Occurrence of the t(2;5)(p23;q35) in non-Hodgkin's lymphoma

Primary CD30(Ki-1)-positive anaplastic large-cell lymphoma (ALCL) is considered by some to be a distinct clinicopathologic entity associated with the t(2;5) (p23;q35). However, the specificity of t(2;5) for ALCL has not been carefully studied. Therefore, we performed a detailed analysis of all cases of ALCL with abnormal cytogenetics results in the Nebraska Lymphoma Study Group registry, as well as all other cases of non-Hodgkin's lymphoma with t(2;5) in the registry. We found the t(2;5) in only five of 10 cases of ALCL, four of whom were young patients. However, we also found the t(2;5) in 11 other cases of nonanaplastic lymphoma, including eight children with typical peripheral T-cell lymphomas of various types. The t(2;5) was also found in three older adults with B-cell lymphomas of various types. Thus, the t(2;5) was not specific for CD30+ ALCL. However, t(2;5) may define a clinicopathologic entity in children and young adults characterized by variable morphologies with a T-cell or indeterminate phenotype, CD30-positivity, nodal disease with frequent extranodal involvement, advanced stage, and an excellent response to therapy, including bone marrow transplantation for relapsed disease. The clinical relevance of the t(2;5) in older patients requires further study.     

Psychosocial and physiological predictors of sudden cardiac death after healing of acute myocardial infarction

Several major prospective studies that have examined the relation between type A behavior and cardiac mortality have failed to find an association. Since psychosocial factors have been implicated in the etiology of sudden cardiac death, it is possible that this association may emerge if sudden cardiac death is distinguished as an outcome distinct from other cardiac mortality. Predictors of sudden death and other cardiac outcomes were examined using data from the Recurrent Coronary Prevention Project, a 4.5-year prospective clinical trial of 1,012 postinfarction patients begun in San Francisco in 1978. A unique set of risk factors was found for the differing outcomes: sudden cardiac death had predominantly psychosocial predictors while nonsudden cardiac death and nonfatal recurrences were predominantly predicted by biologic factors. Type A behavior was an independent predictor of sudden, but not nonsudden, cardiac death in this population (p = 0.04). These results are the first demonstration of a direct relation between stress and sudden cardiac death in a large prospective clinical study, and provide insight into the failure of past prospective studies to find an association between type A behavior and cardiac mortality.