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Brain-cancer link with lead exposure in workplace
Newsdesk
New uniform response criteria for multiple myeloma The International Myeloma Working Group (IMWG) has issued new uniform criteria for assessing treatment response in patients with multiple myeloma (Leukemia 2006; 20: 1467–73), to harmonise and update the existing international patchwork of criteria. “The lack of uniformity is problematic”, explains co-author Vincent Rajkumar (Mayo Clinic, Rochester, MN, USA). “Uniform criteria will allow comparison of results from various trials.” IMWG criteria overlap greatly with that of the widely used European Group for Blood and Bone Marrow Transplant (EBMT), which will allow comparisons between older, continuing, and future clinical trials. But the IMWG criteria have new and precise outcome categories, such as a very good partial response (VGPR), and a stricter definition of complete response. Stringent complete response is defined as negative immunofixation
of the serum and urine, disappearance of soft-tissue plasmacytomas, absence of clonal plasma cells in bone marrow, and a healthy serum free light chain (FLC) ratio. An EBMT category, minor response (25% reduction in serum or urine monoclonal protein amounts), was excluded from IMWG criteria because it was judged unreliable, in favour of a broad category of stable disease. The IMWG criteria also allow assessment of patients with oligosecretory or nonsecretory myeloma (>10% of patients) with new FLC assay data. “These patients can now be eligible for clinical trials”, states Rajkumar. Nicolaus Kröger (University Hospital Eppendorf, Hamburg, Germany) of the EBMT Multiple Myeloma Subcommittee commends the effort to harmonise response criteria, but believes further studies are needed to determine how well IMWG criteria can monitor
response in patients with intact immunoglobulins and light-chain disease. Paolo Corradini (University of Milan, Italy), also of the EBMT subcommittee, says that IMWG criteria still rely on quantification of monoclonal proteins, a surrogate indicator of disease burden. “However, the introduction of FLC assay strengthens this approach and enables response assessment in patients with non-secretory or oligosecretory myeloma”, he comments. “Response criteria are developed for uniformity and validity in clinical trials, but they are also of immense use in clinical practice, especially because many of the endpoints have been validated”, states Rajkumar. “I think there is a lot of confusion about how to interpret the FLC assay. and the new response criteria provide guidance in that regard as well”.
Bryant Furlow
Brain-cancer link with lead exposure in workplace People with regular lead exposure at work are 50% more likely to die from brain cancer than those not exposed, according to new data (Int J Cancer 2006; 119: 1136–44). “If we [can] help explain the cause of 1–2% of the total number of cases [of brain cancer], that’s important”, says lead author Edwin van Wijngaarden, (University of Rochester School of Medicine, NY, USA). Although studies of the relation between lead exposure and brain cancer have been inconclusive, several clues indicate that such exposure could increase brain-cancer risk. Besides passing the blood-brain barrier, lead seems to aid carcinogenesis (eg, inhibiting DNA synthesis). Rats fed lead salts have also shown an increased occurrence of brain tumours. The researchers calculated risk estimates for lead exposure and for brain cancer from a census sample of 317 968 people who reported their http://oncology.thelancet.com Vol 7 October 2006
occupations in 1979–89. A National Cancer Institute job-exposure matrix for lead was used on the sample to estimate the likelihood of exposure and its intensity, which rates occupations on a scale from zero (no exposure) to three (high exposure). The investigators followed cancer rates for 9 years and found 119 brain-cancer deaths. Mortality from brain cancer was higher in people with jobs that had lead exposure than those with unexposed jobs (adjusted hazard ratio 1·5). Risk was greatest in people with the highest levels of probability and intensity of exposure (2·3), such as painters and automobile mechanics. “Use of lead has been limited in most Western countries [and] we just moved the dirty work to developing countries”, says Pierluigi Cocco (Department of Public Health, University of Cagliari, Italy). “International agencies should promote multicentre studies of
occupational cohorts with detailed information about lead exposure, to come up with the study size and the amount of occupational exposure data required to definitely assess such a risk.”
Xavier Bosch
Painters exposed to lead have high risk of death from brain cancer
805
New uniform response criteria for multiple myeloma The International Myeloma Working Group (IMWG) has issued new uniform criteria for assessing treatment response in patients with multiple myeloma (Leukemia 2006; 20: 1467–73), to harmonise and update the existing international patchwork of criteria. “The lack of uniformity is problematic”, explains co-author Vincent Rajkumar (Mayo Clinic, Rochester, MN, USA). “Uniform criteria will allow comparison of results from various trials.” IMWG criteria overlap greatly with that of the widely used European Group for Blood and Bone Marrow Transplant (EBMT), which will allow comparisons between older, continuing, and future clinical trials. But the IMWG criteria have new and precise outcome categories, such as a very good partial response (VGPR), and a stricter definition of complete response. Stringent complete response is defined as negative immunofixation
of the serum and urine, disappearance of soft-tissue plasmacytomas, absence of clonal plasma cells in bone marrow, and a healthy serum free light chain (FLC) ratio. An EBMT category, minor response (25% reduction in serum or urine monoclonal protein amounts), was excluded from IMWG criteria because it was judged unreliable, in favour of a broad category of stable disease. The IMWG criteria also allow assessment of patients with oligosecretory or nonsecretory myeloma (>10% of patients) with new FLC assay data. “These patients can now be eligible for clinical trials”, states Rajkumar. Nicolaus Kröger (University Hospital Eppendorf, Hamburg, Germany) of the EBMT Multiple Myeloma Subcommittee commends the effort to harmonise response criteria, but believes further studies are needed to determine how well IMWG criteria can monitor
response in patients with intact immunoglobulins and light-chain disease. Paolo Corradini (University of Milan, Italy), also of the EBMT subcommittee, says that IMWG criteria still rely on quantification of monoclonal proteins, a surrogate indicator of disease burden. “However, the introduction of FLC assay strengthens this approach and enables response assessment in patients with non-secretory or oligosecretory myeloma”, he comments. “Response criteria are developed for uniformity and validity in clinical trials, but they are also of immense use in clinical practice, especially because many of the endpoints have been validated”, states Rajkumar. “I think there is a lot of confusion about how to interpret the FLC assay. and the new response criteria provide guidance in that regard as well”.
Bryant Furlow
Brain-cancer link with lead exposure in workplace People with regular lead exposure at work are 50% more likely to die from brain cancer than those not exposed, according to new data (Int J Cancer 2006; 119: 1136–44). “If we [can] help explain the cause of 1–2% of the total number of cases [of brain cancer], that’s important”, says lead author Edwin van Wijngaarden, (University of Rochester School of Medicine, NY, USA). Although studies of the relation between lead exposure and brain cancer have been inconclusive, several clues indicate that such exposure could increase brain-cancer risk. Besides passing the blood-brain barrier, lead seems to aid carcinogenesis (eg, inhibiting DNA synthesis). Rats fed lead salts have also shown an increased occurrence of brain tumours. The researchers calculated risk estimates for lead exposure and for brain cancer from a census sample of 317 968 people who reported their http://oncology.thelancet.com Vol 7 October 2006
occupations in 1979–89. A National Cancer Institute job-exposure matrix for lead was used on the sample to estimate the likelihood of exposure and its intensity, which rates occupations on a scale from zero (no exposure) to three (high exposure). The investigators followed cancer rates for 9 years and found 119 brain-cancer deaths. Mortality from brain cancer was higher in people with jobs that had lead exposure than those with unexposed jobs (adjusted hazard ratio 1·5). Risk was greatest in people with the highest levels of probability and intensity of exposure (2·3), such as painters and automobile mechanics. “Use of lead has been limited in most Western countries [and] we just moved the dirty work to developing countries”, says Pierluigi Cocco (Department of Public Health, University of Cagliari, Italy). “International agencies should promote multicentre studies of
occupational cohorts with detailed information about lead exposure, to come up with the study size and the amount of occupational exposure data required to definitely assess such a risk.”
Xavier Bosch
Painters exposed to lead have high risk of death from brain cancer
805