ABO blood group phenotypes influence parity specific immunity to Plasmodium falciparum malaria in Malawian women

Background: Blood group O has been significantly associated with increased placental malaria infection in primiparae and reduced risk of infection in multiparae in the Gambia, an area with markedly seasonal malaria transmission. This study analyses the association between ABO blood group phenotypes in relation to placental malaria pathology and birth outcomes in southern Malawi, an area with perennial malaria transmission. Methods: A cross- sectional study of 647 mother/ child pairs delivering in Montfort Hospital, Chikwawa District between February- June 2004 and January- July 2005 was undertaken. Maternal peripheral and cord blood samples were obtained at delivery. Placental tissue was obtained and malaria histology classified as active, past or no malaria infection. Birth anthropometry was recorded. ABO blood group was measured by agglutination. Results: In primiparae, blood group O was significantly associated with increased risk of active placental infection ( OR 2.18, 95% CI 1.15 - 4.6, p = 0.02) and an increased foetal- placental weight ratio compared to non- O phenotypes ( 5.68 versus 5.45, p = 0.03) In multiparae blood group O was significantly associated with less frequent active placental infection ( OR 0.59, 95% CI 0.36 - 0.98, p = 0.04), and a higher newborn ponderal index compared to non- O phenotypes ( 2.65 versus 2.55, p = 0.007). In multivariate regression parity was independently associated with increased risk of placental malaria ( active andpast infection) in primiparae with blood group O ( p = 0.034) and reduced risk in multiparae with the same phenotype ( p = 0.015). Conclusion: Parity related susceptibility to placental malaria is associated with the mothers ABO phenotype. This interaction influences foetal and placental growth and could be an important modifying factor for pregnancy outcomes. The biological explanation could relate to sialic acid dependent placental membrane differences which vary with ABO blood group

Limited clinical relevance of imaging techniques in the follow-up of patients with advanced chronic lymphocytic leukemia: results of a meta-analysis

The clinical value of imaging is well established for the follow-up of many lymphoid malignancies but not for chronic lymphocytic leukemia (CLL). A meta-analysis was performed with the dataset of 3 German CLL Study Group phase 3 trials (CLL4, CLL5, and CLL8) that included 1372 patients receiving first-line therapy for CLL. Response as well as progression during follow-up was reassessed according to the National Cancer Institute Working Group1996 criteria. A total of 481 events were counted as progressive disease during treatment or follow-up. Of these, 372 progressions (77%) were detected by clinical symptoms or blood counts. Computed tomography (CT) scans or ultrasound were relevant in 44 and 29 cases (9% and 6%), respectively. The decision for relapse treatment was determined by CT scan or ultrasound results in only 2 of 176 patients (1%). CT scan results had an impact on the prognosis of patients in complete remission only after the administration of conventional chemotherapy but not after chemoimmunotherapy. In conclusion, physical examination and blood count remain the methods of choice for staging and clinical follow-up of patients with CLL as recommended by the International Workshop on Chronic Lymphocytic Leukemia 2008 guidelines. These trials are registered at http://www.isrctn.org as ISRCTN 75653261 and ISRCTN 36294212 and at http://www.clinicaltrials.gov as NCT00281918