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A patient with a 13-year history of Hodgkin's disease, who developed the terminal complication of amyloidosis manifesting in a nephrotic syndrome resulting in death, is reported. The incidence of this rare complication is reviewed from reports in the literature; to date only 53 unequivocal cases of amyloidosis, in association with Hodgkin's disease, have been described. The clinical picture is ciscussed, and the possible pathogenesis of amyloidosis is considered. The importance of intensive combination chemotherapy for preventing long-term complications, is stressed.S. Afr. Med. J., 47, 1 (1973).

The data on 217 elderly (aged ≥ 65 years) and 209 middleaged postmenopausal patients with metastatic breast cancer treated in the Department of Medical Oncology, University of Pretoria, from 1976 to 1985 were analysed to determine the effect of age on survival. When considered as a group, the elderly have a more favourable prognosis (median survival 20,3 months) than the middle-aged (median survival 15,54 months) (p= 0,0457). Multivariate age subset analysis (taking into account all other major prognostic factors) reveal a distinct bimodal pattern. The median survival of patients aged 45 - 54 years is 21,2 months and decreases to 16,2 months for patients aged 55 - 64 years (P= 0,08; Cox model). The median survival improves again to 24,6 months for patients aged 64 - 74 years (P= 0,0001; Cox model), followed by an apparent but non-significant decrease to 17,1 months in the very old (aged 75 - 84 years) (P = 0,52; Cox model). The more favourable prognosis in the elderly dictates effective non-toxic treatment.

A retrospective analysis of data concerning 86 patients with multiple myeloma was carried out in order to evaluate factors affecting survival. The overall median survival was 621 days. In a univariate analysis the follOWing factors were significantly associated with poor survival: serum creatinine ≥ 150 mmol/l, haemoglobin < 11 g/dl and serum calcium values> 2,75 mmol/l; and Eastern Cooperative Oncology Group performance status 3 - 4. However, age, sex, Durie and Salmon staging, lytic lesions, serum immunoglobulin concentration, urine Bence Jones protein, percentage of plasma cells in the bone marrow, proteinuria, and type of chemotherapy given were not significantly associated with survival. A strong prediction of survival was found by grouping the serum creatinine and haemoglobin levels of patients at presentation.

Associations between patient characteristics and survival were investigated in 432 patients with hepatocellular carcinoma. Those patients were prospectively studied by the Eastern Cooperative Oncology Group, and each had his or her diagnosis reconfirmed by a pathology review panel. There were 301 North American and 131 South African patients. Sixty-nine % of the North American patients and 82% of the South African patients were male. There were 187 Black patients, 62 of whom were from North America. The study population is unique among hepatocellular carcinoma patients in that eligibility, evaluability, and endpoint definitions were standardized, and patients from both North America and South Africa received similar treatments at a similar time. Factors with the most significant adverse effect on survival are impaired performance status, male sex, older age, and disease symptoms (jaundice and reduced appetite). There is no apparent difference in survival between White and Black patients within North America, but North American patients survived longer than South African patients. Among the different therapies, p.o. 5-fluorouracil was associated with the poorest median survival time (6 wk), and i.v. 5-fluorouracil plus semustine with the best median survival time (24 wk). © 1988, American Association for Cancer Research. All rights reserved.