence in the Mexican-American

Lower incidence rates of cancer for all anatomic sites combined were found in male and female Spanish-surnamed residents of Los Angeles County when compared to other whites. These Mexican-Americans were at lower risk for cancer of the buccal cavity, colon, rectum, larynx, lung, breast, bladder, prostate, and testis, and were at higher risk for cancer of the stomach, gallbladder, liver, and cervix. Immigrant Mexican-Americans had incidence rates most divergent from other whites, whereas indigenous Mexican-Americans had rates between the other two groups. The cancer pattern in Mexican-Americans was generally similar to that in American Indians. These data were most consistent with environmental variations in cause.

Epidemiology of congenital rubella syndrome. The role of maternal parity

Rubella vaccination policies are primarily directed at control of congenital rubella syndrome. In the United States, vaccination of children of both sexes, ages 1 theough 12 years, has been recommended. This policy depends on the hypothesis that children are the major source of infection for pregnant women. If true, then as maternal parity increases one would expect an increasing prevalence of rubella antibody or an increase in the frequence of rubella syndrome in babies. A serologic survey of 3,081 pregnant women has failed to show an increase in prevalence of rubella antibody with increasing parity. Case-control studies comparing groups of children with rubella syndrome to birth certificate and hospital control groups also have failed to show an excess of multiparae among the mothers of babies with rubella syndrome. Thus, these results do not support the hypothesis that children are the major source of infection for pregnant women.