Epidemiology of acute leukaemia in the Cape Province of South Africa.

Of 535 consecutive cases of acute leukaemia diagnosed in the Cape Province between 1978 and 1985, demographic data are incomplete in 75 black patients and they have had to be excluded from the spatial analysis. Of the remaining 460 cases, 223 (48.5%) occurred in white patients and 237 (51.5%) in those of mixed ancestry, classified as coloureds according to the Population Registration Act No. 30 of 1950. The average incidence was 2.12, 1.37 and 0.58/100,000 for whites, coloureds and blacks respectively. There was no temporal trend in the incidence of acute leukaemia between the three race groups. The median age for whites was 30 years and for the coloureds was 15 years, which is comparable to the 16 years for the black patients. The two-peak age distribution for leukaemia was seen in the white group, but was absent in the other two groups. This is accounted for by a different distribution in non-lymphoblastic as opposed to lymphoblastic subtypes. Furthermore, there was a disproportionately high frequency of acute progranulocytic leukaemia in the black patients, whereas the white and coloured groups were similar. There was a single, clearly defined macro-scale cluster restricted to white patients in Statistical Region 17 (SR-17). This exploratory study provides the first epidemiologic data for acute leukaemia in the Cape Province. It needs to be extended in order to verify these observations under more controlled circumstances and to seek evidence for some environmental factors that may account for the geographical cluster.

Prognostic factors in multiple myeloma.

All patients with multiple myeloma seen over a 9-year period at Tygerberg Hospital were studied retrospectively. Presentation data of 144 patients, as well as individual laboratory results were included in the survival analysis. Cox's proportional hazard model (a non-parametric multivariate regression method) was used to predict survival and divide patients into prognostic groups. The relationship between pairs of variables at the time of diagnosis was investigated. The survival of groups of patients was compared using the generalized Wilcoxon and Savage tests. The association of the following factors with prognosis were again substantiated: haemoglobin; serum creatinine, urea and albumin; percentage of plasma cells in the bone marrow aspirate and trephine biopsy specimen; and the number of lytic lesions on skeletal radiography. The following factors were not substantiated: serum uric acid, light-chain proteinuria, age at presentation of the disease and IgG rather than the IgA class. In addition, a higher serum monoclonal peak size at presentation of the disease, and a more rapid fall in the abnormal serum monoclonal peak within the first 40 days after commencing treatment were associated with a significantly longer survival.

Lipoid proteinosis. A case report.

A 31-year-old Coloured man was admitted to Tygerberg Hospital in 1981 with hoarseness, hyperkeratotic skin lesions and nodules on the eyelids. There was a history of an episode of loss of consciousness. Skull radiographs demonstrated bilateral symmetrical calcifications in the temporal region. Skin biopsy was consistent with a diagnosis of lipoid proteinosis.

[Multiple myeloma in South Africa--is the incidence increasing?]. / Miëlomatose in Suid-Afrika - neem die insidensie toe?

Multiple myeloma was once thought to be extremely rare, with an estimated frequency of less than 0,1% of all malignant tumours. In 1964 Oettlé reported that available mortality statistics showed 171 deaths in the 10-year period 1949-1958 in the RSA for Whites, Coloureds and Asiatics aged 20 years and older. During the 5-year period 1968-1972, however, 222 cases of multiple myeloma appeared in the mortality records of the Central Statistical Service. Since 1964 150 new cases have been diagnosed at Karl Bremer Hospital and later at Tygerberg Hospital, with an average of 15 new cases cases per year from 1978 to 1982. Four examples of familial myelomatosis and one of familial macroglobulinaemia were found at these two hospitals. On 1 January 1983, 48 patients were on record who had attended the Tygerberg Hospital Haematology Clinic and 78 who had attended Groote Schuur Hospital, giving a total of 126 patients under treatment in the Western Cape during 1982. In addition, for the 6-year period from January 1971 to December 1976, 162 patients were reported from the haematology clinics at the Johannesburg General Hospital and Baragwanath Hospital. The true incidence of multiple myeloma in the RSA is problematical because there is no National Cancer Register; establishment of such a register would need the co-operation of all doctors in the country.

Hodgkin's disease and acute promyelocytic leukaemia. A case report.

A case of Hodgkin's disease is reported in which acute promyelocytic leukaemia developed within 5 months of initiation of chemotherapy. Only 3 other cases, possibly of a similar nature, were found in the literature; these had occurred 15, 77, and 226 months respectively after the initial diagnosis of Hodgkin's disease.