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Classification of lymphoid malignancy has changed markedly in recent years and advances have been made in therapy. This study investigated the variations in treatment and survival of 1622 patients in a population-based registry. A total of 1009 cases of malignant lymphoma (ML) were classified according to the Kiel classification. Pathology review resulted in major diagnostic changes for 24% of cases. Of the ML cases, 39% had not had full staging procedures. Younger patients were more likely to have been treated with multiagent chemotherapy regimens, as were patients with B symptoms. Median survival for ML patients was 12 months for high-grade patients and more than 60 months for low-grade patients. Significant factors affecting the survival of ML patients were performance status, whether treatment had followed a recognised protocol, whether treatment had been carried out at a specialist oncology centre (SOC), grade of disease, stage, gender and age. The same factors had a significant effect on survival of the leukaemia patients, except for treatment at an SOC, which had a significant favourable effect on survival of acute lymphoblastic leukaemia (ALL) patients only. Median survival for patients with chronic lymphocytic leukaemia was 43 months and 7 months for ALL patients.

Presenting features and natural history were assessed in 48 children with acute lymphoblastic leukaemia less than 2 years of age at diagnosis. Of these, 16 were less than 1 year (group 1) and 32 were between 1 and 2 years (group 2). Results were compared with a group of 348 children between the ages of 2 and 14 years (group 3) diagnosed over the same period. The children in group 1 presented with a higher prevalence of null cell acute lymphoblastic leukaemia, leucocyte counts greater than 100 X 10(9)/l, and hepatosplenomegaly and had a higher central nervous system (CNS) relapse rate and shorter duration of remission than those in the other two groups. Disease free survival and overall survival in group 2 paralleled that of group 3, although children in group 2 had a significantly higher CNS relapse rate. Neurological toxicity resulting from treatment with methotrexate and radiation was common in those under 2 years as a whole. In conclusion, children under 1 year have a particularly poor prognosis, while those between 1 and 2 years have a prognosis similar to that in the older age group. Alternative approaches to CNS prophylaxis are needed to reduce the high prevalence of CNS disease and toxicity.

The annual incidence of leukaemia among children aged up to 14 years as estimated by the Manchester Children's Tumour Registry has been analysed for the 24 years 1954-1977. A significant increase in acute lymphoid leukaemia (ALL) was found, while the incidence of acute myeloid leukaemia (AML) remained constant. Other types of leukaemia were too rare to be analysed separately. The increase in ALL was concentrated among boys in the 1--5-year age group. Analysis with respect to initial white-cell count showed the increase to be more pronounced in children with initial white cell counts of 1-5 x 10(4)/microliters. The proportion of cases presenting in Lancashire compared with Greater Manchester did not change during the study period. The distribution of cases with respect to social class and socio-economic group of the parents also remained constant. Due to advances in the treatment of childhood ALL survival improved considerably during the study period and no increase in mortality was seen.

The distribution of mortality from 11 causes of death (lymphoid leukaemia, other leukaemia, leukaemia of all types, Hodgkin's disease, other lymphomas, all lymphomas, multiple myeloma, lung cancer, other malignancies, all malignancies and all other causes) has been examined in three age groups throughout England and Wales over the period 1969-78. The reorganisation of local authority administration in 1974 meant that the smallest areas that could be examined were 400 county districts or (in some cases) approximate county districts formed by aggregating pre-1974 local authority areas. The variation in the numbers of deaths observed about the numbers expected was assessed using log-linear models to estimate the effect on the relative risk in each district associated with social class, rural status, population size, health authority region and proximity to one of 15 nuclear installations. Trends in risk with increasing proximity to an installation (as judged by the proportion of the population resident within 10 miles) were examined after adjustment for the other four variables. The results showed that in districts near to an installation there were significant excess mortalities in persons under 25 years of age from leukaemia (RR = 1.15, P = 0.01) and especially from lymphoid leukaemia (RR 1.21, P = 0.01) and from Hodgkin's disease (RR 1.24, P = 0.05) and a significant deficiency of mortality from lymphoid leukaemia in persons aged 25-64 years. No significant trends were observed with an increasing proportion of the population near to the installations and the greatest excess mortality from lymphoid leukaemia in young persons was observed in the districts with the intermediate proportion of the population (10.0-65.9%) near an installation.

Over a ten-year period we have studied 75 cases of adult acute lymphoblastic leukaemia (ALL). Sixty of the cases were seen from 1979 to 1984 and represent an unselected series of all known cases in a region of 3 000 000 people. Study of these patients has given further insight into the heterogeneous, clinical and cytological nature of adult ALL. Three protocols have been used and results are presented indicating that conventional approaches to treatment in this disease are unsatisfactory. Not all patients could be entered on protocols but these patients are included to give the overall perspective of this disease in clinical practice. A new strategy is proposed which envisages abandoning traditional maintenance chemotherapy in favour of either allogeneic marrow transplant or autologous transplant in first remission in the post-consolidation phase. Preliminary results of this flexible approach are given.

Changes in serum-beta 2-microglobulin (beta 2-m) levels were measured in 52 patients with chronic lymphocytic leukaemia during periods of observation of 5-43 months. While the majority of patients had elevated levels (> 3 mg/l), higher values tended to be associated with more advanced disease as assessed clinically. Patients with nonprogressive, predominantly Rai stage 0 and I disease had persistently normal or near normal beta 2-m levels, whereas patients with progressive, predominantly Rai stage II-IV disease, had higher levels often showing rapid changes. Sequential measurements of serum beta 2-m show patterns of change that reflect and may anticipate the clinical progression of the disease.

A decline, the first ever observed, has recently occurred in leukemia mortality rates for the white population of the United States between the ages of 1 and 74. Possible explanations include diminished exposure to medical x-rays following the release in the United States and Great Britain in 1956 of widely publicized reports on the biologic effects of ionizing radiation.