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PROGNOSTIC FACTORS IN MYELODYSPLASTIC SYNDROMES
1044 IN-VIVO AND IN-VITRO DRUG SENSITIVITY CHARACTERISTICS OF SEVEN P FALCIPARUM CASES FROM BENIN
CQ = chloroqume; AQ =amodlaqume; Q = quinine; MQ=mefloqume. Cut-off points for resistance in vitro are CI50 *Late recrudescence; t3 weeks’ follow-up; #then MQ 25 mg/kg daily for 1 day; then MQ 17 mg/kg daily for I day.
(table). Cases 1 and 5 were French expatriates and the others were Africans residing in France, all had returned to France after a few months’ stay in Benin. All but case 5 were probably infected in Cotonou or the suburbs. The malaria attacks were typical and were not severe clinically, and occurred despite regular excess chloroquine prophylaxis. The failure of quinine treatment in three cases underlines the need for adequate doses and duration when using this drug alone. As in Gabon in the past year,6 the decrease in sensitivity to quinine suggests that it may be worth combining a cycline with quinine for the treatment of severe malaria from areas of West Africa where chloroquine resistance of P falciparum has been recorded. The need for epidemiological surveillance is obvious in such highly endemic malarial areas which rely mostly on chloroquine for therapeutic control of the disease. National Reference Centre for Chemoresistance of Malaria, Hôpital Claude Bernard; 75944 Paris, France
JACQUES LE BRAS
Parasitic Diseases Service, Centre Hospitalier de Bicètre Kremlin Bicètre
PATRICE BOUREE OMER COCO-CIANCI
Parasitic Diseases Service, Hôpital de la Croix-Rousse,
JEAN-PAUL GARIN
Lyon
MICHEL REY
Infectious Diseases Service, Hôpital Pasteur, Paris
GUY CHARMOT
Infectious Diseases Service, Hôpital des Armées Bégin, Saint-Mande
100, 500, and up to 60 nmo]/l for CQ, Q, and MQ, respectively.
the predictive value of FAB classification and weight loss, but none of the other seventy-one clinical and pathological variables studied were significant in predicting survival. Varela et aF studied data on 56 patients and did a multivariate analysis (Cox regression proportional hazards) of the prognostic importance of several variables, including the scoring system proposed by two working conferences of the FAB Cooperative Group (including quantitative and qualitative variables-neutrophil and platelet counts, megakaryocytes, dysgranulopoiesis, and dysmegakaryopoiesis). The scoring system was the only covariate with predictive value and no other factors, not even the FAB classification, provided more information to predict survival. We have done a multivariate survival analysis of the prognostic significance of 36 clinical, biological, and morphological characteristics at diagnosis, including FAB classification, in a series of 107 cases with MDS. The best combination of characteristics,
ISABELLE HATIN
Infectious Diseases Service, Hôtel Dieu, Clermont-Ferrand
=
SUMMARY OF MULTIVARIATE ANALYSIS ON SURVIVAL IN MDS
_ i !— —
RENÉ ROUE
OJ P falciparum infection not responding to chloroquine in Nigeria. Trans Roy Soc Trop Med Hyg 1985; 79: 141. 2. Neequaye J. In vivo chloroquine-resistant falciparum malaria in western Africa. Lancet 1986; i: 153 3. Sansonetti PJ, Le Bras J, Verdier F, Charmot G, Dupont B, Lapresle C. Chloroquine resistant Plasinodium falciparum in Cameroon. Lancet 1985; i: 1154-55. 4. Le Bras J, Coulaud JP, Bricaire F, Le Bras M, Roue R, Grenier B, Fournier M. Chloroquine resistant falciparum malaria in the Congo. Lancet 1985; ii: 1071. 5 Le Bras J, Simon F, Foulon G, Lambert F Evolution de la chimiorésistance du paludisme en 1985 Bull Epidemiol Hebdom OMS 1986, 26: 1-3. 6. Simon F, Le Bras J, Charmot G, et al. Severe chloroquine resistant falciparum malaria in Gabon with decreased sensitivity to quinine. Trans Roy Soc Trop Med Hyg 1986; 1. Ekanem
80: 5.
selected by the Cox method, is given in the table, variables being listed in the order entered by the forward stepwise modelling procedure. Once again, the FAB classification was the first variable to enter the regression model. MIGUEL A. SANZ Clinical
Haematology Section, Haematology Service, Hospital La Fe, 46009 Valencia, Spain
SONIA GARCIA
J. IGNACIO LORENZO VICTORIA AMIGO
1. Foucar 2.
K, Langdon RM, Armitage JO, Olson DB, Carroll TJ. Myelodysplastic syndromes: a clinical and pathologic analysis of 109 cases. Cancer 1985; 56: 553-61. Varela BL, Chuang C, Woll JE, Bennett JM. Modification in the classification of primary myelodysplastic syndromes: the addition of a scoring system. Hematol Oncol 1985; 3: 55-63
PROGNOSTIC FACTORS IN MYELODYSPLASTIC SYNDROMES
ASPIRIN-LIKE ANALGESICS AND CATARACT
S:R,—Your Aug 23 editorial discusses the prediction of outcome impact of this in planning therapy in myelodysplastic syndromes (MDS). We have observed an uncritical attitude to prognostic factors mentioned in reports cited in your editorial. That the FAB classification is the most useful prognostic marker in MDS seems to have almost universal agreement. However, the prognostic value of peripheral blood findings, multilineage defects, and other disease characteristics, must be questioned because there are controversial results and the statistical approach has usually been inadequate. Most analyses were done by univariate analysis, and no account was taken of correlation between covariates. The only report cited in your editorial that incorporated multivariate analysis1 confirmed
SIR,-Professor Kewitz and colleagues (Sept 20, p 689) were unable to confirm our fmding1 that aspirin-like analgesics are associated with protection against cataract. They suggest that this is because our controls were from a different hospital or general practice. Although taking controls from the same hospital confers advantages, it may lead to problems in surveys of major eye diseases in an eye hospital. Kewitz et al do not state if their controls had the same age-sex distribution as the cases; presumably they did not. If we had adopted their approach but retained the age-sex distribution match we would have found that most of the controls had glaucoma or diabetic retinopathy. Both glaucoma and diabetes are powerful risk factors for cataract.’ One of us saw the results of a case-control study of glaucoma presented where diabetes was identified as a
and the
CQ = chloroqume; AQ =amodlaqume; Q = quinine; MQ=mefloqume. Cut-off points for resistance in vitro are CI50 *Late recrudescence; t3 weeks’ follow-up; #then MQ 25 mg/kg daily for 1 day; then MQ 17 mg/kg daily for I day.
(table). Cases 1 and 5 were French expatriates and the others were Africans residing in France, all had returned to France after a few months’ stay in Benin. All but case 5 were probably infected in Cotonou or the suburbs. The malaria attacks were typical and were not severe clinically, and occurred despite regular excess chloroquine prophylaxis. The failure of quinine treatment in three cases underlines the need for adequate doses and duration when using this drug alone. As in Gabon in the past year,6 the decrease in sensitivity to quinine suggests that it may be worth combining a cycline with quinine for the treatment of severe malaria from areas of West Africa where chloroquine resistance of P falciparum has been recorded. The need for epidemiological surveillance is obvious in such highly endemic malarial areas which rely mostly on chloroquine for therapeutic control of the disease. National Reference Centre for Chemoresistance of Malaria, Hôpital Claude Bernard; 75944 Paris, France
JACQUES LE BRAS
Parasitic Diseases Service, Centre Hospitalier de Bicètre Kremlin Bicètre
PATRICE BOUREE OMER COCO-CIANCI
Parasitic Diseases Service, Hôpital de la Croix-Rousse,
JEAN-PAUL GARIN
Lyon
MICHEL REY
Infectious Diseases Service, Hôpital Pasteur, Paris
GUY CHARMOT
Infectious Diseases Service, Hôpital des Armées Bégin, Saint-Mande
100, 500, and up to 60 nmo]/l for CQ, Q, and MQ, respectively.
the predictive value of FAB classification and weight loss, but none of the other seventy-one clinical and pathological variables studied were significant in predicting survival. Varela et aF studied data on 56 patients and did a multivariate analysis (Cox regression proportional hazards) of the prognostic importance of several variables, including the scoring system proposed by two working conferences of the FAB Cooperative Group (including quantitative and qualitative variables-neutrophil and platelet counts, megakaryocytes, dysgranulopoiesis, and dysmegakaryopoiesis). The scoring system was the only covariate with predictive value and no other factors, not even the FAB classification, provided more information to predict survival. We have done a multivariate survival analysis of the prognostic significance of 36 clinical, biological, and morphological characteristics at diagnosis, including FAB classification, in a series of 107 cases with MDS. The best combination of characteristics,
ISABELLE HATIN
Infectious Diseases Service, Hôtel Dieu, Clermont-Ferrand
=
SUMMARY OF MULTIVARIATE ANALYSIS ON SURVIVAL IN MDS
_ i !— —
RENÉ ROUE
OJ P falciparum infection not responding to chloroquine in Nigeria. Trans Roy Soc Trop Med Hyg 1985; 79: 141. 2. Neequaye J. In vivo chloroquine-resistant falciparum malaria in western Africa. Lancet 1986; i: 153 3. Sansonetti PJ, Le Bras J, Verdier F, Charmot G, Dupont B, Lapresle C. Chloroquine resistant Plasinodium falciparum in Cameroon. Lancet 1985; i: 1154-55. 4. Le Bras J, Coulaud JP, Bricaire F, Le Bras M, Roue R, Grenier B, Fournier M. Chloroquine resistant falciparum malaria in the Congo. Lancet 1985; ii: 1071. 5 Le Bras J, Simon F, Foulon G, Lambert F Evolution de la chimiorésistance du paludisme en 1985 Bull Epidemiol Hebdom OMS 1986, 26: 1-3. 6. Simon F, Le Bras J, Charmot G, et al. Severe chloroquine resistant falciparum malaria in Gabon with decreased sensitivity to quinine. Trans Roy Soc Trop Med Hyg 1986; 1. Ekanem
80: 5.
selected by the Cox method, is given in the table, variables being listed in the order entered by the forward stepwise modelling procedure. Once again, the FAB classification was the first variable to enter the regression model. MIGUEL A. SANZ Clinical
Haematology Section, Haematology Service, Hospital La Fe, 46009 Valencia, Spain
SONIA GARCIA
J. IGNACIO LORENZO VICTORIA AMIGO
1. Foucar 2.
K, Langdon RM, Armitage JO, Olson DB, Carroll TJ. Myelodysplastic syndromes: a clinical and pathologic analysis of 109 cases. Cancer 1985; 56: 553-61. Varela BL, Chuang C, Woll JE, Bennett JM. Modification in the classification of primary myelodysplastic syndromes: the addition of a scoring system. Hematol Oncol 1985; 3: 55-63
PROGNOSTIC FACTORS IN MYELODYSPLASTIC SYNDROMES
ASPIRIN-LIKE ANALGESICS AND CATARACT
S:R,—Your Aug 23 editorial discusses the prediction of outcome impact of this in planning therapy in myelodysplastic syndromes (MDS). We have observed an uncritical attitude to prognostic factors mentioned in reports cited in your editorial. That the FAB classification is the most useful prognostic marker in MDS seems to have almost universal agreement. However, the prognostic value of peripheral blood findings, multilineage defects, and other disease characteristics, must be questioned because there are controversial results and the statistical approach has usually been inadequate. Most analyses were done by univariate analysis, and no account was taken of correlation between covariates. The only report cited in your editorial that incorporated multivariate analysis1 confirmed
SIR,-Professor Kewitz and colleagues (Sept 20, p 689) were unable to confirm our fmding1 that aspirin-like analgesics are associated with protection against cataract. They suggest that this is because our controls were from a different hospital or general practice. Although taking controls from the same hospital confers advantages, it may lead to problems in surveys of major eye diseases in an eye hospital. Kewitz et al do not state if their controls had the same age-sex distribution as the cases; presumably they did not. If we had adopted their approach but retained the age-sex distribution match we would have found that most of the controls had glaucoma or diabetic retinopathy. Both glaucoma and diabetes are powerful risk factors for cataract.’ One of us saw the results of a case-control study of glaucoma presented where diabetes was identified as a
and the