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controls seven episodes of rejection were noted while only oneepisode of rejection was noted (and treated) in those on BT563. (Asecond patient had a rejection 2 weeks after BT563 treatment wasstopped.) 10 of the 18 scheduled biopsies in the BT563 group werehistopathologically graded RO; 3 were RO-1, 4 were Rl, and 1 wasRl-2. During the first 10 days of BT563 administration, meanserum antibody levels (murine IgG) were 2-45 (SD 16) mg/ml.During the second 10 days antibody levels fell to 0-30 (0-46) µg/mldue to rising titres of human anti-mouse antibody. Infections werenoted in four controls and in three patients on BT563. In the BT563group pleural and/or abdominal effusions seemed to be morefrequent (5 vs 1) and longer lasting than they were in the controls.We conclude that BT563 reduces the risk of early rejection after

liver transplantation. Histological pointers to rejection (in 8 biopsyspecimens) did not correlate with symptoms. Whether the effusionsnoted are related to BT563 remains unclear. We are now trying toreduce conventional immunosuppression and to define the bestregimen for this monoclonal antibody.

University Surgical Clinic,6900 Heidelberg, West Germany

Institute of Pathology,University of Heidelberg

Biotest-Pharma GmbH, Dreieich

Department of Applied Immunology,German Cancer Centre, Heidelberg

GERD OTTO

JOCHEN THIESMARTIN MANNERCHRISTIAN HERFARTH

WALTER J. HOFMANN

HELMUT SCHLAG

STEFAN MEUER

1. Kupiec-Weglinski JW, Diamantstein T, Tilney NL. Interleukin 2 receptor-targetedtherapy: rationale and applications in organ transplantation. Transplantation 1987;46: 785-92.

2 Soulillou JP, Le MauffB, Olive D, et al. Prevention of rejection of kidney transplantsby monoclonal antibody directed against interleukin 2. Lancet 1987; ii: 1339-42.

3. Cantarovich D, Le Mauff B, Hourmant M, et al. Anti-IL2 receptor monoclonalantibody (33B3.1) in prophylaxis of early kidney rejection in humans: a randomizedtrial versus rabbit antithymocyte globulin. Transpl Proc 1989; 21: 1769-71.

4. Cantarovich D, Le Mauff B, Hourmant M, et al. Anti-interleukin 2 receptormonoclonal antibody in the treatment of ongoing acute rejection episodes of humankidney graft: a pilot study. Transplantation 1989; 47: 454-57.

5. Herve P, Wijdenes J, Bergerat JP, Milpied N, Gaud C, Bordigoni P Treatment ofacute graft-versus-host disease with monoclonal antibody to IL-2 receptor. Lancet1988; ii: 1072-73.

Elderly patients with head-and-neck cancer

SIR,-Mr Fentiman and colleagues report (April 28, p 1020) oncancer in elderly patients, which prompted us to record ourexperience with elderly patients with head-and-neck cancer.Our policy has been to make no distinction on the basis of age,

with respect to treatment for head-and-neck cancer. The effects ofuncontrolled disease in the head and neck area are so devastating tothe patient that we feel that all reasonable attempts to control thelocal and regional disease should be made. In a recent questionnairesurvey of 75 patients about the quality of life in such patientsattending our clinic, only those with fungating malignancies thathad recurred despite surgery and radiotherapy were concernedabout their appearance. Patients who had had major resections ofthe oral cavity, pharynx, larynx, or neck were remarkablyunconcerned about the cosmetic effects of their treatment

Although Fentiman and colleagues’ data indicated that about50% of patients with cancer could be expected to be over age 70,only 32 % of our patients were aged over 70-a figure that is close tooverall data for head-and-neck cancer in England and Wales(37%).1

Other data from our survey support the view that the elderlydeserve vigorous therapeutic endeavours. Such patients aged over70 were every bit as active in the community and socially (with 54%and 85%, respectively, belonging to clubs or having physicallyactive or outdoor hobbies), as were those under 70 (52% and 56%respectively). This pattern was maintained after treatment.We also measured psychological well-being, with an abbreviated

form of assessment devised by Warr et al2 ("the degree to which aperson reports satisfaction with life and life space"). The older

PSYCHOLOGICAL WELL-BEING ("LIFE SATISFACTION") SCORESIN PATIENTS WITH HEAD AND NECK CANCER

patients presenting with head-and-neck cancer had as good scoresas did their younger counterparts, and the scores after treatmentwere generally as good as that for the general population (table).

This year the theme for the New Zealand "Telethon" is focusedon caring for the elderly, a timely reminder that elderly people seekto participate in daily life just as actively as younger people.Head and Neck Oncology Clinic,Auckland and Green Lane Hospitals,Auckland 3, New Zealand

RANDALL P. MORTONC. S. BENJAMIN

1. Office of Population Censuses and Surveys. Cancer Statistics Registrations, Englandand Wales. 1978. London: HM Stationery Office, 1982.

2. Warr P, Cook J, Wall T. Scales for the measurement of some work attitudes andaspects of psychological well-being. J Occupat Psych 1979; 52: 129-48.

Cancer mortality patterns among laboratoryworkers

SIR,—Dr Cordier (May 5, p 1097) reports on excess risk of canceramong laboratory workers. We report similar findings from aretrospective cohort study of cancer risk in the Istituto Superiore diSanita (ISS). The ISS was founded in the 1930s as a public healthinstitute mainly for the study of malaria; subsequently its field ofinterest was widened to include food safety, drug control,microbiology (including production of pilot antibiotics),environmental health, and biomedical research. Today, about 1500people work at ISS.The cohort included all subjects employed from Jan 1, 1960, to

June 30, 1989.Records for technical and administrative staff were kept

separately; altogether 1797 technical and 345 administrative

employees (1269 men and 873 women, 34 354 person-years) wereconsidered. Dates of leaving, mainly because of retirement, wereavailable for subjects who left ISS by June 30, 1989.

Vital status was ascertained for 99 1% of the population, andcauses of death were established for 98 3% of those who died. The

cause, sex, age, and calendar-time specific mortality rates werecompared with those of the Italian general population.The table shows the observed and expected mortality among

technical staff. A relatively low mortality from all causes, all cancers,

MORTALITY IN TECHNICAL AND ADMINISTRATIVE STAFF AT ISSBETWEEN JAN, 1960, AND JUNE, 1989

0 = observed. E=expected, SMR=standard mortality ratio; Cl=confidenceinterval- al