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Lei JY, Chen H, Zhou DH, Xu LH, Fang JP, Mai YG. Pneumocystis jirovecii-associated immune reconstitution inflammatory syndrome-like phenomenon in a child with leukaemia: a case report and literature review. BMC Pediatr 2022; 22:410. [PMID: 35820900 PMCID: PMC9277966 DOI: 10.1186/s12887-022-03441-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Immune reconstitution inflammatory syndrome (IRIS) refers to the phenomenon of intense immune responses against pathogens in patients with AIDS undergoing antiretroviral therapy to reconstitute immune function, resulting in functional impairment of multiple organs. Non-AIDS immunosuppressed hosts may also develop similar manifestations to IRIS during immune recovery. CASE PRESENTATION An 8-year-old girl presented with acute lymphoblastic leukaemia was admitted for scheduled chemotherapy treatment. During chemotherapy, she experienced pancytopenia and Pneumocystis jirovecii pneumonia, which was diagnosed based on the abnormal shadows observed on chest computed tomography, the elevation of serum β-D-glucan, and the positive mNGS results of Pneumocystis jirovecii in both sputum and blood. After treatment with Granulocyte Colony-Stimulating Factor, sulfamethoxazole, and caspofungin, aggravation of lung lesions was discovered and severe interstitial lung disease developed in a short period along with a rapidly increasing leukocyte count. Intravenous methylprednisolone pulse therapy was given, but lung function did not improve, and she finally died after the withdrawal of medical care. CONCLUSIONS For patients with acute lymphocytic leukaemia infected with Pneumocystis jirovecii, the rapid aggravation of pulmonary lesions in the process of blood recovery and immune reconstitution should raise vigilance against the possibility of IRIS-like reactions. The use of granulocyte stimulating factors may aggravate the inflammatory response in the lungs. The timing, dosage, and duration of treatment of glucocorticoids and the impact of high-dose methylprednisolone pulse therapy on the prognosis of patients should be explored in further research.
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Affiliation(s)
- Jia-Ying Lei
- Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Children's Medical Center, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China
| | - Han Chen
- Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Children's Medical Center, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China
| | - Dun-Hua Zhou
- Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Children's Medical Center, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China
| | - Lu-Hong Xu
- Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Children's Medical Center, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China
| | - Jian-Pei Fang
- Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Children's Medical Center, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China
| | - You-Gang Mai
- Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-Sen University, Guangzhou, People's Republic of China. .,Children's Medical Center, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China.
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2
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Bhaskar M, Biraris P, Tisekar O, Kaushal RK, Janu A, Tandon S. Unilateral Interstitial Lung Disease with Contralateral Effusion: Unusual Case Report of Dasatinib Toxicity. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1742334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractDasatinib is a second-generation tyrosine kinase inhibitor (TKI) used in chronic myelogenous leukemia (CML). While pleural effusion due to Dasatinib is well described in the literature, interstitial lung disease (ILD) caused by it is rare. A 60-year-old gentleman was on treatment with 100 mg of tablet Dasatinib per day for chronic myeloid leukemia. He presented to the outpatient department with history of progressive breathlessness over 2 months. High-resolution computerized tomography (HRCT) thorax revealed mild right-sided effusion and non-specific interstitial pneumonia (NSIP) pattern of ILD in the left lower lobe. Thoracocentesis of the right-sided pleural effusion showed exudative and lymphocytic rich pleural effusion. The effusion was negative for malignant cells or infection. Biopsy of the left lower lobe was consistent with the diagnosis of ILD. He was started on prednisolone which was gradually tapered and stopped. At 3 months, there was a complete resolution of the ILD and pleural effusion. Clinicians need to be aware about the pleuroparenchymal toxicities of Dasatinib. Early diagnosis and treatment with steroids can lead to complete resolution of the signs and symptoms.
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Affiliation(s)
- Maheema Bhaskar
- Department of Pulmonary Medicine, Tata Memorial hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Pavankumar Biraris
- Department of Pulmonary Medicine, Tata Memorial hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Owais Tisekar
- Department of Pulmonary Medicine, Tata Memorial hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rajiv Kumar Kaushal
- Department of Pathology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Janu
- Department of Radiology, Tata Memorial hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sandeep Tandon
- Department of Pulmonary Medicine, Tata Memorial hospital and Homi Bhabha National Institute, Mumbai, Maharashtra, India
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3
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Kim SA, Kwon BS, Chung JH, Lee JY, Bang SM, Lee JO. Interstitial pneumonitis associated with dasatinib treatment for chronic myeloid leukemia or acute lymphoblastic leukemia: case series and a literature review. Ther Adv Respir Dis 2022; 16:17534666221135322. [PMID: 36346055 PMCID: PMC9647296 DOI: 10.1177/17534666221135322] [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] [Indexed: 11/11/2022] Open
Abstract
Dasatinib, a tyrosine kinase inhibitor, is usually prescribed for chronic myeloid
leukemia and Philadelphia chromosome–positive acute lymphoblastic leukemia.
However, some patients may develop an intolerance to this drug over the years.
Among various toxicities related to dasatinib, dasatinib-associated interstitial
pneumonitis is not reported frequently in the literature yet. Moreover,
published studies have reported only few cases of dasatinib-associated
pneumonitis, almost exclusively in chronic myeloid leukemia. In this study, we
describe three cases of dasatinib-associated interstitial pneumonitis in
patients with chronic myeloid leukemia or Philadelphia chromosome–positive acute
lymphoblastic leukemia (a 56-year-old man, a 34-year-old man, and a 46-year-old
woman) at our institution. In all three patients, the time from the initiation
of dasatinib therapy to the onset of interstitial pneumonitis varied greatly.
Among them, one patient underwent a surgical lung biopsy, which revealed chronic
granulomatous inflammation without any causative pathogen. In all patients,
dasatinib was discontinued after the diagnosis of interstitial pneumonitis, and
two patients were treated with systemic steroids. Although infrequent,
dasatinib-induced pneumonitis should be considered a possible diagnosis in
dasatinib-treated patients with fever and respiratory symptoms. In addition,
hematologists and pulmonologists should be aware of this rare but critical
toxicity.
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Affiliation(s)
- Sang-A Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Byoung Soo Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jin-Haeng Chung
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Ji Yun Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Soo-Mee Bang
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jeong-Ok Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, South Korea
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4
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Nekoukar Z, Moghimi M, Salehifar E. A narrative review on adverse effects of dasatinib with a focus on pharmacotherapy of dasatinib-induced pulmonary toxicities. Blood Res 2021; 56:229-242. [PMID: 34776414 PMCID: PMC8721448 DOI: 10.5045/br.2021.2021117] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/15/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Chronic myeloid leukemia (CML), a myeloproliferative disorder caused by the over activity of BCR-ABL1 (breakpoint cluster region-Abelson), has been successfully treated by Tyrosine kinase inhibitors (TKIs). While imatinib is known as the first-line treatment of CML, in some cases other TKIs including dasatinib, nilotinib, bosutinib, and ponatinib may be preferred. Dasatinib, a second-generation TKI, inhibits multiple family kinases including BCR-ABL, SRC family kinases, receptor kinases, and TEC family kinases. It is effective against most imatinib-resistant cases except T315I mutation. Despite the superiority of dasatinib in its hematologic and cytogenetic responses in CML compared to imatinib, its potentially harmful pulmonary complications including pleural effusion (PE) and pulmonary arterial hypertension (PAH) may limit its use. Appropriate management of these serious adverse reactions is critical in both improving the quality of life and the outcome of the patient. In this narrative review, we will scrutinize the pulmonary complications of dasatinib and focus on the management of these toxicities.
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Affiliation(s)
- Zahra Nekoukar
- Department of Clinical Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Minoo Moghimi
- Department of Clinical Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ebrahim Salehifar
- Pharmaceutical Sciences Research Center, Hemoglobinopathy Institute, Department of Clinical Pharmacy, Mazandaran University of Medial Scienses, Sari, Iran
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Takekoshi D, Matsui Y, Akutsu T, Nishioka A, Kiritani A, Okuda K, Watanabe J, Miyagawa H, Utsumi H, Hashimoto M, Wakui H, Minagawa S, Hara H, Numata T, Noda Y, Makishima R, Ikegami M, Kawabata Y, Araya J, Kuwano K. Dasatinib-induced Nonspecific Interstitial Pneumonia That Developed 7 Years after the Initiation of Dasatinib. Intern Med 2020; 59:2297-2300. [PMID: 32536651 PMCID: PMC7578610 DOI: 10.2169/internalmedicine.4714-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report the case of a 56-year-old man with chronic myeloid leukemia (CML) who developed dasatinib-induced interstitial lung disease (ILD) 7 years after starting dasatinib, a BCR-ABL1 inhibitor. The patient presented with dyspnea. Chest imaging showed diffuse ground-glass opacities. A surgical lung biopsy showed cellular non-specific interstitial pneumonia (NSIP). Corticosteroid treatment ameliorated his condition. Bosutinib, another BCR-ABL1 inhibitor, was successfully re-instituted. The present case and relevant literature suggest that dasatinib-induced ILD can present as NSIP after an extended period, responds to corticosteroids, and is amenable to re-challenge at a lower-dose or with alternative BCR-ABL1 inhibitors.
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Affiliation(s)
- Daisuke Takekoshi
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
| | - Yuma Matsui
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
| | - Takuya Akutsu
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
| | - Ayako Nishioka
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
| | - Ayu Kiritani
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
| | - Keitaro Okuda
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
| | - Junko Watanabe
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
| | - Hanae Miyagawa
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
| | - Hirohumi Utsumi
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
| | - Mitsuo Hashimoto
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
| | - Hiroshi Wakui
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
| | - Shunsuke Minagawa
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
| | - Hiromichi Hara
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
| | - Takanori Numata
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
| | - Yuki Noda
- Division of Thoracic Surgery, Department of Surgery, Jikei University School of Medicine, Japan
| | - Rei Makishima
- Department of Pathology, Jikei University School of Medicine, Japan
| | - Masahiro Ikegami
- Department of Pathology, Jikei University School of Medicine, Japan
| | - Yoshinori Kawabata
- Department of Pathology, Saitama Cardiovascular and Respiratory Center, Japan
| | - Jun Araya
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
| | - Kazuyoshi Kuwano
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei University School of Medicine, Japan
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6
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Davidson KR, Ha DM, Schwarz MI, Chan ED. Bronchoalveolar lavage as a diagnostic procedure: a review of known cellular and molecular findings in various lung diseases. J Thorac Dis 2020; 12:4991-5019. [PMID: 33145073 PMCID: PMC7578496 DOI: 10.21037/jtd-20-651] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Bronchoalveolar lavage (BAL) is a commonly used procedure in the evaluation of lung disease as it allows for sampling of the lower respiratory tract. In many circumstances, BAL differential cell counts have been reported to be typical of specific lung disorders. In addition, more specific diagnostic tests including molecular assays such as polymerase chain reaction (PCR) or enzyme-linked immunosorbent assay, special cytopathologic stains, or particular microscopic findings have been described as part of BAL fluid analysis. This review focuses on common cellular and molecular findings of BAL in a wide range of lung diseases. Since the performance of the first lung irrigation in 1927, BAL has become a common and important diagnostic tool. While some pulmonary disorders have a highly characteristic signature of BAL findings, BAL results alone often lack specificity and require interpretation along with other clinical and radiographic details. Development of new diagnostic assays is certain to reinforce the utility of BAL in the future. Our review of the BAL literature is intended to serve as a resource to assist clinicians in the care of patients with lung disorders.
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Affiliation(s)
- Kevin R Davidson
- Division of Pulmonary Sciences & Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Duc M Ha
- Division of Pulmonary Sciences & Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.,Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Marvin I Schwarz
- Division of Pulmonary Sciences & Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Edward D Chan
- Division of Pulmonary Sciences & Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.,National Jewish Health, Denver, Colorado, USA
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7
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Weatherald J, Bondeelle L, Chaumais MC, Guignabert C, Savale L, Jaïs X, Sitbon O, Rousselot P, Humbert M, Bergeron A, Montani D. Pulmonary complications of Bcr-Abl tyrosine kinase inhibitors. Eur Respir J 2020; 56:13993003.00279-2020. [DOI: 10.1183/13993003.00279-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/02/2020] [Indexed: 12/17/2022]
Abstract
Tyrosine kinase inhibitors (TKIs) targeting the Bcr-Abl oncoprotein revolutionised the treatment of chronic myelogenous leukaemia. Following the success of imatinib, second- and third-generation molecules were developed. Different profiles of kinase inhibition and off-target effects vary between TKIs, which leads to a broad spectrum of potential toxicities.Pulmonary complications are most frequently observed with dasatinib but all other Bcr-Abl TKIs have been implicated. Pleural effusions are the most frequent pulmonary complication of TKIs, usually associated with dasatinib and bosutinib. Pulmonary arterial hypertension is an uncommon but serious complication of dasatinib, which is often reversible upon discontinuation. Bosutinib and ponatinib have also been associated with pulmonary arterial hypertension, while imatinib has not. Rarely, interstitial lung disease has been associated with TKIs, predominantly with imatinib.Mechanistically, dasatinib affects maintenance of normal pulmonary endothelial integrity by generating mitochondrial oxidative stress, inducing endothelial apoptosis and impairing vascular permeability in a dose-dependent manner. The mechanisms underlying other TKI-related complications are largely unknown. Awareness and early diagnosis of the pulmonary complications of Bcr-Abl TKIs is essential given their seriousness, potential reversibility, and impact on future treatment options for the underlying chronic myelogenous leukaemia.
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8
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Ito Y, Tanigawa M, Iwamoto K, Nigi A, Itani H, Kondo S, Tokui T, Usui E, Tamaki S. Interstitial pneumonitis associated with dasatinib: two case reports and literature review. Respir Investig 2019; 57:506-509. [PMID: 31311724 DOI: 10.1016/j.resinv.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/03/2019] [Accepted: 06/10/2019] [Indexed: 12/01/2022]
Abstract
Dasatinib has increasingly been used to treat chronic myeloid leukemia (CML), although interstitial pneumonitis has been found as a complication in large clinical trials. In the present study, 23 patients received dasatinib for CML between 2012 and 2017 at our institution, of whom 2 developed symptomatic interstitial pneumonitis. Notably, the first patient developed interstitial pneumonitis five years after initiating dasatinib. Interstitial pneumonitis should be considered as a complication in patients receiving dasatinib for CML, which may even occur after a long period of uncomplicated administration.
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Affiliation(s)
- Yuhei Ito
- Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, 1-471-2 Funae, Ise 516-8512, Japan.
| | - Motoaki Tanigawa
- Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, 1-471-2 Funae, Ise 516-8512, Japan.
| | - Keisuke Iwamoto
- Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, 1-471-2 Funae, Ise 516-8512, Japan.
| | - Akina Nigi
- Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, 1-471-2 Funae, Ise 516-8512, Japan.
| | - Hidetoshi Itani
- Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, 1-471-2 Funae, Ise 516-8512, Japan.
| | - Shigeto Kondo
- Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, 1-471-2 Funae, Ise 516-8512, Japan.
| | - Toshiya Tokui
- Department of Thoracic Surgery, Japanese Red Cross Ise Hospital, 1-471-2 Funae, Ise 516-8512, Japan.
| | - Eiji Usui
- Department of Hematology, Japanese Red Cross Ise Hospital, 1-471-2 Funae, Ise 516-8512, Japan.
| | - Shigehisa Tamaki
- Department of Hematology, Japanese Red Cross Ise Hospital, 1-471-2 Funae, Ise 516-8512, Japan.
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