Age is a nonreversible risk factor for atherosclerosis. The atherosclerotic process begins early in life, progresses during the middle years, and usually culminates in clinical disease towards the later years of the life span. Since atherosclerosis is a multifactorial disease, and many of the "risk factors" are time- and age related, it has been difficult to sort out intrinsic aging from environmental factors that operate over many years. Furthermore, the role of genetic factors remains unknown. This workshop has produced much worthwhile information that is helping elucidate the impact of age on atherogenesis. Important strides have been made in understanding the role of changes in the arterial wall and of lipoproteins, platelets, and monocyte-derived macrophages in the disease process. In parallel, our understanding of the biology of aging has increased sufficiently so that these two areas of interest can now profitably intersect. The proceedings of this successful workshop emphasize that there is much to be gained by continued interaction between those scientists interested in the biology of aging at all levels and those interested in the atherosclerotic process. Hopefully, we may eventually progress in our understanding and reach the stage when atherosclerosis will no longer be an inexorable concomitant of human aging. Edwin L. Bierman, M. D. Contents Foreword V Contributors IX Participants in the Workshop XV Introduction and Statement of Research Recommendations Sandra R."

Leading oncologists, hematologists, and nephrologists comprehensively review the role of HGFs in clinical practice, explain the molecular basis of their effects, and consider potential future developments. The authors focus on the use of HGFs in oncology, describing their cutting-edge application to patients with lung cancer, Hodgkin's and nonhodgkin's lymphoma, breast cancer, chronic lymphocytic leukemia, AIDS-related malignancies, myelodysplastic syndromes, and aplastic anemias. Among the HGFs described are granulocyte colony-stimulating factor, erythropoietc factors, thrombopoietic factors, and stem cell factor and its receptor, C-kit. To complete their survey, the contributors also consider the safety and economic implications of HGFs and the future potential for HGF antagonists in oncology.

Teleologically, the hemostatic mechanism is among The of Coronary Thrombosis and the most fundamental yet complex physiologic pro- in essence, represents a heartfelt gift of cesses in humans. Early scientists and physicians were knowledge from a dedicated group of scientists and fascinated by the blood's ability to remain in a liquid clinicians, who collectively have set out on a mission state only to clot in response to vascular injury. The to minimize the societal impact of"hemostasis in the cellular and noncellular components of normal wrong place. " The book is divided into four distinct hemostasis took centuries to discover, and the intrica- sections: Part 1, Scientific Principles, lays down the cies of their delicate interactions are still being unrav- supporting foundation; Part 2, Clinical Application eled today. As is so often the case, an in-depth of Scientific Principles, places the knowledge base in appreciation of physiologic hemostasis, representing a a working perspective, directly applying science to basic life-sustaining sequence of events, paved the patient care; Part 3, New Dimensions, provides a way for understanding abnormal hemostasis or glimpse of tomorrow. Steering the field clear of se- pathologic thrombosis. Aristotle, Malpighi, and proclaimed victory and the dangers of complacency as Osier, representing but a few of the founding fathers we move into the 21st century, Part 4, Evolution of in the field, would undoubtedly be honored to see Thrombocardiology, focuses on laboratory standards, their observations form the template for lifesaving clinical trials, and drugs in development.

In the summer of 1988, my developmental biology professor announced to the class that hematopoietic stem cells (HSCs) had finally been purified. Somehow, I never forgot the professor's words. When I started working in Dr. Irv Weissman's labo- tory at Stanford as a postdoctoral fellow, I realized that the findings mentioned by the professor were from Weissman's laboratory and had been published in a 1988 edition of the journal Science. It has been over 20 years since the publication of that seminal paper, and since then tremendous advances in understanding the biology and maturation of HSCs, namely the process of hematopoiesis, which includes lymphocyte development, have been made. These discoveries were made possible in part by advancements in technology. For example, recent availability of user friendly fluorescence activated cell sorting (FACS) machines and monoclonal an- bodies with a variety of fluorescent labels has allowed more scientists to sort and analyze rare populations in the bone marrow, such as HSCs. All classes of hematopoietic cells are derived from HSCs. Stem cell biology draws enormous attention not only from scientists, but also from ordinary people because of the tremendous potential for development of new therapeutic application to diseases that currently lack any type of effective therapy. Thus, this type of "regenerative medicine" is a relatively new and attractive field in both basic science and clinical medicine.

This monograph is a collection of invited contributions from a group of investiga tors who share a common interest in the interrelationships between the shape, struc ture, and functional characteristics of normal and pathologic erythrocytes. Most of the authors participated in a workshop on red cell shape held in June, 1972 at the Institute of Cell Pathology, Hopital de Bicetre, Paris. We hope that these various contributions on the physiology, pathology, and ultrastructure of red cell shape will be useful and stimulating for other investigators interested in the correlation of shape and structure with the biochemistry and biophysics of the red cell. The text is divided into four sections. Section I deals with red cell shape, including the presentation of a rational descriptive nomenclature and a discussion of post splenectomy changes. Section II deals with biochemical factors that underlie the disco cyte-echinocyte (crenated) and discocyte-stomatocyte (cup-shaped) transformation. This section includes discussions of plasma factors, and of the biochemical dynamics of erythrocyte lipids and consideration of the effects of such factors as cellular ATP, calcium, aging, and various chemical agents as determinants of shape. Section III, which deals with biophysical measurements, includes studies of the deformability of cells of different shapes, descriptions of ways to define precisely the geometric dimensions of the red cell under various circumstances, and a model of membrane structure, which is proposed to account for the dimensions of red cells that undergo shape change."

In the last six years, a remarkable series of stUdies have demonstrated an intimate relationship between red cell metabolism and the function of the cell as an organ of gas transport. First came the demonstration of binding of organic phosphocompounds of the red cell to hemoglobin; this was followed by studies that demonstrated modification of hemoglobin oxygen affinity by such binding. At present we are in an exhilirating phase of accrual of data showing that the levels of these phosphorylated inter mediates can be rapidly altered in the red cell to modulate hemo globin function. At one time it was said that the red cell was an inert bag full of hemoglobin. Now we know not only that the cell has an active metabolism crucial to its viability, but that this metabolism is just as crucial to the whole organism in the proper adjustment of oxygen transport. On October first, second and third, 1969, red cell biochemists, general biochemists, geneticists, cardio-pulmonary physiologists, exercise physiologists, experts in blood storage, and represen tatives from many other disciplines met in the Towsley Center for Continuing Medical Education at the University of Michigan, Ann Arbor, to present recent findings and discuss developments in this new interdisciplinary field. The meeting was dedicated to Dr. Alfred Chanutin, Professor Emeritus of the University of Virginia, to honor his retirement in 1967 and in recognition of his great contributions to the studies outlined in the first paragraph of this preface."

In the last decade, remarkable advances have been made in bone marrow transplantation (BMT), which is now becoming a powerful tool in the treatment of diseases such as leukemia, aplastic anemia, and congenital immunodeficiency. In animal experiments, it has been found that BMT can be used to treat not only systemic autoimmune diseases but also organ-specific autoimmune diseases. In humans, it has recently been shown that rheumatoid arthritis, ulcerative colitis, and Crohn's disease can be successfully treated after BMT. This volume contains new information on how to prevent graft rejection, how T cell functions can be completely restored, and how concomitant BMT can prevent the rejection of organ allografts without the use of immunosuppressive agents. BMT will become an increasingly useful and powerful treatment for various currently intractable diseases, and this book will contribute by providing details of the latest research in the field.

Hemoglobin and the red cell have continued to set a dizzying pace as the objects of research in the two and one-half year interval since the First International Conference on Red Cell Metabolism and Function. Most exciting perhaps, is a beginning molecular attack on sickle cell disease. The story of the inter action of red cell metabolism and oxygen transport has continued to unfold, and we can now infer that patients with hypoxia usually utilize red cell metabolic adjustments to improve oxygenation. This puts the red cell squarely in the center of medical practice, since much of medicine-heart, pulmonary, and blood disease- deals with inadequate oxygenation. On April 27th through the 29th, 1972, crystallographers, chemists, biochemists, physiologists, geneticists, and physi cians from many medical disciplines met in the Towsley Center for Continuing Medical Education at the University of Michigan, Ann Arbor to present new data, to review recent developments, and to try to piece together additional features of the red cell puzzle. The meeting was dedicated to Dr. Francis John Worsley Roughton, Professor Emeritus of Colloid Science, University of Cambridge, England, in recognition of his numerous excellent contributions to the understanding of hemoglobin and red cell function. The program got off to a good start with a paper from M. F. Perutz, Nobel Laureate, on the structure of hemoglobin. Dr."

This, the third volume of the Blood Cell Biochemistry series, follows the pattern estab- lished in the two previous volumes by containing up-to-date specialist reviews of topics of current interest within the field of study defined by the subtitle. Thus, the topics included can be loosely classified under the broad subtitle "Lymphocytes and Granulocytes," but this does not indicate the full scope of content, scientific interest, and emphasis of the present volume. The opening chapter, by Antonio Bonati, surveys the currently available bio- chemical, immunological, and molecular markers of hemopoietic precursor cells. This is followed, appropriately, by a contribution from Arnold S. Freedman on the cell surface markers in leukemia and lymphoma. In a detailed chapter, Annette Schmitt-Graff and Giulio Gabbiani discuss the cytoskeletal organization of normal and leukemic lympho- cytes and lymphoblasts. John C. Cambier and his colleagues then present a discussion of the signaling events in T-Iymphocyte-dependent B-Iymphocyte activation. Lymphocyte IgE receptors and IgE-binding factors are dealt with by Kwang-Myong Kim and his colleagues, and the role ofgranule mediators in lymphocyte-mediated cytolysis is covered by John Ding-E Young and his associates. A short contribution from James D. Katz deals with the intricacies and difficulties of studies on the complement C3b (CRl) receptor and its cytoskeletal interactions in neutrophils. Arthur K. Sullivan then presents an in-depth survey of the membrane biochemistry surrounding the flow of granule organelles in leukocyte differentiation.

The discussion of some diseases is only occasionally enlivened by the emergence of new worthwhile facts. In the case of others, it would seem that, even if only a few years have passed, each new discussion wears the air of a revolution. Hodgkin's disease, at least from the pathological standpoint, is not so extraordinarily fickle and certainly does not touch either of these two extremes of variability. But it is still a fertile field of study and presents its full share of innovations and practical results. This is perhaps due to the special position it occupies between tumours and inflammatory diseases, or possibly to a lucky series of coincidences; the truth is that events have been on the move for some years now in the case of this disease. There can be no doubt that surprising progress has been made in connec tion with Hodgkin's disease, due, one feels, to close cooperation between several branches of medical science, each of which has had occasion to make new and useful contributions. This does not, however, hide the fact that certain important matters are still not clear, in particular the cause of the disease, its essential nature and, indeed, the best method for its treatment.

Managing infections that complicate care of neutropenic patients with leukemia and hematopoietic stem cell recipients has become a distinct specialty. In Managing Infections in Patients with Hematological Malignancies, the authors and editor draw on their extensive expertise while providing a roadmap for hematologists to efficiently manage the complex infections within their patients. The first section of the text reviews viral, bacterial, and fungal pathogens, and provides brief descriptions of the microbes and diseases they cause in patients with hematological malignancies. The second section is devoted to management of infections in patients with the different underlying hematological malignancies, while the third addresses several important topics that are often ignored in most books about infections and hematological malignancies. Managing Infections in Hematological Malignancies is a useful tool for all clinicians and practicing hematologists who treat individual patients and aspire to build stronger infectious diseases programs within their respective cancer centers.

Our understanding of the function of natural killer (NK) cells has dramatically changed in recent years. The discovery of NK receptors specific for MHC class I molecules, and the study of the role of co-stimulatory and adhesion molecules have led to an understanding of how NK cells recognize tumor and virally infected cells that have lost expression of MHC class I molecules or have altered distribution of normal cell surface molecules. Such recognition events lead to intracellular signals which can be either stimulatory or inhibitory. This book provides an insight into how NK cells develop, how they learn to distinguish altered cells from normal cells, and into their biological role in controlling infections and tumors.

Recent years have seen great strides in research on the pathogenesis of thromboses, unmatched by progress in other branches of hemostasiology. The orthodox concepts of the mechanisms of thrombus formation described by Virchow have come down to us as a "classical triad" of factors. Now, due to developments in molecular biology, pharmacology, and patho- physiology, they appear in a basically new light. The fruits of modern research, currently being tested or already imple- mented in clinical practice, have opened up the possibility of controlling the hemostatic process and developing effec- tive antithrombotic drugs. Much progress has been achieved in the past years, but much more remains to be achieved in such areas as the patho- genesis of venous and arterial thromboses, early diagnosis, therapy, and control of disorders. Many scientists in the U.S.S.R. are involved in studying these problems. Their data, from years of research carried out in leading laboratories and clinics in the U.S.S.R., are summarized in this monograph. This work is written by experts in various fields of biology and medicine. It deals with new and original con- cepts on the structure and function of the fibrinolytic sys- tem, the role of nonenzymatic fibrinolysis in regulating physiological hemostasis, the heterogeneous and discrete pat- terns of the system regulating blood coagulation, the molecu- lar mechanisms of fibrin polymerization, and the anticoagu- lating effects of fibrinogen/fibrin degradation products.

Kurz nach Erscheinen unseres Handbuchs iiber die Non-Hodgkin-Lymphome wurden Stimmen laut, die nach einem klein en handlichen AbriB der Lymphom- diagnostik riefen. Auch die Mitglieder des Europiiischen Lymphom-Clubs (1. DIEBOLD, Paris, R. GERARD-MARCHANT, Villejuif, Y. KAPANCI, Genf, G. KE- LENYI, Pecs, H. NOEL, Briissel, F. RILKE, Mailand, A.G. STANSFELD, London, und J.A.M. VAN UNNIK, Utrecht) bestiirkten mich darin, einen solchen Ratgeber fUr den diagnostischen Alltag zu schreiben. Ja sie identifizierten sich mit diesem Plan und stell ten sich fUr die Obersetzung in mehrere Sprachen zur VerfUgung. So habe ich J. DIEBOLD, R. GERARD-MARCHANT, F. RILKE und A.G. STANSFELD fUr die prompte Obertragung ins Franzosische, Italienische und Englische zu danken. F. RILKE iibernahm die Initiative, einen Beitrag zur "Working Formula- tion for Clinical Usage" zu verfassen. Obersetzungen in weitere Fremdsprachen wurden von ehemaligen Mitarbeitern und befreundeten Kollegen bereitwillig durchgefUhrt, so von A. LLOMBART BOSCH ins Spanische, von IRENE LORAND und J.M. MACHADO ins Portugiesische und von N. MOHRI ins Japanische. Das Erscheinen in verschiedenen Sprachen einschlief3lich meiner Muttersprache sollte den Gebrauch des Abrisses im Alltag we iter erleichtern.

I am prepared to predict that this monograph by Dr. Ernest Beutler will long serve as a model for monographs dealing with topics in medical science. I make this bold statement because we encounter in this work a degree of accuracy and authoritativeness well beyond that found in much of the medical literature. Too often, a monograph is simply a review of past reviews. The preparation of an exhaustive and completely accurate study such as the present one is a very laborious task; consequently, many authors make extensive use of the reviews of earlier writers assum ing that the latter have checked and evaluated each previously published report. Unfortunately, however, this assumption of validity has not al ways been correct. Dr. Beutler, who is a world authority on the subject about which he writes, was determined to make this book as correct and complete as possible, and, to this end, has checked all the original sources. Nowhere else will such an exhaustive bibliography be found. Moreover, he has also undertaken to reevaluate in the light of current knowledge material pub lished in earlier days. This he is eminently able to do, and in some in stances his investigations have resulted in new interpretations. The result is a volume that will be recognized as truly the last word on this important subject.

The development of new techniques such as immuno phenotyping, cytogenetic investigations and, more recently, molecular studies has considerably increased our diagnostic repertoire and broadened our ideas about the biology of acute leukemias. While immunophenotyping with mono clonal antibodies has yielded increased diagnostic precision and made it possible to develop a highly reproducible classification of acute leukemias based on cell-biological features, further insights have been gained into the patho genetic mechanisms involved in leukemogenesis by means of cytogenetic detection of acquired structural chromosomal abnormalities. Analysis of the leukemia-associated chromo somal breakpoints using molecular techniques can now pinpoint many genomic sites essential for normal develop ment and maturation of hematopoietic cells but functionally disrupted in leukemic cells. The main goal of the international workshop that we held in Berlin with a select group of scientists and clinicians involved in leukemia research was to describe the state of the art and new developments in the immunologic, cytogenetic, and molecular characterization of acute leukemias and to discuss the clinical importance of cell biological features. After introductory survey lectures dealing with the immunological and molecular-biological characteristics of normal vs. malignant lymphatic and myeloid progenitor cells, the workshop centered on con tributions characterizing the immunophenotype and both numerical and structural chromosomal abnormalities in acute leukemias."

Each of the four authors of this book has a particular interest in disorders of porphyrin metabolism and special experience in their management. Their individual involvement in the field varies from 12 to 52 years and, combined, represents more than a century of personal experience. Since it has been written by both basic scientists and practicing physicians, the book is intended to be of value to all those involved in porphyrin metab olism and the porphyrias. It is hoped that the fascination of porphyrin metabolism and the clinical challenge of the porphyrias experienced by each of the authors will be conveyed to the readers. Michael R. Moore Kenneth E. L. McColl Claude Rimington Abraham Goldberg vii CONTENTS Color Plates ............................................ xvii 1. The History, Classification, and Incidence of the Porphyrias 1 1.1. History ........................................ 1 1.1.1. Early Chemistry . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.1.2. Early Descriptions of Porphyria .............. 4 1.1.3. Biochemical Developments .................. 4 1.1.4. Acute Porphyria . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.1.5. A Complete Pathway ...................... 8 1.2. Classification of the Porphyrias . . . . . . . . . . . . . . . . . . . . . 9 1.2.1. The Current Classification. . . . . . . . . . . . . . . 12 . . . .

In 1988 we presented our Guide to Bone Marrow Transplan tation. The reception has been enthusiastic and we have re ceived a flood of critical comments, suggestions and requests to provide an update in due time. Although several books on marrow transplantation have recently been published, their scope and goal have generally been different. Hence, we have decided to prepare a second edition of the Guide. Our aim was to maintain a short, concise text which never theless would incorporate changes that have occurred over the past four or five years. We have streamlined the description of pretransplant considerations, by condensing two sections into one (Treatment Planning and Timing of Transplantation). This also facilitated the review of controversial indications for marrow transplantation, for example in patients with acute myelogenous leukemia in first chemotherapy-induced remission. We have updated the chapter dealing with conditioning regimens and have expanded the section on donor selection, in particular in regard to the current level of tissue typing and the identification of unrelated volunteer donors. In the chapter on collection, processing, and infusion of marrow, we have incorporated recent developments, for example, the use of closed systems for marrow harvesting and processing and the use of solid phase separation of stem cells."

Recent developments in recombinant DNA technology have led to the large-scale production of human erythropoietin and to the demonstration that it is effective in the treatment of renal and possibly some other anaemias. This has lent a new impetus to studies of the pathophysiology and pharmacology of the hormone which is reflected in this report of the proceedings of a meeting held in Liibeck in June 1988. In 15 papers, all from European centres, the broad topics covered are erythropoietin's physiology and chemistry, the patho- physiology of erythropoiesis and the use of erythropoietin in the treatment of anaemia. Several of the papers include up-to-date reviews of the literature. The field is now expanding rapidly, and this volume, though not comprehensive, usefully points up many areas of recent understanding as well as others of continuing un- certainty. Overall, it contains material likely to be of interest to biochemists and experimental haematologists as well as to phar- macologists, clinical haematologists and nephrologists.

The Second Conference of the International Society of Hemorheology took place under the auspices of the University of Heidelberg from July 27 - August 1,1969 in Heidel berg. At this conference the name of the Society was changed to THE INTERNA TIONAL SOCIETY OF BIORHEOLOGY, since the members decided to enlarge the scope of the Society to include all fields of biorheology. Meanwhile the Society has become an Affiliated Commission of the International Union of Pure and Applied Biophysics. The abstracts of the scientific papers, as they appeared in the program of the Confe rence, have been reprinted in BIORHEOLOGY (volume 6, No.4, April 1970). This international journal has become the official organ of our Society. We are greatly indebted to the Honorary Chairman, Professor G. QUADBECK, Dean of the University of Heidelberg Medical School, who gave substantial aid to one of us (H. H. H.), the Conference Chairman, in organizing this international meeting. We are grateful to the Mayor of the City of Heidelberg who welcomed the participants and their families in the Cellar of the Great Barrel of the Heidelberger SchloB. We thank the members of the Ladies' Committee, Mrs. IRMGARD QUADBECK, Mrs. ELISABETH HARTERT and Mrs. KARIN KREITER, who arranged a most successful social program in Heidelberg and the romantic Neckar valley."

A great deal of new information has been obtained during the past four years, and this monograph provides a clear and well reviewed update on biochemical mechanisms and the results of important new clinical studies using the interferons. Reviews include what is presently known about the biosynthesis, physiological role and mechanisms of action of the interferons (alpha, beta, gamma). New biochemical information on interferon-receptor interactions and signalling pathways is provided. The pharmacokinetic considerations in treating leukemia, lymphoma, myeloma, neuroendocrine tumors and other solid tumors are reviewed with special emphasis on studies of adjuvant chemotherapy in malignancies of the immune system.

As the demographics of the population shift toward an increasingly aged society, the number of individuals with cancer increases and with it the need to give the most comprehensive possible health care delivery. Although much has been written about the specific therapy best suited for the various types of cancer and about the basic and clinical research which has dramatically improved treat ment, overall patient care requires attention to supportive care, which includes such items as pain management, the use of blood products, nutrition, and psychosocial needs. Yet infection remains the leading cause of death in cancer patients and is a major cause of morbidity and hospitaliza tion, making it a major aspect of the supportive care of cancer patients. It therefore deserves a full exposition. Bone marrow transplantation is increasingly being utilized as part of a therapeutic modality in the treatment of cancer patients. Transplantation patients are at such a particularly high risk of developing a wide variety of different types of infection, that they inevitably can serve as an excellent framework for discussion of all the types of infections that occur during the treatment of cancer. The patient undergoing allogeneic bone marrow transplantation is at particularly high risk of infection due to the major perturbations of host defenses, which include granulo cytopenia, cellular immune dysfunction, humoral immune dysfunction, blood product transfusions, and vascular access devices. Each of these perturbations results in a different set of infectious disease problems."

Endocrine glands may be involved in patients with thalassemia major. In the last 20 years, new therapies have significantly improved life expectancy, while several endocrine abnormalities have been described in children, adolescents, and young adults suffering from thalassemia major.
The practical objective of this book is to establish guidelines for the management of endocrine disorders underlying the various phases of thalassemic life. Internationally acknowledged experts give a state-of-the-art account of physiopathological and therapeutical approaches to endocrine disorders in thalassemia and focus on such topics as growth hormones, thyroid diseases, puberty, hypogonadism, diabetes, and bone metabolism.

In June 1986 a symposium was held in Giessen on Modern Trends in Virology. It was initiated by the Deutsche Forschungsgemeinschaft, which had supported virus research for the past 18 years in the Sonderforschungsbereich 47 at the University of Giessen. The purpose of the meeting was to serve as a forum for the members of the Sonderforschungsbereich to discuss scientific topics of mutual interest with about 200 virologists that had come from various parts of Europe, the United States, and Japan. It was not by chance that the symposium took place shortly after the 60th birthday of Rudolf Rott, who had founded the Sonderforschungsbereich in 1968 and has been its speaker ever since. Without his vision and his never resting energy Giessen would not have gained the position in the field of virology that it has today. This Festschrift, which contains the contributions presented at the plenary sessions of the symposium, is therefore dedicated to Rudolf Rott. HEINZ BAuER HANS-DIETER KLENK CHRISTOPH SCHOLTISSEK Table of Contents A Genetic Approach to Determining Glycoprotein Topology: The Influenza B Virus NB Glycoprotein has an Extracellular NHz-Terminal Domain Containing two N-linked Carbohydrate Chains R. A. LAMB and M. A. WILLIAMS . . . . . . . . . . . . . . . . . . . . . . . . . 1 Paramyxovirus Metabolisms Associated with the Cytoskeletal Framework Y. NAGAI, T. ToYODA, and M. HAMAGUCHI . . . . . . . . . . . . . . . . . . . 15 Correlation of High Evolutionary Rate of Influenza A Viruses in Man with High Mutation Rate Measured in Tissue Culture: A Hypothesis P. PALESE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

On March 27, 1990, the National Cancer Institute sponsored a workshop on the epidemiology of multiple myeloma, held at the National Institutes of Health. This book comprises articles prepared by participants in this work shop. Discussed in these papers are: the descriptive and analytic epidemi ology, differences in risk factors between blacks and whites, monoclonal gammopathies and their progression, and hypotheses regarding the etiology and pathogenesis of multiple myeloma. Several epidemiologic research areas received particular attention during this workshop, and are reviewed in detail in this volume. There have been striking increases in the incidence of multiple myeloma over the past thirty years, especially among older individuals and blacks, which may not be entirely explained by changes in diagnostic capabilities. Occupational and environmental exposures have been associated with an increased risk of multiple myeloma, including farming exposures, occupational exposure to petroleum and rubber processing, exposure to ionizing radiation, and asso ciations with persistent virus infections. The most striking epidemiological finding is reflected in the differences in incidence rates of multiple myeloma which are twice as high in blacks as compared with whites. Further, since 1950 the mortality rates for multiple myeloma have quadrupled in blacks while doubling for whites. Among hematopoietic malignancies, multiple myeloma is the only one with increased incidence and mortality rates among blacks. 1\vo major possibilities for explaining ethnic/racial differences in suscepti bility to multiple myeloma are genetic and environmental factors.