The prognostic significance of disease features recorded at the time of diagnosis was examined among 813 patients with Philadelphia chromosome- positive, nonblastic chronic granulocytic leukemia (CGL) collected from six European and American series. The survival pattern for this population was typical of “good-risk” patients, and median survival was 47 mo. There were multiple interrelationships among different disease features, which led to highly significant correlations with survival for some that had no primary prognostic significance, such as hematocrit. Multivariable regression analysis indicated that spleen size and the percentage of circulating blasts were the most important prognostic indicators. These features, and age, behaved as continuous variables with progressively unfavorable import at higher values. The platelet count did not influence survival significantly at values below 700 X 10(9)/liter but was increasingly unfavorable above this level. Basophils plus eosinophils over 15%, more than 5% marrow blasts, and karyotypic abnormalities in addition to the Ph1 were also significant unfavorable signs. The Cox model, generated with four variables representing percent blasts, spleen size, platelet count, and age, provided a useful representation of risk status in this population, with good fit between predicted and observed survival over more than a twofold survival range. A hazard function derived from half of the patient population successfully segregated the remainder into three groups with significantly different survival patterns. We conclude that it should be possible to identify a lower risk group of patients with a 2-yr survival of 90%, subsequent risk averaging somewhat less than 20%/yr and median survival of 5 yr, an intermediate group, and a high- risk group with a 2-yr survival of 65%, followed by a death rate of about 35%/yr and median survival of 2.5 yr.

Autopsy data on 1,206 children and adult patients with acute myelocytic leukemia (AML) (585), chronic granulocytic leukemia (CGL) (204), acute lymphocytic leukemia (ALL) (308), and chronic lymphocytic leukemia (CLL) (109) obtained from 1958 to 1982 were reviewed. This analysis has shown that, whereas the proportion of patients with residual AML at any anatomic site decreased significantly and uniformly over the entire study period, significant corresponding decreases in patients with CGL and ALL occurred only since 1976 and 1978, respectively. No significant corresponding decreases were noted in patients with CLL at any time. Significant decreases were also noted over time in the rates of extramedullary site involvement by AML, CGL, and ALL. Whereas the lymphoreticular organs, kidneys, adrenals, and pituitary were most often involved at autopsy by CLL, the testes, leptomeninges, dura mater, uterus, large bowel, and pancreas were most often involved by ALL. In general, patients with AML and CGL showed the lowest relative rates of involvement of the various organs by leukemia during the 24-year period. Whereas patients with AML and ALL showed significant decreases in the rates of involvement of nearly all anatomic sites during the most recent study periods, those with CGL and CLL showed corresponding decreases in only a few organ sites. The lower rates of organ involvement in patients with AML and ALL attest to the more aggressive eradication of leukemic cells by therapeutic regimens in these diseases over time. In particular, the significant decrease in the rate of meningeal involvement by ALL during the most recent period is probably attributable to central nervous system prophylaxis.

No abstract

Eutypa dieback is a perennial canker disease that adversely affects grape (Vitis vinifera) production throughout the world. The causal agent has been known as either Eutypa armeniacae or E. lata, and it has been unclear whether the two taxa are separate species. We analyzed 115 isolates of Eutypa and conspecific strains, including 106 from California, using amplified fragment length polymorphism (AFLP) and sequence analysis of the ribosomal DNA (rDNA) internal transcribed spacer (ITS) sequence. Strains from cultivated plant species exhibited an average genetic distance of 0.34, as calculated by the DICE coefficient (NTSYS-pc software). An unweighted pair-group method with arithmetic averages dendrogram revealed a genetically distinct (distance of 0.73) group of Eutypa strains from valley oak (Quercus lobata) and madrone (Arbutus menziesii) and a strain from grape. Analysis of rDNA ITS sequences strongly supported the genetically distinct cluster detected in the AFLP data. Combined data indicated the presence of two species of Eutypa (E. armeniacae and E. lata) in our sample population. However, both Eutypa species were capable of infecting native and cultivated hosts, suggesting the potential for native tree species to serve as inoculum sources for grape infection in California. Further investigations of E. armeniacae and E. lata would contribute to the development of a successful disease management strategy.