Pretransplantation Mog was significantly associated with an increased risk of GVHD-related mortality, which supports the relevance of CCR4-expressing Tregs after allo-HSCT in humans. In clinical practice, Mog should be cautiously used for patients with ATLL who are eligible for allo-HSCT.

SummaryThis study evaluated the clinical features of 276 patients with aggressive adult T-cell leukaemia-lymphoma (ATL) in 3 Japan Clinical Oncology Group (JCOG) trials. We assessed the long-term survivors who survived >5 years and constructed a prognostic index (PI), named the JCOG-PI, based on covariates obtained by Cox regression analysis. The median survival time (MST) of the entire cohort was 11 months. In 37 patients who survived >5 years, no disease-related deaths in 10 patients with lymphomatype were observed in contrast to the 10 ATL-related deaths in other types. In multivariate analysis of 193 patients, the JCOG-PI based on corrected calcium levels and performance status identified moderate and high risk groups with an MST of 14 and 8 months respectively (hazard ratio, 1Á926). The JCOG-PI was reproducible in an external validation. Patients with lymphoma-type who survived >5 years might have been cured. The JCOG-PI is valuable for identifying patients with extremely poor prognosis and will be useful for the design of future trials combining new drugs or investigational treatment strategies.

Abbreviations: AITD, autoimmune thyroid disease; PCR, polymerase chain reaction; TG, thyroglobulin; TPO, thyroid peroxidase.A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Association of CTLA-4 Gene A/G Polymorphism in Japanese Type 1 Diabetic Patients With Younger Age of Onset and Autoimmune Thyroid Disease O R I G I N A L A R T I C L EOBJECTIVE -We studied the association between type 1 diabetes with autoimmune thyroid disease (AITD) and A/G allele polymorphism in exon 1 of the CTLA-4 gene in a Japanese population.RESEARCH DESIGN AND METHODS -We studied 74 Japanese type 1 diabetic patients with or without AITD and 107 normal subjects to identify the association between CTLA-4 polymorphism and type 1 diabetes using polymerase chain reaction-restriction fragment length polymorphism analysis.RESULTS -The frequency of the CTLA-4 G allele differed significantly between the type 1 diabetic patients (61%) and the normal control subjects (48%) (P = 0.016). The difference in the CTLA-4 G allele became greater between patients with a younger age of onset of type 1 diabetes (age at onset Ͻ30 years) and the normal control subjects (64% and 48%, respectively). However, the frequency of the CTLA-4 G allele did not differ between type 1 diabetic patients with younger and older age of onset (64% vs. 57%). The G allele frequencies in the patients with younger-onset type 1 diabetes and AITD increased more than in the control patients (P = 0.025). These differences reflected a significant increase in the frequency of G/G genotype-that is, 54% in those with younger-onset type 1 diabetes and AITD, 39% in those without AITD, and 28% in control subjects.CONCLUSIONS -An association was detected between the CTLA-4 gene polymorphism and younger-onset type 1 diabetes with AITD. The G variant was suggested to be genetically linked to AITD-associated type 1 diabetes of younger onset in this Japanese population. The defect in these patients presumably lies in a T-cell-mediated autoimmune mechanism. E p i d e m i o l o g y / H e a l t h S e r v i c e s / P s y c h o s o c i a l R e s e a r c h 976DIABETES CARE, VOLUME 23, NUMBER 7, JULY 2000 CTLA-4 gene A/G polymorphism in type 1 diabetes and AITDtide level of Ͻ20 µg/day (20). Blood was sampled at intervals of 6-12 months for the measurement of the thyroid autoantibodies (anti-thyroid peroxidase [TPO] and anti-thyroglobulin [TG] antibodies), GAD65 antibody, and IA-2 antibody. Antibodies were determined by radioimmunoassay (20,21). Cutoff levels of GAD65 antibody, IA-2 antibody, and thyroid autoantibody were 1.2, 0.5, and 0.4 U/ml, respectively. Thyroid autoantibodies were measured Ͼ3 times in all patients with diabetes during the follow-up period. When the thyroid autoantibodies were detected Ͼ2 times in same patient, autoantibodies were considered to be positive. The diagnosis of AITD was based on the finding of palpable goiter or the presence of chronic thyroiditis with ultrasonography examination in the...