Risk for second malignancies in non-Hodgkin's lymphoma survivors: a meta-analysis.

BACKGROUND: Late side-effects are becoming an important issue in non-Hodgkin's lymphoma (NHL) survivors. We intended to estimate pooled relative risk (RR) of secondary malignant neoplasms (SMNs), to evaluate site-associated RR and the impact of different treatments. DESIGN: We carried out an electronic search of Medline and EMBASE seeking articles investigating the risk of SMNs and reporting RR measures. The studies were evaluated for heterogeneity before meta-analysis and for publication bias. Pooled RRs were estimated using fixed- and random-effects models. RESULTS: A total of 23 studies met the inclusion criteria. Pooled RRs of SMNs overall and for solid tumors were 1.88 and 1.32, respectively. We found an excess of risk for several specific cancer sites. Radiotherapy alone did not increase the risk for SMNs, while chemotherapy and combined treatments augmented the RR. Regression analyses revealed a positive significant association for all SMNs with total body irradiation, and for solid SMNs with younger age. No publication bias was observed. CONCLUSIONS: Our results indicate that NHL patients experience a higher risk for SMNs than the general population and that various treatments have different impact on RR. More information will be necessary to evaluate possible interactions with genetic susceptibility and environmental exposure.

Prognostic models for diffuse large B-cell lymphoma in the rituximab era: a never-ending story.

BACKGROUND: Improved treatment have modified survival outcome in patients with diffuse large B-cell lymphoma (DLBCL) and altered the importance of previously recognized prognostic markers. DESIGN AND METHODS: To evaluate International Prognostic Index (IPI) score before and after rituximab introduction and to validate the absolute lymphocyte count (ALC)/revised International Prognostic Index (R-IPI) model, we carried out a retrospective analysis on a total of 831 patients with DLBCL. RESULTS: Our results show that IPI lost its discriminating power with the introduction of rituximab. The analysis of our second set allowed us to validate the ALC/R-IPI model. The R-IPI and ALC/R-IPI could still be used for designing clinical trials, but both have difficulty recognizing a high percentage of poor prognosis patients, though it remains an important goal of a good prognostic model considering the modest impact of salvage treatments on survival. CONCLUSIONS: A new model on the basis of significant variables in the rituximab era and built on a large database of patients treated with rituximab is urgently needed. As prognostic models are changing with the efficacy and mechanisms of action of treatment utilized, looking for a new prognostic score is a never-ending story in which researchers are trying to hit a continuously moving target.

[Epidemiology of work related injuries in young people: results of a survey carried out in Modena (Italy) between January and June 2000]. / Epidemiologia degli infortuni lavorativi in minori: risultatidi una indagine condotta nella città di Modena nel periodo gennaio-giugno 2000.

Work related injuries, above all those involving young people, are an important health and social issue, even though up to now small attention has been deserved in spite of the presence of about 68 workers per 1000 young people and the occurrence of 27400 injures in young people in 2000 in Italy. This study was aimed at improving the knowledge on work related injures occurring in Modena in 14-17 year old subjects in the period January-June 2000. A descriptive epidemiological study was carried out. Information was collected at the two emergency departments operating in Modena by checking hospital and INAIL records. Injures were defined as events caused by a violent external cause producing one or more lesions. Injuries were defined as work related when occurring during working activities or "in itinere". Work related injures and other injures were compared using the different statistical methods. Work related injuries occurring in young people during January-June 2000 in Modena were 76 (6-month incidence: 1.5 per 100 subjects of the same age) and represent 8.5% of all injuries. The most involved subjects were 17 year old males working in the industrial field, and in most cases prognoses were lasting less than 8 days. A Cluster Analysis identified two types of injures: the "in itinere" ones which resulted similar to the road accidents, both for body sites involved and for the way of occurrence and the injuries occurring at the working place characterised by a high frequency of lesions concerning hand, head, above all eyes. The study showed a remarkable incidence of work related injuries among 14-17 year old subjects in Modena in the first 6 months of 2000. Nevertheless many difficulties in finding information raised during the survey: a higher accuracy and completeness in collecting and recording of the data is needed to better define the epidemiological aspects of this issue.