"Low bone mineral density (BMD) is associated with increased fracture risk, and increased BMD during therapy is associated with a corresponding decrease in fracture risk. However, BMD is only one factor that contributes to bone strength and fracture risk in spine and hip."

"Given that most bone mass is achieved by age 18 years, and setting aside cost for the moment, it may be prudent to screen the entire population of high-risk individuals (white girls) during childhood or adolescence, prior to development of osteoporosis or osteopenia," Dr. Buchman writes. "Even patients diagnosed as having celiac disease before menopause have more significant improvements in BMD that those diagnosed after menopause. However, one must evaluate the cost not just to identify an asymptomatic individual with celiac disease, but also to prevent a fracture."

"The cost to prevent a single fracture in a patient with celiac disease and osteoporosis would be $43,000 (similar to the cost of screening mammography to detect a breast cancer)," Dr. Buchman states. "This cost would be far greater for a patient with osteopenia, to say nothing of a population screen." Dr Buchman also points out that, "Not all investigations have reported an increased prevalence of celiac disease in individuals with osteoporosis or an increased fracture risk in patients with celiac disease."

"However, the questions remain: Who should be screened for celiac disease? And at what cost? The data from Stenson et al raise an important issue, but given the variations in study findings and cost estimates, it is impossible to make a clear recommendation for celiac disease screening in a population even as defined as those with osteoporosis," Dr. Buchman concludes. "As is often the case, further study is indicated."

archinternmed

"In the case of myeloma, we believe the marrow T-cells have certain surface markers that may help them migrate back to the site of the tumor," he says. "Moreover, the marrow itself contains some type of stimulant to attract the cells," says Kimberly Noonan, researcher and first author of the paper.

To treat patients, the scientists will collect a small amount of bone marrow from patients and with relative ease, grow and activate large numbers of T-cells from that source. These would then be given intravenously back to patients. However, according to Borrello, they may find that an additional cancer vaccine may increase the overall anti-tumor effect of the marrow T-cells.

They also believe that patients with other blood, bone marrow and solid tumors such as breast cancer may benefit from this type of immunotherapy. Evidence from other research groups indicates that breast cancer patients have T-cells in their bone marrow that are specific to their tumor.

Myeloma strikes close to 16,000 Americans annually and kills 11,300.

Other participants of this research include William Matsui, Paolo Serafini, Rebecca Carbley, Gladys Tan, Hyam Levitsky, and Katherine Whartenby from Johns Hopkins; and Jahan Khalili and Mark Bonyhadi from Xcyte Therapies.

www.hopkinskimmelcancercenter