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Sensorineural hearing loss (SNHL) is a common adverse effect for nasopharyngeal carcinoma (NPC) patients treated with chemoradiotherapy. We report a case of 12-year follow-up from a patient with stage IIB NPC, treated in 2004 with intensity-modulated radiotherapy and cisplatin-based chemotherapy. Pure-tone audiograms were conducted before treatment and at two other points in the 12-year period after treatment. Analysis of the patient’s audiograms reveals that the development of high-frequency SNHL started after treatment and reached a plateau accompanied by tinnitus approximately 32 months after treatment conclusion. After the plateau, high-frequency SNHL continued to develop slowly in the next 10 years, possibly a long-term effect from radiation-induced microvascular change of the hearing apparatus. The continuous high-frequency hearing decline is associated with increased tinnitus pitch in the patient. With experience learned from this case, we recommend hearing tests at regular intervals for at least 3–5 years for NPC patients treated with chemoradiotherapy. Patients need to be educated about tinnitus and counseling can be offered when they begin to feel inconvenienced by tinnitus. These patients also need to be advised against exposure to noise that can aggravate the already compromised hearing apparatus, leading to further hearing loss and worsening tinnitus. Limiting the peak dose and total cumulative dose of cisplatin should be considered based on the patients’ risk factors to achieve a balance between treatment efficacy and long-term adverse effects.

Existing studies on modern roundabouts performance are mostly based on data from singe lane roundabouts that are not heavily congested. For planners and designers interested in building multilane roundabouts for intersections with potential growth in future traffic, there has been a lack of existing studies with field data that provide reference values in terms of capacity and delay measurements. With the intent of providing such reference values, a case study was conducted by using the East Dowling Road Roundabouts in Anchorage, Alaska, which are currently operating with extensive queues during the evening peak hours. This research used multiple video camcorders to capture vehicle turning movements at the roundabouts as well as the progression of vehicle queues at the roundabout entrance approaches. With these video records, the number of vehicles in the queues can be accurately counted in any single minute during the peak hours. This study shows that unbalanced entrance flow patterns (i.e., one entrance has significant higher flow than others) can intensify the queue and delay for the overall roundabouts. Then various software packages including RODEL, SIDRA and VISSIM were used to estimate several performance measurements, such as capacity, queue length, and delay, compared with the collected field data. With the comparison, it is found that all the three software packages overestimate multi-lane roundabout capacity before calibration. With default parameters, SIDRA and VISSIM tend to underestimate delays and queue lengths for the multi-lane roundabouts under congestion, while RODEL results in higher delay and queue length estimations at most of the entrance approaches.

Investigation of the dynamic processes of activity scheduling and trip chaining has been an interest of transportation researchers over the past decade because of its relevance to the effectiveness of congestion management and intelligent transportation systems. To empirically examine the processes, a computerized survey instrument is developed to collect household activity scheduling data. The instrument is unique in that it records the evolution of activity schedules from intentions to final outcomes for a weekly period. This paper summarizes the investigation on the dynamic processes of activity scheduling and trip chaining based on data collected from a pilot study of the instrument. With the data, ordered logit models are applied to identify factors that are pertinent to the scheduling horizon of activities. Results of the empirical analysis show that a daily schedule often starts with certain activities occupying a portion of the schedule and other activities are then arranged around these pre-occupants. Activities of shorter duration are more likely to be opportunistically inserted in a schedule already anchored by their longer duration counterparts. Persons with children often expect more constraining activities than those with no children. The analysis also shows that female respondents tend to be more structured in terms of how the week is planned. Additionally, analysis of travel patterns reveals that many trip-chains are formed opportunistically. Travel time required to reach an activity is positively related to the scheduling horizon for the activity, with more distant stops being planned earlier than closer locations.

A procedure is developed to model network traffic for planning applications in small and/or medium-sized communities with limited planning resources. The proposed method is based on the theories and assumptions of conventional four-step travel demand models, but the baseline trip table is estimated from existing traffic counts using path flow estimator PFE to render a quick response approach that requires less data than the conventional approach. The proposed modeling approach is suitable for short-range, small area planning applications, such as the evaluation of alternative roadway networks that does not involve significant growth in trip generation patterns. A case study is set up with data from a small community St. Helena, Calif. to demonstrate the proposed approach. An O-D trip table is estimated with PFE from traffic counts. The estimation process is shown to be feasible as the results matched observed data with a satisfactory error bound. The traffic impacts of various scenarios of land use and network changes can be effectively evaluated with the proposed modeling approach.

Purpose: Patients with relapsed mantle-cell lymphoma have poor prognosis and short survival. Our aim was to determine the efficacy of nonablative allogeneic stem-cell transplantation in patients with relapsed mantle-cell lymphoma. Patients and Methods: Eighteen patients were treated in one of two consecutive trials. Thirteen patients underwent a conditioning regimen of fludarabine (30 mg/m2 daily for 3 days), cyclophosphamide (750 mg/m2 daily for 3 days), and high-dose rituximab. For the remaining five patients, the conditioning regimen consisted of cisplatin (25 mg/m2 daily for 4 days), fludarabine (30 mg/m2 daily for 2 days), and cytarabine (1,000 mg/m2 daily for 2 days). Tacrolimus and methotrexate were used for graft-versus-host disease prophylaxis. Results: The median age was 56.5 years. Patients underwent a median of three prior chemotherapy regimens. Prior autologous transplantation failed in five (28%) patients and 16 (89%) had chemosensitive disease. Donor cell engraftment occurred in all patients. Eight patients (44%) required no platelet or RBC transfusion, and acute graft-versus-host disease of greater than grade 2 did not develop in any patient. The day-100 mortality was 0%. Complete remission (CR) occurred in 17 patients. Three patients progressed, and one was reinduced into continuous CR with donor lymphocyte infusion. With a median follow-up period of 26 months, the actuarial probability of current-event-free-survival at 3 years was 82% (95% CI, 65% to 99%). Conclusion:Our data suggest that nonablative allogeneic transplantation is a safe and potentially effective strategy for patients with relapsed and chemosensitive mantle-cell lymphoma.

Understanding the process of activity scheduling is a critical prerequisite to an understanding of changes in travel behavior. To examine this process, a web-based activity survey program, REACT!, was developed to collect household activity scheduling data. REACT! is unique in that it records the evolution of activity schedules from intentions to final outcomes for a multi-day period. This paper summarizes an investigation of the structure of activity/travel patterns based on a REACT! data set from a pilot study conducted in Irvine, California. The term structure refers to the outcome of a set of decisions facing individuals as they conduct their daily activities. At a minimum, structure can be interpreted as the sequence by which various activities enter one's daily activity scheduling process. Results of the empirical analyses show that activities of shorter duration were more likely to be opportunistically inserted in a schedule already anchored by longer duration counterparts. Additionally, analysis of tour structure reveals that many trip-chains were formed opportunistically. Travel time required to reach an activity was also positively related to the scheduling horizon for the activity, with more distant stops being planned earlier than closer locations.

Summary. The PML/RARα fusion gene in acute promyelocytic leukaemia (APL) has three subtypes based on the breakpoint site of the PML gene: long (bcr1), short (bcr3) and variable (bcr2) subtypes. The PML/RARα fusion protein is involved in the pathogenesis of APL and the breakpoint site of the PML gene might be associated with aetiological factor(s). Because APL is over-represented in patients that originate in Latin America (Latinos), we evaluated whether the distribution of the PML/RARα fusion mRNA in this population is different to that reported in non-Latinos. Among 52 APL patients (28 from Mexico and Central America diagnosed in Los Angeles and 24 from Peru, South America), bcr1, bcr2 and bcr3 expression was 75%, 10% and 15% respectively. However, bcr1 breakpoints were significantly higher compared with non-Latino patients (340/654, 52%) reported in four studies. Often bcr1 and bcr2 are reported together; 862 (60%) of 1429 non-Latino APL patients reported in nine studies were either bcr1 or bcr2, compared with 44 (85%) in our 52 Latino patients. This difference was also statistically significant when our patients were compared to each of the individual studies from USA and Europe, but not for a small series from China and Japan. These results suggest that the overrepresentation of APL among Latin American patients can be accounted for by an increase of a single subtype – bcr1, and the breakage sites in the PML gene may not be random but possibly influenced by genetic and/or environmental factor(s).

Summary. The small number of progenitor cells is the major limitation to the use of umbilical cord blood (UCB) for the transplantation of adults. We tested the hypothesis that two units transplanted simultaneously could each contribute to haematopoietic reconstitution. A patient with advanced acute lymphocytic leukaemia received a mismatched, unrelated UCB transplant using units from two donors after conditioning. The recipient achieved a complete remission without graft-versus-host disease. Double chimaerism was documented in several leucocyte subpopulations; both units contributed to haematopoiesis until relapse. Triple chimaerism was present from relapse until death due to leukaemia. This approach may potentially improve UCB transplantation outcome for adults lacking a histocompatible donor.

The process of activity scheduling is crucial to the understanding of travel behavior changes. In-depth research is urgently needed to unearth this process. A new computer program, REACT!, was developed to collect household activity scheduling data for this purpose. The program is implemented as a stand-alone program with Internet connectivity for remote data transmission. It also contains a geographic information system for location identification and a special feature that traces the decisions in the scheduling process. A pilot study was conducted in Irvine, California, to evaluate the program’s performance. Preliminary analysis validated the program’s capability of guiding participants to complete data entry tasks on their own; thus, the objective of reducing the cost of human resources for such a computerized survey is achieved. Other positive results were obtained regarding the objectives of reducing instrumental biases and expanding program capabilities. Areas for improvement were identified in the pilot study. On the basis of the findings, REACT! represents an ideal platform for a computerized household survey that can produce data for activity-based travel models.

Background. The breakpoint site of the breakpoint cluster region (bcr) has been correlated with patient characteristics, with the disease phase, and with the prognosis of patients with chronic myelogenous leukemia (CML), but the findings remain controversial. Methods. Appropriate restriction enzymes and the 3′ and universal probes were used to map the breakpoint site by Southern blot analysis into 5′ and 3′ breakpoints and a breakpoint in zone 3 (or fragment 2) in 362 patients in different phases of CML (238 in early chronic phase, 69 in late chronic phase, 31 in accelerated phase, and 24 in blastic phase). Standard statistical methods were used to evaluate differences in characteristics and in prognosis by the breakpoint site. Results. No correlation was noted between CML phases and breakpoint site. Among patients in the early chronic phase, thrombocytosis was significantly associated with the 3′ breakpoint site (P = 0.02), whereas peripheral basophilia occurred more frequently with the 5′ breakpoint site (P = 0.05). Other patient and disease characteristics were similar in frequency among the breakpoint-site subgroups. There was no difference in response to alpha-interferon therapy (186 patients treated) by the breakpoint site. Survival, dated from either referral to the authors' institution or from diagnosis, was not significantly different among patients with early chronic phase CML by the breakpoint site. However, patients with a 3′ deletion tended to have a shorter survival. Conclusion. Determination of the breakpoint site by Southern blot analysis does not help to predict prognosis of patients with CML. Cancer 1995;76:992–7.

Background. Abnormalities in chromosome 11q13 regions have been frequently found in head and neck squamous carcinoma. Recent studies indicate that the PRAD-1 (also CCND1), which encodes cyclin D1, is a putative oncogene that is an important component of this region. Methods. DNA was extracted from 32 snap-frozen specimens from primary head and neck squamous carcinomas. DNA from peripheral blood lymphocytes, normal mucosa, and salivary gland tissue were used as controls. A genomic DNA probe containing the first exon of PRAD-1 was used for hybridization with specimen DNAs by the Southern technique. A 5.6-kb genomic DNA probe of immunoglobulin heavy chain was used as an internal standard for assessing PRAD-1 amplification. Results. Eleven (34.4%) squamous carcinoma specimens showed PRAD-1 amplification (2- to 10-fold). Although no significant statistical correlation among amplification status, grade stage, and DNA ploidy was observed in this small cohort, amplification was more noted in high grade, high stage, and aneuploid tumors. A highly statistical correlation between PRAD-1 amplification and proliferative activity was noted (P > 0.001). Conclusion. The results of this study indicate that PRAD-1 amplification appears to be a late event in the tumorigenesis of head and neck carcinoma and is associated often with a subset of aggressive tumors and high proliferation neoplasms.

Nonmyeloablative stem cell transplantation in patients with follicular lymphoma has been designed to exploit the graft-versus-lymphoma immunity. The long-term effectiveness and toxicity of this strategy, however, is unknown. In this prospective study, we analyzed our 8-year experience. Patients received a conditioning regimen of fludarabine (30 mg/m2 daily for 3 days), cyclophosphamide (750 mg/m2 daily for 3 days), and rituximab (375 mg/m2 for 1 day plus 1000 mg/m2 for 3 days). They were then given an infusion of human leukocyte antigen-matched hematopoietic cells from related (n = 45) or unrelated donors (n = 2). Tacrolimus and methotrexate were used for graft-versus-host disease (GVHD) prophylaxis. Forty-seven patients were included. All patients experienced complete remission, with only 2 relapses. With a median follow-up time of 60 months (range, 19-94), the estimated survival and progression-free survival rates were 85% and 83%, respectively. All 18 patients who were tested and had evidence of JH/bcl-2 fusion transcripts in the bone marrow at study entry experienced continuous molecular remission. The incidence of grade 2-IV acute GVHD was 11%. Only 5 patients were still undergoing immunosuppressive therapy at the time of last follow-up. We believe that the described results are a step forward toward developing a curative strategy for recurrent follicular lymphoma.

Summary ZAP-70 (zeta-chain-associated protein 70 kDa) expression is associated with poor prognosis in patients with chronic lymphocytic leukaemia (CLL). This study evaluated the efficacy of non-myeloablative allogeneic stem cell transplantation in patients with advanced CLL and assessed the impact of ZAP-70 expression on the outcome. Thirty-nine sequential patients were included. All had previously been treated with fludarabine. All patients received a preparative regimen of fludarabine (30 mg/m2/d for 3 d), intravenous cyclophosphamide (750 mg/m2/d for 3 d), and high-dose rituximab. Immunohistochemical techniques on marrow biopsy samples were used to determine that ZAP-70 was expressed in 25 patients, whereas 13 other patients were ZAP-70 negative, and one was of indeterminate status. With a median follow-up time of 27 months, the estimated overall survival and current progression-free survival (CPFS) rates at 4 years were 48% and 44% respectively. Patients who were ZAP-70 positive had 56% survival, and their CPFS rate increased from 30% to 53% after a donor lymphocyte infusion. Multivariate analysis indicated that chemorefractory disease and mixed T cell chimerism at day 90, but not ZAP-70 positivity, were associated with the risk of disease progression after transplantation. These results demonstrate a potent graft-versus-leukaemia effect that can overcome the adverse prognostic effect of ZAP-70 expression.

Purpose: This study was undertaken to compare the molecular response (MR) rates of 2 regimens, central lymphatic irradiation (CLI) and alternating triple therapy (ATT), in the treatment of Stage I-III follicular lymphoma. MR was defined as disappearance of t(14;18) (q32;q21) amplified by polymerase chain reaction (PCR). Patients and Methods: Sixty-five patients with Stage I to III follicular lymphoma were randomized. CLI consisted of the mantle, abdomen, and pelvic radiation fields. ATT alternated among CHOD-Bleo, ESHAP, and NOPP for 12 courses. Bone marrow (BM) and peripheral blood (PB) samples were obtained before treatment for PCR analysis. PCR-positive patients were followed by PCR analysis. The random-effects logistic model was fitted to the data from the posttreatment PCRs. The factors included in the model were treatment arm, type of PCR (BM vs. PB), and time to PCR sample procurement from the date of registration. Results: At a median follow-up of 71 months, the 5-year relapse-free survival (RFS) rates were 45% and 54% for CLI and ATT, respectively ( p = 0.42). The probability of attaining an MR increased with time after registration ( p = 0.007), was lower for BM compared with PB ( p = 0.012), and was higher for ATT than for CLI ( p = 0.020). Conclusion: ATT regimen achieved a higher MR than CLI, although both arms had similar 5-year RFS.

The PML/RARalpha fusion gene in acute promyelocytic leukaemia (APL) has three subtypes based on the breakpoint site of the PML gene: long (bcr1), short (bcr3) and variable (bcr2) subtypes. The PML/RARalpha fusion protein is involved in the pathogenesis of APL and the breakpoint site of the PML gene might be associated with aetiological factor(s). Because APL is over-represented in patients that originate in Latin America (Latinos), we evaluated whether the distribution of the PML/RARalpha fusion mRNA in this population is different to that reported in non-Latinos. Among 52 APL patients (28 from Mexico and Central America diagnosed in Los Angeles and 24 from Peru, South America), bcr1, bcr2 and bcr3 expression was 75%, 10% and 15% respectively. However, bcr1 breakpoints were significantly higher compared with non-Latino patients (340/654, 52%) reported in four studies. Often bcr1 and bcr2 are reported together; 862 (60%) of 1429 non-Latino APL patients reported in nine studies were either bcr1 or bcr2, compared with 44 (85%) in our 52 Latino patients. This difference was also statistically significant when our patients were compared to each of the individual studies from USA and Europe, but not for a small series from China and Japan. These results suggest that the overrepresentation of APL among Latin American patients can be accounted for by an increase of a single subtype--bcr1, and the breakage sites in the PML gene may not be random but possibly influenced by genetic and/or environmental factor(s).

The majority of patients with systemic mastocytosis with associated clonal, hematological non-mast cell lineage disease (SM-AHNMD) have a myeloid stem cell malignancy including myelodysplastic syndromes (MDS), myelodysplastic/myeloproliferative disorders, acute myeloid leukemia (AML), or chronic myeloproliferative disease. The clinicopathologic features of SM-AHNMD have not been fully characterized. We describe seven cases of this entity: 3 with MDS, 3 with AML, and 1 with chronic myelomonocytic leukemia. In the majority of cases, SM was diagnosed concurrently with the myeloid malignancy and aberrant mast cell morphology was observed. The commonly described c-kit enzymatic site mutation Asp816Val was detected only in 2 cases, while 3 patients carried the Asp816His mutation. Among the 3 cases with AML, 2 patients carried the translocation t(8;21). On the basis of our results and other reported cases, there appears to be a specific association between SM and AML with t(8;21). Concurrent occurrence of SM may define a subset of patients with de novo AML and other myeloid malignancies who have an adverse prognosis. As clinically effective tyrosine kinase inhibitors that inhibit enzymatic-type c-kit mutations are being developed, detection of mast cell proliferation associated with myeloid malignancy may have important therapeutic implications.

The small number of progenitor cells is the major limitation to the use of umbilical cord blood (UCB) for the transplantation of adults. We tested the hypothesis that two units transplanted simultaneously could each contribute to haematopoietic reconstitution. A patient with advanced acute lymphocytic leukaemia received a mismatched, unrelated UCB transplant using units from two donors after conditioning. The recipient achieved a complete remission without graft-versus-host disease. Double chimaerism was documented in several leucocyte subpopulations; both units contributed to haematopoiesis until relapse. Triple chimaerism was present from relapse until death due to leukaemia. This approach may potentially improve UCB transplantation outcome for adults lacking a histocompatible donor.

NMT carries the promise of long-term disease control in FL by graft-versus-lymphoma immunity. We investigated the long-term efficacy of this strategy. Between March 1999 and April 2005, 47 consecutive patients were enrolled, ranging in age from 33 to 68 years (median, 53 years). The time from diagnosis to transplantation ranged from 7 months to 24 years (median, 3 years). All patients had recurrent chemosensitive FL. Each patient had received 2 to 7 (median, 2) chemotherapy regimens. Eight patients (17%) had failed a prior autologous transplantation. At the time of transplantation, 29 patients (61%) were in PR, and 18 (31%) were in CR. The conditioning regimen consisted of fludarabine (30 mg/m2 daily for 3 days), cyclophosphamide (750 mg/m2 daily for 3 days) and rituximab (Khouri, Blood 2001). This was followed by an infusion of HLA-matched hematopoietic cells from related (n=45) or unelated donors (n=2). Tacrolimus and methotrexate were used for graft-versus-disease (GVHD) prophylaxis. All patients achieved CR after transplantation. The median time to achieve CR in patients who had evidence of active disease at study entry was 5.5 months. Two relapses occurred. One was observed at 18 months; this patient responded to DLI with a continuous CR at 24+ months. The other patient who developed a relapse, was found to be simultaneously in graft failure 20 months after his transplantation. That patient was treated with rituximab and is still in CR at his last follow-up 4 years later. Eighteen patients had PCR evidence of bcl-2 translocation in the bone marrow at study entry. There were a total of 100 bone marrow post-treatment PCR samples available for analysis. Ninety eight samples that are drawn at a median time of 45 months after transplantation (range 4 months to 72 months) showed a negative PCR result. Two samples from 2 different patients were PCR-positive early after transplant; they became PCR-negative 3 months later. With a median follow-up time of 56 months (range, 19–94 months), the estimated overall survival (OS) and current progression-free survival (CPFS) rates at 6 years were 85% (95% confidence interval [CI], 71%–93%) and 83% (95% CI 69%–91%), respectively. The incidence of acute grade II–IV GVHD was 11% (95% CI, 31%–66%). The incidence of chronic extensive and limited GVHD, was 51% (95% CI, 44%–78%). Of the 28 patients who developed chronic GVHD, 20 (71%) had a de novo onset. The median time of onset of chronic GVHD was 262 days after transplantation, and the OS of patients with chronic GVHD was 89%, with a median follow-up time of 57 months (range, 19–94 months). Only five patients of the whole study group are still receiving immunosuppressive therapy at the time of their last follow-up. In conclusion, the longer follow-up of our study does provide further insight into long-term disease activity and regimen toxicity of NMT for FL, laying the groundwork for prospective comparative trials. We believe that the described results are a step forward toward finding a cure for this disease.

Recent studies demonstrated that ZAP-70 is an important prognostic factor in CLL. Patients (pts) who were ZAP-70 positive were reported to have an early time to treatment failure and a shorter survival. We determined the effect of ZAP-70 status on the outcome of NST in pts with advanced relapsed CLL. Between 1999 and 2005, 39 pts were enrolled, ranging in age from 34 to 70 years (median, 57 years). All pts had recurrent advanced CLL and had been previously treated with fludarabine-rituximab-based regimens. Each pt had received 2 to 8 (median, 3) chemotherapy regimens. Thirty-four pts (87%) had active disease at the time of study entry. Using immunohistochemical techniques on marrow biopsy samples, we determined that 25 pts were ZAP-70 positive, 13 were ZAP-70 negative, and 1 was of indeterminate status. All pts received a preparative regimen of fludarabine (30 mg/m2 daily for 3 days), intravenous cyclophosphamide (750 mg/m2 daily for 3 days), and high-dose rituximab, as previously reported. Thirty-five pts underwent allogeneic transplantation from a sibling donor and 4 from a matched unrelated donor. The median number of CD34+ cells infused ranged from 1.96 to 6.6 x 106 /kg (median, 4.7 x 106 /kg). Neutrophil counts recovered to > 0.5 x 109/L at a median of 10 days after NST. Donor cells failed to engraft in 1 patient. The median percentage of donor T cells at day 30 was 68% (range, 0%-100%), and increased to 93% and 100% at days 90 and 180, respectively (P < 0.001). Fourteen pts experienced disease progression after transplantation and required immunomanipulation. The last progressions within the whole group and among those patients who were ZAP-70 positive occurred at 23 and 18 months, respectively after transplantation. By multivariate analysis, chemorefractory disease (P = 0.01) and having mixed T cell chimerism at day 90 (P = 0.02), but not ZAP-70 positivity, were identified as the most significant factors for progression after transplantation. Of the 14 pts who required immunomanipulation after transplantation, 6 experienced a complete response (CR) and 1 had a partial response. Responses occurred after therapy with rituximab and donor lymphocyte infusion (DLI) (median, 1 dose of 1 x 107 CD3+/kg). Overall, of the 38 evaluable patients, 27 (71%) experienced a CR. The incidence of acute grade II-IV GVHD was 45%, whereas the incidence of chronic extensive GVHD, pre- and post-DLI, was 58%. With a median follow-up time of 27 months (range, 4–80 months), the estimated overall survival (OS) and current progression-free survival (CFPS) rates at 4 years was 48% and 44%, respectively. Pts who were ZAP-70 positive had a median follow-up period of 41 months (range, 5–80 months). Their estimated OS and CPFS rates at 4 years were estimated to be 56% and 53%, respectively. These results indicate that NST can overcome the negative prognostic feature of ZAP-70 expression in advanced CLL.

Follicular lymphoma is characterized by the presence of the t(14;18)(q32;q21) chromosomal translocation which juxtaposes the bcl-2 gene at 18q21 with the immunoglobulin heavy chain locus at 14q32. Quantification of t(14;18) carrying cells in FL patients can be achieved by real-time PCR, a highly sensitive technique for evaluating treatment efficacy and minimal residual disease. Despite the many advantages of real-time technology for this purpose, one disadvantage is that current real-time t(14;18) PCR assays amplify a control gene as a normalizer in a separate reaction. Since each PCR reaction has its own kinetics, separate PCR assays for target and control sequences can potentially result in inaccurate quantification of t(14;18)-positive cells. In addition, the real-time t(14;18) PCR assays do not determine the size of the amplified fusion sequence, which is helpful for excluding contamination and is commonly used to demonstrate clonal identity between pre- and post-treatment specimens from a patient. To address these limitations, we designed a multiplex real-time PCR protocol that allows amplification of control and target genes in the same reaction and precise size determination of bcl-2/JH fusion sequences by capillary electrophoresis. This multiplex PCR assay is equally sensitive to previous assays, allows more accurate quantification of bcl-2/JH fusion sequences, and is more convenient.