Citations

Thromboangiitis obliterans (TAO) is often cited as an extreme phenotype of vasculopathy and tobacco dependence. Although tobacco exposure is essential to progression of arterial ischemia in TAO, expert opinion differs regarding the degree of tobacco dependence in this population. The authors designed a prospective, case-control study to test the hypothesis that subjects with TAO have a greater degree of tobacco dependence than control subjects with coronary atherosclerosis (coronary artery disease [CAD]) do. Subjects with TAO (n=218, confirmed by angiography, biopsy, or noninvasive arterial testing) or CAD (n=343, diagnosed by coronary angiography) were mailed a standardized questionnaire regarding tobacco use, to which 103 and 273 responded, respectively. The degree of tobacco dependence in each group was ascertained by several methods, including the Fagerström Test for Nicotine Dependence Questionnaire. The TAO group was younger at index date (year of first diagnosis for TAO patients, year of percutaneous transluminal coronary angioplasty [PTCA] for CAD patients) (TAO 37.6 ±9.0 vs CAD 43.3 ±4.9 yr, p<0.0001), but the groups did not differ in age at first tobacco exposure (TAO 16.7 ±3.1 vs CAD 17.3 ±4.2 yr, p=0.67), current tobacco use at time of survey (TAO 54% vs CAD 46%, p=0.17), or Fagerström score (TAO 4.7 ±2.3 vs CAD 5.1 ±2.3, p=0.24). Kaplan-Meier curves showed no significant difference in time to stopping tobacco use after first diagnosis (p=0.076). TAO subjects smoked fewer cigarettes per day than CAD subjects (TAO 22.3 ±10.7 vs CAD 27.7 ±15.3 cigarettes/day, p=0.003). Among current smokers (n=170), TAO subjects also smoked fewer cigarettes/day (20.2 ±8.2 vs 24.6 ±12.7, p=0.03), and were more likely to have made a serious attempt to stop (97% vs 90%, p=0.03). In contrast to case reports of extreme tobacco dependence in the TAO population, the degree of tobacco dependence in subjects with TAO is similar to that in subjects with CAD.

AbstractLittle effort has been made to quantitate adverse outcomes of monoclonal gammopathy of undetermined significance (MGUS) of the immunoglobulin M (IgM) class, which progresses to lymphoma or Waldenström macroglobulinemia, whereas IgA and IgG MGUS progress to multiple myeloma, primary amyloidosis (AL), or a related plasma cell disorder. From 1960 to 1994, IgM MGUS was diagnosed in 213 patients in southeastern Minnesota. The end point was progression to lymphoma or a related disorder, as assessed with the Kaplan-Meier method. The 213 patients were followed up for 1567 person-years (median, 6.3 years per patient). Lymphoma developed in 17 patients (relative risk [RR], 14.8), Waldenström macroglobulinemia in 6 (RR, 262), primary amyloidosis in 3 (RR, 16.3), and chronic lymphocytic leukemia in 3 (RR, 5.7). The relative risk of progression was 16-fold higher in the patients with IgM MGUS than in the white population of the Iowa Surveillance, Epidemiology, and End Results Program. Cumulative incidence of progression was 10% at 5 years, 18% at 10 years, and 24% at 15 years. On multivariate analysis, the serum monoclonal protein and serum albumin concentrations at diagnosis were the only risk factors for progression to lymphoma or a related disorder. Risk for progression to lymphoma or a related disorder at 10 years after the diagnosis of MGUS was 14% with an initial monoclonal protein concentration of 0.5 g/dL or less, 26% with 1.5 g/dL, 34% for 2.0 g/dL, and 41% for more than 2.5 g/dL. (Blood. 2003;102:3759-3764)

Abstract The plasma cell labeling index (PCLI) is a measure of plasma cell proliferative activity and is an important prognostic factor in newly diagnosed multiple myeloma (MM). Occasionally patients have been observed with stable, plateau phase MM with minimal numbers of residual light-chain–restricted monoclonal plasma cells, but a high PCLI. No data are available on the outcomes for such patients. Data from 57 patients with plateau phase MM and a marrow PCLI of more than 1.0% were compared with 105 matched control patients with MM with a marrow PCLI of less than 1.0%. All patients had less than 10% total plasma cells on marrow aspirate and biopsy. The median time to progression and overall survival were 8 months and 20 months, respectively, in the high PCLI group versus 39 months and 56 months, respectively, in the low PCLI group (P &lt; .0001). These findings suggest that a high PCLI in patients with apparently stable, plateau phase MM is an adverse parameter that may predict a short time to disease progression and death.