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Nakaya A, Kondo M, Ogura E, Katayama Y, Yoshino E, Hozumi K, Tago S, Teranishi Y, Minamibashi Y, Harada M, Kawano Y, Arai Y, Kobayashi M, Kouyama A, Yoshida K, Shimizu S, Ogura K, Iwashita K. Treatment of patients with COVID-19 on hemodialysis: Efficacy of remdesivir. Nefrologia 2023; 43 Suppl 2:112-113. [PMID: 36707332 PMCID: PMC9876038 DOI: 10.1016/j.nefroe.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/21/2022] [Indexed: 06/18/2023] Open
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Shimura Y, Shibayama H, Nakaya A, Yamamura R, Imada K, Kaneko H, Hanamoto H, Fuchida SI, Tanaka H, Kosugi S, Kiyota M, Matsui T, Kanda J, Iida M, Matsuda M, Uoshima N, Shibano M, Karasuno T, Hamada T, Ohta K, Ito T, Yagi H, Yoshihara S, Shimazaki C, Nomura S, Hino M, Takaori-Kondo A, Matsumura I, Kanakura Y, Kuroda J. Real-world data on induction therapy in patients with transplant-ineligible newly diagnosed multiple myeloma: retrospective analysis of 598 cases from Kansai Myeloma Forum. Int J Hematol 2023; 118:609-617. [PMID: 37668833 DOI: 10.1007/s12185-023-03653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
To investigate the real-world clinical outcomes and management of novel drug-containing therapies for newly diagnosed multiple myeloma (MM) patients, we retrospectively analyzed data on the first-line treatment for newly diagnosed transplant-ineligible MM patients from Kansai Myeloma Forum, a registry network in Japan. A total of 598 patients treated with novel drugs between March 2007 and February 2018 were analyzed. Regimens used were VD (n = 305), Rd (n = 103), VMP (n = 97), VCD (n = 71), and VRd (n = 22). Younger patients tended to receive VRd or VCD, whereas the regimen with the highest median patient age was Rd. More than three-quarters of patients in the Rd group received a reduced dose of lenalidomide. The Rd and VRd groups had a relatively high incidence of infection and skin complications, and the VMP group had the highest incidence of peripheral neuropathy. Overall response rate did not differ significantly between regimens. Multivariate analysis in all patients revealed several poor prognostic factors, such as poor performance status. Novel drug-containing regimens for newly diagnosed MM showed a durable response with manageable AEs in the real-world setting.
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Nagate Y, Nakaya A, Kamimura R, Hirose Y, Nojima S, Fujita J, Kiyohara E, Shibayama H. Venetoclax Combined with Azacytidine Can Be a First-line Treatment Option for Elderly Blastic Plasmacytoid Dendritic Cell Neoplasm. Intern Med 2023; 62:2547-2551. [PMID: 37661416 PMCID: PMC10518555 DOI: 10.2169/internalmedicine.0318-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/07/2022] [Indexed: 09/05/2023] Open
Abstract
An 84-year-old Japanese man was diagnosed with blastic plasmacytoid dendritic cell neoplasm (BPDCN). We administered combination therapy using venetoclax and azacytidine. We observed neutropenia (Grade 4), thrombocytopenia (Grade 2), and stomatitis (Grade 3). After six cycles of treatment, the BPDCN abnormal cells in the bone marrow specimen almost disappeared, and atypical cells were not detected in a skin biopsy. We propose venetoclax combined with azacytidine as a useful treatment approach in elderly patients, although clinicians should be mindful that therapeutic modifications may be essential to minimize and/or avoid adverse events.
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Nakaya A, Nagate Y, Toda J, Yamashita Y, Hirose Y, Mori K, Shibayama H. [Plasmablastic lymphoma presenting clinical symptoms similar to plasmablastic myeloma]. [RINSHO KETSUEKI] THE JAPANESE JOURNAL OF CLINICAL HEMATOLOGY 2023; 64:260-264. [PMID: 37121769 DOI: 10.11406/rinketsu.64.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
A 75-year-old man developed multiple head masses as well as a compression fracture. His blood test revealed elevated immunoglobulin G (IgG) protein levels, and immunofixation electrophoresis revealed the presence of monoclonal IgGκ. Furthermore, positron emission tomography/computed tomography revealed multiple bone lesions, although bone marrow examination revealed only 1.2% of plasma cells. Biopsy of a head mass led to the diagnosis of plasmablastic lymphoma (PBL), an aggressive B-cell lymphoma with plasma cell phenotypes but no B-cell antigen expression. Because the tumor cells have plasmablastic morphologies, it is difficult to distinguish PBL from plasmablastic myeloma, which is a subtype of multiple myeloma. Both diseases have similar immunophenotypes and clinical courses. In this case, PBL was finally diagnosed based on Epstein-Barr virus positivity, and the patient made a complete recovery after treatment with DA-EPOCH.
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Nakaya A, Kondo M, Ogura E, Katayama Y, Yoshino E, Hozumi K, Tago S, Teranishi Y, Minamibashi Y, Harada M, Kawano Y, Arai Y, Kobayashi M, Kouyama A, Yoshida K, Shimizu S, Ogura K, Iwashita K. [Treatment of patients with COVID-19 on Hemodialysis: Efficacy of Remdesivir]. Nefrologia 2022; 43:S0211-6995(22)00123-0. [PMID: 35937587 PMCID: PMC9345654 DOI: 10.1016/j.nefro.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is no standard therapy for hemodialysis (HD) patients with COVID-19. Data on remdesivir in HD patients with COVID-19 are scarce. METHODS We retrospectively analyzed 25 HD patients with COVID-19 treated with remdesivir. RESULTS The median age of the patients was 78 years (range, 45-92 years) and was predominantly male (84%). A total of 44% of the patients had mild disease, 36% had moderate-1, and 20% had moderate-2. The most common symptoms were fever (76%) and coughing (44%). The most common comorbidity was renal failure (100%), followed by hypertension (60%) and cardiac disease (44%). The most frequent biomarker was elevated creatinine (100%), followed by C-reactive protein (80%), lymphopenia (76%), and D-dimer (68%). C-reactive protein levels decreased significantly before and after remdesivir administration (p < 0.001). Two patients showed deterioration, but none died. All patients recovered from COVID-19 and no adverse effects of treatment with remdesivir were observed. CONCLUSION Our study suggests the safe use of remdesivir in HD patients with COVID-19.
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Onda Y, Kanda J, Kaneko H, Shimura Y, Fuchida SI, Nakaya A, Itou T, Yamamura R, Tanaka H, Shibayama H, Shimazu Y, Uchiyama H, Yoshihara S, Adachi Y, Matsuda M, Hanamoto H, Uoshima N, Kosugi S, Ohta K, Yagi H, Kanakura Y, Matsumura I, Hino M, Nomura S, Shimazaki C, Takaori-Kondo A, Kuroda J. Real-world effectiveness and safety analysis of carfilzomib–lenalidomide–dexamethasone and carfilzomib–dexamethasone in relapsed/refractory multiple myeloma: a multicenter retrospective analysis. Ther Adv Hematol 2022; 13:20406207221104584. [PMID: 35785245 PMCID: PMC9240591 DOI: 10.1177/20406207221104584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/16/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Little is known about the real-world survival benefits and safety profiles of
carfilzomib–lenalidomide–dexamethasone (KRd) and carfilzomib–dexamethasone
(Kd). Methods: We performed a retrospective analysis to evaluate their efficacy and safety
in 157 patients registered in the Kansai Myeloma Forum database. Results: A total of 107 patients received KRd. Before KRd, 99% of patients had
received bortezomib (54% were refractory disease), and 82% had received
lenalidomide (57% were refractory disease). The overall response rate (ORR)
was 68.2%. The median progression-free survival (PFS) and overall survival
(OS) were 8.8 and 29.3 months, respectively. Multivariate analysis showed
that reduction of the carfilzomib dose and non-IgG M protein were
significantly associated with lower PFS and reduction of the carfilzomib
dose and refractoriness to prior bortezomib-based regimens were
significantly associated with lower OS. A total of 50 patients received Kd.
Before Kd, 96% of patients had received bortezomib (54% were refractory
disease). The ORR was 62.0%. The median PFS and OS were 7.1 and 20.9 months,
respectively. Based on the multivariate analysis, reduction of the
carfilzomib dose and International Staging System Stage III (ISS III) were
significantly associated with lower PFS. Grade III or higher adverse events
were observed in 48% of KRd cases and 54% of Kd cases. Cardiovascular
events, cytopenia, and infections were frequent, and 4 KRd patients died due
to heart failure, arrhythmia, cerebral hemorrhage, and pneumonia. Conclusion: Our analysis showed that an adequate dose of carfilzomib is important for
achieving the best survival benefits in a real-world setting. Adverse
effects after KRd and Kd therapy should also be considered.
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Nakaya A, Ogura E, Katayama Y, Yoshii M, Yoshino E, Hozumi K, Tago S, Teranishi Y, Minamibashi Y, Harada M, Yoshioka M, Kawano Y, Arai Y, Yoshida K, Shimizu S, Ogura K, Iwashita K. Hiccups as a specific neurological manifestation in males with COVID-19. IDCases 2021; 26:e01330. [PMID: 34777996 PMCID: PMC8577838 DOI: 10.1016/j.idcr.2021.e01330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 10/27/2022] Open
Abstract
Several clinical manifestations of COVID-19 have been reported in the literature since then. In addition to upper respiratory symptoms, dysgeusia and anosmia are relatively common neurological manifestations with COVID-19. We had five cases of hiccups in succession; therefore, we assume that hiccups might be a specific symptom of COVID-19. We retrospectively analyzed 46 patients with COVID-19 diagnosed from February 2021 to May 2021. Among the 46 patients, 5 developed hiccups (11%). All patients were male. The median age of was 56 years. None of the patients were smokers. Further, all patients exhibited pneumonia without dysgeusia or anosmia. The median onset of hiccups was 5 days after diagnosis, with a median duration of 2 days. All patients recovered from hiccups and COVID-19. Hiccups might be a specific neurological symptom in male patients with COVID-19.
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Nakaya A, Shibayama H, Nakatani E, Shimura Y, Kosugi S, Tanaka H, Fuchida S, Kanda J, Uoshima N, Kaneko H, Imada K, Ohta K, Ito T, Yagi H, Yoshihara S, Hino M, Shimazaki C, Takaori‐Kondo A, Kuroda J, Matsumura I, Kanakura Y, Nomura S. Significance of maintenance therapy after HDT/ASCT in symptomatic multiple myeloma: A multicenter retrospective analysis in Kansai Myeloma Forum. EJHAEM 2021; 2:765-773. [PMID: 35845216 PMCID: PMC9175982 DOI: 10.1002/jha2.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 06/15/2023]
Abstract
A total of 129 symptomatic patients with multiple myeloma (MM) who underwent high-dose chemotherapy with autologous stem cell transplantation (HDT/ASCT) were analyzed. The 4-year overall survival (OS) of patients with maintenance (n = 82) was 80%, whereas that of patients without maintenance (n = 47) was 72% (p = 0.426). The 4-year progression-free survival (PFS) of patients with maintenance was 38%, whereas that of patients without maintenance was 27% (p = 0.088). Multivariate analysis revealed that an International Staging System score ≥2 was associated with worse PFS (hazard ratio 1.62, p = 0.043). Among the 129 patients, two were excluded owing to early relapse, 50 patients achieved complete response (CR), and 77 patients failed to achieve CR. Patients who achieved CR showed better 4-year PFS than those who failed to achieve CR (41% vs. 30%, p = 0.027); however, 4-year OS was not different (76% vs. 82%, p = 0.971). In patients who achieved CR, 4-year OS with/without maintenance was 74%/81% (p = 0.357), 4-year PFS with/without maintenance was 42%/40% (p = 0.954). In patients who failed to achieve CR, the 4-year OS with/without maintenance was 97%/91% (p = 0.107), and 4-year PFS with/without maintenance was 36%/16% (p < 0.001). In patients who failed to achieve CR, maintenance significantly improved the PFS. Maintenance after HDT/ASCT can prolong PFS in patients who fail to achieve CR in real-world settings.
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Nakaya A, Ogura E, Katayama Y, Yoshii M, Yoshino E, Hozumi K, Tago S, Teranishi Y, Minamibashi Y, Harada M, Yoshioka M, Kawano Y, Arai Y, Yoshida K, Shimizu S, Ogura K, Iwashita K. Red face may be a specific sign of SARS-CoV-2 alpha variant. IDCases 2021; 25:e01214. [PMID: 34230877 PMCID: PMC8247189 DOI: 10.1016/j.idcr.2021.e01214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022] Open
Abstract
Red face was seen in three patients with COVID-19. Red face may reflect a cytokine storm. Red face may be predictive of a sudden deterioration.
Japan is currently suffering the fourth wave of the COVID-19 pandemic, with the dominant type being SARS-CoV-2 alpha variant. Patients with COVID-19 variant types show more aggressive symptoms. In the present study, three patients developed a red face during treatment. Two of them suddenly worsened shortly after. We assumed that the red face reflected a cytokine storm and conjectured that it may be a specific sign of variant type COVID-19, because we have never seen it in patients with non-variant type. Moreover, we believe that red face may be predictive of a sudden deterioration.
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Nakaya A, Qiu H, Santos EB, Hamlin DK, Wilbur DS, Storb R, Sandmaier BM. Addition of Astatine-211-Labeled Anti-CD45 Antibody to TBI as Conditioning for DLA-Identical Marrow Transplantation: A Novel Strategy to Overcome Graft Rejection in a Canine Presensitization Model: "Radioimmunotherapy to Overcome Transfusion-Induced Sensitization". Transplant Cell Ther 2021; 27:476.e1-476.e7. [PMID: 33775618 DOI: 10.1016/j.jtct.2021.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 11/26/2022]
Abstract
In a canine model of presensitization using donor blood transfusions, 100% of historical control dogs receiving 9.2 Gy total body irradiation (TBI) conditioning before dog leukocyte antigen (DLA)-identical marrow grafts had graft rejection. In this presensitization model, we investigated whether the addition of monoclonal antibody (mAb)-based targeted radioimmunotherapy (RIT) with astatine-211 (211At) to TBI could overcome graft rejection. 211At is an alpha-particle-emitting isotope that has a short path length, very high energy, and a short t½ of 7.2 hours, which allowed targeting radiation to the T cells responsible for graft rejection. Normal canine recipients were given three preceding transfusions of unirradiated whole blood on days -24, -17, and -10 before transplant from their DLA-identical marrow donors. 211At-anti-CD45 mAb was administered on day -3, and TBI followed by marrow grafts on day 0. Six of the 7 dogs (86%) achieved sustained engraftment as assessed by 100% donor chimerism in mononuclear cells, granulocytes, and CD3+ T cells. One dog receiving the lowest CD34+ cell content (0.35 × 106 cells/kg) rejected the graft. There were no late rejections in dogs followed up to 1 year. Graft-versus-host disease was seen in one dog. 211At-anti-CD45 mAb in combination with TBI as conditioning was successful in abrogating graft rejection in 86% of dogs in this presensitization model. 211At-anti-CD45 mAb conditioning with TBI may serve as a novel promising strategy to overcome graft rejection in heavily transfused patients with red cell disorders.
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Takakuwa T, Yamamura R, Ohta K, Kaneko H, Imada K, Nakaya A, Fuchida SI, Shibayama H, Matsuda M, Shimazu Y, Adachi Y, Kosugi S, Uchiyama H, Tanaka H, Hanamoto H, Shimura Y, Kanda J, Onda Y, Uoshima N, Yagi H, Yoshihara S, Hino M, Shimazaki C, Takaori-Kondo A, Kuroda J, Matsumura I, Kanakura Y, Nomura S. Outcomes of ixazomib/lenalidomide/dexamethasone for multiple myeloma: A multicenter retrospective analysis. Eur J Haematol 2021; 106:555-562. [PMID: 33476404 DOI: 10.1111/ejh.13586] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES This study aimed to investigate real-world data of ixazomib plus lenalidomide and dexamethasone (IRd) therapy for patients with relapsed and refractory multiple myeloma (RRMM). METHODS We retrospectively analyzed 122 patients treated with IRd at 16 centers from May 2017 to January 2019 by using the Kansai Myeloma Forum database. RESULT At the start of IRd, the median age was 72 years, 66.7% of patients had IgG type, and the median number of prior therapies was 4, comprising bortezomib (85.4%) and lenalidomide (89.3%)-based regimens. Disease progression and adverse events accounted for treatment discontinuation in 46 and 32 patients, respectively. The median overall survival (OS) was not reached, and the median progression-free survival (PFS) was 11.9 months. Sensitivity to bortezomib did not affect the PFS, whereas lenalidomide-refractory patients had significantly lower PFS than lenalidomide-sensitive patients, who were comparable to TOURMALINE-MM1 study. The patients with IgG type had significantly better PFS and OS than those with non-IgG type. CONCLUSION This study presents the largest real-world data of patients treated with IRd in Asia. However, in real clinical practice, the patient background is different from the TOURMALINE-MM1 study, and IRd showed poor efficacy, especially in the non-IgG type and lenalidomide-refractory patients with RRMM.
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Konishi A, Nakaya A, Ishii K, Nomura S. Six cases of autoimmune acquired coagulation factor VIII deficiency: Single center experience in Japan. Hematol Rep 2020; 12:8525. [PMID: 33282165 PMCID: PMC7686854 DOI: 10.4081/hr.2020.8525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Abstract
We report six cases of autoimmune acquired coagulation factor VIII deficiency, which is a rare bleeding disorder. It is an autoimmune disease, however, there are various causes. We experienced cases with malignancy, co-exist with another autoimmune disease, pregnancy, and unknown epidemiology with repeated bleeding episode. All patients were controlled the acute bleeding phase and they have been under treatment with immunosuppression.
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Nakaya A, Kohara T, Shibayama H, Onda Y, Kanda J, Kaneko H, Imada K, Kida T, Kosugi S, Ishikawa J, Yamamura R, Shimazu Y, Tanaka H, Fuchida SI, Shimura Y, Kiyota M, Wada K, Ito T, Uoshima N, Yagi H, Yoshihara S, Ohta K, Shimazaki C, Hino M, Takaori-Kondo A, Kuroda J, Matsumura I, Kanakura Y, Nomura S. Retrospective multi-center study of Adolescent and Young Adult (AYA) Multiple Myeloma in Kansai Myeloma Forum registry. Int J Hematol 2020; 112:435-438. [PMID: 32959221 DOI: 10.1007/s12185-020-02996-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022]
Abstract
We retrospectively analyzed the clinical features and outcomes in a real-world cohort of adolescents and the young adult (AYA) patients (age between 16 and 39 years) with symptomatic multiple myeloma (MM) registered with the Kansai Myeloma Forum. 26 patients had been diagnosed as symptomatic MM out of 3284 patients. The prevalence of AYA-MM was 0.8% in this cohort. 81% of the patients was received stem cell transplantation, which may improve outcome. Anemia and hypercalcemia might be prognostic factors, however International Staging System failed to predict overall survival. Five patients developed late-onset adverse events which were serious and life-threatening. The 5-year overall survival was 71.0%. We need to develop the new strategy to overcome AYA-MM.
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Nakaya A, Tanaka H, Yagi H, Ohta K, Shibayama H, Kohara T, Kanda J, Shindo M, Shimura Y, Kosugi S, Kida T, Kaneko H, Imada K, Karasuno T, Matsuda M, Iida M, Adachi Y, Fuchida SI, Uoshima N, Uchiyama H, Takahashi R, Matsui T, Wada K, Kiyota M, Shimazaki C, Hino M, Kuroda J, Kanakura Y, Takaori-Kondo A, Nomura S, Matsumura I. Retrospective analysis of plasmacytoma in Kansai Myeloma Forum Registry. Int J Hematol 2020; 112:666-673. [PMID: 32783165 DOI: 10.1007/s12185-020-02961-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 11/28/2022]
Abstract
We retrospectively analyzed 51 patients with solitary plasmacytoma diagnosed from October 2002 to September 2018 from a cohort of 3575 patients with plasma cell dyscrasias registered in the Kansai Myeloma Forum. Twenty-seven patients had solitary bone plasmacytoma (SBP) and 24 had extramedullary plasmacytoma (EMP), with prevalence of 0.8% and 0.7%, respectively. The most frequent M protein was IgG (40%) in SBP, whereas non-secretory proteins were most frequent (50%) in EMP. Five-year overall survival was 78.2% in SBP and 80.8% in EMP (P = 0.894). Among patients with SBP, 44% progressed to MM with a median time of 10.5 months (2.4-93.3 months), whereas 8% of EMP patients progressed to MM with a median time of 18.6 months (13.0-24.2 months). The most frequent treatment was radiotherapy (41%) or observation (41%) in SBP, and chemotherapy (54%) in EMP. No statistically significant difference was observed upon univariate analysis of prognostic factors including age, sex, performance status, and IgG M protein. Our results suggest that there are biological differences between SBP and EMP in real-world settings.
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Satake A, Konishi A, Azuma Y, Tsubokura Y, Yoshimura H, Hotta M, Nakanishi T, Fujita S, Nakaya A, Ito T, Ishii K, Nomura S. Clinical efficacy of mogamulizumab for relapsed/refractory aggressive adult T-cell leukemia/lymphoma: A retrospective analysis. Eur J Haematol 2020; 105:704-711. [PMID: 32564395 DOI: 10.1111/ejh.13474] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Although phase 2 studies have confirmed the efficacy of mogamulizumab for adult T-cell leukemia/lymphoma (ATL), real-world data on its benefits are limited. We assessed the benefits of mogamulizumab for relapsed/refractory ATL in clinical practice. METHODS We retrospectively analyzed patients with acute- and lymphoma-type ATL. Among 57 patients diagnosed with ATL between January 2008 and August 2018, 42 who received salvage therapy were eligible, including 24 who received mogamulizumab. RESULTS The overall response rate to mogamulizumab was 54.2%. Median survival time (MST) and 1-year overall survival (OS) rate from mogamulizumab initiation were 7.7 months and 42.0%, respectively. Patients with acute-type ATL showed longer MST (15.1 months) and higher 1-year OS (63.6%). MST without skin rash was 5.0 months, and 1-year OS was 34.3%; however, MST with skin rash was not reached and 1-year OS was 66.7%. Among patients who received the salvage therapy, longer MST and higher 1-year OS were observed with mogamulizumab than without mogamulizumab (P = .078; 9.2 vs. 3.9 months; 47.9% vs. 17.6%, respectively). Mogamulizumab administration improved prognosis in patients with acute-type ATL and skin rash. CONCLUSIONS In clinical practice, mogamulizumab improved OS in patients with relapsed/refractory ATL, especially those with acute-type ATL and skin rash.
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Nakaya A, Ishii K, Nomura S. Primary dural high grade B cell lymphoma mimicking subdural hematoma. Hematol Transfus Cell Ther 2020; 43:541-542. [PMID: 32247785 PMCID: PMC8572988 DOI: 10.1016/j.htct.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/12/2019] [Accepted: 01/08/2020] [Indexed: 11/15/2022] Open
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Nakaya A, Fujita S, Satake A, Nakanishi T, Azuma Y, Tsubokura Y, Saito R, Konishi A, Hotta M, Yoshimura H, Ishii K, Ito T, Nomura S. Evaluation of azacitidine in patients with transplant-ineligible myelodysplastic syndromes and acute myeloid leukemia with myelodysplasia-related changes in a Japanese clinical setting. Oncol Lett 2019; 19:1317-1321. [PMID: 31966063 PMCID: PMC6956411 DOI: 10.3892/ol.2019.11225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 06/26/2019] [Indexed: 01/28/2023] Open
Abstract
Patients with high-risk myelodysplastic syndromes (MDS) treated with azacitidine (AZA) have exhibited improved overall survival. However, information on AZA in real-world settings is limited. The present study retrospectively analyzed 85 patients with MDS treated with AZA. Complete response was achieved in 24% of cases and hematologic improvement in 29%. Severe adverse events (grade ≥3) included neutropenia and infection. Multivariate analysis identified higher revised international prognostic scoring system (IPSS-R) and male sex as significant factors affecting survival. However, the present study did not identify any significant associations between patient characteristics and response to AZA. In conclusion, AZA could produce a hematologic response in ~53% of patients with MDS. Furthermore, IPSS-R may reflect MDS prognosis. Further studies are required to establish the criteria for identifying patients likely to obtain maximum benefit from AZA treatment.
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Nakaya A, Ishii K, Shimizu T, Tamaki T, Ishiura Y, Inaba M, Uemura Y, Nakamine H, Nomura S. Localized lymphadenopathy with myelodysplastic syndrome associated with tuberculosis. Hematol Rep 2019; 11:8147. [PMID: 31871609 PMCID: PMC6902273 DOI: 10.4081/hr.2019.8147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/21/2019] [Indexed: 11/27/2022] Open
Abstract
We report the case of a man who developed myelodysplastic syndrome (MDS) and refractory cytopenia of unilineage dysplasia, 5 months after aortic valve replacement surgery. He also developed fever of unknown origin. After bone marrow- and other laboratory examinations, he was diagnosed with tuberculosis.
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Nakaya A, Fujita S, Satake A, Nakanishi T, Azuma Y, Tsubokura Y, Saito R, Konishi A, Hotta M, Yoshimura H, Ishii K, Ito T, Nomura S. Trend of salvage treatment in diffuse large B cell lymphoma in the outpatient chemotherapy era. Mol Clin Oncol 2019; 11:557-562. [PMID: 31692990 PMCID: PMC6826265 DOI: 10.3892/mco.2019.1930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/20/2019] [Indexed: 12/03/2022] Open
Abstract
Patients with diffuse large B cell lymphoma (DLBCL) who have failed to achieve complete remission with first-line therapy can subsequently receive salvage therapy. However, there is no definite consensus on the use of salvage therapy, and little information on the optimal treatment regimen. The present study retrospectively analyzed data from 131 patients diagnosed with DLBCL between April 2002 and November 2017 who relapsed and received salvage therapy. Primary treatment included R-CHOP or R-CHOP-like regimens. The most common salvage regimen was R-DeVIC (42%), followed by R-ESHAP (23%), other aggressive regimens (12%) and palliative therapy (23%). The median overall survival (OS) was 45.7 months for R-DeVIC, 41.8 months for palliative therapy, 29.4 months for R-ESHAP, and 28.5 months for aggressive regimens (P=0.937). A total of 25 patients underwent autologous stem cell transplantation (ASCT), and the OS was 75.6 months for these patients compared with 33.5 months (range, 25.6–45.6 months) for patients who did not undergo ASCT (P=0.033). Following the establishment of an outpatient chemotherapy unit in 2014, R-DeVIC use became more common, increasing from 37% prior to 2014 to 46% after 2014, whereas R-ESHAP use decreased (31 to 17%). The present study did not identify the optimal salvage regimen for patients with DLBCL. However, salvage ASCT improved the outcome, and regimens administered via peripheral veins were demonstrated to be more common in outpatient chemotherapy settings.
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Nakanishi T, Nakaya A, Nishio Y, Fujita S, Satake A, Azuma Y, Tsubokura Y, Saito R, Konishi A, Hotta M, Yoshimura H, Kadosaka Y, Ishii K, Ito T, Tsuta K, Nomura S. A variant of acute promyelocytic leukemia with t(4;17)(q12;q21) showed two different clinical symptoms. Hematol Rep 2019; 11:7971. [PMID: 31579135 PMCID: PMC6761461 DOI: 10.4081/hr.2019.7971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/05/2019] [Indexed: 11/23/2022] Open
Abstract
A 63-year-old man was diagnosed with a rare variant of acute promyelocytic leukemia (APL) with t(4;17)(q12; q21) that showed atypical morphological features and two different clinical symptoms. He was started on standard induction chemotherapy for acute myeloid leukemia, which decreased myeloblast numbers; however, APL-like blasts remained. He then received a salvage therapy that added all-trans retinoic acid (ATRA). After ATRA commenced, APL-like blasts disappeared and cytogenetic analysis became normal. However, myeloblasts subsequently increased, and he became resistant. In summary, this patient exhibited two different clinical courses of acute myeloid leukemia and APL.
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Ito T, Hashimoto Y, Tanaka Y, Nakaya A, Fujita S, Satake A, Nakanishi T, Konishi A, Hotta M, Yoshimura H, Ishii K, Hashimoto A, Kondo T, Omura H, Shinzato I, Tanaka T, Nomura S. Efficacy and safety of anagrelide as a first-line drug in cytoreductive treatment-naïve essential thrombocythemia patients in a real-world setting. Eur J Haematol 2019; 103:116-123. [PMID: 31107982 PMCID: PMC6851998 DOI: 10.1111/ejh.13265] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 12/31/2022]
Abstract
Objective This study aimed to retrospectively assess the efficacy and safety of anagrelide in cytoreduction therapy‐naïve essential thrombocythemia (ET) patients in a real‐world setting. Method Data from 53 ET patients who received anagrelide as a first‐line therapy were reviewed for patient characteristics, antiplatelet status, cytoreduction status, therapeutic effects, adverse events, thrombohemorrhagic event development, progression to myelofibrosis or acute leukemia, and cause of death. Results The rate of achieving a platelet count of <600 × 109/L during anagrelide monotherapy was 83.0%. Adverse events occurred in 32 of 53 patients, and tended to be slightly more severe in patients with cardiac failure; however, they were mostly tolerable. The therapeutic effect of anagrelide was consistent, regardless of genetic mutation profiles. The incidence of anemia as an adverse event was significantly higher in the CALR mutation‐positive group. Favorable platelet counts were also achieved in patients for whom hydroxyurea was introduced as a replacement for anagrelide or in addition to anagrelide because of unresponsiveness or intolerance to treatment. Conclusion In Japanese cytoreduction therapy‐naïve ET patients, anagrelide administration as a first‐line therapy demonstrated favorable effects in reducing platelet counts, and its safety profile that was generally consistent with those in previous reports.
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Azuma Y, Nakaya A, Fujita S, Satake A, Nakanishi T, Tsubokura Y, Saito R, Konishi A, Hotta M, Yoshimura H, Ishii K, Ito T, Nomura S. Neutrophil-to-lymphocyte ratio (NLR) fails to predict outcome of diffuse large B cell lymphoma. Leuk Res Rep 2019; 12:100173. [PMID: 31194040 PMCID: PMC6551461 DOI: 10.1016/j.lrr.2019.100173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/25/2019] [Accepted: 05/25/2019] [Indexed: 12/18/2022] Open
Abstract
Background Neutrophil-to-lymphocyte ratio (NLR) has been recognized as a poor prognostic indicator in various solid tumors. Methods We retrospectively analyzed 530 patients with de novo DLBCL who were diagnosed from April 2002 to November 2017. Results The median age of patients was 69 (range, 20-95) years, and 59% were male. The optimal cutoff for NLR was 5.2. NLR (5.2) was not associated with overall and progression free survival. Conclusion Our study failed to reveal the predictive value of NLR and demonstrated that the NCCN-IPI might be the most powerful predictor in DLBCL.
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Ishii K, Nakaya A, Fujita S, Satake A, Azuma Y, Tsubokura Y, Saito R, Konishi A, Hotta M, Yoshimura H, Ito T, Nomura S. Myodesopsia is a symptom of central nervous system blast crisis in chronic myeloid leukemia. Leuk Res Rep 2019; 11:8-10. [PMID: 30911463 PMCID: PMC6416525 DOI: 10.1016/j.lrr.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/30/2019] [Accepted: 03/03/2019] [Indexed: 11/19/2022] Open
Abstract
Patient with chronic myeloid leukemia in the chronic phase developed myodesopsia. Patient was in molecular response in bone marrow. It was an isolated central nervous system blast crisis.
A 49-year-old woman diagnosed with chronic myeloid leukemia in the chronic phase was started on dasatinib treatment, after which she complained of myodesopsia. Nineteen months after diagnosis, the patient again complained of myodesopsia and developed bilateral optic neuritis. Cerebrospinal fluid analysis revealed an increase in blasts, although peripheral blood and bone marrow examination confirmed that the patient remained in a molecular response to tyrosine kinase inhibitor (TKI) therapy. The patient was diagnosed with an isolated central nervous system blast crisis, a rare occurrence with second-generation TKI therapy, and the initial presentation of myodesopsia represented a symptom of this condition.
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Nakaya A, Fujita S, Satake A, Nakanishi T, Azuma Y, Tsubokura Y, Saito R, Konishi A, Hotta M, Yoshimura H, Ishii K, Ito T, Nomura S. Retrospective analysis of adolescent and young adult with lymphoma at two cancer facilities in Japan. Leuk Res Rep 2019; 12:100174. [PMID: 31194137 PMCID: PMC6551502 DOI: 10.1016/j.lrr.2019.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/29/2019] [Accepted: 05/25/2019] [Indexed: 11/28/2022] Open
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Niki M, Nakaya A, Kurata T, Nakahama K, Yoshioka H, Kaneda T, Kibata K, Ogata M, Nomura S. Pembrolizumab-induced autoimmune encephalitis in a patient with advanced non-small cell lung cancer: A case report. Mol Clin Oncol 2018; 10:267-269. [PMID: 30680206 DOI: 10.3892/mco.2018.1777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/23/2018] [Indexed: 12/16/2022] Open
Abstract
Immune checkpoint inhibitors have markedly changed lung cancer treatment and improved overall survival. However, immune checkpoint inhibitors may be associated with various adverse events, including encephalitis, although this complication is rare. We herein describe the clinical characteristics of a case of immune checkpoint inhibitor-induced encephalitis and its management. A 51-year-old man with squamous non-small cell lung cancer was receiving pembrolizumab treatment when he suddenly displayed an altered level of consciousness. Cerebrospinal fluid examination revealed elevated lymphocyte count and autoimmune encephalitis was suspected. The patient was promptly started on steroids and his consciousness immediately improved. Pembrolizumab treatment was discontinued; however, stable disease was maintained. In conclusion, encephalitis is a rare but possibly fatal adverse event of immune checkpoint inhibitors, and prompt diagnosis and treatment are mandatory.
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