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Morimoto A, Sakamoto K, Kudo K, Shioda Y. [Central nervous system disorders secondary to histiocytoses: neurodegeneration with potential for improvement]. Rinsho Shinkeigaku 2024; 64:85-92. [PMID: 38281751 DOI: 10.5692/clinicalneurol.cn-001899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Histiocytoses, including Langerhans cell histiocytosis (LCH) and Erdheim-Chester disease (ECD), are inflammatory myeloid tumors in which monocyte lineage cells aggregate in various organs, causing tissue damage. Most of these tumors harbor oncogenic mutations in mitogen-activated protein kinase (MAPK) pathway genes, typified by BRAFV600E. Some patients with LCH develop bilateral symmetrical cerebellar lesions and brain atrophy several years after diagnosis when the initial symptoms disappear, leading to cerebellar ataxia and higher cerebral dysfunction. A similar neurological disorder has also been reported in ECD. This neurological disorder can be improved with MAPK inhibitors. When patients with this neurological disorder are identified among neurodegeneration of unknown etiology or histiocytosis patients and treated early with MAPK inhibitors, the disorder can be reversible.
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Affiliation(s)
| | | | - Ko Kudo
- Department of Pediatrics, Hirosaki University School of Medicine
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development
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2
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Imai T, Sakamoto K, Hasegawa T, Shioda Y, Tsutsumi Y, Sakaue S, Imamura T, Morimoto A, Iehara T. Cerebellar peduncle damage in Langerhans cell histiocytosis-associated neurodegenerative disease revealed by diffusion tensor imaging. Neuroradiology 2024; 66:43-54. [PMID: 37983002 DOI: 10.1007/s00234-023-03249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/12/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE To confirm the hypothesis that brain white matter damage is involved in the pathogenesis and disease progression of Langerhans cell histiocytosis (LCH)-associated neurodegenerative disease (ND), we aimed to analyze pediatric patients with LCH using diffusion tensor imaging (DTI). METHODS We enrolled 33 patients with LCH and obtained 33 DTI datasets. Using DTI-based tractography, fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD), and radial diffusivity (RD) were measured in the cerebral and cerebellar white matter tracts. The participants were divided into three groups-non-ND, ND without clinical symptoms (r-ND), and ND with clinical symptoms (c-ND)-according to their clinical status during the examination with DTI. We compared the DTI parameters in white matter tracts were compared among the three groups. RESULTS In the order of non-ND, r-ND, and c-ND groups, the FA in superior cerebellar peduncle (SCP) and middle cerebellar peduncle (MCP) significantly decreased, the ADC, AD, and RD of MCP, and the RD of SCP were significantly elevated (FA-SCP; p < 0.001, FA-MCP; p = 0.026, ADC-MCP; p < 0.001, AD-MCP; p = 0.002, RD-MCP; p = 0.003, and RD-SCP; p = 0.018). Furthermore, in the simple linear regression analysis, the FA, ADC, AD, and RD values in the MCP and the FA value in the SCP were significantly influenced by the presence of neurological symptoms and ND findings on MRI (all p < 0.001). CONCLUSION In LCH-ND, we identified microstructural damage in the SCP and MCP. DTI parameters in these tracts may help monitor LCH-ND; therefore, future studies are required to validate these results in a large cohort.
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Affiliation(s)
- Tomohiko Imai
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Kenichi Sakamoto
- Departments of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - Tatsuji Hasegawa
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
| | - Yoko Shioda
- Departments of Pediatrics, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yoshiyuki Tsutsumi
- Departments of Radiology, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Sakaue
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Akira Morimoto
- Departments of Pediatrics, Showa Inan General Hospital, Komagane, Japan
| | - Tomoko Iehara
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
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Yoshinari H, Kawahara Y, Niijima H, Oh Y, Morimoto A. High Plasma Presepsin Levels in Children With Hemophagocytic Lymphohistiocytosis. J Pediatr Hematol Oncol 2024; 46:e103-e106. [PMID: 37910819 DOI: 10.1097/mph.0000000000002779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
Presepsin is reported as a novel diagnostic and prognostic biomarker for sepsis, and its optimal cutoff value is reported to be 600 to 650 pg/mL. Three children were diagnosed with hemophagocytic lymphohistiocytosis (HLH). The cause of HLH was unknown in cases 1 and 2, while Epstein-Barr virus infection was the cause in case 3. The plasma presepsin levels at the diagnosis were 1020, 1080, and 3160 pg/mL in cases 1, 2, and 3, respectively. In case 1, the plasma level of presepsin decreased to 164 pg/mL on day 19 of her sickness, when symptoms improved. Follow-up plasma presepsin levels were missing for cases 2 and 3. No microbiological pathogens were detected in the blood cultures of any of the patients. Our cases suggest that plasma presepsin levels can be elevated in childhood HLH.
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Affiliation(s)
- Hiroki Yoshinari
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
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Ono R, Sakamoto K, Doi T, Yanagisawa R, Morimoto A, Kanegane H, Nakazawa Y, Shioda Y. Dexamethasone palmitate as an etoposide-free treatment for children with hemophagocytic lymphohistiocytosis after hematopoietic cell transplantation. Bone Marrow Transplant 2023; 58:1286-1288. [PMID: 37644136 DOI: 10.1038/s41409-023-02098-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Rintaro Ono
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Kenichi Sakamoto
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan.
| | - Takehiko Doi
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ryu Yanagisawa
- Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
- Department of Pediatrics, Showa Inan Hospital, Komagane, Japan
| | - Hirokazu Kanegane
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yozo Nakazawa
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
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Erickson DPJ, Saini J, Cao N, Ford EC, Emery R, Kranz M, Goff PH, Meyer J, Wong T, Bloch C, Stewart RD, Sandison GA, Morimoto A, DeLonais-Dick A, Shaver B, Rengan R, Zeng J, Schwarz M. Adaptation of a Clinical Proton Pencil Beam Scanning System for FLASH Experiments. Int J Radiat Oncol Biol Phys 2023; 117:e664. [PMID: 37785966 DOI: 10.1016/j.ijrobp.2023.06.2103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To characterize a proton pencil beam scanning system for ultra-high dose rate (UHDR) irradiations and validate it with FLASH preclinical experiments. MATERIALS/METHODS After modifications to the beamline to maximize the beam current at isocenter in our gantry room, we characterized the UHDR beam in terms of: 1) Size and shape of the beam spot in three configurations; pristine beam, 75 mm water-equivalent-thickness (WET) range shifter (RS), and custom-built 135 mm WET RS mounted 310 mm upstream of the aperture in the snout housing. These configurations were analyzed to determine which one achieved the highest dose rate; 2) Beam transport efficiency and beam output. We compared the signal in the monitor chambers of the proton system with a Faraday cup and plane parallel ionization chamber (PPC05, IBA dosimetry) for beam current at the cyclotron from 7.5 nA to 800 nA; 3) Dose homogeneity, beam penumbra, and dose rate for the fields to be used in preclinical irradiations. All measurements were performed at isocenter, in air or at 1 cm depth in solid water, using the highest energy (about 230 MeV), which corresponded to a nominal range of 32.9 cm in water. We modeled the UHDR beam in our treatment planning system (TPS) to optimize the dose homogeneity and lateral penumbra of the irradiation fields. We performed the preclinical experiments in single fractions of 19 Gy (RBE), 21 Gy (RBE) and 23 Gy (RBE) (RBE = 1.1), targeting the pelvis of C57BL/6 mice and using survival as the endpoint. Each arm included 6-10 mice. The proton beam was used in transmission mode, positioning the center of the mouse pelvis at isocenter, and irradiating the pelvis with a 2x6 cm^2 field. Apertures were placed at 9cm from the isocenter to sharpen the lateral penumbra. RESULTS The range measurements with a multi-layer ionization chamber were consistent within 1 mm with the nominal range. In UHDR mode, the spot size at the isocenter varied from 4.5 mm for the pristine beam to 9.2 mm for the 135 mm RS. The spot size at isocenter remained constant when the beam intensity varied from 7.5 nA to 800 nA at the cyclotron exit. By employing the configuration with the 135 mm RS and optimizing the fields in the TPS, we achieved a dose rate of 1 Gy (RBE)/s for the conventional regime and 75(RBE) Gy/s for the UHDR regime. The monitor chambers of the proton system were affected by recombination at high dose rates: we observed about 35% higher output for the same number of monitor units delivered at 800 nA vs 7.5 nA. The delivered dose was determined with the PPC05 for each field, as this detector did not show recombination effects. When preclinical irradiations were independently monitored, the delivered dose was typically within 1% of the intended value. In three independent experiments, a dose of 21 Gy (RBE) or higher was associated with an increased survival in the UHDR arm compared to the conventional arm. CONCLUSION We adapted a clinical proton system for preclinical irradiations at UHDR. Our results confirm the presence of the FLASH effect.
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Affiliation(s)
- D P J Erickson
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - J Saini
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - N Cao
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - E C Ford
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - R Emery
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - M Kranz
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - P H Goff
- Department of Radiation Oncology, University of Washington / Fred Hutchinson Cancer Center, Seattle, WA
| | - J Meyer
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - T Wong
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - C Bloch
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - R D Stewart
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - G A Sandison
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - A Morimoto
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - A DeLonais-Dick
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - B Shaver
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - R Rengan
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - J Zeng
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - M Schwarz
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
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Shimizu S, Sakamoto K, Kudo K, Morimoto A, Shioda Y. Detection of BRAF V600E mutation in radiological Langerhans cell histiocytosis-associated neurodegenerative disease using droplet digital PCR analysis. Int J Hematol 2023:10.1007/s12185-023-03588-w. [PMID: 37010809 DOI: 10.1007/s12185-023-03588-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/19/2023] [Accepted: 03/22/2023] [Indexed: 04/04/2023]
Abstract
Langerhans cell histiocytosis-associated neurodegenerative disease (LCH-ND) is the most serious late complication secondary to LCH and is gradually progressive, destructive, and irreversible. Detection of the BRAF V600E mutation in peripheral blood mononuclear cells (PBMCs), even in the absence of active LCH lesions, is considered a sign of clinical LCH-ND, presenting with both abnormal imaging findings and neurological symptoms. However, the detection of the BRAF V600E mutation in PBMCs of patients with asymptomatic radiological LCH-ND (rLCH-ND) without active LCH lesions who present only with abnormal imaging findings is unknown. In this study, we analyzed the BRAF V600E mutations in PBMCs and cell-free DNA (cfDNA) of patients with rLCH-ND without active LCH lesions (n = 5) using a droplet digital polymerase chain reaction (ddPCR) assay. The BRAF V600E mutation in PBMCs was detected in three out of five (60%) cases. The mutant allele frequencies in the three positive cases were 0.049%, 0.027%, and 0.015%, respectively. However, the cfDNA BRAF V600E mutation remained undetected in all patients. Detection of the BRAF V600E mutant allele in PBMCs may be helpful in identifying asymptomatic rLCH-ND in patients at high risk for developing LCH-ND, including those with relapses at CNS risk sites or central diabetes insipidus.
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Affiliation(s)
- Soichiro Shimizu
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kenichi Sakamoto
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan.
- Department of Pediatrics, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Ko Kudo
- Department of Pediatrics, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
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Morimoto A, Shioda Y, Kudo K, Kanegane H, Imamura T, Koh K, Kosaka Y, Yuza Y, Nakazawa A, Saito AM, Watanabe T, Nakazawa Y. Intensification of treatment with vinca alkaloid does not improve outcomes in pediatric patients with Langerhans cell histiocytosis: results from the JPLSG LCH-12 study. Int J Hematol 2023:10.1007/s12185-023-03568-0. [PMID: 36871086 DOI: 10.1007/s12185-023-03568-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023]
Abstract
Chemotherapy with cytarabine, vincristine (VCR), and prednisolone has achieved low mortality rates in pediatric patients with Langerhans cell histiocytosis (LCH). However, relapse rates remain high, making event-free survival (EFS) rates unsatisfactory. A nationwide clinical trial, LCH-12, tested a modified protocol in which the early maintenance phase was intensified with increasing dosages of VCR. Patients newly diagnosed with multifocal bone (MFB) or multisystem (MS) LCH and aged < 20 years at diagnosis were enrolled between June 2012 and November 2017. Of the 150 eligible patients, 43 with MFB were treated for 30 weeks and 107 with MS LCH were treated for 54 weeks. One patient with MS LCH died of sepsis during the induction phase. The 3-year EFS rates among patients with MFB LCH, risk organ (RO)-negative MS LCH, and RO-positive MS LCH were 66.7% (95% confidential interval [CI], 56.5-77.0%), 66.1% (95% CI 52.9-76.4%), and 51.1% (95% CI 35.8-64.5%), respectively, similar to previously observed rates. EFS rates were significantly lower in patients with disease activity scores > 6 than in those with scores ≤ 6. The strategy that included more intense treatment with VCR was not effective. Other strategies are required to improve outcomes in patients with pediatric LCH.
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Affiliation(s)
- Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan. .,Department of Pediatrics, Showa Inan General Hospital, 3230, Akaho, Komagane, Nagano, 399-4117, Japan.
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kazuko Kudo
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hirokazu Kanegane
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshiyuki Kosaka
- Department of Hematology/Oncology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Yuki Yuza
- Departments of Hematology/Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Atsuko Nakazawa
- Department of Clinical Research, Saitama Children's Medical Center, Saitama, Japan
| | - Akiko M Saito
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Tomoyuki Watanabe
- Department of Health and Nutrition, Faculty of Psychological and Physical Science, Aichi Gakuin University, Nisshin, Japan
| | - Yozo Nakazawa
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
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Sakamoto K, Morimoto A, Shioda Y, Imamura T, Imashuku S. Relapses of multisystem/multifocal bone Langerhans cell histiocytosis in paediatric patients: Data analysis from the JLSG-96/02 study. Br J Haematol 2023; 200:769-775. [PMID: 36511451 DOI: 10.1111/bjh.18583] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/12/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
We assessed relapse patterns in paediatric patients with relapsed Langerhans cell histiocytosis (LCH) who were initially treated with the JLSG-96/02 protocol. We analysed 187 relapse events in 101 relapsed LCH patients [31 with multifocal bone (MFB) and 70 with multisystem (MS) at LCH diagnosis] among a total 317 patients enrolled in JLSG-96/-02 studies. Relapse of LCH was defined as an exacerbation of the non-active disease (NAD) condition. Of the 317 patients, 101 (31.9%) had the first relapse at 1.5 years after initiation of therapy. The first relapse and subsequent relapses did not differ between patients with MFB and MS disease. Of the 187 relapse events, relapse occurred as a single-system disease (n = 159; 85%), in which isolated bone relapse (n = 104; 55%) was the most common. Relapse at MS disease with the risk of organ involvement is extremely rare. After relapse(s), most patients underwent chemotherapy (122/187; 65%) and 87% of them achieved NAD status again. The incidence of permanent consequences was significantly higher in patients with relapses than in those without relapses. In the JLSG cohort, bone relapse most occurred in both MFB and MS patients. Most relapses could be effectively controlled by repeated administration of the initial chemotherapy.
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Affiliation(s)
- Kenichi Sakamoto
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan.,Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinsaku Imashuku
- Division of Laboratory Medicine, Uji-Tokushukai Medical Center, Uji, Japan
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Grange LJ, Reynolds JJ, Ullah F, Isidor B, Shearer RF, Latypova X, Baxley RM, Oliver AW, Ganesh A, Cooke SL, Jhujh SS, McNee GS, Hollingworth R, Higgs MR, Natsume T, Khan T, Martos-Moreno GÁ, Chupp S, Mathew CG, Parry D, Simpson MA, Nahavandi N, Yüksel Z, Drasdo M, Kron A, Vogt P, Jonasson A, Seth SA, Gonzaga-Jauregui C, Brigatti KW, Stegmann APA, Kanemaki M, Josifova D, Uchiyama Y, Oh Y, Morimoto A, Osaka H, Ammous Z, Argente J, Matsumoto N, Stumpel CTRM, Taylor AMR, Jackson AP, Bielinsky AK, Mailand N, Le Caignec C, Davis EE, Stewart GS. Pathogenic variants in SLF2 and SMC5 cause segmented chromosomes and mosaic variegated hyperploidy. Nat Commun 2022; 13:6664. [PMID: 36333305 PMCID: PMC9636423 DOI: 10.1038/s41467-022-34349-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Embryonic development is dictated by tight regulation of DNA replication, cell division and differentiation. Mutations in DNA repair and replication genes disrupt this equilibrium, giving rise to neurodevelopmental disease characterized by microcephaly, short stature and chromosomal breakage. Here, we identify biallelic variants in two components of the RAD18-SLF1/2-SMC5/6 genome stability pathway, SLF2 and SMC5, in 11 patients with microcephaly, short stature, cardiac abnormalities and anemia. Patient-derived cells exhibit a unique chromosomal instability phenotype consisting of segmented and dicentric chromosomes with mosaic variegated hyperploidy. To signify the importance of these segmented chromosomes, we have named this disorder Atelís (meaning - incomplete) Syndrome. Analysis of Atelís Syndrome cells reveals elevated levels of replication stress, partly due to a reduced ability to replicate through G-quadruplex DNA structures, and also loss of sister chromatid cohesion. Together, these data strengthen the functional link between SLF2 and the SMC5/6 complex, highlighting a distinct role for this pathway in maintaining genome stability.
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Affiliation(s)
- Laura J Grange
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - John J Reynolds
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Farid Ullah
- Advanced Center for Genetic and Translational Medicine (ACT-GeM), Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
- National Institute for Biotechnology and Genetic Engineering (NIBGE-C), Faisalabad, Pakistan Institute of Engineering and Applied Sciences (PIEAS), Islamabad, Pakistan
| | - Bertrand Isidor
- Service de Génétique Médicale, CHU Nantes, Nantes Cedex 1, France
| | - Robert F Shearer
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Xenia Latypova
- Service de Génétique Médicale, CHU Nantes, Nantes Cedex 1, France
| | - Ryan M Baxley
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - Antony W Oliver
- Genome Damage and Stability Centre, Science Park Road, University of Sussex, Falmer, Brighton, UK
| | - Anil Ganesh
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Sophie L Cooke
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Satpal S Jhujh
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Gavin S McNee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Robert Hollingworth
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Martin R Higgs
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Toyoaki Natsume
- Department of Chromosome Science, National Institute of Genetics, Research Organization of Information and Systems (ROIS), Mishima, Shizuoka, Japan
| | - Tahir Khan
- Center for Human Disease Modeling, Duke University Medical Center, Durham, NC, USA
| | - Gabriel Á Martos-Moreno
- Hospital Infantil Universitario Niño Jesús, CIBER de fisiopatología de la obesidad y nutrición (CIBEROBN), Instituto de Salud Carlos III, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Christopher G Mathew
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David Parry
- MRC Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, The University of Edinburgh, Edinburgh, Scotland
| | - Michael A Simpson
- Department of Medical and Molecular Genetics, Faculty of Life Science and Medicine, Guy's Hospital, King's College London, London, UK
| | - Nahid Nahavandi
- Bioscientia Institute for Medical Diagnostics, Human Genetics, Ingelheim, Germany
| | - Zafer Yüksel
- Bioscientia Institute for Medical Diagnostics, Human Genetics, Ingelheim, Germany
| | - Mojgan Drasdo
- Bioscientia Institute for Medical Diagnostics, Human Genetics, Ingelheim, Germany
| | - Anja Kron
- Bioscientia Institute for Medical Diagnostics, Human Genetics, Ingelheim, Germany
| | - Petra Vogt
- Bioscientia Institute for Medical Diagnostics, Human Genetics, Ingelheim, Germany
| | - Annemarie Jonasson
- Bioscientia Institute for Medical Diagnostics, Human Genetics, Ingelheim, Germany
| | | | - Claudia Gonzaga-Jauregui
- Regeneron Genetics Center, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
- International Laboratory for Human Genome Research, Universidad Nacional Autónoma de México, Querétaro, México
| | | | - Alexander P A Stegmann
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Masato Kanemaki
- Department of Genetics, The Graduate University for Advanced Studies (SOKENDAI), Mishima, Shizuoka, Japan
| | | | - Yuri Uchiyama
- Department of Rare Disease Genomics, Yokohama City University Hospital, Yokohama, Japan
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yukiko Oh
- Department of Paediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Akira Morimoto
- Department of Paediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hitoshi Osaka
- Department of Paediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | | | - Jesús Argente
- Hospital Infantil Universitario Niño Jesús, CIBER de fisiopatología de la obesidad y nutrición (CIBEROBN), Instituto de Salud Carlos III, Universidad Autónoma de Madrid, Madrid, Spain
- IMDEA Alimentación/IMDEA Food, Madrid, Spain
| | - Naomichi Matsumoto
- Department of Rare Disease Genomics, Yokohama City University Hospital, Yokohama, Japan
| | - Constance T R M Stumpel
- Department of Clinical Genetics and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alexander M R Taylor
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Andrew P Jackson
- MRC Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, The University of Edinburgh, Edinburgh, Scotland
| | - Anja-Katrin Bielinsky
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN, USA
| | - Niels Mailand
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cedric Le Caignec
- Centre Hospitalier Universitaire Toulouse, Service de Génétique Médicale and ToNIC, Toulouse NeuroImaging Center, Inserm, UPS, Université de Toulouse, Toulouse, France.
| | - Erica E Davis
- Advanced Center for Genetic and Translational Medicine (ACT-GeM), Stanley Manne Children's Research Institute, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA.
- Department of Pediatrics; Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Grant S Stewart
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
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10
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Shioda Y, Sakamoto K, Morimoto A. New biomarker paves the way for a clinical trial for neurodegeneration in Langerhans cell histiocytosis. Br J Haematol 2022; 198:623-624. [PMID: 35727899 DOI: 10.1111/bjh.18308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Abstract
Neurodegeneration in Langerhans cell histiocytosis (ND-LCH) is a major clinical issue requiring urgent resolution. Sveijer et al. showed that plasma neurofilament light protein is a promising biomarker for screening patients with ND-LCH and determining the therapeutic effect of a mitogen-activated protein kinase inhibitor. Therefore, this can be a powerful tool for conducting clinical trials for ND-LCH. Commentary on: Sveijer M, von Bahr Greenwood T, Jädersten M, Kvedaraite E, Zetterberg H, Blennow K, et al. Screening for neurodegeneration in Langerhans cell histiocytosis with neurofilament light in plasma. Br J Haematol. 2022;00:1-8. doi: 10.1111/bjh.18247.
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Affiliation(s)
- Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kenichi Sakamoto
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Akira Morimoto
- Department of Pediatrics, Showa Inan General Hospital, Komagane, Japan
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11
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Hayase T, Mieno MN, Kobayashi K, Mori N, Lebowitz AJ, Kato Y, Saito Y, Yuza Y, Sano H, Osone S, Hori T, Shinkoda Y, Yamamoto N, Hasegawa D, Yano M, Ashiarai M, Hasegawa D, Sawada A, Yamaguchi T, Morimoto A, Fukushima K. Reliability and Validity of the Japanese Pediatric Version of Memorial Symptom Assessment Scale. J Pain Symptom Manage 2022; 63:e495-e504. [PMID: 35031501 DOI: 10.1016/j.jpainsymman.2021.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT Few instruments in Japanese assess health-related quality of life in pediatric cancer patients. OBJECTIVES To translate the Memorial Symptom Assessment Scale (MSAS) into Japanese pediatric and proxy versions (MSAS-J 7-12, MSAS-J 13-18, and MSAS-J-Proxy) and assess validity and reliability. METHODS Phase I comprised forward-backward translation and pilot testing in 13 children and 16 guardians. Phase II consisted of psychometric testing of the three MSAS-J versions in 162 children and 238 guardians. Internal consistency, test-retest reliability, and construct and known-group validity of the MSAS-J were assessed. RESULTS Cronbach's alpha coefficients for the total and subscale scores were over 0.70, excluding the psychological symptom (PSYCH) subscale score of the MSAS-J 7-12. Most MSAS-J scores significantly inversely correlated with two versions of the Pediatric Quality of Life Inventory. A strong child-guardian correlation was shown in the total and subscale scores (ICC range 0.66-0.83). Kappa estimates showed acceptable child-guardian symptom agreement. MSAS-J 7-12 and proxy differentiated patients according to clinical status. CONCLUSION MSAS-J is a reliable and valid instrument to assess symptoms among Japanese children with cancer.
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Affiliation(s)
- Tomomi Hayase
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan.
| | - Makiko N Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Shimotsuke, Japan
| | - Kyoko Kobayashi
- Department of Child Health Nursing, St. Luke's International University Graduate School of Nursing Science, Tokyo, Japan
| | - Naoko Mori
- Department of Pediatrics, Akabane Zaitaku Clinic, Tokyo, Japan; Departments of Hematology/Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Adam Jon Lebowitz
- Department of General Education, Jichi Medical University, Shimotsuke, Japan
| | - Yoko Kato
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuya Saito
- Departments of Hematology/Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuki Yuza
- Departments of Hematology/Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hirozumi Sano
- Department of Pediatrics, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Shinya Osone
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsukasa Hori
- Department of Pediatrics, Sapporo Medical University, Sapporo, Japan
| | - Yuichi Shinkoda
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
| | - Nobuyuki Yamamoto
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daiichiro Hasegawa
- Department of Hematology and Oncology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Michihiro Yano
- Department of Pediatrics, Akita University School of Medicine, Akita, Japan
| | - Miho Ashiarai
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Daisuke Hasegawa
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Akihisa Sawada
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Keitaro Fukushima
- Department of Pediatrics, Dokkyo Medical University School of Medicine, Mibu, Japan
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12
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Morimoto A, Ozeki M, Sasaki S, Baba N, Kuwano Y, Kaneko T. Severe hypoglycemia in propranolol treatment for infantile hemangiomas. Pediatr Int 2022; 64:e15278. [PMID: 35972062 PMCID: PMC9541900 DOI: 10.1111/ped.15278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Infantile hemangioma (IH), formerly termed strawberry hemangioma, is a benign vascular tumor caused by capillary endothelial cell proliferation. The tumor regresses after 1 year of age, but sequelae occur in approximately half of the patients without systemic treatment. Propranolol (PPL) is currently the first-line therapeutic agent in Japan as well as in Western countries. It is not commonly known that PPL may induce severe hypoglycemia, in addition to cardiovascular and respiratory side effects. METHODS We retrospectively analyzed patients with severe PPL-induced hypoglycemia in the 3 years since the launch of Hemangiol®, a PPL preparation specific for IH, in Japan in 2016. RESULTS The incidence of severe hypoglycemia and of hypoglycemic convulsions following PPL treatment was estimated to be 0.54% and 0.35%, respectively. The incidence of hypoglycemic convulsions appeared to be higher in Japan than in Western countries. Severe hypoglycemia was common in infants aged >1 year, when PPL was used for ≥6 months. Severe hypoglycemia often develops from 05:00 a.m. to 09:00 a.m. and is frequently associated with prolonged periods of fasting, poor feeding, or poor physical conditions. CONCLUSION To avoid the risk of hypoglycemia, the treatment should be initiated by 6 months of age during the proliferative phase at the latest, and should not be extended indiscriminately beyond 1 year of age. Guardians should be advised not to administer PPL on an empty stomach, in the presence of poor feeding, or who are in poor physical condition, not to prolong fasting after PPL administration, and to monitor the child's condition immediately after he or she wakes up.
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Affiliation(s)
- Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan.,Division of Pediatrics, Showa Inan General Hospital, Komagane, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Satoru Sasaki
- Center for Vascular Anomalies, KKR Sapporo Medical Center Tonan Hospital, Sapporo, Japan
| | - Naoko Baba
- Department of Dermatology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yoshihiro Kuwano
- Department of Dermatology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan
| | - Tsuyoshi Kaneko
- Department of Plastic and Reconstructive Surgery, National Center for Child Health and Development, Tokyo, Japan
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13
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Ikeda T, Kawahara Y, Miyauchi A, Niijima H, Furukawa R, Shimozawa N, Morimoto A, Osaka H, Yamagata T. Low donor chimerism may be sufficient to prevent demyelination in adrenoleukodystrophy. JIMD Rep 2022; 63:19-24. [PMID: 35028267 PMCID: PMC8743339 DOI: 10.1002/jmd2.12259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/08/2022] Open
Abstract
Adrenoleukodystrophy (ALD) is a peroxisomal disorder characterized by white matter degeneration caused by adenosine triphosphate-binding cassette subfamily D member 1 (ABCD1) gene mutations, which lead to an accumulation of very-long-chain fatty acids (VLCFA). Hematopoietic stem cell transplantation (HSCT) is the most effective treatment; however, the ratio of donor-to-recipient cells required to prevent the progression of demyelination is unclear. The proband was diagnosed with the childhood cerebral form of ALD at 5 years of age based on the clinical phenotype, elevated plasma VLCFA levels, and pathogenic ABCD1 mutation c.293C>T (p.Ser98Leu). Soon after the diagnosis, he became bedridden. At 1 year of age, his younger brother was found to carry the same ABCD1 mutation; despite being asymptomatic, at 1 year and 9 months, head magnetic resonance imaging (MRI) showed high-signal-intensity lesions in the cerebral white matter. The patient underwent unrelated cord blood transplantation (UCBT) with a reduced conditioning regimen, which resulted in mixed chimerism. For 7 years after UCBT, the donor chimerism remained low (<10%) in peripheral blood and cerebrospinal fluid. However, even though a second HSCT was not performed, his neurological symptoms and brain MRI findings did not deteriorate. Our case suggests that even a small number of donor cells may prevent demyelination in ALD. This is an important case when considering the timing of a second HSCT.
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Affiliation(s)
- Takahiro Ikeda
- Department of PediatricsJichi Medical UniversityTochigiJapan
| | - Yuta Kawahara
- Department of PediatricsJichi Medical UniversityTochigiJapan
| | | | - Hitomi Niijima
- Department of PediatricsJichi Medical UniversityTochigiJapan
| | - Rieko Furukawa
- Department of RadiologyJichi Medical UniversityTochigiJapan
| | - Nobuyuki Shimozawa
- Division of Genomics Research, Life Science Research CenterGifu UniversityGifuJapan
| | - Akira Morimoto
- Department of PediatricsJichi Medical UniversityTochigiJapan
| | - Hitoshi Osaka
- Department of PediatricsJichi Medical UniversityTochigiJapan
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14
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Morimoto A, Shioda Y, Sakamoto K, Imamura T, Imashuku S. Bone lesions of Langerhans cell histiocytosis triggered by trauma in children. Pediatr Int 2022; 64:e15199. [PMID: 35770832 DOI: 10.1111/ped.15199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/09/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bone lesions of Langerhans cell histiocytosis (LCH) may be triggered by trauma. METHODS The characteristics of pediatric patients in the JLSG-02 study cohort who developed a bone lesion at the trauma site at diagnosis of LCH were analyzed retrospectively. RESULTS Of the 261 pediatric patients with LCH, 12 (4.6%), of median age 4.9 years, had trauma-triggered bone LCH lesions at diagnosis, making them significantly older than the remaining patients (P = 0.006). Trauma sites included the craniofacial regions in 10 patients and the lumbar spine and pelvis in one patient each. At the time of trauma, six patients had a bump at the site, whereas none had extradural hematomas or bone fractures. The median time from trauma to onset was 4 weeks. Of these 12 patients, three had isolated bone (IB) disease; four had multifocal bone (MFB) disease, including the bone lesion at the trauma site; and five had multisystem disease, including four with lesions in neighboring tissue and one with polyuria (posterior pituitary lesion) more than 1 year before the trauma-triggered bone lesion. Treatment responses were good in all 12 patients and none died, but relapses were observed in two patients, one each with IB and MFB disease. CONCLUSIONS About 5% of pediatric patients with LCH developed new trauma-triggered bone lesions at a relatively old age. These lesions can manifest as IB, or, in patients with underlying LCH diseases, as MFB or multisystem. Good clinical outcomes were observed in these patients.
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Affiliation(s)
- Akira Morimoto
- Department of Pediatrics, Showa Innan General Hospital, Komagane, Japan.,Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | | | - Toshihiko Imamura
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinsaku Imashuku
- Department of Laboratory Medicine, Uji-Tokushukai Medical Center, Uji, Kyoto, Japan
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15
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Morimoto A, Shioda Y, Sakamoto K, Kudo K, Imamura T, Kudo K. [Elucidated pathogenesis and therapeutic prospects in Langerhans cell histiocytosis]. Rinsho Ketsueki 2022; 63:373-382. [PMID: 35662160 DOI: 10.11406/rinketsu.63.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Langerhans cell histiocytosis (LCH) is characterized by immature dendritic cell proliferation, which is currently classified as an inflammatory myeloid neoplasm. Clinical features and outcomes vary from spontaneously regressing isolated bone disease to fatal liver, spleen, or hematopoietic system (risk organ) involvement-positive multisystem disease. LCH cells have the only mutation in the mitogen-activated protein kinase (MAPK) signaling pathway gene, represented by the BRAF V600E mutation, which is the driver mutation. The type of disease depends on the stage of hematopoietic cell differentiation at which the mutation occurs. LCH cells acquire anti-apoptosis and senescence-associated secretory phenotype by oncogene-induced senescence, with migration failure to lymph nodes. These cause LCH cell accumulation and various inflammatory cell recruitment in the lesion, resulting in severe inflammation. Tissue damage in LCH is due to this inflammation, not the LCH cell proliferation. Patients with a risk of organ involvement without the initial treatment response may be rescued by allogeneic hematopoietic stem cell transplantation after reducing the disease activity with MAPK inhibitors. Intravenous zoledronic acid and intrathecal cytarabine injections have been introduced into the ongoing clinical trial in Japan to reduce bone recurrence and prevent neurodegeneration as sequelae.
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Affiliation(s)
- Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development
| | | | - Ko Kudo
- Department of Pediatrics, Hirosaki University Graduate School of Medicine
| | - Toshihiko Imamura
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Kazuko Kudo
- Department of Pediatrics, Fujita Health University
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16
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Imashuku S, Morimoto A, Ishii E. Virus-triggered secondary hemophagocytic lymphohistiocytosis. Acta Paediatr 2021; 110:2729-2736. [PMID: 34096649 DOI: 10.1111/apa.15973] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/18/2021] [Accepted: 06/04/2021] [Indexed: 12/16/2022]
Abstract
Primary (familial/hereditary) and secondary (non-familial/hereditary) hemophagocytic lymphohistiocytosis (HLH) are hyperinflammatory and hypercytokinemic syndromes. Secondary HLH includes infection- (eg viral/bacterial/fungal/parasitic) and non-infection- (eg collagen disease or malignancy) related diseases. Viral HLH is the major type among all age groups. Secondary viral HLH and primary HLH must be differentiated carefully because primary HLH can be associated with viral infection(s), and the outcome is dismal without a timely diagnosis and hematopoietic stem cell transplantation (HSCT). Epstein-Barr virus (EBV)-related HLH (EBV-HLH) is the most common type of viral HLH in childhood. For non-EBV-HLH, appropriate treatment of viral infection, followed by immunomodulatory agent(s) such as corticosteroids, intravenous immunoglobulin or cyclosporine A, is usually successful; however, recent SARS-CoV-2-related HLH may become life-threatening. EBV-HLH may occur heterogeneously associated with the primary infection, with chronic active EBV infection or with underlying primary HLH. Although immunomodulatory agent(s) are effective in the majority of EBV-HLH cases, management differs from that of non-EBV-HLH because severe and refractory cases may require etoposide-containing HLH-1994/2004 regimens or other experimental agents. The novel agent, emapalumab (an anti-IFN-γ monoclonal antibody) can be used to treat EBV-HLH cases to avoid the risk of secondary malignancy due to etoposide. Finally, HSCT is required for refractory EBV-HLH cases and can also be curative in some other cases.
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Affiliation(s)
- Shinsaku Imashuku
- Department of Laboratory Medicine Uji‐Tokushukai Medical Center Uji Kyoto Japan
| | - Akira Morimoto
- Department of Pediatrics Jichi Medical University School of Medicine Shimotsuke, Tochigi Japan
| | - Eiichi Ishii
- Director Imabari City Hospital Imabari, Ehime Japan
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17
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Yamamoto S, Kato M, Watanabe K, Ishimaru S, Hasegawa D, Noguchi M, Hama A, Sato M, Koike T, Iwasaki F, Yagasaki H, Takahashi Y, Kosaka Y, Hashii Y, Morimoto A, Atsuta Y, Hasegawa D, Yoshida N. Prognostic value of the revised International Prognostic Scoring System five-group cytogenetic abnormality classification for the outcome prediction of hematopoietic stem cell transplantation in pediatric myelodysplastic syndrome. Bone Marrow Transplant 2021; 56:3016-3023. [PMID: 34508178 DOI: 10.1038/s41409-021-01446-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 11/09/2022]
Abstract
Cytogenetic abnormalities are a major risk factor for relapse after hematopoietic stem cell transplantation (HSCT) for myelodysplastic syndrome (MDS). We aimed to evaluate the value of the five-group cytogenetic classification according to the revised International Prognostic Scoring System (R-IPSS) for predicting the outcome after HSCT in pediatric patients with MDS. We retrospectively analyzed the Japanese registration data of 242 pediatric patients with MDS. According to the R-IPSS classification, 112 (45.5%) patients had good, 55 (22.7%) had intermediate, 64 (26.4%) had poor, and 11 (4.6%) had very poor cytogenetics. The 5-year overall survival (5yOS) was 72%, 69%, 59%, and 30% in the good, intermediate, poor, and very poor cytogenetic subgroups (p = 0.026), respectively. The very good, good, and intermediate subgroups were grouped into a "standard" subgroup and reclassified into three subgroups (standard, poor, and very poor). Patients with very poor risk had worse 5yOS (hazard ratio 2.17, 95% confidence interval (CI) 1.02-4.61; p = 0.04) and a much higher 5yCIR (hazard ratio 2.52, 95% CI 1.05-6.04; p = 0.04) than those of patients in the standard group in the multivariate analysis, indicating that very poor risk cytogenetic characteristics independently predicted worse outcome after HSCT in pediatric patients with MDS.
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Affiliation(s)
- Shohei Yamamoto
- Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Kanagawa, Japan. .,Department of Pediatrics, Showa University Fujigaoka Hospital, Kanagawa, Japan.
| | - Motohiro Kato
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kenichiro Watanabe
- Department of Hematology and Oncology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Sae Ishimaru
- Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Daisuke Hasegawa
- Department of Pediatrics, St Luke's International Hospital, Tokyo, Japan
| | - Maiko Noguchi
- Department of Pediatrics, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Asahito Hama
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Aichi, Japan
| | - Maho Sato
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Takashi Koike
- Division of Cell Transplantation, Tokai University School of Medicine, Kanagawa, Japan
| | - Fuminori Iwasaki
- Division of Hemato-Oncology/Regenerative Medicine, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Hiroshi Yagasaki
- Department of Pediatrics and Child Health, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yoshiyuki Kosaka
- Department of Hematology and Oncology, Center of Childhood Cancer, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Yoshiko Hashii
- Cancer Immunotherapy/Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yoshiko Atsuta
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan
| | - Daiichiro Hasegawa
- Department of Hematology and Oncology, Center of Childhood Cancer, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Nao Yoshida
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Aichi, Japan
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18
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Okada N, Kawahara Y, Sanada Y, Hirata Y, Otomo S, Niijima H, Tanaka A, Morimoto A, Lefor AK, Urahashi T, Yasuda Y, Mizuta K, Sakuma Y, Sata N. Successful living donor liver transplantation for liver failure due to maternal T cell engraftment following cord blood transplantation in X-linked severe combined immunodeficiency disease: Case report. Am J Transplant 2021; 21:3184-3189. [PMID: 33793086 DOI: 10.1111/ajt.16588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/21/2021] [Accepted: 03/26/2021] [Indexed: 01/25/2023]
Abstract
Maternal T cells from perinatal transplacental passage have been identified in up to 40% of patients with severe combined immunodeficiency (SCID). Although engrafted maternal T cells sometimes injure newborn tissue, liver failure due to maternal T cells has not been reported. We rescued a boy with X-linked SCID who developed liver failure due to engrafted maternal T cell invasion following living donor liver transplantation (LDLT) following unrelated umbilical cord blood transplantation (UCBT). After developing respiratory failure 3 weeks postpartum, he was diagnosed with X-linked SCID. Pathological findings showed maternal T cells engrafted in his liver and hepatic fibrosis gradually progressed. He underwent UCBT at 6 months, but hepatic function did not recover and liver failure progressed. Therefore, he underwent LDLT using an S2 monosegment graft at age 1.3 years. The patient had a leak at the Roux-en-Y anastomosis, which was repaired. Despite occasional episodes of pneumonia and otitis media, he is generally doing well 6 years after LDLT with continued immunosuppression agents. In conclusion, the combination of hematopoietic stem cell transplantation (HSCT) and liver transplantation may be efficacious, and HSCT should precede liver transplantation for children with X-linked SCID and liver failure.
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Affiliation(s)
- Noriki Okada
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yuta Kawahara
- Department of Pediatrics, Jichi Medical University, Tochigi-ken, Japan
| | - Yukihiro Sanada
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yuta Hirata
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Shinya Otomo
- Pharmacy, Jichi Medical University Hospital, Tochigi-ken, Japan
| | - Hitomi Niijima
- Department of Pediatrics, Jichi Medical University, Tochigi-ken, Japan
| | - Akira Tanaka
- Department of Pathology, Jichi Medical University, Tochigi-ken, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University, Tochigi-ken, Japan
| | - Alan K Lefor
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Taizen Urahashi
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yoshikazu Yasuda
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Koichi Mizuta
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Yasunaru Sakuma
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
| | - Naohiro Sata
- Department of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi-ken, Japan
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19
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Nakatani H, Takasawa K, Kashimada K, Morimoto A, Oshiba A, Nagasawa M. Central diabetes insipidus developing in a 6-year-old patient 4 years after the remission of unifocal bone Langerhans cell histiocytosis. Clin Pediatr Endocrinol 2021; 30:149-153. [PMID: 34285458 PMCID: PMC8267555 DOI: 10.1297/cpe.30.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022] Open
Abstract
A six-year-old boy was referred with a one-and-a-half months history of polyuria and
polydipsia. At the age of two, he had a single lytic bone lesion in his femoral head,
diagnosed as Langerhans cell histiocytosis (LCH) by biopsy at another hospital. As no
other affected organs were detected and the affected bone lesion was self-limited, he was
not followed up afterward and was doing well. He was diagnosed with diabetes insipidus
(DI) by confirming hypernatremia (Na: 148 mEq/l) with hyperosmolar serum (s-Osm 298
mOSM/kg) and inappropriately diluted urine (u-Osm 205 mOSM/kg). His polyuria and
polydipsia improved dramatically using the perioral diuretic hormone, and other pituitary
functions were not impaired. Magnetic resonance imaging revealed an enlarged pituitary
stalk. Sensitive and specific biomarkers of germ cell tumors, including alpha-fetoprotein,
placental alkaline phosphatase, and β-hCG in the cerebrospinal fluid, were not detected,
indicating relapse of LCH. Genetic analysis revealed a BRAF V600E mutation in the primary
bone lesion. We recommend systematic follow-up of patients with a history of LCH, even
non-CNS single-system single-site disease, especially with BRAF V600E mutation.
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Affiliation(s)
- Hisae Nakatani
- Department of Pediatrics, Musashino Red Cross Hospital, Tokyo, Japan
| | - Kei Takasawa
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Akihiro Oshiba
- Department of Pediatrics, Musashino Red Cross Hospital, Tokyo, Japan
| | - Masayuki Nagasawa
- Department of Pediatrics, Musashino Red Cross Hospital, Tokyo, Japan
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20
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Yoshinari H, Kawahara Y, Niijima H, Oh Y, Hirata Y, Okada N, Sanada Y, Onishi Y, Sakuma Y, Morimoto A. Rapid blood cell recovery with immunosuppressive therapy combined with romiplostim in a patient with very severe hepatitis-associated aplastic anemia who underwent liver transplantation. Int J Hematol 2021; 114:524-527. [PMID: 34110619 DOI: 10.1007/s12185-021-03165-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/12/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022]
Abstract
Patients with hepatitis-associated aplastic anemia (HAA) who undergo living-donor liver transplantation (LDLT) have a poor prognosis with infections and bleeding complications. Rapid recovery of blood cells is critical for preventing these complications and improving the outcome. Immunosuppressive therapy (IST) combined with thrombopoietin receptor agonists is considered effective for aplastic anemia. However, there are no data on the benefits of adding thrombopoietin receptor agonists to IST for HAA. We present the case of a child with severe HAA who underwent LDLT, and who achieved rapid blood cell recovery with IST combined with romiplostim, a thrombopoietin receptor agonist. In addition, despite having undergone LDLT, the patient had no adverse events such as serious liver dysfunction or thrombosis. This case suggests that IST combined with thrombopoietin receptor agonists may be a promising treatment option for HAA patients undergoing LDLT.
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Affiliation(s)
- Hiroki Yoshinari
- Department of Pediatrics, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yuta Kawahara
- Department of Pediatrics, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Hitomi Niijima
- Department of Pediatrics, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yukiko Oh
- Department of Pediatrics, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yuta Hirata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Noriki Okada
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Yukihiro Sanada
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Yasuharu Onishi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Yasunaru Sakuma
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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21
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Taniguchi M, Sakamoto K, Shioda Y, Doi T, Kudo K, Fujino H, Kudo K, Morimoto A. Salvage therapy with 2-chlorodeoxyadenosine for refractory and relapsed pediatric Langerhans cell histiocytosis: an updated nationwide survey in Japan. Int J Hematol 2021; 113:461-463. [PMID: 33564966 DOI: 10.1007/s12185-020-03073-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Maki Taniguchi
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kenichi Sakamoto
- Children's Cancer Center, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Takehiko Doi
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ko Kudo
- Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hisanori Fujino
- Department of Pediatrics, Osaka Red Cross Hospital, Osaka, Japan
| | - Kazuko Kudo
- Department of Pediatrics, Fujita Health University, Toyoake, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
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22
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Sakamoto K, Morimoto A, Shioda Y, Imamura T, Imashuku S. Long-term complications in uniformly treated paediatric Langerhans histiocytosis patients disclosed by 12 years of follow-up of the JLSG-96/02 studies. Br J Haematol 2020; 192:615-620. [PMID: 33236384 DOI: 10.1111/bjh.17243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 11/29/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare inflammatory myeloid neoplasia derived from immature myeloid dendritic cells with the mitogen-activated protein kinase (MAPK) pathway gene mutation. LCH is rarely fatal, but patients develop various permanent consequences (PCs). We report the frequencies of LCH-related PCs in paediatric patients (n = 317) treated by the JLSG-96/02 AraC-containing regimens. One-third of LCH patients had at least one PC at a median follow-up of 12 years. Central nervous system (CNS)-related PCs (neurological and endocrinological) accounted for 21·5%, non-CNS-related 16·7%. We require novel therapeutic measures to further reduce the frequency of LCH-related PCs.
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Affiliation(s)
- Kenichi Sakamoto
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinsaku Imashuku
- Division of Laboratory Medicine, Uji-Tokushukai Medical Center, Uji, Japan
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23
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Kawahara Y, Morimoto A, Inagaki J, Koh K, Noguchi M, Goto H, Yoshida N, Cho Y, Hori T, Hiwatari M, Kato K, Ogawa A, Hashii Y, Inoue M, Kato K, Atsuta Y, Kimura F, Kato M. Unrelated cord blood transplantation with myeloablative conditioning for pediatric acute lymphoblastic leukemia in remission: prognostic factors. Bone Marrow Transplant 2020; 56:357-367. [PMID: 32782350 DOI: 10.1038/s41409-020-01019-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022]
Abstract
The number of individuals undergoing unrelated cord blood transplantation (UCBT) has increased in recent years; however, information on prognostic factors is limited. We retrospectively analyzed data from 475 children and adolescents receiving UCBT with myeloablative conditioning for acute lymphoblastic leukemia (ALL) in complete remission (CR), based on a nationwide registry. In the total patient cohort, 5-year leukemia-free survival (LFS) and overall survival (OS) rates after UCBT were 61.1% and 67.7%, respectively. UCBT at first CR and UCBT after 2007 were associated with good survival, while grade II-IV acute graft-versus-host disease (GVHD) was associated with low relapse rate but did not affect survival. Analysis according to human leukocyte antigen (HLA) disparity revealed that tacrolimus-based GVHD prophylaxis resulted in higher OS and lower relapse rate and nonrelapse mortality (NRM) than cyclosporine-based GVHD prophylaxis in patients transplanted with 6/6 and ≤4/6 HLA-matched umbilical cord blood. Furthermore, grade II-IV acute GVHD was associated with good LFS and low relapse rate, without high NRM, in patients receiving 5/6 HLA-matched UCBT. These data indicate that prognostic factors for ALL differ depending on HLA disparity in UCBT.
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Affiliation(s)
- Yuta Kawahara
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan.
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Jiro Inagaki
- Department of Pediatrics, Kitakyushu City Yahata Hospital, Kitakyushu, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Maiko Noguchi
- Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan
| | - Hiroaki Goto
- Division of Hematology/Oncology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Nao Yoshida
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Yuko Cho
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Tsukasa Hori
- Department of Pediatrics, Sapporo Medical University Hospital, Sapporo, Japan
| | - Mitsuteru Hiwatari
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Keisuke Kato
- Division of Pediatric Hematology and Oncology, Ibaraki Children's Hospital, Mito, Japan
| | - Atsushi Ogawa
- Department of Pediatrics, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yoshiko Hashii
- Department of Cancer Immunotherapy/Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masami Inoue
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Koji Kato
- Central Japan Cord Blood Bank, Seto, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumihiko Kimura
- Division of Hematology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Motohiro Kato
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
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24
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Yoshida M, Tanase-Nakao K, Shima H, Shirai R, Yoshida K, Osumi T, Deguchi T, Mori M, Arakawa Y, Takagi M, Miyamura T, Sakaguchi K, Toyoda H, Ishida H, Sakata N, Imamura T, Kawahara Y, Morimoto A, Koike T, Yagasaki H, Ito S, Tomizawa D, Kiyokawa N, Narumi S, Kato M. Prevalence of germline GATA2 and SAMD9/9L variants in paediatric haematological disorders with monosomy 7. Br J Haematol 2020; 191:835-843. [PMID: 32770553 DOI: 10.1111/bjh.17006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/06/2020] [Indexed: 01/20/2023]
Abstract
Monosomy 7 (-7) occurs in various types of paediatric myeloid disorders and has a poor prognosis. Recent studies have demonstrated that patients with germline gain-of-function SAMD9/9L variants and loss-of-function GATA2 variants are prone to developing myelodysplastic syndrome (MDS) associated with -7. However, the prevalence of the genetic variants among paediatric haematologic disorders with -7 is unknown. The present study screened germline variants of GATA2 and SAMD9/9L in 25 patients with various types of paediatric haematological disorders associated with -7. The diagnoses of the 25 patients included MDS (n = 10), acute myeloid leukaemia (AML) and myeloid sarcomas (n = 9), juvenile myelomonocytic leukaemia (n = 3) and other disorders (n = 3). Seven patients with a germline pathogenic GATA2 variant were found. For SAMD9/9L screening, next-generation sequencing was used to detect low-abundance variants and found four novel germline variants. Functional analysis revealed that three out of the four variants showed growth-restricting capacity in vitro and thus, were judged to be pathogenic. Cases with GATA2 mutation tended to be older, compared to those with SAMD9/9L mutations. In conclusion, GATA2 and SAMD9/9L were sequenced in 25 patients with paediatric haematologic disorders associated with -7, and 40% of them were found to have some pathogenic germline variants in the three genes.
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Affiliation(s)
- Masanori Yoshida
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan.,Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kanako Tanase-Nakao
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hirohito Shima
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan.,Department of Advanced Pediatric Medicine, Tohoku University School of Medicine, Tokyo, Japan
| | - Ryota Shirai
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan.,Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kaoru Yoshida
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Tomoo Osumi
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan.,Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Takao Deguchi
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Makiko Mori
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Yuki Arakawa
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Masatoshi Takagi
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takako Miyamura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kimiyoshi Sakaguchi
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Hisashi Ishida
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Naoki Sakata
- Department of Pediatrics, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuta Kawahara
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Takashi Koike
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Hiroshi Yagasaki
- Department of Pediatrics, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Daisuke Tomizawa
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Nobutaka Kiyokawa
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Satoshi Narumi
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Motohiro Kato
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan.,Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
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25
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Ohki K, Takahashi H, Fukushima T, Nanmoku T, Kusano S, Mori M, Nakazawa Y, Yuza Y, Migita M, Okuno H, Morimoto A, Yoshino H, Kato M, Hayashi Y, Manabe A, Ohara A, Hasegawa D, Inukai T, Tomizawa D, Koh K, Kiyokawa N. Impact of immunophenotypic characteristics on genetic subgrouping in childhood acute lymphoblastic leukemia: Tokyo Children's Cancer Study Group (TCCSG) study L04-16. Genes Chromosomes Cancer 2020; 59:551-561. [PMID: 32368831 DOI: 10.1002/gcc.22858] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 12/31/2022] Open
Abstract
Immunophenotyping was performed in 1044 consecutive childhood acute lymphoblastic leukemia (ALL) patients enrolled in the Tokyo Children's Cancer Study Group L04-16 trial, revealing novel findings associated with genetic abnormalities. In addition to TCF3-PBX1 and MEF2D fusions, the CD10(+) subtype of KMT2A-MLLT3-positive ALL frequently exhibited the cytoplasmic-μ(+) pre-B ALL immunophenotype. Although ETV6-RUNX1 was significantly correlated with myeloid antigen expression, more than half of patients expressed neither CD33 nor CD13, while the CD27(+) /CD44(-) immunophenotype was maintained. Expression of CD117 and CD56 in B-cell precursor-ALL was limited to certain subtypes including ETV6-RUNX1 and KMT2A-MLLT3. Besides BCR-ABL1, CRLF2, hyperdiploidy, and hypodiploidy, CD66c was also expressed in Ph-like kinase fusion-, PAX5 fusion-, and DUX4 fusion-positive ALL, but not in MEF2D fusion-positive ALL, indicating constant selectivity of CD66c expression. In T-ALL, SIL-TAL1-positive patients were likely to exhibit a more mature immunophenotype. Expression of CD21 and CD10 was not rare in T-ALL, while lack of CD28 was an additional feature of early T-cell precursor-ALL. Considering the immunophenotype as a prognostic maker, MEF2D fusion-positive ALL with CD5 expression may be associated with a poorer prognosis in comparison with those lacking CD5 expression. In cases with characteristic marker expression, the presence of certain fusion transcripts could be predicted accurately.
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Affiliation(s)
- Kentaro Ohki
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development (Research Institute, National Center for Child Health and Development, NCCHD), Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - Takashi Fukushima
- Department of Pediatric Hematology and Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toru Nanmoku
- Department of Clinical Laboratory, University of Tsukuba Hospital, Ibaraki, Japan
| | - Shinpei Kusano
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development (Research Institute, National Center for Child Health and Development, NCCHD), Tokyo, Japan.,Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makiko Mori
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Yozo Nakazawa
- Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
| | - Yuki Yuza
- Department of Hematology-Oncology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masahiro Migita
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Haruna Okuno
- Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Hiroshi Yoshino
- Department of Pediatrics, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Motohiro Kato
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development (Research Institute, National Center for Child Health and Development, NCCHD), Tokyo, Japan.,Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yasuhide Hayashi
- Institute of Physiology and Medicine, Jobu University, Gunma, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Akira Ohara
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - Daisuke Hasegawa
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Takeshi Inukai
- Department of Pediatrics, University of Yamanashi, Yamanashi, Japan
| | - Daisuke Tomizawa
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Nobutaka Kiyokawa
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development (Research Institute, National Center for Child Health and Development, NCCHD), Tokyo, Japan
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26
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Hayase T, Saito S, Shioda Y, Imamura T, Watanabe K, Ohki K, Yoshioka T, Oh Y, Kawahara Y, Niijima H, Imashuku S, Morimoto A. Analysis of the BRAF and MAP2K1 mutations in patients with Langerhans cell histiocytosis in Japan. Int J Hematol 2020; 112:560-567. [PMID: 32654047 DOI: 10.1007/s12185-020-02940-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/11/2020] [Accepted: 06/23/2020] [Indexed: 12/22/2022]
Abstract
In Langerhans cell histiocytosis (LCH), somatic gene mutations in the mitogen-activated protein kinase pathway have been identified in more than 80% of cases in Western countries, in which mutually exclusive BRAF and MAP2K1 mutations are involved. Among them, BRAF V600E mutation is the major contributor (50-60%). In 59 patients (50 children and nine adults) with LCH (not including pulmonary LCH) in Japan, we first screened for BRAF V600E in all patients followed by target sequencing for other gene mutations in 17 of BRAF V600E-negative patients. As a result, BRAF V600E mutation was detected in 27/59 (46%) patients. We also identified BRAF mutations other than V600E in five and MAP2K1 mutations in nine patients. Thus, gene mutations in BRAF or MAP2K1 were identified in 41/44 (93%) of the fully tested patients. Regarding the correlation of clinical features and genotype in pediatric patients, we found that BRAF V600E mutation status was not correlated with sex, age at diagnosis, disease extent, response to first-line therapy, relapse, or CNS-related sequelae. Interestingly, MAP2K1 exon 2 in-frame deletion was related to the risk organ involvement; however, further studies are required to clarify the impact of these gene mutations on the clinical features of patients with LCH.
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Affiliation(s)
- Tomomi Hayase
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shiori Saito
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yoko Shioda
- Department of Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenichiro Watanabe
- Department of Hematology and Oncology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kentaro Ohki
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Takako Yoshioka
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Yukiko Oh
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yuta Kawahara
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hitomi Niijima
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shinsaku Imashuku
- Division of Laboratory Medicine, Uji Tokushukai Medical Center, Uji, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
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Maeda M, Morimoto A, Shioda Y, Asano T, Koga Y, Nakazawa Y, Kanegane H, Kudo K, Ohga S, Ishii E. Long-term outcomes of children with extracutaneous juvenile xanthogranulomas in Japan. Pediatr Blood Cancer 2020; 67:e28381. [PMID: 32383820 DOI: 10.1002/pbc.28381] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/27/2020] [Accepted: 04/16/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Juvenile xanthogranuloma (JXG) is the most common non-Langerhans cell histiocytosis in children. The mortality and morbidity of JXG with extracutaneous lesions remain unclear. METHODS Data of patients aged < 18 years who were diagnosed with JXG between 2001 and 2010 were retrospectively collected through a nationwide survey. RESULTS Twenty patients (11 male and nine female) had extracutaneous lesions. The median observation time was 10 years (range, 0-17). Six patients presented with symptoms at birth. The median age at diagnosis was 8.5 months (range, 0 month-13 years). Fifteen patients underwent treatment for JXG, including chemotherapy (n = 11), and five did not receive treatment. All patients except one survived; 17 were disease-free and two survived with disease. One newborn-onset patient with liver, spleen, and bone marrow involvement died of the disease. Permanent sequelae included central diabetes insipidus, growth hormone deficiency, and panhypopituitarism detected at diagnosis in three, one, and two patients, respectively. Four patients had visual impairment (optic nerve compression and intraocular invasion in two each), three had epilepsy, one had mental retardation, and one had a skin scar. Eight patients who had intracranial lesions were older at diagnosis, and had a higher frequency of disease-related comorbidities and permanent sequelae than those without intracranial involvement. CONCLUSIONS Patients with extracutaneous JXG had good outcomes, although those with intracranial lesions had serious permanent sequelae. Effective and safe treatment regimens for patients with intracranial JXG need to be developed.
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Affiliation(s)
- Miho Maeda
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Takeshi Asano
- Department of Pediatrics, Nippon Medical School Chiba Hokuso Hospital, Chiba, Japan
| | - Yuhki Koga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yozo Nakazawa
- Department of Pediatrics, Shinshu University, Matsumoto, Japan
| | - Hirokazu Kanegane
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuko Kudo
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eiichi Ishii
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Japan
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Affiliation(s)
- Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Kazuko Kudo
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
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Oh Y, Niijima H, Kawahara Y, Hayase T, Shimizu T, Ishida T, Morimoto A. An immediate hypersensitivity reaction induced by PEGylated recombinant factor VIII. Haemophilia 2020; 26:e236-e239. [PMID: 32497373 DOI: 10.1111/hae.14048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Yukiko Oh
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hitomi Niijima
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yuta Kawahara
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Tomomi Hayase
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Taro Shimizu
- Department of Pharmacokinetics and Biopharmaceutics, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Tatsuhiro Ishida
- Department of Pharmacokinetics and Biopharmaceutics, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
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Isenberg D, Furie R, Jones NS, Guibord P, Galanter J, Lee C, Mcgregor A, Toth B, Rae J, Hwang O, Lokku A, Miranda P, De Souza V, Jaller-Raad J, Maura Fernandes A, Garcia Salinas R, Chinn L, Townsend MJ, Morimoto A, Tuckwell K. OP0233 EFFICACY, SAFETY, AND PHARMACODYNAMIC EFFECTS OF THE BRUTON’S TYROSINE KINASE INHIBITOR, FENEBRUTINIB (GDC-0853), IN MODERATE TO SEVERE SYSTEMIC LUPUS ERYTHEMATOSUS IN A PHASE 2 CONTROLLED STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2949] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Fenebrutinib (GDC-0853, FEN) is an oral, non-covalent, and selective inhibitor of Bruton’s tyrosine kinase (BTK) in clinical development for autoimmune diseases.Objectives:This was a randomized, placebo-controlled, multi-center study to evaluate the efficacy, safety, and pharmacodynamic effects of FEN in patients with moderate-to-severe systemic lupus erythematosus (SLE) activity.Methods:Patients who met SLICC or revised ACR SLE criteria, had ≥1 serologic marker of SLE, SLEDAI ≥8, and were on ≥1 standard of care (SOC) therapy were included; patients with renal or CNS involvement, or exposure to B cell depleting or calcineurin inhibitor therapy were excluded. Patients were randomized to placebo (PBO), FEN 150 mg QD, or FEN 200 mg BID, for 48 weeks. A corticosteroid taper was recommended, with burst and taper permitted from Week 0 (W0) to W12 and W24 to W36. The primary endpoint was SRI-4 at W48. Post hoc subgroup analyses were conducted based on patient baseline disease characteristics.Results:This study enrolled 260 patients, with the majority recruited in Latin America, USA, and Western Europe. At W48, the SRI-4 response rates for FEN 150 mg QD and FEN 200 mg BID were 51% (95% CI: -8.5, 21.2; p value 0.37) and 52% (95% CI: -7.3, 22.4; p value 0.34), respectively, compared to 44% for PBO (Table 1). Post-hoc analysis showed larger responses in subgroups of patients with higher baseline disease activity (Table 1). Safety results were similar between FEN and PBO arms, although more serious adverse events were observed in the FEN 200 mg BID arm. Study discontinuations were balanced across the 3 arms (24-26%). FEN treatment significantly reduced levels of CD19+ B cells, anti-dsDNA autoantibodies, IgG, and a BTK-dependent RNA signature highly expressed in plasmablasts by W48 compared to PBO; C4 levels modestly improved with FEN vs. PBO (Table 2).Table 1.SRI-4 Response (%) at W48 in Primary Analysis and in Post-hoc Patient SubgroupsPBOFEN 150 mg QDFEN 200 mg BIDSRI-4 Response (%) at W4844n=8451n=8752n=88SRI-4 Response (%) in Baseline Subgroups At least 1 BILAG A48n=4254n=3959n=46 At least 1 BILAG A and SLEDAI increased DNA binding37n=1953n=1765n=26 SLEDAI arthritis with at least 4 swollen joints39n=5750n=5457n=54 SLEDAI arthritis with at least 4 tender joints39n=7153n=7059n=69 CLASI >=1021n=1436n=1131n=16Table 2.Key Biomarker ResultsPBOFEN 150 mg QDFEN 200 mg BIDMedian (%) Change from Baseline at W48 Plasmablast signature-19.7%n=52-54.3%*n=53-51.7%*n=57 CD19+B cells (cells/µl)-0.50n=38-57.0*n=49-57.5*n=48 Anti-dsDNA#(IU/ml)+6.9n=31-38.3*n=36-75.7*n=33 Total IgG (g/L)-0.20n=65-1.25*n=64-1.56*n=64 C3 (g/L)-0.02n=65+0.01n=67-0.01n=66 C4 (g/L)0.00n=65+0.02*n=67+0.01*n=66#Patients who were positive at baseline (>30 IU/mL)*Denotes significant vs. PBO; Kruskal-Wallis false-discovery rate controlled two sided (p-value ≤0.05)Conclusion:The primary endpoint of SRI-4 for FEN was not met despite evidence of strong BTK target and pathway inhibition. FEN had an acceptable safety profile. Several disease activity subgroups were suggestive of a greater treatment effect on SRI-4 compared to PBODisclosure of Interests:David Isenberg Consultant of: Study Investigator and Consultant to Genentech, Richard Furie Grant/research support from: AstraZeneca, Biogen, Consultant of: AstraZeneca, Biogen, Nicholas S. Jones Shareholder of: Genentech/Roche, Employee of: Genentech/Roche, Pascal Guibord Shareholder of: Roche, Employee of: Roche, Joshua Galanter Shareholder of: Genentech/Roche, Employee of: Genentech/Roche, Chin Lee Shareholder of: Genentech/Roche and Eli Lilly, Employee of: Genentech/Roche, Anna McGregor Employee of: Genentech/Roche, Balazs Toth Shareholder of: Genentech/Roche, Employee of: Genentech/Roche, Julie Rae Shareholder of: Genentech/Roche, Employee of: Genentech/Roche, Olivia Hwang Shareholder of: Genentech/Roche, Employee of: Genentech/Roche, Armend Lokku Shareholder of: Roche, Employee of: Roche, Pedro Miranda Consultant of: Study Investigator for Genentech, Viviane de Souza Consultant of: Study investigator for Genentech, Juan Jaller-Raad Consultant of: Study investigator for Genentech, Anna Maura Fernandes Consultant of: Study investigator for Genentech, Rodrigo Garcia Salinas Consultant of: Study investigator for Genentech, Leslie Chinn Shareholder of: Genentech/Roche, Employee of: Genentech/Roche, Michael J. Townsend Shareholder of: Genentech/Roche, Employee of: Genentech/Roche, Alyssa Morimoto Shareholder of: Genentech/Roche, Employee of: Genentech/Roche, Katie Tuckwell Shareholder of: Genentech/Roche, Employee of: Genentech/Roche
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Kitera N, Matsubara K, Fujioka C, Yokomachi K, Nishimaru E, Kiguchi M, Morimoto A, Ishifuro M, Awai K. [Organ-based Tube-current Modulation Applied on Different MDCT Scanners: Reduction in the Radiation Dose to the Eye Lens at Head CT]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2020; 76:366-374. [PMID: 32307364 DOI: 10.6009/jjrt.2020_jsrt_76.4.366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Organ-based tube current modulation (OB-TCM) techniques, which are provided by three vendors, reduces the radiation dose to the lens of the eyes by decreasing the tube current, when the X-ray tube passes over the anterior surface of critical organs. However, the characteristics of dose modulation of these techniques are different. The purpose of this study was to understand the performance characteristics of OB-TCM technique of each computed tomography (CT) vendor at head CT. METHODS We used three CT scanners (SOMATOM Definition Flash; Siemens Healthcare, Revolution CT; GE Healthcare, and Aquilion ONE Genesis Edition; Canon Medical Systems). We measured the radiation dose to the lens surface as evaluation of radiation dose reduction and measured the image noise as index of image quality. We measured the radiation dose rate in the air for analysis of the characteristics of dose modulation in each OB-TCM. RESULTS When applying OB-TCM, the radiation doses for the lens surface were decreased by 28%, 22%, and 25% for Siemens, GE, and Canon CT scanners, respectively, and the image noise level was increased by 5.6%, 8.5%, and 15.1% for Siemens, GE, and Canon CT scanners, respectively. The characteristics of dose modulation in each OB-TCM were also confirmed by measured the radiation dose rate. CONCLUSION We confirmed that each OB-TCM has different influence on image quality and radiation doses for lens surface, due to the different characteristics of dose modulation for each CT vendor.
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Affiliation(s)
- Nobuo Kitera
- Department of Radiology, Hiroshima University Hospital.,Graduate School of Medical Science, Kanazawa University
| | - Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | | | | | | | - Masao Kiguchi
- Department of Radiology, Hiroshima University Hospital
| | | | | | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Hospital
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Kawahara Y, Morimoto A, Oh Y, Furukawa R, Wakabayashi K, Monden Y, Osaka H, Yamagata T. Serum and cerebrospinal fluid cytokines in children with acute encephalopathy. Brain Dev 2020; 42:185-191. [PMID: 31787380 DOI: 10.1016/j.braindev.2019.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/24/2019] [Accepted: 11/08/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The pathogenesis of acute encephalopathy (AE) remains unclear, and a biomarker has not been identified. METHODS Levels of 49 cytokines and chemokines, including osteopontin (OPN), were measured in serum and cerebrospinal fluid (CSF) of children with AE (n = 17) or febrile convulsion (FC; n = 8; control group). The AE group included acute necrotizing encephalopathy (n = 1), acute encephalopathy with biphasic seizures and late reduced diffusion (AESD; n = 3), clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS; n = 4), and unclassified acute encephalopathy (UCAE; n = 9) that does not meet the criteria of syndrome classification. Five individuals with AE had neurological sequelae or death (poor prognosis), whereas 12 were alive without neurological sequelae (good prognosis). RESULTS The CSF:serum ratios of OPN, CC chemokine ligand (CCL)4, and interleukin (IL)-10 were significantly higher in AE than in FC. The CSF levels of macrophage inhibitory factor (MIF) and leukemia inhibitory factor (LIF) were significantly higher in the poor-prognosis group than in the good-prognosis group. The CSF:serum ratios of OPN were significantly higher in AESD and in MERS than in FC. The CSF:serum ratios of MIF and OPN were higher in MERS than in UCAE or FC. CONCLUSION Our results suggest that microglia-related cytokines and chemokines such as OPN, MIF, and LIF could be novel biomarkers of AE, in addition to the previously reported IL-10 and CCL4, and that MIF and LIF may be markers of poor prognosis.
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Affiliation(s)
- Yuta Kawahara
- Department of Pediatrics, Jichi Medical University School of Medicine, Japan.
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Japan
| | - Yukiko Oh
- Department of Pediatrics, Jichi Medical University School of Medicine, Japan
| | - Rieko Furukawa
- Department of Pediatric Medical Imaging, Jichi Medical University School of Medicine, Japan
| | - Kei Wakabayashi
- Department of Pediatrics, Jichi Medical University School of Medicine, Japan
| | - Yukifumi Monden
- Department of Pediatrics, Jichi Medical University School of Medicine, Japan; Department of Pediatrics, International University of Health and Welfare, Japan
| | - Hitoshi Osaka
- Department of Pediatrics, Jichi Medical University School of Medicine, Japan
| | - Takanori Yamagata
- Department of Pediatrics, Jichi Medical University School of Medicine, Japan
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Hoshino A, Takashima T, Yoshida K, Morimoto A, Kawahara Y, Yeh TW, Okano T, Yamashita M, Mitsuiki N, Imai K, Sakatani T, Nakazawa A, Okuno Y, Shiraishi Y, Chiba K, Tanaka H, Miyano S, Ogawa S, Kojima S, Morio T, Kanegane H. Dysregulation of Epstein-Barr Virus Infection in Hypomorphic ZAP70 Mutation. J Infect Dis 2019; 218:825-834. [PMID: 29684201 DOI: 10.1093/infdis/jiy231] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 04/17/2018] [Indexed: 12/17/2022] Open
Abstract
Background Some patients with genetic defects develop Epstein-Barr virus (EBV)-associated lymphoproliferative disorder (LPD)/lymphoma as the main feature. Hypomophic mutations can cause different clinical and laboratory manifestations from null mutations in the same genes. Methods We sought to describe the clinical and immunologic phenotype of a 21-month-old boy with EBV-associated LPD who was in good health until then. A genetic and immunologic analysis was performed. Results Whole-exome sequencing identified a novel compound heterozygous mutation of ZAP70 c.703-1G>A and c.1674G>A. A small amount of the normal transcript was observed. Unlike ZAP70 deficiency, which has been previously described as severe combined immunodeficiency with nonfunctional CD4+ T cells and absent CD8+ T cells, the patient had slightly low numbers of CD8+ T cells and a small amount of functional T cells. EBV-specific CD8+ T cells and invariant natural killer T (iNKT) cells were absent. The T-cell receptor repertoire, determined using next generation sequencing, was significantly restricted. Conclusions Our patient showed that a hypomorphic mutation of ZAP70 can lead to EBV-associated LPD and that EBV-specific CD8+ T cells and iNKT cells are critically involved in immune response against EBV infection.
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Affiliation(s)
- Akihiro Hoshino
- Department of Pediatrics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan.,Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Takehiro Takashima
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Kenichi Yoshida
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University of Medicine, Shimotsuke, Japan
| | - Yuta Kawahara
- Department of Pediatrics, Jichi Medical University of Medicine, Shimotsuke, Japan
| | - Tzu-Wen Yeh
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Tsubasa Okano
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Motoi Yamashita
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Noriko Mitsuiki
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Kohsuke Imai
- Department of Community Pediatrics, Perinatal and Maternal Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Takashi Sakatani
- Department of Diagnostic Pathology, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Atsuko Nakazawa
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Yusuke Okuno
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | - Yuichi Shiraishi
- Laboratory of DNA Information Analysis, The University of Tokyo, Japan
| | - Kenichi Chiba
- Laboratory of DNA Information Analysis, The University of Tokyo, Japan
| | - Hiroko Tanaka
- Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Japan
| | - Satoru Miyano
- Laboratory of DNA Information Analysis, The University of Tokyo, Japan.,Laboratory of Sequence Analysis, Human Genome Center, Institute of Medical Science, The University of Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Graduate School of Medicine, Kyoto University, Japan
| | - Seiji Kojima
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Hirokazu Kanegane
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
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Hayase T, Ikeda T, Yoshimoto T, Imai K, Morimoto A. Fatal idiopathic pneumonia syndrome in Artemis deficiency. Pediatr Int 2019; 61:929-931. [PMID: 31393046 DOI: 10.1111/ped.13951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 04/09/2019] [Accepted: 05/15/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Tomomi Hayase
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takahiro Ikeda
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Taichiro Yoshimoto
- Department of Integrative Pathology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kohsuke Imai
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Iguchi A, Cho Y, Yabe H, Kato S, Kato K, Hara J, Koh K, Takita J, Ishihara T, Inoue M, Imai K, Nakayama H, Hashii Y, Morimoto A, Atsuta Y, Morio T. Long-term outcome and chimerism in patients with Wiskott-Aldrich syndrome treated by hematopoietic cell transplantation: a retrospective nationwide survey. Int J Hematol 2019; 110:364-369. [PMID: 31187438 DOI: 10.1007/s12185-019-02686-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
We analyzed the outcomes of allogeneic stem cell transplantation (SCT) and risk factors for chimerism in 108 patients with Wiskott-Aldrich syndrome (WAS) who were registered with The Japan Society for Hematopoietic Cell Transplantation between January 1985 and December 2016. A preparative conditioning regimen consisting of myeloablative conditioning (MAC) was provided to 76 patients, and reduced-intensity conditioning was provided to 30 patients. Fifty-one patients received prophylaxis against graft-versus-host disease (GVHD) with cyclosporine, and 51 patients received tacrolimus (Tac). Chimerism analyses had been performed in 91 patients. Neutrophil engraftment was achieved in 91 patients (84.3%). The engraftment rate was significantly higher in patients who received Tac for GVHD prophylaxis (p = 0.028). Overall survival rate (OS) was significantly higher in patients with complete chimerism than in patients with mixed chimerism (88.2 ± 6.1% and 66.7 ± 9.9%, respectively, p = 0.003). Multivariate analysis showed that the rate of complete chimerism in patients who received MAC including cyclophosphamide (CY) at a dose of 200 mg/kg was significantly higher (p = 0.021) than that in patients who received other conditioning. Thus, MAC including CY at a dose of 200 mg/kg and Tac for GVHD prophylaxis were optimal conditions of SCT for patients with WAS under existing study.
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Affiliation(s)
- Akihiro Iguchi
- Department of Pediatrics, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8638, Japan.
| | - Yuko Cho
- Department of Pediatrics, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiromasa Yabe
- Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Tokyo, Japan
| | - Shunichi Kato
- Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Tokyo, Japan
| | - Koji Kato
- Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Junichi Hara
- Department of Pediatric Hematology/Oncology, Osaka City General Hospital, Osaka, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Junko Takita
- Department of Cell Therapy and Transplantation Medicine (Pediatrics), The University of Tokyo Hospital, Tokyo, Japan
| | - Takashi Ishihara
- Department of Pediatrics, Nara Medical University Hospital, Nara, Japan
| | - Masami Inoue
- Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
| | - Kohsuke Imai
- Department of Pediatrics, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideki Nakayama
- Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan
| | - Yoshiko Hashii
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Morimoto
- Children's Medical Center Tochigi, Jichi Medical University, Shimotsuke, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomohiro Morio
- Department of Pediatrics, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
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Oh Y, Hayase T, Ito T, Kawahara Y, Morimoto A. Cladribine-related myelodysplastic syndrome in Langerhans cell histiocytosis. Pediatr Int 2019; 61:419-421. [PMID: 30993805 DOI: 10.1111/ped.13792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/07/2018] [Accepted: 01/31/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Yukiko Oh
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Tomomi Hayase
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Takane Ito
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Yuta Kawahara
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
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Yanagaisawa R, Matsuda K, Ohga S, Kanegane H, Morimoto A, Okamoto Y, Ohara A, Fukushima K, Sotomatsu M, Nomura K, Saito AM, Horibe K, Ishii E, Nakazawa Y. Factors predicting the recurrence of Epstein–Barr virus-associated hemophagocytic lymphohistiocytosis in children after treatment using the HLH-2004 protocol. Int J Hematol 2019; 109:612-617. [DOI: 10.1007/s12185-019-02612-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 12/13/2022]
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Sakamoto K, Morimoto A, Shioda Y, Imamura T, Imashuku S. Central diabetes insipidus in pediatric patients with Langerhans cell histiocytosis: Results from the JLSG-96/02 studies. Pediatr Blood Cancer 2019; 66:e27454. [PMID: 30207064 DOI: 10.1002/pbc.27454] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE We analyzed central diabetes insipidus (CDI) development in pediatric patients with Langerhans cell histiocytosis (LCH) treated according to the Japan LCH Study Group (JLSG) regimen, which is the combination chemotherapy including cytarabine (Ara-C). METHODS Retrospective data from 317 patients (multisystem disease (MS), n = 206; multiple focal bone (MFB), n = 111) treated according to the JLSG-96/02 regimens were analyzed. RESULTS The median follow-up duration was 10.6 years (range, 0.1-21.1). A total of 50/317 (15.8%) patients developed CDI (MFB, n = 4; MS, n = 46). Of the 50 cases, CDI was already present at the time of LCH diagnosis (pre-CDI) in 25, and it newly developed after the diagnosis and initiation of treatment (post-CDI) in the other 25 cases. The cumulative incidence of post-CDI at 10-year calculated by Kaplan-Meier analysis was 9.0% for total and 12.0% for MS patients. A positive correlation with LCH lesions at the CNS risk sites at diagnosis was found in pre-CDI cases (17/164 vs 8/171; P = 0.0359), but not in post-CDI cases (14/129 vs 11/163; P = 0.254). Multivariate analysis showed that relapse at the CNS risk sites was significantly associated with post-CDI development (hazard ratio: 4.70; 95% CI, 1.29-17.1, P < 0.05). CONCLUSIONS In the JLSG-96/02 studies, CDI developed in 15.8% of the cohort in which half as pre- and the other half as post-CDI. Relapse, particularly at the CNS risk sites, was linked with the development of post-CDI.
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Affiliation(s)
- Kenichi Sakamoto
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinsaku Imashuku
- Division of Laboratory Medicine, Uji-Tokushukai Medical Center, Uji, Japan
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- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Yanagisawa R, Nakazawa Y, Matsuda K, Yasumi T, Kanegane H, Ohga S, Morimoto A, Hashii Y, Imaizumi M, Okamoto Y, Saito AM, Horibe K, Ishii E. Outcomes in children with hemophagocytic lymphohistiocytosis treated using HLH-2004 protocol in Japan. Int J Hematol 2018; 109:206-213. [PMID: 30535855 DOI: 10.1007/s12185-018-02572-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/12/2022]
Abstract
Recent advances in intensive chemo- and immunotherapy have contributed to the outcome of hemophagocytic lymphohistiocytosis (HLH); however, the prognosis of HLH in children differs by HLH subtype. In Japan, secondary HLH, particularly Epstein-Barr virus-associated HLH (EBV-HLH), is the most common HLH subtype. The prognosis of HLH has improved in recent years. We here conducted a prospective study of 73 patients who were treated with HLH-2004 protocol in Japan. EBV-HLH, familial HLH (FHL), and HLH of unknown etiology were seen in 41, 9, and 23 patients, respectively. Patients with resistant or relapsed disease after HLH-2004 treatment and those with FHL received hematopoietic stem cell transplantation (HSCT). The induction rate after initial therapy was 58.9%, and the 3-year overall survival (OS) rate of all patients was 73.9% and differed significantly among those with EBV-HLH, FHL, and HLH of unknown etiology. Of the 17 patients who received HSCT, the 3-year OS rates of those with and without complete resolution before HSCT were 83.3% and 54.5%, respectively. Outcomes in children with HLH who were treated with the same protocol differed among HLH subtypes. Appropriate strategy for each subtype should be established in future studies.
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Affiliation(s)
- Ryu Yanagisawa
- Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan
- Department of Pediatrics, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yozo Nakazawa
- Department of Pediatrics, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Kazuyuki Matsuda
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Takahiro Yasumi
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirokazu Kanegane
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yoshiko Hashii
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masue Imaizumi
- Department of Hematology and Oncology, Miyagi Children's Hospital, Sendai, Japan
| | - Yasuhiro Okamoto
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akiko M Saito
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Keizo Horibe
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Eiichi Ishii
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Japan
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Hayase T, Matsubara D, Maeda K, Aihara T, Morimoto A. Pediatric ovarian dysgerminoma with highly elevated serum neuron-specific enolase. Pediatr Int 2018; 60:982-983. [PMID: 30345703 DOI: 10.1111/ped.13676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/19/2018] [Accepted: 08/07/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Tomomi Hayase
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Daisuke Matsubara
- Department of Diagnostic Pathology, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Kosaku Maeda
- Department of Pediatric Surgery, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Toshinori Aihara
- Department of Pediatric Medical Imaging, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
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Murakami I, Wada N, Nakashima J, Iguchi M, Toi M, Hashida Y, Higuchi T, Daibata M, Matsushita M, Iwasaki T, Kuwamoto S, Horie Y, Nagata K, Hayashi K, Oka T, Yoshino T, Imamura T, Morimoto A, Imashuku S, Gogusev J, Jaubert F. Merkel cell polyomavirus and Langerhans cell neoplasm. Cell Commun Signal 2018; 16:49. [PMID: 30134914 PMCID: PMC6103986 DOI: 10.1186/s12964-018-0261-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The relationship between various external agents such as pollen, food, and infectious agents and human sensitivity exists and is variable depending upon individual's health conditions. For example, we believe that the pathogenetic potential of the Merkel cell polyomavirus (MCPyV), the resident virus in skin, is variable and depends from the degree of individual's reactivity. MCPyV as well as Epstein-Barr virus, which are normally connected with humans under the form of subclinical infection, are thought to be involved at various degrees in several neoplastic and inflammatory diseases. In this review, we cover two types of Langerhans cell neoplasms, the Langerhans cell sarcoma (LCS) and Langerhans cell histiocytosis (LCH), represented as either neoplastic or inflammatory diseases caused by MCPyV. METHODS We meta-analyzed both our previous analyses, composed of quantitative PCR for MCPyV-DNA, proteomics, immunohistochemistry which construct IL-17 endocrine model and interleukin-1 (IL-1) activation loop model, and other groups' data. RESULTS We have shown that there were subgroups associated with the MCPyV as a causal agent in these two different neoplasms. Comparatively, LCS, distinct from the LCH, is a neoplastic lesion (or sarcoma) without presence of inflammatory granuloma frequently observed in the elderly. LCH is a proliferative disease of Langerhans-like abnormal cells which carry mutations of genes involved in the RAS/MAPK signaling pathway. We found that MCPyV may be involved in the development of LCH. CONCLUSION We hypothesized that a subgroup of LCS developed according the same mechanism involved in Merkel cell carcinoma pathogenesis. We proposed LCH developed from an inflammatory process that was sustained due to gene mutations. We hypothesized that MCPyV infection triggered an IL-1 activation loop that lies beneath the pathogenesis of LCH and propose a new triple-factor model.
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Affiliation(s)
- Ichiro Murakami
- Department of Pathology, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
- Department of Pathology, Kochi University Hospital, 185-1 Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Noriko Wada
- Department of Pathology, Kochi University Hospital, 185-1 Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Junko Nakashima
- Department of Pathology, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
- Department of Pathology, Kochi University Hospital, 185-1 Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Mitsuko Iguchi
- Department of Pathology, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
- Department of Pathology, Kochi University Hospital, 185-1 Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Makoto Toi
- Department of Pathology, Kochi University Hospital, 185-1 Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Yumiko Hashida
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Tomonori Higuchi
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Masanori Daibata
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kohasu, Okoh, Nankoku, Kochi 783-8505 Japan
| | - Michiko Matsushita
- Department of Pathobiological Science and Technology, School of Health Science, Faculty of Medicine, Tottori University, 86 Nishi, Yonago, Tottori, 683-8503 Japan
| | - Takeshi Iwasaki
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582 Japan
| | - Satoshi Kuwamoto
- Department of Pathology, Tottori University Hospital, 86 Nishi, Yonago, Tottori, 683-8503 Japan
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi, Yonago, Tottori, 683-8503 Japan
| | - Yasushi Horie
- Department of Pathology, Tottori University Hospital, 86 Nishi, Yonago, Tottori, 683-8503 Japan
| | - Keiko Nagata
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi, Yonago, Tottori, 683-8503 Japan
| | - Kazuhiko Hayashi
- Division of Molecular Pathology, Faculty of Medicine, Tottori University, 86 Nishi, Yonago, Tottori, 683-8503 Japan
| | - Takashi Oka
- Department of Virology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Kita-ku, Okayama, Okayama 700-8558 Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata, Kita-ku, Okayama, Okayama 700-8558 Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Kyoto 602-8566 Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Shinsaku Imashuku
- Division of Laboratory Medicine, Uji-Tokushukai Medical Center, 145 Ishibashi, Makishima, Uji, Kyoto, 611-0041 Japan
| | - Jean Gogusev
- Inserm U507 and U1016, Institut Cochin, 75014 Paris, France
| | - Francis Jaubert
- AP-HP Hôpital Necker-Enfants Malades, University Paris Descartes (Paris 5), 75006 Paris, France
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Ishida H, Imamura T, Morimoto A, Fujiwara T, Harigae H. Five-aminolevulinic acid: New approach for congenital sideroblastic anemia. Pediatr Int 2018; 60:496-497. [PMID: 29878633 DOI: 10.1111/ped.13558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/02/2018] [Accepted: 03/09/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Hiroyuki Ishida
- Department of Pediatrics, Kyoto City Hospital, Kyoto, Japan.,Department of Pediatrics, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akira Morimoto
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Tohru Fujiwara
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideo Harigae
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Tanaka T, Yoshioka K, Nishikomori R, Sakai H, Abe J, Yamashita Y, Hiramoto R, Morimoto A, Ishii E, Arakawa H, Kaneko U, Ohshima Y, Okamoto N, Ohara O, Hata I, Shigematsu Y, Kawai T, Yasumi T, Heike T. National survey of Japanese patients with mevalonate kinase deficiency reveals distinctive genetic and clinical characteristics. Mod Rheumatol 2018; 29:181-187. [PMID: 29451047 DOI: 10.1080/14397595.2018.1442639] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Mevalonate kinase deficiency (MKD), a rare autosomal recessive autoinflammatory syndrome, is caused by disease-causing variants of the mevalonate kinase (MVK) gene. A national survey was undertaken to investigate clinical and genetic features of MKD patients in Japan. METHODS The survey identified ten patients with MKD. Clinical information and laboratory data were collected from medical records and by direct interviews with patients, their families, and their attending physicians. Genetic analysis and measurement of MVK activity and urinary excretion of mevalonic acid were performed. RESULTS None of the 10 patients harbored MVK disease-causing variants that are common in European patients. However, overall symptoms were in line with previous European reports. Continuous fever was observed in half of the patients. Elevated transaminase was observed in four of the 10 patients, two of whom fulfilled the diagnostic criteria for hemophagocytic lymphohistiocytosis. About half of the patients responded to temporary administration of glucocorticoids and NSAIDs; the others required biologics such as anti-IL-1 drugs. CONCLUSION This is the first national survey of MKD patients in a non-European country. Although clinical symptoms were similar to those reported in Europe, the incidence of continuous fever and elevated transaminase was higher, probably due to differences in disease-causing variants.
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Affiliation(s)
- Takayuki Tanaka
- a Department of Pediatrics , Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Kohei Yoshioka
- a Department of Pediatrics , Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Ryuta Nishikomori
- a Department of Pediatrics , Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Hidemasa Sakai
- a Department of Pediatrics , Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Junya Abe
- a Department of Pediatrics , Kyoto University Graduate School of Medicine , Kyoto , Japan.,b Department of Pediatrics , Kitano Hospital, Tazuke Kofukai Medical Research Institute , Osaka , Japan
| | - Yuriko Yamashita
- c Department of Pediatrics , Matsudo City General Hospital Children's Medical Centre , Matsudo , Japan
| | - Ryugo Hiramoto
- c Department of Pediatrics , Matsudo City General Hospital Children's Medical Centre , Matsudo , Japan
| | - Akira Morimoto
- d Department of Pediatrics , Jichi Medical University of School of Medicine , Shimotsuke , Japan
| | - Eiichi Ishii
- e Department of Pediatrics , Ehime University Graduate School of Medicine , Toon , Japan
| | - Hirokazu Arakawa
- f Department of Pediatrics , Gumma University Graduate School of Medicine , Maebashi , Japan
| | - Utako Kaneko
- g Department of Pediatrics , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Yusei Ohshima
- h Department of Pediatrics, Faculty of Medical Sciences , University of Fukui , Fukui , Japan
| | - Nami Okamoto
- i Department of Pediatrics , Osaka Medical College , Takatsuki , Japan
| | - Osamu Ohara
- j Department of Technology, Kazusa DNA Research Institute , Chiba , Japan
| | - Ikue Hata
- h Department of Pediatrics, Faculty of Medical Sciences , University of Fukui , Fukui , Japan
| | - Yosuke Shigematsu
- h Department of Pediatrics, Faculty of Medical Sciences , University of Fukui , Fukui , Japan
| | - Tomoki Kawai
- a Department of Pediatrics , Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Takahiro Yasumi
- a Department of Pediatrics , Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Toshio Heike
- a Department of Pediatrics , Kyoto University Graduate School of Medicine , Kyoto , Japan
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Kaneko T, Sasaki S, Baba N, Koh K, Matsui K, Ohjimi H, Hayashi N, Nakano A, Ohki K, Kuwano Y, Morimoto A, Tamaki Z, Kakazu M, Kishi K, Oyama T, Sato A, Kato R, Higuchi T. Efficacy and safety of oral propranolol for infantile hemangioma in Japan. Pediatr Int 2017; 59:869-877. [PMID: 28453894 DOI: 10.1111/ped.13318] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/06/2017] [Accepted: 04/26/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND There have been few reports on the efficacy and safety of oral propranolol at 3 mg/kg/day for infantile hemangioma (IH) in Japanese patients. METHODS A multicenter, open-label phase III study was conducted to evaluate the efficacy and safety of oral propranolol solution in Japanese infants aged 35-150 days with proliferating IH. Thirty-two patients were enrolled in the study, received propranolol solution for 24 weeks at 3 mg/kg/day, and completed the study. RESULTS The success rate (complete or nearly complete resolution) at week 24 (primary endpoint) was 78% (95%CI: 60-91%). The improvement rate since the previous visit was 100% (32/32) after week 5. Overall, the IH surface area, maximum diameter, and color intensity all decreased over time. Consistency in assessment between the centralized and the investigator on-site assessments was observed in 26 patients. Of the 32 patients, 11 needed further treatment other than the study drug. The incidence of adverse events (AE) and drug-related AE was 97% and 31%, respectively. AE that occurred in ≥two patients were either typical of propranolol use (such as blood pressure decrease) or common events in infants. AE that resulted in dose reduction were observed in two patients, but no serious AE or AE that led to study drug discontinuation were observed. CONCLUSION Oral propranolol solution at 3 mg/kg/day is effective and safe in Japanese IH patients.
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Affiliation(s)
- Tsuyoshi Kaneko
- Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Satoru Sasaki
- Center for Vascular Anomalies, KKR Tonan Hospital, Hokkaido, Japan
| | - Naoko Baba
- Department of Dermatology, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Kiyoshi Matsui
- Department of General Medicine, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Hiroyuki Ohjimi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Atsuko Nakano
- Division of Otorhinolaryngology, Chiba Children's Hospital, Chiba, Japan
| | - Kentaro Ohki
- Department of Hematology and Oncology, Gunma Children's Medical Center, Gunma, Japan
| | | | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Zenshiro Tamaki
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Mariko Kakazu
- Department of Hematology and Oncology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomoki Oyama
- Department of Plastic Surgery, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Atsushi Sato
- Department of Hematology and Oncology, Miyagi Children's Hospital, Miyagi, Japan
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Morimoto A, Oh Y, Nakamura S, Shioda Y, Hayase T, Imamura T, Kudo K, Imashuku S. Inflammatory serum cytokines and chemokines increase associated with the disease extent in pediatric Langerhans cell histiocytosis. Cytokine 2017; 97:73-79. [PMID: 28582647 DOI: 10.1016/j.cyto.2017.05.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 05/23/2017] [Accepted: 05/27/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Langerhans cell histiocytosis (LCH) is characterized by immature dendritic cell proliferation, infiltration of LCH lesions by various inflammatory cells, and a lesional cytokine storm. It is classified into three groups on the basis of disease extent, namely, multisystem with risk-organ involvement (MS+), multisystem without risk-organ involvement (MS-), and single-system (SS) disease. We comprehensively analyzed whether serum levels of cytokines/chemokines reflect the disease extent. METHODS Serum samples from 52 children with LCH (eight, 25, and 19 with MS+, MS-, and SS, respectively) and 34 control children were analyzed quantitatively for 48 humoral factors. DNA samples extracted from biopsied LCH lesions from 12 patients were tested for BRAF V600E status. RESULTS The LCH patients had significantly higher serum levels of IL-1Ra, IL-3, IL-6, IL-8, IL-9, IL-10, IL12, IL-13, IL-15, IL-17, IL-18, TNF-α, G-CSF, M-CSF, MIF, HGF, VEGF, CCL2, CCL3, CCL7, CXCL1, and CXCL9 than the controls by univariate analysis. Of these IL-9, IL-15 and MIF were significant by multivariate analysis; but not differed between MS and SS diseases. MS disease associated with significantly higher IL-2R, IL-3, IL-8, IL-18, M-CSF, HGF, CCL2, CXCL1, and CXCL9 levels than SS disease by univariate analysis. Of these, CCL2 and M-CSF were significant by multivariate analysis. IL-18 levels were significantly higher in MS+ disease than MS- disease. The LCH patients with BRAF V600E mutation had higher serum levels of CCL7. CONCLUSION Numerous inflammatory cytokines and chemokines play a role in LCH. Of those, more specific ones reflect the disease extent (MS vs. SS and MS+ vs. MS-) or the BRAF V600E mutation status. It is thought that the most responsible cytokines and chemokines involved in the poor outcome may become future candidate therapeutic targets in LCH.
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Affiliation(s)
- Akira Morimoto
- Department of Pediatrics, Jichi Medical University, School of Medicine, Shimotsuke, Japan.
| | - Yukiko Oh
- Department of Pediatrics, Jichi Medical University, School of Medicine, Shimotsuke, Japan
| | - Sachie Nakamura
- Department of Pediatrics, Jichi Medical University, School of Medicine, Shimotsuke, Japan
| | - Yoko Shioda
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tomomi Hayase
- Department of Pediatrics, Jichi Medical University, School of Medicine, Shimotsuke, Japan
| | - Toshihiko Imamura
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuko Kudo
- Department of Pediatrics, Fujita Health University, Toyoake, Japan
| | - Shinsaku Imashuku
- Division of Laboratory Medicine, Uji-Tokushukai Medical Center, Uji, Japan
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Kawahara Y, Nijima H, Suzuki Y, Furukawa R, Morimoto A. Successful use of propranolol for congenital hepatic hemangioma with Kasabach-Merritt phenomenon. Pediatr Int 2017; 59:634-636. [PMID: 28402071 DOI: 10.1111/ped.13244] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 01/16/2017] [Accepted: 01/19/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Yuta Kawahara
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Hitomi Nijima
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Yume Suzuki
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Rieko Furukawa
- Department of Pediatric Medical Imaging, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan
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Nishikawa E, Yagasaki H, Hama A, Yabe H, Ohara A, Kosaka Y, Kudo K, Kobayashi R, Ohga S, Morimoto A, Watanabe KI, Yoshida N, Muramatsu H, Takahashi Y, Kojima S. Long-term outcomes of 95 children with moderate aplastic anemia treated with horse antithymocyte globulin and cyclosporine. Pediatr Blood Cancer 2017; 64. [PMID: 27808465 DOI: 10.1002/pbc.26305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 08/24/2016] [Accepted: 09/12/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Currently, the standard management of moderate aplastic anemia (MAA) has not been well described, although the superiority of the combination of antithymocyte globulin (ATG) and cyclosporine (CyA) over CyA alone has been demonstrated in terms of hematological responses and failure-free survival (FFS). PROCEDURE We adopted this therapeutic strategy and treated 95 children with MAA who were enrolled in two consecutive prospective studies between October 1992 and August 2009. RESULTS For these patients, the 6-month response rate was 54.7% (complete response, 13.7%; partial response, 41.1%). There were no statistically significant differences in the overall response rates between the transfusion-dependent (48.8%, n = 41) and transfusion-independent groups (59.3%, n = 54; P = 0.4). Treatment failure was defined as the requirement of salvage treatment, and was observed in 52 patients. The 10-year FFS was 44.0% (95% confidence interval [CI], 32.9%-54.6%). Of the 22 patients who underwent a second immunosuppressive therapy (IST), 12 responded. Forty patients underwent hematopoietic stem cell transplantation as second- or third-line therapy and three died of complications. Consequently, the 10-year overall survival rate was 96.0% (95% CI, 88.0%-98.7%) with a median follow-up period of 103 months (range, 29-221 months). CONCLUSIONS Although current guidelines recommend only observation for patients with transfusion-independent MAA, the results of our study justify early intervention with ATG and CyA in those patients. A prospective randomized trial is warranted to clarify the risks and benefits of early intervention with IST and observation alone until progression to severe AA in patients with MAA.
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Affiliation(s)
- Eri Nishikawa
- School of Medicine, Nihon University, Itabashi, Japan.,Graduate School of Medicine, Nagoya University, Japan
| | | | - Asahito Hama
- Graduate School of Medicine, Nagoya University, Japan
| | - Hiromasa Yabe
- School of Medicine, Tokai University, Isehara, Japan
| | - Akira Ohara
- School of Medicine, Toho University, Ohta, Japan
| | | | - Kazuko Kudo
- School of Medicine, Fujita Health University, Aichi, Japan
| | | | - Shouichi Ohga
- Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Akira Morimoto
- School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | | | - Nao Yoshida
- Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | | | | | - Seiji Kojima
- Graduate School of Medicine, Nagoya University, Japan
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Adachi A, Komine M, Murata S, Tsuda H, Kawahara Y, Morimoto A, Ohtsuki M. Pediatric case of microscopic polyangiitis with skin manifestations resembling vesiculobullous type erythema elevatum diutinum with immunoglobulin A antineutrophil cytoplasmic antibody. J Dermatol 2016; 43:1377-1378. [DOI: 10.1111/1346-8138.13394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Akimasa Adachi
- Department of Dermatology; Jichi Medical University; Tochigi Japan
| | - Mayumi Komine
- Department of Dermatology; Jichi Medical University; Tochigi Japan
| | - Satoru Murata
- Department of Dermatology; Jichi Medical University; Tochigi Japan
| | - Hidetoshi Tsuda
- Department of Dermatology; Jichi Medical University; Tochigi Japan
| | - Yuta Kawahara
- Department of Pediatrics; Jichi Medical University; Tochigi Japan
| | - Akira Morimoto
- Department of Pediatrics; Jichi Medical University; Tochigi Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology; Jichi Medical University; Tochigi Japan
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Morimoto A, Nakazawa Y, Ishii E. Hemophagocytic lymphohistiocytosis: Pathogenesis, diagnosis, and management. Pediatr Int 2016; 58:817-25. [PMID: 27289085 DOI: 10.1111/ped.13064] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/03/2016] [Accepted: 06/09/2016] [Indexed: 12/14/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that is classified into primary and secondary HLH. Primary HLH consists of monogenic disorders that mainly affect the perforin-mediated cytotoxicity of cytotoxic T lymphocytes and natural killer cells. Secondary HLH occurs as a complication in various settings such as infection, malignancy, autoimmune disease, and post-allogeneic hematopoietic stem cell transplantation. Both primary and secondary HLH are characterized by uncontrolled hypercytokinemia that results in myelosuppression and vascular endothelium damage. More than 10% of patients with HLH die within 2 months of diagnosis due to bleeding in the visceral organs, opportunistic infection due to neutropenia, or multiple organ failure. The most obvious presentations of HLH are persistent fever refractory to antimicrobial agents and hyperferritinemia due to hypersecretion of various cytokines. The first rule is not to overlook signs of hypercytokinemia and to settle the hyperactivated immunological state as soon as possible. In addition, to improve outcome, it is essential to identify the disorders underlying HLH and provide disorder-appropriate treatment.
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Affiliation(s)
- Akira Morimoto
- Department of Pediatrics, Jichi Medical University of Medicine, Shimotsuke, Tochigi, Japan.
| | - Yozo Nakazawa
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Eiichi Ishii
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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Hayase T, Niijima H, Tanaka D, Wada S, Kawahara Y, Oh Y, Morimoto A. Successful allogeneic bone marrow transplantation with reduced intensity conditioning regimen for a pediatric relapsed ALK positive anaplastic large cell lymphoma. Rinsho Ketsueki 2016; 57:859-63. [PMID: 27498729 DOI: 10.11406/rinketsu.57.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pediatric anaplastic large cell lymphoma (ALCL) is a chemosensitive malignancy, but about 30% of patients experience relapse. In most of these patients, a second complete remission is obtainable with salvage chemotherapy, though relapse free survival rates are as low as 30-60%. Herein, we report a 6-year-old boy with relapsed anaplastic lymphoma kinase (ALK) positive ALCL successfully treated with vinblastine monotherapy followed by allogeneic hematopoietic stem cell transplantation (allo-HSCT), with a reduced intensity conditioning (RIC) regimen, from his father. One HLA locus from the father was mismatched. The boy had neither severe graft-versus-host disease nor transplantation related complications. He is currently well and has remained disease free for 10 months, to date, since transplantation. Allo-HSCT with a RIC regimen may be a promising treatment strategy for relapsed ALK positive ALCL based on obtaining graft-versus lymphoma effects as well as reducing transplantation-related mortality.
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