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Mizutani H, Ushida T, Ozeki K, Tano S, Iitani Y, Imai K, Nishiwaki K, Kajiyama H, Kotani T. Predictive performance of Shock Index for postpartum hemorrhage during cesarean delivery. Int J Obstet Anesth 2024; 58:103957. [PMID: 38071128 DOI: 10.1016/j.ijoa.2023.103957] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 10/05/2023] [Accepted: 11/15/2023] [Indexed: 05/07/2024]
Abstract
BACKGROUND The Shock Index (SI), defined as heart rate divided by systolic blood pressure, is reportedly an early surrogate indicator for postpartum hemorrhage (PPH). However, most previous studies have used clinical data of women who delivered vaginally. Therefore, we aimed to evaluate the SI pattern during cesarean delivery and determine its usefulness in detecting PPH. METHODS This was a single-center retrospective study using the clinical data of women (n = 331) who underwent cesarean delivery under spinal anesthesia at term between 2018 and 2021. We assessed the SI pattern stratified by total blood loss and evaluated the predictive performance of each vital sign in detecting PPH (total blood loss ≥1000 mL) based on the area under the receiver operating characteristic curve (AUROC). RESULTS At 10-15 min after delivery, the mean SI peaked between 0.84 and 0.90 and then decreased to a level between 0.72 and 0.77, which was similar to that upon entering the operating room. Among 331 women, 91 (27.5%) were diagnosed with PPH. There was no correlation between SI and total blood loss (rs = 0.02). The SI had low ability to detect PPH (AUROC 0.54, 95% confidence interval 0.47 to 0.61), which was similar to other vital signs (AUROCs 0.53-0.56). CONCLUSION We determined the pattern of SI during cesarean delivery. We found no correlation between SI and total blood loss. Unlike in vaginal delivery, the prognostic accuracy of SI for PPH detection in cesarean delivery was low.
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Affiliation(s)
- H Mizutani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
| | - K Ozeki
- Department of Anesthesia, Montreal Children's Hospital, Montreal, Canada; Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Tano
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Y Iitani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Nishiwaki
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - H Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Reproduction and Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
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2
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Suzuki K, Gunji T, Kawashima M, Uryu H, Nagao R, Momoki M, Yokoyama H, Ishii H, Tanoue S, Saito T, Nishiwaki K, Yano S. Contribution of post-transplantation therapy to sustained MRD negativity in multiple myeloma: a retrospective analysis. Int J Hematol 2024; 119:39-49. [PMID: 38103160 DOI: 10.1007/s12185-023-03682-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023]
Abstract
Post-transplantation therapy is commonly performed in patients with myeloma and can prolong progression-free survival (PFS). However, whether post-transplantation therapy contributes to achieving and continuing MRD-negativity remains controversial. This retrospective analysis aimed to evaluate the clinical impact of post-transplantation therapy, including tandem autologous stem cell transplantation (ASCT), in myeloma patients. The subjects were 79 patients (median age: 62 years) who received induction therapy, including bortezomib and/or lenalidomide, of whom 58 underwent post-transplantation therapy. At the median follow-up time of 50 months, the 4-year PFS rate was significantly higher in patients who underwent post-transplantation therapy than those who did not (60.6% vs. 28.6%, P = 0.012). Multivariate analysis revealed post-transplantation therapy to be a significant prognostic factor for long PFS. Tandem ASCT followed by consolidation and/or maintenance therapies improved PFS and OS. The minimal residual disease (MRD)-negative rate was significantly higher in patients who underwent post-transplantation therapy than those who did not (50.9% vs. 16.7%, P = 0.006). Post-transplantation therapy contributed to sustained MRD-negativity, which predicted long PFS and overall survival. Patients frequently discontinued post-transplantation therapy due to adverse events within 4 months. In conclusion, post-transplantation therapy improved PFS and contributed to sustained MRD-negativity in myeloma patients.
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Affiliation(s)
- Kazuhito Suzuki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan.
| | - Tadahiro Gunji
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Daisan Hospital, Komoe, Japan
| | - Masaharu Kawashima
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Hideki Uryu
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Daisan Hospital, Komoe, Japan
| | - Riku Nagao
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Mamiko Momoki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Hiroki Yokoyama
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Hiroto Ishii
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Susumu Tanoue
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Takeshi Saito
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan
| | - Kaichi Nishiwaki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Shingo Yano
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan
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3
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Suzuki K, Shimazu Y, Minakata D, Ikeda T, Takahashi H, Tsukada N, Kanda Y, Doki N, Nishiwaki K, Miwa A, Sawa M, Kataoka K, Hiramoto N, Ota S, Itagaki M, Ichinohe T, Atsuta Y, Yano S, Kawamura K. Efficacy of Autologous Stem Cell Transplantation for Myeloma Patients with Suboptimal Response: A Multicenter Retrospective Analysis. Transplant Cell Ther 2023; 29:688.e1-688.e13. [PMID: 37574125 DOI: 10.1016/j.jtct.2023.08.006] [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] [Received: 05/20/2023] [Revised: 07/20/2023] [Accepted: 08/06/2023] [Indexed: 08/15/2023]
Abstract
Autologous stem cell transplantation (ASCT) is the standard of care for myeloma patients who achieve partial response (PR) or better after induction therapy. However, its clinical significance in patients with suboptimal response (SR) before ASCT, including stable disease (SD) and progressive disease (PD), has not been established. Additionally, functional high-risk, including SR and early PD within 12 months, was a poor prognostic factor up to now. This study aimed to evaluate the efficacy of ASCT in myeloma patients with SR in the novel agent era. This multicenter retrospective study was conducted using the Transplant Registry Unified Management Program database of the Japanese Society of Transplantation and Cellular Therapy and included 3898 transplantation-eligible patients with newly diagnosed multiple myeloma who underwent ASCT between 2007 and 2020 and were followed up until 2021. The SR rate was 4.7%, including 1.7% with PD. In survival time analysis for overall cases, a significant difference in PFS between the very good partial response (VGPR) and PR groups was observed, whereas there was no significant difference in overall survival (OS) between the VGPR and PR groups. Additionally, there was no significant difference in OS or PFS between the PR and SD groups. Therefore, we focused on the PR, SD, and PD groups, as the purpose of this retrospective study was to investigate the clinical significance of ASCT in patients with SR compared with those with PR. The median patient age was 60 years (range, 30 to 77 years). In total, 1605 (97.4%) patients received bortezomib, 561 (38.2%) received an immunomodulatory drug (ImiD), and 512 (34.9%) received both bortezomib and an ImiD. A total of 558 patients (38.0%) received reinduction therapy. There were 229 patients (37.7%) with high-risk cytogenetics (HRCA). With a median follow-up of 31.7 months, there was a significant difference in 30-month OS rates among the PR, SD, and PD groups (86.3%, 78.5%, and 39.4%, respectively; P <.001). OS was significantly shorter in the SD group compared to the PR group among the patients with HRCA (P < .001) and patients treated with reinduction therapy (P = .013). In the PD group, the 30-month OS and PFS rates were 39.4% and 17.9%, respectively. Finally, early PD within 12 months after ASCT was predictive of short OS, whereas OS without early PD even in the PD group was similar to that in the SD and PR groups. In conclusion, OS in the SR group was not always short, but SR in the HRCA and the reinduction therapy groups was predictive of short OS, so that therapeutic alternatives to ASCT are needed. OS in the PD group was significantly short, but ASCT improved clinical outcomes when early PD did not occur even in the PD group.
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Affiliation(s)
- Kazuhito Suzuki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan; Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Chiba, Japan.
| | - Yutaka Shimazu
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Daisuke Minakata
- Division of Hematology, Jichi Medical University, Tochigi, Japan
| | - Takashi Ikeda
- Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroyuki Takahashi
- Department of Hematology and Medical Oncology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Nobuhiro Tsukada
- Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University, Tochigi, Japan; Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Kaichi Nishiwaki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan; Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Akiyoshi Miwa
- Department of Hematology, Tokyo-Kita Medical Center, Tokyo, Japan
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Aichi, Japan
| | - Keisuke Kataoka
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Hokkaido, Japan
| | - Mitsuhiro Itagaki
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan; Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Aichi, Japan
| | - Shingo Yano
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Koji Kawamura
- Division of Clinical Laboratory Medicine, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
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4
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Suzuki K, Mizuno S, Shimazu Y, Fuchida SI, Hagiwara S, Itagaki M, Nishiwaki K, Hangaishi A, Karasuno T, Kikuchi T, Shimizu M, Nishikawa A, Kobayashi T, Sunami K, Hiramoto N, Uchiyama H, Maruyama Y, Kanda Y, Ichinohe T, Atsuta Y, Yano S, Kawamura K. Tandem autologous stem cell transplantation in elderly patients with myeloma: A multicenter retrospective analysis. Eur J Haematol 2023; 110:444-454. [PMID: 36597575 DOI: 10.1111/ejh.13922] [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: 11/09/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023]
Abstract
Tandem autologous stem cell transplantation (ASCT) has been reconsidered for high-risk patients with myeloma, and the eligibility criteria for up-front ASCT have been updated to include more elderly patients. This study aimed to evaluate the efficacy and tolerability of tandem ASCT in elderly patients with myeloma compared to tandem ASCT in young patients and single ASCT in elderly patients. A retrospective study using the Transplant Registry Unified Management Program database of the Japanese Society for Transplantation and Cellular Therapy, which included 64 elderly and 613 young patients who received tandem ASCT, and 891 elderly patients who received single ASCT, was conducted. The median overall survival (OS) over 38.5 months in the elderly and young patients who received tandem ASCT, and elderly patients who received single ASCT was 78.9, 92.5, and 77.1 months, respectively; no significant difference in the median OS was observed. The cumulative incidence of transplantation-related mortality was similar in the elderly and young patients receiving tandem ASCT. High-risk cytogenetic abnormality was not identified as a poor prognostic factor for OS in elderly patients who received tandem ASCT but in those who received single ASCT. Thus, tandem ASCT was effective and tolerable in elderly patients with myeloma.
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Affiliation(s)
- Kazuhito Suzuki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Kashiwa, Japan.,Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa, Japan
| | - Shohei Mizuno
- Division of Hematology, Department of Internal Medicine, Aichi Medical University, Nagakute, Japan
| | - Yutaka Shimazu
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shin-Ichi Fuchida
- Department of Hematology, Japan Community Health Care Organization Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Shotaro Hagiwara
- Division of Hematology, Tsukuba University Hospital Mito Clinical Education and Training Center, Tsukuba, Japan
| | - Mitsuhiro Itagaki
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Kaichi Nishiwaki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Kashiwa, Japan.,Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa, Japan
| | - Akira Hangaishi
- Department of Hematology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takahiro Karasuno
- Division of Hematology, Rinku General Medical Center, Izumisano, Japan
| | - Taku Kikuchi
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Misayo Shimizu
- Department of Hematology and Oncology, Hitachi, Ltd. Hitachi General Hospital, Hitachi, Japan
| | - Akinori Nishikawa
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Takeshi Kobayashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Kazutaka Sunami
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hitoji Uchiyama
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Yumiko Maruyama
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University, Shimotsuke, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan.,Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Aichi, Japan
| | - Shingo Yano
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa, Japan
| | - Koji Kawamura
- Division of Clinical Laboratory Medicine, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori, Japan
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5
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Shibata S, Arai Y, Kondo T, Mizuno S, Harada K, Miyakoshi S, Uchida N, Maruyama Y, Eto T, Katsuoka Y, Matsue K, Nishiwaki K, Takada S, Doki N, Itoh M, Nagafuji K, Kawakita T, Tanaka J, Fukuda T, Atsuta Y, Yanada M. Advantages of Higher Busulfan Dose Intensity in Fludarabine-Combined Conditioning for Patients with Acute Myeloid Leukemia Undergoing Cord Blood Transplantation. Transplant Cell Ther 2023; 29:332.e1-332.e11. [PMID: 36796517 DOI: 10.1016/j.jtct.2023.02.004] [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: 11/18/2022] [Revised: 01/15/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Abstract
The alkylating agent busulfan is commonly used as conditioning in allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia (AML). However, a consensus has not yet been reached regarding the optimal busulfan dose in cord blood transplantation (CBT). Therefore, we conducted this large nationwide cohort study to retrospectively analyze the outcomes of CBT in patients with AML receiving busulfan at intermediate (6.4 mg/kg i.v.; BU2) or higher (12.8 mg/kg i.v.; BU4) doses within a fludarabine/i.v. busulfan (FLU/BU) regimen. Among 475 patients who underwent their first CBT following FLU/BU conditioning between 2007 and 2018, 162 received BU2 and 313 received BU4. Multivariate analysis identified BU4 as a significant factor for longer disease-free survival (hazard ratio [HR], .85; 95% confidence interval [CI], .75 to .97; P = .014) and a lower relapse rate (HR, .84; 95% CI, .72 to .98; P = .030). No significant differences were observed in non-relapse mortality between BU4 and BU2 (HR, 1.05; 95% CI, .88-1.26; P = .57). Subgroup analyses showed that BU4 provided significant benefits for patients who underwent transplantation while not in complete remission (CR) and those age <60 years. Our present results suggest that higher busulfan doses are preferable in patients undergoing CBT, particularly those not in CR and younger patients.
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Affiliation(s)
- Sho Shibata
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuyuki Arai
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Center for Research and Application of Cellular Therapy, Kyoto University Hospital, Kyoto, Japan.
| | - Tadakazu Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shohei Mizuno
- Division of Hematology, Department of Internal Medicine, Aichi Medical University, Nagakute, Japan
| | - Kaito Harada
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | | | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Yumiko Maruyama
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Yuna Katsuoka
- Department of Hematology, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Kaichi Nishiwaki
- Division of Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Satoru Takada
- Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Mitsuru Itoh
- Department of Hematology, Kyoto City Hospital, Kyoto, Japan
| | - Koji Nagafuji
- Division of Hematology and Oncology, Department of Medicine, Kurume University Hospital, Kurume, Japan
| | - Toshiro Kawakita
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Junji Tanaka
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan; Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masamitsu Yanada
- Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan
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6
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Okamoto Y, Hirano M, Morino K, Kajita MK, Nakaoka S, Tsuda M, Sugimoto KJ, Tamaki S, Hisatake J, Yokoyama H, Igarashi T, Shinagawa A, Sugawara T, Hara S, Fujikawa K, Shimizu S, Yujiri T, Wakita H, Nishiwaki K, Tojo A, Aihara K. Early dynamics of chronic myeloid leukemia on nilotinib predicts deep molecular response. NPJ Syst Biol Appl 2022; 8:39. [PMID: 36229495 PMCID: PMC9561725 DOI: 10.1038/s41540-022-00248-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022] Open
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative disorder caused by the BCR-ABL1 tyrosine kinase. Although ABL1-specific tyrosine kinase inhibitors (TKIs) including nilotinib have dramatically improved the prognosis of patients with CML, the TKI efficacy depends on the individual patient. In this work, we found that the patients with different nilotinib responses can be classified by using the estimated parameters of our simple dynamical model with two common laboratory findings. Furthermore, our proposed method identified patients who failed to achieve a treatment goal with high fidelity according to the data collected only at three initial time points during nilotinib therapy. Since our model relies on the general properties of TKI response, our framework would be applicable to CML patients who receive frontline nilotinib or other TKIs.
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Affiliation(s)
- Yuji Okamoto
- Institute of Industrial Science, The University of Tokyo, Tokyo, 153-8505, Japan.,Division of Molecular Therapy, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, 108-8639, Japan.,Department of Biomedical Data Intelligence, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Mitsuhito Hirano
- Division of Molecular Therapy, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, 108-8639, Japan
| | - Kai Morino
- Institute of Industrial Science, The University of Tokyo, Tokyo, 153-8505, Japan.,Interdisciplinary Graduate School of Engineering Sciences, Kyushu University, Fukuoka, 816-8580, Japan
| | - Masashi K Kajita
- Institute of Industrial Science, The University of Tokyo, Tokyo, 153-8505, Japan. .,Department of Applied Chemistry and Biotechnology, Faculty of Engineering, University of Fukui, Fukui, 910-8507, Japan. .,Life Science Innovation Center, University of Fukui, Fukui, 910-8507, Japan.
| | - Shinji Nakaoka
- Institute of Industrial Science, The University of Tokyo, Tokyo, 153-8505, Japan.,Faculty of Advanced Life Science, Hokkaido University, Hokkaido, 060-0810, Japan.,PRESTO, Japan Science and Technology Agency, Tokyo, 102-0076, Japan
| | - Mayuko Tsuda
- Division of Molecular Therapy, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, 108-8639, Japan
| | - Kei-Ji Sugimoto
- Division of Hematology, Juntendo University Urayasu Hospital, Chiba, 279-0021, Japan
| | - Shigehisa Tamaki
- Department of Hematology, Japanese Red Cross Ise Hospital, Mie, 516-8512, Japan
| | - Junichi Hisatake
- Department of Hematology, Japanese Red Cross Omori Hospital, Tokyo, 143-8527, Japan
| | - Hisayuki Yokoyama
- Department of Hematology, National Hospital Organization, Sendai Medical Center, Miyagi, 983-8520, Japan
| | - Tadahiko Igarashi
- Divison of Hematology and Oncology, Gunma Cancer Center, Gunma, 373-8550, Japan
| | - Atsushi Shinagawa
- Department of Internal Medicine, Hitachi General Hospital, Ibaraki, 317-0077, Japan
| | - Takeaki Sugawara
- Division of Hematology-Oncology, Chiba Cancer Center, Chiba, 260-8717, Japan
| | - Satoru Hara
- Department of Hematology, Chiba Rosai Hospital, Chiba, 290-0003, Japan
| | - Kazuhisa Fujikawa
- Department of Hematology, Chibaken Saiseikai Narashino Hospital, Chiba, 275-8580, Japan
| | - Seiichi Shimizu
- Department of Hematology, Tsuchiura Kyodo General Hospital, Ibaraki, 300-0028, Japan
| | - Toshiaki Yujiri
- Third Department of Internal Medicine, Yamaguchi University, Yamaguchi, 755-0046, Japan
| | - Hisashi Wakita
- Division of Hematology and Oncology, Japanese Red Cross Narita Hospital, Chiba, 286-8523, Japan
| | - Kaichi Nishiwaki
- Division of Oncology and Hematology, Jikei University Kashiwa Hospital, Chiba, 277-8567, Japan
| | - Arinobu Tojo
- Division of Molecular Therapy, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, 108-8639, Japan.,Institute of Innovation Advancement, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | - Kazuyuki Aihara
- Institute of Industrial Science, The University of Tokyo, Tokyo, 153-8505, Japan. .,International Research Center for Neurointelligence (WPI-IRCN), The University of Tokyo, Tokyo, 113-0033, Japan.
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7
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Murai K, Ureshino H, Kumagai T, Tanaka H, Nishiwaki K, Wakita S, Inokuchi K, Fukushima T, Yoshida C, Uoshima N, Kiguchi T, Mita M, Aoki J, Kimura S, Karimata K, Usuki K, Shimono J, Chinen Y, Kuroda J, Matsuda Y, Nakao K, Ono T, Fujimaki K, Shibayama H, Mizumoto C, Takeoka T, Io K, Kondo T, Miura M, Minami Y, Ikezoe T, Imagawa J, Takamori A, Kawaguchi A, Sakamoto J, Kimura S. Low-dose dasatinib in older patients with chronic myeloid leukaemia in chronic phase (DAVLEC): a single-arm, multicentre, phase 2 trial. The Lancet Haematology 2021; 8:e902-e911. [DOI: 10.1016/s2352-3026(21)00333-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 12/30/2022]
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8
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Ito Y, Nishiwaki K, Matsuzawa H, Hattori D, Tanoue S, Suzuki K, Katori M, Hirooka S, Masuoka H, Yano S. A difficult case of angioimmunoblastic T-cell lymphoma with Epstein-Barr virus-negative large mononuclear atypical cells. J Clin Exp Hematop 2021; 61:224-226. [PMID: 34707033 PMCID: PMC8808111 DOI: 10.3960/jslrt.21009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yuta Ito
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Kaichi Nishiwaki
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Haruka Matsuzawa
- Department of Pathology, The Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Daiki Hattori
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Susumu Tanoue
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Kazuhito Suzuki
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Mitsuji Katori
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Shinichi Hirooka
- Department of Pathology, The Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Hidekazu Masuoka
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Shingo Yano
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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9
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Suzuki K, Nishiwaki K, Yano S. Treatment Strategy for Multiple Myeloma to Improve Immunological Environment and Maintain MRD Negativity. Cancers (Basel) 2021; 13:4867. [PMID: 34638353 PMCID: PMC8508145 DOI: 10.3390/cancers13194867] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 02/06/2023] Open
Abstract
Improving the immunological environment and eradicating minimal residual disease (MRD) are the two main treatment goals for long-term survival in patients with multiple myeloma (MM). Immunomodulatory drugs (IMiDs), monoclonal antibody drugs (MoAbs), and autologous grafts for autologous stem cell transplantation (ASCT) can improve the immunological microenvironment. ASCT, MoAbs, and proteasome inhibitors (PIs) may be important for the achievement of MRD negativity. An improved immunological environment may be useful for maintaining MRD negativity, although the specific treatment for persistent MRD negativity is unknown. However, whether the ongoing treatment should be continued or changed if the MRD status remains positive is controversial. In this case, genetic, immunophenotypic, and clinical analysis of residual myeloma cells may be necessary to select the effective treatment for the residual myeloma cells. The purpose of this review is to discuss the MM treatment strategy to "cure MM" based on currently available therapies, including IMiDs, PIs, MoAbs, and ASCT, and expected immunotherapies, such as chimeric antigen receptor T cell (CAR-T) therapy, via improvement of the immunological environment and maintenance of MRD negativity.
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Affiliation(s)
- Kazuhito Suzuki
- Department of Internal Medicine, Division of Clinical Oncology and Hematology, The Jikei University Kashiwa Hospital, Tokyo 277-8567, Japan;
- Department of Internal Medicine, Division of Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo 105-8461, Japan;
| | - Kaichi Nishiwaki
- Department of Internal Medicine, Division of Clinical Oncology and Hematology, The Jikei University Kashiwa Hospital, Tokyo 277-8567, Japan;
- Department of Internal Medicine, Division of Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo 105-8461, Japan;
| | - Shingo Yano
- Department of Internal Medicine, Division of Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo 105-8461, Japan;
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10
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Inagaki N, Udaka J, Nishiwaki K, Hattori D, Hiramoto Y, Saito M. Acute Compartment Syndrome of the Upper Extremity in Acquired Hemophilia A: A Case Report and Literature Review. JBJS Case Connect 2021; 11:01709767-202109000-00094. [PMID: 34449450 DOI: 10.2106/jbjs.cc.21.00304] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Acute compartment syndrome (ACS) with acquired hemophilia A (AHA) is rare and has no established treatment strategy. A 64-year-old woman presented with a giant hematoma in the rectus abdominis. Laboratory findings included decreased hemoglobin and increased activated partial thromboplastin time. Arterial embolization was performed for hemostasis. After catheter removal, she developed severe arm pain and numbness with blistering. Fasciotomy was performed to decrease intracompartmental pressure. Laboratory investigations revealed decreased factor VIII (FVIII) activity and increased FVIII inhibitor. AHA was diagnosed and treated with immunosuppressive and FVIII inhibitor-bypassing agents. CONCLUSIONS Fasciotomy should be performed promptly if ACS with AHA is suspected.
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Affiliation(s)
- Naoya Inagaki
- Department of Orthopaedic Surgery, The Jikei University School of medicine, Tokyo, Japan
| | - Jun Udaka
- Department of Orthopaedic Surgery, The Jikei University School of medicine, Tokyo, Japan
| | - Kaichi Nishiwaki
- Division of Oncology and Hematology, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Daiki Hattori
- Division of Oncology and Hematology, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Yuki Hiramoto
- Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of medicine, Tokyo, Japan
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11
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Suzuki K, Nishiwaki K, Nagao R, Katori M, Fukushima R, Hattori D, Masuoka H, Yano S. Clinical significance of the lymphocyte-to-monocyte ratio in multiple myeloma patients with negative minimal residual disease: a single-center retrospective analysis. Int J Hematol 2021; 114:599-607. [PMID: 34339005 DOI: 10.1007/s12185-021-03201-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/26/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 01/10/2023]
Abstract
Minimal residual disease (MRD) is a surrogate marker for survival in multiple myeloma (MM), while the lymphocyte-to-monocyte ratio (LMR) is a prognostic factor associated with the patients' immunological status. We retrospectively evaluated the clinical impact of MRD negativity and LMR. MRD was analyzed by multicolor flowcytometry (threshold, 1 × 10-5). Fifty-eight patients (median age 70 years) who achieved complete response were included in this study. Twenty-two patients received autologous stem cell transplantation, 14 received daratumumab-based chemotherapy, and 22 received another treatment. Forty-one (70.7%) patients achieved MRD negativity. Over the median follow-up time of 15.1 months, PFS in MRD-negative patients was significantly longer than in MRD-positive patients (P = 0.020). In addition, a high LMR at MRD assessment was associated with MRD negativity (P = 0.019) and long PFS (P = 0.009). Finally, neither MRD negativity nor high LMR at MRD assessment was associated with significantly shorter PFS compared with MRD positivity or low LMR (P = 0.002). In conclusion, high LMR was associated with MRD negativity and can be used as a predictor of long PFS. Change of treatment strategy might be essential for patients with MRD positivity and high LMR at MRD assessment due to their short PFS.
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Affiliation(s)
- Kazuhito Suzuki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan. .,The Jikei University School of Medicine, Tokyo, Japan.
| | - Kaichi Nishiwaki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan.,The Jikei University School of Medicine, Tokyo, Japan
| | - Riku Nagao
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan.,The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuji Katori
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan.,The Jikei University School of Medicine, Tokyo, Japan
| | - Ryoko Fukushima
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan.,The Jikei University School of Medicine, Tokyo, Japan
| | - Daiki Hattori
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan.,The Jikei University School of Medicine, Tokyo, Japan
| | - Hidekazu Masuoka
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa, Chiba, 277-8567, Japan.,The Jikei University School of Medicine, Tokyo, Japan
| | - Shingo Yano
- The Jikei University School of Medicine, Tokyo, Japan
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12
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Namiki H, Ito Y, Matsuzawa H, Enoki K, Motohashi K, Hattori D, Tanoue S, Suzuki K, Katori M, Hirooka S, Masuoka H, Sadaoka S, Nishiwaki K, Yano S. [Utility of core-needle biopsy as a primary diagnostic method for detecting aggressive B-cell lymphoma in the intensive care unit]. Rinsho Ketsueki 2021; 62:55-57. [PMID: 33551427 DOI: 10.11406/rinketsu.62.55] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 68-year-old male presented with appetite loss and abdominal distention. The whole-body computed tomography scan revealed an ileocecal mass with a large amount of ascites, which was consistent with malignant lymphoma. Due to the worsening of his general condition following admission, he was intubated and admitted to the intensive care unit (ICU). In the ICU, we performed a core-needle biopsy (CNB) on the left peritoneal mass, the findings of which showed a pathological diffuse infiltration of CD20+ middle-sized lymphoid cells. After chemotherapy was initiated, the patient showed complete response, suggesting that CNB can be performed immediately and safely even on a critically ill patient.
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Affiliation(s)
- Hiroya Namiki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital
| | - Yuta Ito
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital.,Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Keitaro Enoki
- Department of Radiology, The Jikei University Kashiwa Hospital
| | - Kenji Motohashi
- Department of Radiology, The Jikei University Kashiwa Hospital
| | - Daiki Hattori
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital.,Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Susumu Tanoue
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital.,Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Kazuhito Suzuki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital.,Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Mitsuji Katori
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital.,Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Hidekazu Masuoka
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital.,Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Kaichi Nishiwaki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital.,Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Shingo Yano
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine
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13
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Kamitani I, Saito T, Yokoyama H, Nakano A, Ishii H, Tanoue S, Hattori D, Oshima S, Ishii S, Gunji T, Fukushima R, Katsube A, Shimada T, Nishiwaki K, Dobashi N, Yano S. Successful bridge therapy of gilteritinib to cord blood transplantation in relapsed acute myeloid leukemia after bone marrow transplantation. J Infect Chemother 2020; 27:639-641. [PMID: 33214069 DOI: 10.1016/j.jiac.2020.11.003] [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: 09/21/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 11/15/2022]
Abstract
The FMS-related tyrosine kinase 3 (FLT3) internal tandem duplication mutations (FLT3-ITD) positive acute myeloid leukemia (AML) is a disease with a dismal outcome. Gilteritinib is a second-generation FLT3 inhibitor with activity against ITD and high affinity toward the FLT3 receptor, thereby showing therapeutic potential for relapsed/refractory FLT3-mutated AML. Bone marrow transplantation (BMT) from a human leukocyte antigen (HLA) identical sibling donor was performed in a 38-year-old Japanese male with FLT3-ITD positive AML. Neutrophil engraftment (>0.5 × 109/L) was achieved on day 16, and bone marrow remission was revealed on day 32. The patient's AML relapsed hematologically four months after BMT and was resistant to salvage chemotherapy. Gilteritinib was administered and the patient achieved non-remission but 'stable disease' status according to the response criteria. During administration, liver damage was observed but controllable. The patient received cord blood transplantation (CBT) as the second hematopoietic stem cell transplantation (HSCT) three months after relapse and achieved second remission. There was no evidence of recurrence of AML four months after CBT. This case demonstrates that gilteritinib can control FLT3-ITD positive AML that relapsed early after initial HSCT and can bridge to second HSCT.
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Affiliation(s)
- Iku Kamitani
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Takeshi Saito
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Japan.
| | - Hiroki Yokoyama
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Aya Nakano
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Hiroto Ishii
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Susumu Tanoue
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Daiki Hattori
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Sayaka Oshima
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Shoko Ishii
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Tadahiro Gunji
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Ryoko Fukushima
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Atsushi Katsube
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Takaki Shimada
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
| | - Kaichi Nishiwaki
- Division of Clinical Oncology/Hematology, The Jikei University Kashiwa Hospital, Japan
| | - Nobuaki Dobashi
- Division of Clinical Oncology/Hematology, The Jikei University Daisan Hospital, Japan
| | - Shingo Yano
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
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14
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Okuyama T, Komukai K, Maehara T, Kamba T, Fukushima K, Yoshida R, Oki Y, Shirasaki K, Kubota T, Miyanaga S, Ito Y, Nishiwaki K, Yoshimura M. Rare and Massive Cardiac Invasion of Malignant Lymphoma. Circ Rep 2020; 2:538-539. [PMID: 33693281 PMCID: PMC7819643 DOI: 10.1253/circrep.cr-20-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Toraaki Okuyama
- Division of Cardiology, The Jikei University Kashiwa Hospital
| | - Kimiaki Komukai
- Division of Cardiology, The Jikei University Kashiwa Hospital
| | - Tomoki Maehara
- Division of Cardiology, The Jikei University Kashiwa Hospital
| | - Takahito Kamba
- Division of Cardiology, The Jikei University Kashiwa Hospital
| | | | - Ritsu Yoshida
- Division of Cardiology, The Jikei University Kashiwa Hospital
| | - Yoshitsugu Oki
- Division of Cardiology, The Jikei University Kashiwa Hospital
| | | | - Takeyuki Kubota
- Division of Cardiology, The Jikei University Kashiwa Hospital
| | - Satoru Miyanaga
- Division of Cardiology, The Jikei University Kashiwa Hospital
| | - Yuta Ito
- Division of Clinical Oncology/Hematology, The Jikei University Kashiwa Hospital
| | - Kaichi Nishiwaki
- Division of Clinical Oncology/Hematology, The Jikei University Kashiwa Hospital
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
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15
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Tanaka T, Fuga M, Teshigawara A, Hasegawa Y, Nishiwaki K, Murayama Y, Yokoo H. IgG4-Related Disease in the Frontal Convexity Concomitant with Smoldering Multiple Myeloma: A Case Report and Review of the Literature Regarding Therapeutic Implications. World Neurosurg 2020; 143:247-260. [PMID: 32768593 DOI: 10.1016/j.wneu.2020.07.212] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND We have reported an extremely rare case of a frontal convexity tumor diagnosed as IgG4-related disease (IgG4-RD) with unique neuroradiological images. CASE DESCRIPTION A 64-year-old man with a history of monoclonal gammopathy of undetermined significance and conservative treatment had presented with a left facial spasm. Computed tomography showed a high-density round tumor with perifocal edema in the right frontal convexity. Magnetic resonance imaging demonstrated unique findings, including low signal intensity on T1- and T2-weighted, fluid-attenuated inversion recovery, and diffusion-weighted images, with slight gadolinium enhancement. The tumor was totally removed via right frontal craniotomy. It had been located in the subdural space, was not adherent to the dura, and was less vascular than meningiomas. Histological investigation demonstrated plasma cells that were strongly positive for IgG4 and contained κ and λ light chains at a ratio of 1.5:1. The serum IgG4 level was elevated. The tumor met the diagnostic criteria for IgG4-RD. The patient was followed up for 3 years during postoperative adjuvant steroid therapy. The steroid therapy was discontinued, and during the next 4 years, neither tumor recurrence nor symptoms were observed. CONCLUSION Intracranial IgG4-RD with smoldering monoclonal gammopathy of undetermined significance is extremely rare. We reviewed the differential diagnosis of plasma cell granuloma and plasmacytoma, therapeutic implications, and clinical outcomes. Complete resection of a conspicuous and solitary IgG4-RD lesion in the frontal convexity is simple and could provide a cure with less-aggressive adjuvant therapy.
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Affiliation(s)
- Toshihide Tanaka
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan.
| | - Michiyasu Fuga
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Kaichi Nishiwaki
- Department of Clinical Oncology and Hematology, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hideaki Yokoo
- Department of Pathology, Gumma University Graduate School of Medicine, Maebashi, Japan
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16
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Kumagai T, Nakaseko C, Nishiwaki K, Yoshida C, Ohashi K, Takezako N, Takano H, Kouzai Y, Murase T, Matsue K, Morita S, Sakamoto J, Wakita H, Sakamaki H, Inokuchi K. Silent NK/T cell reactions to dasatinib during sustained deep molecular response before cessation are associated with longer treatment-free remission. Cancer Sci 2020; 111:2923-2934. [PMID: 32614159 PMCID: PMC7419041 DOI: 10.1111/cas.14518] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/18/2022] Open
Abstract
This study presents the final report of the multicenter, prospective tyrosine kinase inhibitor discontinuation study, D-STOP, after a 3-year follow-up of 54 patients with chronic CML who discontinued dasatinib after a sustained deep molecular response (DMR) for ≥2 years with dasatinib treatment. Estimated treatment-free remission (TFR) rates at 12 and 36 months were 63.0% [95% confidence interval (CI): 48.7-74.3] and 59.3% (95% CI: 45.0-71.0), respectively. CD3- CD56+ NK, CD16+ CD56+ NK, and CD57+ CD56+ NK large granular lymphocyte (NK-LGL), CD8+ CD4- cytotoxic T cell, and CD57+ CD3+ T-LGL cell numbers were relatively elevated throughout the 24-month consolidation only in failed patients who molecularly relapsed within 12 months. In successful patients, these subsets elevated transiently after 12 months, but returned to basal levels after 24-month consolidation. Therefore, smaller changes in NK/T, particularly the NK subset throughout consolidation, reflected higher TFR rates. TFR rates of those patients exhibiting elevation in CD3- CD56+ NK >376 cells/μL, CD16+ CD56+ NK > 241 cells/μL, or CD57+ CD56+ NK-LGL >242 cells/μL during consolidation compared with others were 26.7% (8.3%-49.6%) vs 78.3% (55.4%-90.3%), HR 0.032 (0.0027-0.38; P = .0064), 31.2% (11.4%-53.6%) vs 85.0% (60.4%-94.9%), HR 0.039 (0.0031-0.48; P = .011), or 36.8% (16.5%-57.5%) vs 77.3% (53.7%-89.8%), HR 0.21 (0.065-0.69; P = .010), respectively. Therefore, silent responses of T/NK subsets to dasatinib throughout consolidation were significant for longer TFR. Elevated NK/T, particularly NK lymphocytes responsive to dasatinib, may be immunologically insufficient to maintain TFR. Their decline, subsequently replaced by altered lymphocyte population with less response to dasatinib during sustained DMR, might be immunologically significant. (D-STOP, NCT01627132).
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Affiliation(s)
- Takashi Kumagai
- Department of Hematology, Ome Municipal General Hospital, Tokyo, Japan
| | - Chiaki Nakaseko
- Department of Hematology, Chiba University Hospital, Chiba, Japan
| | - Kaichi Nishiwaki
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Chikashi Yoshida
- Department of Hematology, National Hospital Organization, Mito Medical Center, Higashiibarakigun, Japan
| | - Kazuteru Ohashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Naoki Takezako
- Department of Hematology, National Hospital Organization Disaster Medical Center, Tachikawa, Japan
| | - Hina Takano
- Department of Hematology, Musashino Red Cross Hospital, Musashino, Japan
| | - Yasuji Kouzai
- Department of Hematology, Tokyo Metropolitan Tama Synthesis Medical Center, Tokyo, Japan
| | - Tadashi Murase
- Department of Laboratory Medicine, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Hisashi Wakita
- Division of Hematology and Oncology, Japanese Red Cross Society, Narita Red Cross Hosp, Narita, Japan
| | - Hisashi Sakamaki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Koiti Inokuchi
- Department of Hematology, Nippon Medical School, Tokyo, Japan
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17
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Mukai T, Sakuta K, Hirano K, Suzuki K, Nishiwaki K, Yaguchi H. [Acute myeloid leukemia diagnosed by dysphagia due to bilateral vagus nerve palsy: a case report]. Rinsho Shinkeigaku 2020; 60:504-507. [PMID: 32536666 DOI: 10.5692/clinicalneurol.60.cn-001424] [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] [Indexed: 11/05/2022]
Abstract
This is the rare case report that bilateral vagus nerve paralysis was emerged as the initial symptom of acute myelogenous leukemia (AML). An 83-year-old man admitted to our hospital because of dysphagia. His dysphagia progressed two months prior to admission. Although physical examination revealed no abnormality, videoendoscopy and videofluorography examination clearly revealed bilateral vagus nerve palsy. Brain MRI showed hypointense signals at the bilateral clivus on T1 weighted images, suggesting tumor infiltration to bilateral petroclivus. He was diagnosed as AML by blood samples and bone marrow biopsy. After initiation of the treatment including radiation therapy, dysphagia shows mild improvement. Although bilateral cranial nerve palsy due to malignant tumor involving at the clivus is very uncommon, we should pay attention to the symptom.
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Affiliation(s)
- Taiji Mukai
- Department of Neurology, The Jikei University Kashiwa Hospital
| | - Kenichi Sakuta
- Department of Neurology, The Jikei University Kashiwa Hospital
| | - Kei Hirano
- Division of Clinical Oncology/Hematology, The Jikei University Kashiwa Hospital
| | - Kazuhito Suzuki
- Division of Clinical Oncology/Hematology, The Jikei University Kashiwa Hospital
| | - Kaichi Nishiwaki
- Division of Clinical Oncology/Hematology, The Jikei University Kashiwa Hospital
| | - Hiroshi Yaguchi
- Department of Neurology, The Jikei University Kashiwa Hospital
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18
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Nishiwaki K, Sugimoto KJ, Tamaki S, Hisatake J, Yokoyama H, Igarashi T, Shinagawa A, Sugawara T, Hara S, Fujikawa K, Shimizu S, Yujiri T, Tojo A, Wakita H. Optimal treatment strategy with nilotinib for patients with newly diagnosed chronic-phase chronic myeloid leukemia based on early achievement of deep molecular response (MR 4.5 ): The phase 2, multicenter N-Road study. Cancer Med 2020; 9:3742-3751. [PMID: 32253827 PMCID: PMC7286457 DOI: 10.1002/cam4.3034] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 03/04/2020] [Accepted: 03/15/2020] [Indexed: 01/06/2023] Open
Abstract
For patients who have chronic myeloid leukemia (CML), one of the primary treatment options is administration of nilotinib 300 mg twice daily (BID). In previous studies which compared outcomes associated with nilotinib or imatinib treatment, nilotinib achieved a higher rate of deep molecular response (MR). We conducted a phase II, open‐label, multicenter study to investigate an intrapatient nilotinib dose‐escalation strategy for patients with newly diagnosed chronic‐phase (CP) CML based on early MR4.5 achievement. The primary study endpoint was achievement of MR4.5 by 24 months following the initiation of nilotinib 300 mg BID. Fifty‐three patients were enrolled, 51 received nilotinib, and 37 completed the treatment. An increase in the nilotinib dose (to 400 mg BID) was allowed when patients satisfied our criteria for no optimal response at any time point. The median (range) dose intensity was 600 (207‐736) mg/day. Of 46 evaluable patients, 18 achieved an optimal response and 28 did not. Of the latter, nine patients underwent dose escalation to 400 mg BID, and none achieved MR4.5. The remaining 19 patients could not undergo dose escalation, 12 (63%) because of adverse events (AEs), and 7 (37%) for non‐AE related reasons. Four of these patients achieved MR4.5. The MR4.5 rate by 24 months was 45.7%. The progression‐free, overall and event‐free survival were each 97.6%. No new safety concerns were observed. Our findings support the use of continuous nilotinib at a dose of 300 mg BID for newly diagnosed patients with CML‐CP.
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Affiliation(s)
- Kaichi Nishiwaki
- Division of Oncology and Hematology, Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Kei-Ji Sugimoto
- Division of Hematology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shigehisa Tamaki
- Department of Hematology/Infectious Disease, Ise Red Cross Hospital, Ise, Japan
| | - Junichi Hisatake
- Department of Hematology, Omori Red Cross Hospital, Tokyo, Japan
| | - Hisayuki Yokoyama
- Department of Hematology, National Hospital Organization, Sendai Medical Center, Sendai, Japan
| | - Tadahiko Igarashi
- Division of Hematology and Oncology, Gunma Cancer Center, Ohta, Japan
| | - Atsushi Shinagawa
- Department of Internal Medicine, Hitachi General Hospital, Ibaraki, Japan
| | - Takeaki Sugawara
- Division of Hematology-Oncology, Chiba Cancer Center, Chiba, Japan
| | - Satoru Hara
- Department of Hematology, Chiba Rosai Hospital, Chiba, Japan
| | - Kazuhisa Fujikawa
- Department of Hematology, Chibaken Saiseikai Narashino Hospital, Narashino, Japan
| | - Seiichi Shimizu
- Department of Hematology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Toshiaki Yujiri
- Third Department of Internal Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Arinobu Tojo
- Division of Molecular Therapy, Institute of Medical Science, Tokyo University, Tokyo, Japan
| | - Hisashi Wakita
- Division of Hematology and Oncology, Japanese Red Cross Society, Narita Red Cross Hospital, Narita, Japan
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19
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Fujii T, Nishiwaki K. Clarification on chronic pain – a painfully persistent problem? A reply. Anaesthesia 2020; 75:408-409. [DOI: 10.1111/anae.14960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- T. Fujii
- Nagoya University Graduate School of Medicine Nagoya Japan
| | - K. Nishiwaki
- Nagoya University Graduate School of Medicine Nagoya Japan
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20
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Fujii T, Nishiwaki K. Chronic pain after breast surgery - still many unanswered questions: a reply. Anaesthesia 2020; 75:416-417. [PMID: 32022920 DOI: 10.1111/anae.14982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- T Fujii
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Nishiwaki
- Nagoya University Graduate School of Medicine, Nagoya, Japan
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21
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Suzuki K, Nishiwaki K, Gunji T, Katori M, Masuoka H, Yano S. Elevated eosinophil level predicted long time to next treatment in relapsed or refractory myeloma patients treated with lenalidomide. Cancer Med 2020; 9:1694-1702. [PMID: 31950647 PMCID: PMC7050101 DOI: 10.1002/cam4.2828] [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] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/17/2019] [Accepted: 12/26/2019] [Indexed: 12/19/2022] Open
Abstract
Lenalidomide is an immunomodulatory drug that is administered commonly in patients with relapsed or refractory multiple myeloma (RRMM). Eosinophils have immunological functions, for instance, in allergic diseases and asthma. The purpose of this study was to investigate the clinical significance of elevated eosinophil levels in patients with RRMM treated with lenalidomide. A total of 59 patients were included. Elevated eosinophil level was defined as an increase in the eosinophil count of ≥250/µL from the eosinophil count on day 1 during the first cycle. The percentage of patients with elevated eosinophil levels was 22.0%. The overall response ratio in the elevated eosinophil group and nonelevated eosinophil group was 84.6% and 63.0% (P = .189), respectively. The median time to next treatment (TTNT) in the elevated eosinophil group was significantly longer than that in the nonelevated group (40.3 months vs 8.4 months; P = .017). Additionally, TTNT in the elevated eosinophil group with partial response (PR) or better was significantly longer than that in the nonelevated eosinophil group with PR or better (40.3 months vs 11.9 months; P = .021). We concluded that elevated eosinophil levels were frequently observed and might predict a longer TTNT in patients with RRMM treated with lenalidomide.
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Affiliation(s)
- Kazuhito Suzuki
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Kaichi Nishiwaki
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Tadahiro Gunji
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuji Katori
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Hidekazu Masuoka
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Shingo Yano
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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22
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Abstract
A 48-year-old woman with polyneuropathy, organomegaly, endocrinopathy, M-protein, skin change (POEMS) syndrome suddenly presented with numbness of her right upper limb. Magnetic resonance imaging showed multiple acute infarctions in her left cerebrum, and magnetic resonance angiography (MRA) showed multiple intra-cranial vascular lesions, which contrasted with previously normal MRA results obtained eight months prior to the stroke. After completing successful treatment for POEMS syndrome, there were no recurrent stroke episodes. A six-month follow-up scan showed that although the vascular lesions did not progress, they did not improve much either. POEMS syndrome is associated with the rapid extension of large blood vessels-vasculopathy-resulting in nearly irreversible brain lesions.
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Affiliation(s)
- Kenichi Sakuta
- Department of Neurology, Kashiwa Hospital, The Jikei University School of Medicine, Japan
| | - Taiji Mukai
- Department of Neurology, Kashiwa Hospital, The Jikei University School of Medicine, Japan
| | - Kazuhito Suzuki
- Department of Clinical Oncology/Hematology, Kashiwa Hospital, The Jikei University School of Medicine, Japan
| | - Kaichi Nishiwaki
- Department of Clinical Oncology/Hematology, Kashiwa Hospital, The Jikei University School of Medicine, Japan
| | - Hiroshi Yaguchi
- Department of Neurology, Kashiwa Hospital, The Jikei University School of Medicine, Japan
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23
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Minase M, Miyamoto T, Hayashi N, Minase G, Nishiwaki K, Sengoku K. A patient with a didelphys vaginal septum and infertility diagnosed by laparoscopy and magnetic resonance imaging. CLIN EXP OBSTET GYN 2019. [DOI: 10.12891/ceog4842.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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24
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Suzuki K, Tsukada N, Nishimura N, Nagata Y, Okazuka K, Mishima Y, Yokoyama M, Nishiwaki K, Ishida T, Yano S, Terui Y, Suzuki K. Bortezomib, lenalidomide, and dexamethasone in transplant-eligible newly diagnosed multiple myeloma patients: a multicenter retrospective comparative analysis. Int J Hematol 2019; 111:103-111. [PMID: 31673952 DOI: 10.1007/s12185-019-02764-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/04/2019] [Revised: 10/17/2019] [Accepted: 10/17/2019] [Indexed: 12/01/2022]
Abstract
The combination of bortezomib, lenalidomide, and dexamethasone (VRD) is used as induction treatment in multiple myeloma; however, the optimum schedule for this regimen remains controversial. In this retrospective study, we compared the efficacy and tolerability of twice-weekly VRD (twVRD) and modified VRD-lite in transplant-eligible myeloma patients. Fifty-five patients (median age 61 years) were included; 22 received twVRD (bortezomib [1.3 mg/m2 on days 1, 4, 8, and 11] and lenalidomide [25 mg/body on days 1-14] over 21-day cycles) and 33 received modified VRD-lite (bortezomib [1.3 mg/m2 on days 1, 8, 15, and 22) and lenalidomide [15 mg/body on days 2-7, 9-14, 16-21] over 28-day cycles). Overall response, very good partial response, and complete response rates after VRD were 96.4%, 45.5%, and 20.0%, respectively (median follow-up period, 17.7 months). The 1-year progression-free survival (PFS) and overall survival rates were 95.8% and 98.2%, respectively. The response rate and PFS were similar between the groups, regardless of cytogenetic risk and age. The incidence of peripheral neuropathy ≥ grade 2 and thrombocytopenia ≥ grade 3 was higher in the twVRD group (27.2% vs. 0.0%, P = 0.003 and 27.2% vs. 0.0%, P = 0.003). In conclusion, modified VRD-lite had similar efficacy with, but better tolerability than, twVRD in transplant-eligible patients.
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Affiliation(s)
- Kazuhito Suzuki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa-shi, Chiba, 277-8567, Japan. .,Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
| | - Nobuhiro Tsukada
- Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Noriko Nishimura
- Department of Hematology Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yasuyuki Nagata
- Division of Hematology, Internal Medicine 3, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kiyoshi Okazuka
- Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yuko Mishima
- Department of Hematology Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masahiro Yokoyama
- Department of Hematology Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kaichi Nishiwaki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-shita, Kashiwa-shi, Chiba, 277-8567, Japan.,Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Tadao Ishida
- Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shingo Yano
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuhito Terui
- Department of Hematology Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kenshi Suzuki
- Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
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25
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Tamura T, Yokota S, Ando M, Kubo Y, Nishiwaki K. A triple-blinded randomized trial comparing spinal morphine with posterior quadratus lumborum block after cesarean section. Int J Obstet Anesth 2019; 40:32-38. [DOI: 10.1016/j.ijoa.2019.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/16/2019] [Accepted: 06/16/2019] [Indexed: 10/26/2022]
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26
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Fujii T, Shibata Y, Akane A, Aoki W, Sekiguchi A, Takahashi K, Matsui S, Nishiwaki K. A randomised controlled trial of pectoral nerve‐2 (
PECS
2) block vs. serratus plane block for chronic pain after mastectomy. Anaesthesia 2019; 74:1558-1562. [DOI: 10.1111/anae.14856] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2019] [Indexed: 12/20/2022]
Affiliation(s)
- T. Fujii
- Department of Anaesthesiology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Y. Shibata
- Department of Surgery Nagoya University Hospital Nagoya Japan
| | - A. Akane
- Department of Anaesthesiology Nagoya University Hospital Nagoya Japan
| | - W. Aoki
- Department of Anaesthesiology Nagoya University Hospital Nagoya Japan
| | - A. Sekiguchi
- Department of Anaesthesiology Nagoya University Hospital Nagoya Japan
| | - K. Takahashi
- Department of Biostatistics Nagoya University Graduate School of Medicine Nagoya Japan
| | - S. Matsui
- Department of Biostatistics Nagoya University Graduate School of Medicine Nagoya Japan
| | - K. Nishiwaki
- Department of Anaesthesiology Nagoya University Graduate School of Medicine Nagoya Japan
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27
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Suzuki K, Nishiwaki K, Minami J, Masuoka H, Katori M, Yokoyama H, Uryu H, Yano S. Successful allogeneic peripheral blood stem cell transplantation for an aggressive variant of T-cell large granular-lymphocyte leukemia: A case report. Blood Cell Ther 2019; 2:5-8. [PMID: 37969695 PMCID: PMC10645481 DOI: 10.31547/bct-2018-006] [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] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 09/05/2018] [Indexed: 11/17/2023]
Abstract
The aggressive variant of large granular lymphocyte (LGL) leukemia is very rare and the prognosis of this disease is poor. A 47-year-old woman with progressive pancytopenia and severe liver damage visited our institute. Upon hospitalization, about 30% LGL was detected in her peripheral blood and bone marrow samples. Flow cytometry was conducted to analyze lymphocytes in the bone marrow, which revealed the presence of CD3 and T-cell receptor (TCR) α/β and absence of CD4, CD8, CD16, CD56, CD22, CD79a, and terminal deoxynucleotidyl transferase (TdT). Southern blotting was performed, which revealed the presence of rearrangement of TCR-Cβ1 and Jγ. We made a diagnosis of the aggressive variant of T-LGL leukemia, and performed myeloablative allogeneic peripheral stem cell transplantation (allo-HSCT) from an HLA-matched sibling for primary refractory disease of CHOP and hyper CVAD therapy. She is alive in remission with donor-derived T-LGL lymphocytosis in peripheral blood for 7 years after allo-HSCT. Overall, Allo-HSCT could be active against the aggressive variant of LGL leukemia and induce graft-versus-leukemia effect.
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Affiliation(s)
- Kazuhito Suzuki
- Division of Clinical Oncology/Hematology, The Jikei University Kashiwa Hospital
- Division of Clinical Oncology/Hematology, The Jikei University School of Medicine
| | - Kaichi Nishiwaki
- Division of Clinical Oncology/Hematology, The Jikei University Kashiwa Hospital
- Division of Clinical Oncology/Hematology, The Jikei University School of Medicine
| | - Jiro Minami
- Division of Clinical Oncology/Hematology, The Jikei University School of Medicine
| | - Hidekazu Masuoka
- Division of Clinical Oncology/Hematology, The Jikei University Kashiwa Hospital
- Division of Clinical Oncology/Hematology, The Jikei University School of Medicine
| | - Mitsuji Katori
- Division of Clinical Oncology/Hematology, The Jikei University Kashiwa Hospital
- Division of Clinical Oncology/Hematology, The Jikei University School of Medicine
| | - Hiroki Yokoyama
- Division of Clinical Oncology/Hematology, The Jikei University Kashiwa Hospital
- Division of Clinical Oncology/Hematology, The Jikei University School of Medicine
| | - Hideki Uryu
- Division of Clinical Oncology/Hematology, The Jikei University Kashiwa Hospital
- Division of Clinical Oncology/Hematology, The Jikei University School of Medicine
| | - Shingo Yano
- Division of Clinical Oncology/Hematology, The Jikei University School of Medicine
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28
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Takahashi N, Nishiwaki K, Nakaseko C, Aotsuka N, Sano K, Ohwada C, Kuroki J, Kimura H, Tokuhira M, Mitani K, Fujikawa K, Iwase O, Ohishi K, Kimura F, Fukuda T, Tanosaki S, Takahashi S, Kameoka Y, Nishikawa H, Wakita H. Treatment-free remission after two-year consolidation therapy with nilotinib in patients with chronic myeloid leukemia: STAT2 trial in Japan. Haematologica 2018; 103:1835-1842. [PMID: 29976734 PMCID: PMC6278957 DOI: 10.3324/haematol.2018.194894] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/28/2018] [Indexed: 12/16/2022] Open
Abstract
The purpose of this trial was to evaluate the efficacy of 2-year consolidation therapy with nilotinib, at a dose of 300 mg twice daily, for achieving treatment-free remission in chronic myeloid leukemia patients with a deep molecular response (BCR-ABL1IS ≤0.0032%). Successful treatment-free remission was defined as no confirmed loss of deep molecular response. We recruited 96 Japanese patients, of whom 78 sustained a deep molecular response during the consolidation phase and were therefore eligible to discontinue nilotinib in the treatment-free remission phase; of these, 53 patients (67.9%; 95% confidence interval: 56.4–78.1%) remained free from molecular recurrence in the first 12 months. The estimated 3-year treatment-free survival was 62.8%. Nilotinib was readministered to all patients (n=29) who experienced a molecular recurrence during the treatment-free remission phase. After restarting treatment, rapid deep molecular response returned in 25 patients (86.2%), with 50% of patients achieving a deep molecular response within 3.5 months. Tyrosine kinase inhibitor withdrawal syndrome was reported in 11/78 patients during the early treatment-free remission phase. The treatment-free survival curve was significantly better in patients with undetectable molecular residual disease than in patients without (3-year treatment-free survival, 75.6 versus 48.6%, respectively; P=0.0126 by the log-rank test). There were no significant differences in treatment-free survival between subgroups based on tyrosine kinase inhibitor treatment before the nilotinib consolidation phase, tyrosine kinase inhibitor-withdrawal syndrome, or absolute number of natural killer cells. The results of this study indicate that it is safe and feasible to stop tyrosine kinase inhibitor therapy in patients with chronic myeloid leukemia who have achieved a sustained deep molecular response with 2 years of treatment with nilotinib. This study was registered with UMIN-CTR (UMIN000005904).
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Affiliation(s)
- Naoto Takahashi
- Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine
| | - Kaichi Nishiwaki
- Department of Oncology and Hematology, Jikei University Kashiwa Hospital
| | - Chiaki Nakaseko
- Department of Hematology, International University of Health and Welfare School of Medicine, Narita.,Department of Hematology, Chiba University Hospital
| | - Nobuyuki Aotsuka
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital
| | - Koji Sano
- Department of Oncology and Hematology, Jikei University Kashiwa Hospital
| | | | - Jun Kuroki
- Department of Internal Medicine, Yuri General Hospital, Yurihonjo
| | - Hideo Kimura
- Department of Hematology, Northern Fukushima Medical Center, Date
| | - Michihide Tokuhira
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe
| | - Kinuko Mitani
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi
| | | | - Osamu Iwase
- Department of Hematology, Tokyo Medical University Hachioji Medical Center
| | - Kohshi Ohishi
- Transfusion Medicine and Cell Therapy, Mie University Hospital, Tsu
| | - Fumihiko Kimura
- Division of Hematology, National Defense Medical College, Tokorozawa
| | - Tetsuya Fukuda
- Department of Hematology, Tokyo Medical and Dental University Hospital.,Department of Hematology, Tottori University Hospital, Yonago
| | - Sakae Tanosaki
- Department of Hematology, The Fraternity Memorial Hospital, Tokyo
| | - Saori Takahashi
- Clinical Research Promotion and Support Center, Akita University Hospital
| | - Yoshihiro Kameoka
- Clinical Research Promotion and Support Center, Akita University Hospital
| | - Hiroyoshi Nishikawa
- Division of Cancer Immunology, Research Institute / Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Tokyo/Kashiwa
| | - Hisashi Wakita
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital.,Japanese Red Cross Chiba Blood Center, Funabashi, Japan
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29
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Nishiwaki K, Sano K, Kamiyama Y, Hayashi K, Tanoue S, Katori M, Masuoka H, Aiba K. [Reduced-intensity umbilical cord blood transplantation for adult patients with fulminant aplastic anemia]. Rinsho Ketsueki 2018; 59:64-68. [PMID: 29415940 DOI: 10.11406/rinketsu.59.64] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation is recommended as a curative treatment option for fulminant aplastic anemia with no neutrophil despite the administration of granulocyte-colony stimulating factor. In the absence of an HLA-matched donor, unrelated cord blood transplantation (UCBT) is a treatment option that can be performed quickly. However, the optimal conditioning regimen of UCBT is yet to be established. We report two cases of fulminant aplastic anemia in adult patients who received UCBT. The first patient was a 52-year-old woman and the second was a 26-year-old man, both of whom received a conditioning regimen of total body irradiation (TBI; 2-4 Gy), fludarabine (Flu; 120 mg/kg), and cyclophosphamide (CY; 100 mg/kg) before UCBT. Short-term methotrexate and tacrolimus were used for prophylaxis of acute graft-versus-host disease (GVHD). Engraftments were achieved on days 26 and 19, and they exhibited complete donor chimerism by days 28 and 34. There was no evidence of acute GVHD, and therefore, the immunosuppressant drugs were discontinued. Reduced-intensity UCBT using a low-dose TBI/Flu/CY conditioning regimen could be an effective treatment option for fulminant aplastic anemia in the absence of a suitable donor.
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Affiliation(s)
- Kaichi Nishiwaki
- Division of Oncology and Hematology, Jikei University Kashiwa Hospital.,Division of Oncology and Hematology, Jikei University
| | - Koji Sano
- Division of Oncology and Hematology, Jikei University Kashiwa Hospital.,Division of Oncology and Hematology, Jikei University
| | | | | | - Susumu Tanoue
- Division of Oncology and Hematology, Jikei University
| | - Mituji Katori
- Division of Oncology and Hematology, Jikei University Kashiwa Hospital.,Division of Oncology and Hematology, Jikei University
| | - Hidekazu Masuoka
- Division of Oncology and Hematology, Jikei University Kashiwa Hospital.,Division of Oncology and Hematology, Jikei University
| | - Keisuke Aiba
- Division of Oncology and Hematology, Jikei University
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Kumagai T, Nakaseko C, Nishiwaki K, Yoshida C, Ohashi K, Takezako N, Takano H, Kouzai Y, Murase T, Matsue K, Morita S, Sakamoto J, Wakita H, Sakamaki H, Inokuchi K. Dasatinib cessation after deep molecular response exceeding 2 years and natural killer cell transition during dasatinib consolidation. Cancer Sci 2017; 109:182-192. [PMID: 29058817 PMCID: PMC5765311 DOI: 10.1111/cas.13430] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 10/12/2017] [Accepted: 10/17/2017] [Indexed: 01/12/2023] Open
Abstract
Tyrosine kinase inhibitors (TKI) improve the prognosis of patients with chronic myelogenous leukemia (CML) by inducing substantial deep molecular responses (DMR); some patients have successfully discontinued TKI therapy after maintaining DMR for ≥1 year. In this cessation study, we investigated the optimal conditions for dasatinib discontinuation in patients who maintained DMR for ≥2 years. This study included 54 patients with CML who were enrolled in a D‐STOP multicenter prospective trial, had achieved DMR, and had discontinued dasatinib after 2‐year consolidation. Peripheral lymphocyte profiles were analyzed by flow cytometry. The estimated 12‐month treatment‐free survival (TFS) was 62.9% (95% confidence interval: 48.5%‐74.2%). During dasatinib consolidation, the percentage of total lymphocytes and numbers of CD3− CD56+ natural killer (NK) cells, CD16+ CD56+ NK cells and CD56+ CD57+ NK‐large granular lymphocytes (LGL) were significantly higher in patients with molecular relapse after discontinuation but remained unchanged in patients without molecular relapse for >7 months. At the end of consolidation, patients whose total lymphocytes comprised <41% CD3− CD56+ NK cells, <35% CD16+ CD56+ NK cells, or <27% CD56+ CD57+ NK‐LGL cells had higher TFS relative to other patients (77% vs 18%; P < .0008; 76% vs 10%; P < .0001; 84% vs 46%; P = .0059, respectively). The increase in the number of these NK cells occurred only during dasatinib consolidation. In patients with DMR, dasatinib discontinuation after 2‐year consolidation can lead to high TFS. This outcome depends significantly on a smaller increase in NK cells during dasatinib consolidation.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/pharmacology
- Consolidation Chemotherapy
- Dasatinib/administration & dosage
- Dasatinib/pharmacology
- Disease-Free Survival
- Female
- Flow Cytometry
- Fusion Proteins, bcr-abl/genetics
- Humans
- Killer Cells, Natural/cytology
- Killer Cells, Natural/drug effects
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Prospective Studies
- Withholding Treatment
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Affiliation(s)
- Takashi Kumagai
- Department of HematologyOme Municipal General HospitalTokyoJapan
| | | | - Kaichi Nishiwaki
- Division of Clinical Oncology and HematologyDepartment of Internal MedicineJikei University School of MedicineKashiwa HospitalChibaJapan
| | - Chikashi Yoshida
- Department of HematologyNational Hospital OrganizationMito Medical CenterHigashiibarakigunJapan
| | - Kazuteru Ohashi
- Hematology DivisionTokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Naoki Takezako
- Department of HematologyNational Hospital Organization Disaster Medical CenterTachikawaJapan
| | - Hina Takano
- Department of HematologyMusashino Red Cross HospitalMusashinoJapan
| | - Yasuji Kouzai
- Department of HematologyTokyo Metropolitan Tama Synthesis Medical CenterTokyoJapan
| | - Tadashi Murase
- Department of Laboratory MedicineDokkyo Medical University Koshigaya HospitalSaitamaJapan
| | - Kosei Matsue
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Satoshi Morita
- Department of Biomedical Statistics and BioinformaticsKyoto University Graduate School of MedicineKyotoJapan
| | | | - Hisashi Wakita
- Division of Hematology and OncologyJapanese Red Cross SocietyNarita Red Cross HospitalNaritaJapan
| | - Hisashi Sakamaki
- Hematology DivisionTokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
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31
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Fujii T, Shibata Y, Ban Y, Shitaokoshi A, Nishiwaki K. Catheterization in an ultrasound-guided thoracic paravertebral block using thoracoscopy. Asian J Anesthesiol 2017; 55:24-25. [PMID: 28846539 DOI: 10.1016/j.aja.2017.05.004] [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] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/30/2016] [Accepted: 01/12/2017] [Indexed: 11/28/2022]
Abstract
Thoracic paravertebral block (TPVB) is an efficient alternative to epidural anesthesia. The location of a catheter within the thoracic paravertebral space (TPVS) has been examined in the human cadaver studies, but it is unclear how it goes into the TPVS during catheterization. In this report, thoracoscopy was used to observe the thoracic cavity in real-time during a parasagittal in-plane approach of ultrasound-guided TPVB. During thoracoscopy, we observed whether a paravertebral catheter could be advanced caudally beyond the ribs into the neighboring TPVS. Our result demonstrated that the catheter was difficult to be advanced beyond the ribs and confined within the same level of TPVS as where it was inserted. In the previous thoracoscopic observation of the paravertebral spread, we assumed that the local anesthetic acts most strongly at the intercostal level of the injection. Therefore, we recommend to insert the catheter for TPVB at the level corresponding to the incision site of thoracotomy.
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Affiliation(s)
- T Fujii
- Department of Anesthesiology, Nagoya University Hospital, Nagoya, Japan.
| | - Y Shibata
- Department of Surgical Center, Nagoya University Hospital, Nagoya, Japan
| | - Y Ban
- Department of Anesthesiology, Tosei General Hospital, Seto, Japan
| | - A Shitaokoshi
- Department of Anesthesiology, Tosei General Hospital, Seto, Japan
| | - K Nishiwaki
- Department of Anesthesiology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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32
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Shiseki M, Yoshida C, Takezako N, Ohwada A, Kumagai T, Nishiwaki K, Horikoshi A, Fukuda T, Takano H, Kouzai Y, Tanaka J, Morita S, Sakamoto J, Sakamaki H, Inokuchi K. Dasatinib rapidly induces deep molecular response in chronic-phase chronic myeloid leukemia patients who achieved major molecular response with detectable levels of BCR-ABL1 transcripts by imatinib therapy. Int J Clin Oncol 2017; 22:972-979. [PMID: 28550414 PMCID: PMC5608785 DOI: 10.1007/s10147-017-1141-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/14/2017] [Indexed: 01/06/2023]
Abstract
Background With the introduction of imatinib, a first-generation tyrosine kinase inhibitor (TKI) to inhibit BCR-ABL1 kinase, the outcome of chronic-phase chronic myeloid leukemia (CP-CML) has improved dramatically. However, only a small proportion of CP-CML patients subsequently achieve a deep molecular response (DMR) with imatinib. Dasatinib, a second-generation TKI, is more potent than imatinib in the inhibition of BCR-ABL1 tyrosine kinase in vitro and more effective in CP-CML patients who do not achieve an optimal response with imatinib treatment. Methods In the present study, we attempted to investigate whether switching the treatment from imatinib to dasatinib can induce DMR in 16 CP-CML patients treated with imatinib for at least two years who achieved a major molecular response (MMR) with detectable levels of BCR-ABL1 transcripts. Results The rates of achievement of DMR at 1, 3, 6 and 12 months after switching to dasatinib treatment in the 16 patients were 44% (7/16), 56% (9/16), 63% (10/16) and 75% (12/16), respectively. The cumulative rate of achieving DMR at 12 months from initiation of dasatinib therapy was 93.8% (15/16). The proportion of natural killer cells and cytotoxic T cells in peripheral lymphocytes increased after switching to dasatinib. In contrast, the proportion of regulatory T cells decreased during treatment. The safety profile of dasatinib was consistent with previous studies. Conclusion Switching to dasatinib would be a therapeutic option for CP-CML patients who achieved MMR but not DMR by imatinib, especially for patients who wish to discontinue TKI therapy.
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Affiliation(s)
- Masayuki Shiseki
- Department of Hematology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Chikashi Yoshida
- Department of Hematology, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Naoki Takezako
- Department of Hematology, National Disaster Medical Center, Tokyo, Japan
| | - Akira Ohwada
- Department of Hematology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Takashi Kumagai
- Department of Hematology, Ohme Municipal General Hospital, Tokyo, Japan
| | - Kaichi Nishiwaki
- Clinical Oncology and Hematology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Akira Horikoshi
- Department of General Internal Medicine, Nerima-Hikarigaoka Hospital, Tokyo, Japan
| | - Tetsuya Fukuda
- Department of Hematology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hina Takano
- Department of Hematology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Yasuji Kouzai
- Hematology Department, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Junji Tanaka
- Department of Hematology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Hisashi Sakamaki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Koiti Inokuchi
- Division of Hematology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
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33
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Sugita Y, Ohwada C, Kawaguchi T, Muto T, Tsukamoto S, Takeda Y, Mimura N, Takeuchi M, Sakaida E, Shimizu N, Tanaka H, Abe D, Fukazawa M, Sugawara T, Aotsuka N, Nishiwaki K, Shono K, Ebinuma H, Fujimura K, Bujo H, Yokote K, Nakaseko C. Prognostic impact of serum soluble LR11 in newly diagnosed diffuse large B-cell lymphoma: A multicenter prospective analysis. Clin Chim Acta 2016; 463:47-52. [DOI: 10.1016/j.cca.2016.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 12/13/2022]
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34
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Suzuki K, Yano S, Nishiwaki K, Sano K, Shimada T, Yahagi Y, Ogasawara Y, Sugiyama K, Takahara S, Saito T, Kasama K, Minami J, Yokoyama H, Kamiyama Y, Katsube A, Masuoka H, Katori M, Machishima T, Ouchi A, Dobashi N, Kaito K, Usui N, Aiba K. Clinical significance of granule-containing myeloma cells in patients with newly diagnosed multiple myeloma. Cancer Med 2016; 5:3051-3058. [PMID: 27734595 PMCID: PMC5119959 DOI: 10.1002/cam4.875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 12/16/2022] Open
Abstract
The clinical features and prognostic significance of myeloma cells containing granules remain unclear. The purpose of this retrospective study was to investigate the clinical significance of granule-containing myeloma cells in patients with newly diagnosed multiple myeloma (NDMM). We retrospectively analyzed the records of 122 patients diagnosed with NDMM between January 2007 and December 2013. Granule-containing myeloma cells were defined as myeloma cells that exhibited three or more granules in their cytoplasm by May-Giemsa staining. The patients were classified into two groups, the granule-containing myeloma (GM) and nongranule-containing myeloma (non-GM) groups, depending on the proportion of myeloma cells that contained granules (cut-off value: 10%). There were 25 (20.5%) patients in the GM group. Patients in the GM group displayed significantly higher CD56 and CD49e expression than those in the non-GM group (t-test, P = 0.027 and 0.042). None of the patient characteristics differed significantly between the two groups. There was no significant difference in the chemotherapy profiles of the two groups, and the overall response rates of the two groups were similar. During the median follow-up period of 33.9 months, the overall survival (OS) in the GM group was similar to that in the non-GM group; 4-year OS of the GM and non-GM groups were 78.5% and 51.9%, respectively (P = 0.126). We concluded that cases of NDMM involving granule-containing myeloma cells are not infrequent. Moreover, CD56 and CD49e expression was significantly higher in the presence of myeloma cell populations, and the presence of granules did not affect survival.
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Affiliation(s)
- Kazuhito Suzuki
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Shingo Yano
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Kaichi Nishiwaki
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Koji Sano
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Takaki Shimada
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Yuichi Yahagi
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Yoji Ogasawara
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Katsuki Sugiyama
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Shinobu Takahara
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Takeshi Saito
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Kinuyo Kasama
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Jiro Minami
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Hiroki Yokoyama
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Yutaro Kamiyama
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Atsushi Katsube
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Hidekazu Masuoka
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Mitsuji Katori
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Tomohito Machishima
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Aya Ouchi
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Nobuaki Dobashi
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Ken Kaito
- Central Clinical LaboratoryThe Jikei University HospitalTokyoJapan
| | - Noriko Usui
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
- Division of Transfusion MedicineThe Jikei University School of MedicineTokyoJapan
| | - Keisuke Aiba
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
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35
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Miyakawa Y, Katsutani S, Yano T, Nomura S, Nishiwaki K, Tomiyama Y, Higashihara M, Shirasugi Y, Nishikawa M, Ozaki K, Abe T, Kikuchi K, Kanakura Y, Fujimura K, Ikeda Y, Okamoto S. Efficacy and safety of rituximab in Japanese patients with relapsed chronic immune thrombocytopenia refractory to conventional therapy. Int J Hematol 2016; 102:654-61. [PMID: 26466831 DOI: 10.1007/s12185-015-1887-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 11/25/2022]
Abstract
Primary immune thrombocytopenia (ITP) is an autoimmune disease mediated by the production of autoantibody against platelets. Rituximab, an anti-CD20 antibody, is reported to be useful for treatment of ITP. In Japan, however, robust evidence on this treatment has not been accumulated. Hence, we conducted this open-label phase III clinical trial to confirm the efficacy and safety of rituximab, administered at 375 mg/m² once per week at weekly intervals for 4 consecutive weeks in Japanese patients with chronic ITP, who had relapsed and were refractory to conventional therapy. The primary endpoint was defined as the percentage of patients with a platelet count above 50 × 10⁹/L at week 24 after the first dose of rituximab, which was 30.8% of 26 patients (95% confidence interval 14.3-51.8%). Although the lower confidence limit of primary endpoint failed to meet the pre-specified threshold of 20%, the clinical efficacy of rituximab is substantial in consideration of the 2% response rate in the placebo arm in other clinical studies in patients with chronic ITP. We conclude that rituximab is clinically useful and safe in the treatment of Japanese patients with chronic ITP, achieving the goal of maintaining platelet count and reducing risk of bleeding while minimizing treatment-related toxicity.
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Kawamura K, Ikeda T, Hagiwara S, Mori T, Shinagawa A, Nishiwaki K, Ohashi K, Kubonishi S, Fukuda T, Ito T, Tomita N, Ichinohe T, Kato K, Morishima Y, Atsuta Y, Sunami K, Kanda Y. Tandem autologous versus autologous/allogeneic transplantation for multiple myeloma: propensity score analysis. Leuk Lymphoma 2016; 57:2077-83. [PMID: 26961137 DOI: 10.3109/10428194.2016.1154958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/13/2022]
Abstract
Autologous hematopoietic stem cell transplantation (auto-HCT) is considered a standard therapy for transplant-eligible patients with multiple myeloma, while allogeneic HCT (allo-HCT) is controversial. We retrospectively analyzed 765 patients with myeloma who underwent tandem transplantation between 1998 and 2012 using Japanese registry data. We evaluated the clinical outcomes of tandem auto-HCT (n = 676) and auto/allo-HCT (n = 89). To adjust for a selection bias, we compared overall survival (OS) between the two groups by a propensity score analysis. The probability of OS at six years was 58.5% for the tandem auto-HCT group and 54.4% for the tandem auto/allo-HCT group (p = 0.47). In a matched-pair analysis based on the propensity score, the difference in survival between the two groups was not statistically significant, although the survival curve appeared to reach a plateau beyond five years in the auto/allo group. Further strategies to reduce treatment-related mortality and enhance a graft-versus-myeloma effect are necessary to improve OS.
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Affiliation(s)
- Koji Kawamura
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan
| | - Takashi Ikeda
- b Division of Hematology and Stem Cell Transplantation , Shizuoka Cancer Center , Shizuoka , Japan
| | - Shotaro Hagiwara
- c Division of Hematology, Internal Medicine , National Center for Global Health and Medicine , Tokyo , Japan
| | - Takehiko Mori
- d Department of Medicine, Division of Hematology , Keio University School of Medicine , Tokyo , Japan
| | - Atsushi Shinagawa
- e Department of Hematology , Hitachi General Hospital, Hitachi Ltd , Hitachi , Japan
| | - Kaichi Nishiwaki
- f Department of Internal Medicine, Division of Oncology and Hematology , Jikei University School of Medicine, Kashiwa Hospital , Kashiwa , Japan
| | - Kazuteru Ohashi
- g Hematology Division , Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital , Tokyo , Japan
| | - Shiro Kubonishi
- h Department of Hematology , National Hospital Organization Okayama Medical Center , Okayama , Japan
| | - Takahiro Fukuda
- i Division of Hematopoietic Stem Cell Transplantation , National Cancer Center Hospital , Tokyo , Japan
| | - Toshiro Ito
- j Second Department of Internal Medicine, Division of Hematology , Shinshu University School of Medicine , Matsumoto , Japan
| | - Naoto Tomita
- k Department of Rheumatology/Hematology/Infectious Disease , Yokohama City University Hospital , Yokohama , Japan
| | - Tatsuo Ichinohe
- l Department of Hematology and Oncology , Research Institute for Radiation Biology and Medicine, Hiroshima University , Hiroshima , Japan
| | - Koji Kato
- m Department of Hematology and Oncology , Children's Medical Center, Japanese Red Cross Nagoya First Hospital , Nagoya , Japan
| | - Yasuo Morishima
- n Department of Epidemiology and Prevention , Aichi Cancer Center Research Institute , Nagoya , Japan
| | - Yoshiko Atsuta
- o Japanese Data Center for Hematopoietic Cell Transplantation , Nagoya, Japan ;,p Department of Healthcare Administration , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Kazutaka Sunami
- h Department of Hematology , National Hospital Organization Okayama Medical Center , Okayama , Japan
| | - Yoshinobu Kanda
- a Division of Hematology , Saitama Medical Center, Jichi Medical University , Saitama , Japan ;,q Department of Medicine, Division of Hematology , Jichi Medical University , Shimotsuke , Japan
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37
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Miyasaka N, Miura O, Kawaguchi T, Arima N, Morishita E, Usuki K, Morita Y, Nishiwaki K, Ninomiya H, Gotoh A, Imashuku S, Urabe A, Shichishima T, Nishimura JI, Kanakura Y. Pregnancy outcomes of patients with paroxysmal nocturnal hemoglobinuria treated with eculizumab: a Japanese experience and updated review. Int J Hematol 2016; 103:703-12. [PMID: 26857155 DOI: 10.1007/s12185-016-1946-x] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 12/16/2022]
Abstract
Pregnancy with paroxysmal nocturnal hemoglobinuria (PNH) is associated with significant risk of complications, such as life-threatening thrombosis. Recently, eculizumab has come into clinical use and revolutionized the treatment of PNH. However, clinical information regarding eculizumab use for PNH during pregnancy is limited. The present report describes pregnancies with PNH treated with eculizumab that were registered with the Japan PNH study group and reviews the literature. In case 1, the patient received eculizumab throughout pregnancy and delivered a healthy neonate at term, although breakthrough hemolysis occurred at 20 weeks of gestation. In case 2, the patient discontinued eculizumab before pregnancy and developed preeclampsia at 27 weeks of gestation. She received eculizumab and delivered a preterm, but healthy, neonate by cesarean section. In case 3, the patient received eculizumab from 18 weeks of gestation and delivered a healthy neonate at term without any complications. Reports of 11 pregnant women treated with eculizumab were identified in the literature. Of 14 pregnancies, including our own cases, breakthrough hemolysis and preeclampsia occurred in five and two cases, respectively. There were no thrombotic complications, maternal or neonatal deaths, or fetal structural abnormalities. Thus, eculizumab appears to be safe and effective for managing PNH during pregnancy.
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Affiliation(s)
- Naoyuki Miyasaka
- Department of Pediatrics, Perinatal and Maternal Medicine, Graduate School of Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. .,Working Group for Pregnancy in PNH, The Japan PNH Study Group, Tokyo, Japan.
| | - Osamu Miura
- Department of Hematology, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan.,Working Group for Pregnancy in PNH, The Japan PNH Study Group, Tokyo, Japan
| | - Tatsuya Kawaguchi
- Departments of Hematology and Infectious Diseases, Kumamoto University Hospital, Kumamoto, Japan.,Working Group for Pregnancy in PNH, The Japan PNH Study Group, Tokyo, Japan
| | - Nobuyoshi Arima
- Department of Hematology, Medical Research Institute Kitano Hospital, Osaka, Japan.,Working Group for Pregnancy in PNH, The Japan PNH Study Group, Tokyo, Japan
| | - Eriko Morishita
- Department of Clinical Laboratory Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.,Working Group for Pregnancy in PNH, The Japan PNH Study Group, Tokyo, Japan
| | - Kensuke Usuki
- Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan.,Working Group for Pregnancy in PNH, The Japan PNH Study Group, Tokyo, Japan
| | - Yasuyoshi Morita
- Division of Hematology and Rheumatology, Department of Internal Medicine, Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan.,Working Group for Pregnancy in PNH, The Japan PNH Study Group, Tokyo, Japan
| | - Kaichi Nishiwaki
- Department of Oncology and Haematology, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan.,Working Group for Pregnancy in PNH, The Japan PNH Study Group, Tokyo, Japan
| | - Haruhiko Ninomiya
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Working Group for Pregnancy in PNH, The Japan PNH Study Group, Tokyo, Japan
| | - Akihiko Gotoh
- Division of Hematology, First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.,Working Group for Pregnancy in PNH, The Japan PNH Study Group, Tokyo, Japan
| | - Shinsaku Imashuku
- Division of Hematology, Takasago-Seibu Hospital, Takasago, Japan.,Working Group for Pregnancy in PNH, The Japan PNH Study Group, Tokyo, Japan
| | - Akio Urabe
- Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan.,Working Group for Pregnancy in PNH, The Japan PNH Study Group, Tokyo, Japan
| | - Tsutomu Shichishima
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.,Working Group for Pregnancy in PNH, The Japan PNH Study Group, Tokyo, Japan
| | - Jun-Ichi Nishimura
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan.,Working Group for Pregnancy in PNH, The Japan PNH Study Group, Tokyo, Japan
| | - Yuzuru Kanakura
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan.,Working Group for Pregnancy in PNH, The Japan PNH Study Group, Tokyo, Japan
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Ouchi A, Sano K, Tanoue S, Machishima T, Katori M, Masuoka S, Nishiwaki K, Usui N, Aiba K. Reversible posterior leukoencephalopathy syndrome during R-ICE therapy for malignant lymphoma. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv472.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yamakawa H, Yoshida M, Yabe M, Ishikawa T, Takagi M, Tanoue S, Sano K, Nishiwaki K, Sato S, Shimizu Y, Kuwano K. Human T-cell Lymphotropic Virus Type-1 (HTLV-1)-associated Bronchioloalveolar Disorder Presenting with Mosaic Perfusion. Intern Med 2015; 54:3039-43. [PMID: 26631889 DOI: 10.2169/internalmedicine.54.4717] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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] [Indexed: 11/06/2022] Open
Abstract
Human T-cell lymphotropic virus type-1 (HTLV-1)-associated bronchioloalveolar disorder (HABA) is a specific state with chronic and progressive respiratory symptoms caused by bronchiolar or alveolar disorder characterized by smoldering adult T-cell leukemia or the HTLV-I carrier state. We herein report a rare case of HABA with an initial presentation of mosaic perfusion in the lung. The diagnosis was made according to the results of a flow cytometry analysis of the bronchoalveolar lavage fluid and pathological findings. Clinicians must be careful to recognize that mosaic perfusion may be a radiological finding of HABA.
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Affiliation(s)
- Hideaki Yamakawa
- Department of Internal Medicine, Division of Respiratory Medicine, Jikei University School of Medicine, Kashiwa Hospital, Japan
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Yamakawa H, Yoshida M, Morikawa N, Fujimoto S, Ishikawa T, Sano K, Nishiwaki K, Takagi M, Hayashi M, Kuwano K, Aiba K. Pulmonary Nocardia nova infection after allogeneic hematopoietic stem cell transplantation. Intern Med 2014; 53:1391-5. [PMID: 24930664 DOI: 10.2169/internalmedicine.53.1860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 11/06/2022] Open
Abstract
We herein report the case of a 68-year-old man with a history of allogeneic hematopoietic stem cell transplantation for acute myelocytic leukemia in whom graft-versus-host disease (GVHD) developed in the gastrointestinal tract and liver five months after transplantation. In that same period, chest computed tomography showed infiltration in both upper lungs. We performed bronchoscopy to clarify the GVHD and pulmonary infection. Nocardia nova was identified in the bronchoalveolar lavage fluid, and we diagnosed the patient as having pulmonary nocardiosis. Because the differential diagnosis is important for the medical management of GVHD and pulmonary infection, performing bronchoscopy is essential for making an appropriate and rapid diagnosis.
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Affiliation(s)
- Hideaki Yamakawa
- Department of Internal Medicine, Division of Respiratory Medicine, Jikei University School of Medicine, Kashiwa Hospital, Japan
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41
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Shinohara Y, Takahashi N, Nishiwaki K, Hino M, Kashimura M, Wakita H, Hatano Y, Hirasawa A, Nakagawa Y, Itoh K, Masuoka H, Aotsuka N, Matsuura Y, Takahara S, Sano K, Kuroki J, Hata T, Nakamae H, Mugitani A, Nakane T, Miyazaki Y, Niioka T, Miura M, Sawada K. A multicenter clinical study evaluating the confirmed complete molecular response rate in imatinib-treated patients with chronic phase chronic myeloid leukemia by using the international scale of real-time quantitative polymerase chain reaction. Haematologica 2013; 98:1407-13. [PMID: 23716542 PMCID: PMC3762097 DOI: 10.3324/haematol.2013.085167] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 05/07/2013] [Indexed: 01/30/2023] Open
Abstract
Achievement of complete molecular response in patients with chronic phase chronic myeloid leukemia has been recognized as an important milestone in therapy cessation and treatment-free remission; the identification of predictors of complete molecular response in these patients is, therefore, important. This study evaluated complete molecular response rates in imatinib-treated chronic phase chronic myeloid leukemia patients with major molecular response by using the international standardization for quantitative polymerase chain reaction analysis of the breakpoint cluster region-Abelson1 gene. The correlation of complete molecular response with various clinical, pharmacokinetic, and immunological parameters was determined. Complete molecular response was observed in 75/152 patients (49.3%). In the univariate analysis, Sokal score, median time to major molecular response, ABCG2 421C>A, and regulatory T cells were significantly lower in chronic phase chronic myeloid leukemia patients with complete molecular response than in those without complete molecular response. In the multivariate analysis, duration of imatinib treatment (odds ratio: 1.0287, P=0.0003), time to major molecular response from imatinib therapy (odds ratio: 0.9652, P=0.0020), and ABCG2 421C/C genotype (odds ratio: 0.3953, P=0.0284) were independent predictors of complete molecular response. In contrast, number of natural killer cells, BIM deletion polymorphisms, and plasma trough imatinib concentration were not significantly associated with achieving a complete molecular response. Several predictive markers for achieving complete molecular response were identified in this study. According to our findings, some chronic myeloid leukemia patients treated with imatinib may benefit from a switch to second-generation tyrosine kinase inhibitors (ClinicalTrials.gov, UMIN000004935).
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Benzamides/blood
- Benzamides/therapeutic use
- Female
- Humans
- Imatinib Mesylate
- Internationality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Piperazines/blood
- Piperazines/therapeutic use
- Pyrimidines/blood
- Pyrimidines/therapeutic use
- Real-Time Polymerase Chain Reaction/methods
- Real-Time Polymerase Chain Reaction/standards
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Yoshinori Shinohara
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Naoto Takahashi
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Kaichi Nishiwaki
- Department of Oncology and Haematology, Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Masayuki Hino
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Makoto Kashimura
- Division of Hematology, National Health Insurance Matsudo City Hospital, Matsudo, Japan
| | - Hisashi Wakita
- Department of Hematology, Narita Red Cross Hospital, Narita, Japan
| | - Yoshiaki Hatano
- Division of Hematology, Yamamoto Kumiai General Hospital, Noshiro, Japan
| | - Akira Hirasawa
- Department of Hematology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Yasuaki Nakagawa
- Department of Internal Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kuniaki Itoh
- Division of Oncology and Hematology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hidekazu Masuoka
- Department of Oncology and Haematology, Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Nobuyuki Aotsuka
- Department of Hematology, Narita Red Cross Hospital, Narita, Japan
| | | | - Sinobu Takahara
- Department of Oncology and Haematology, Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Koji Sano
- Department of Oncology and Haematology, Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Jun Kuroki
- Division of Hematology, Yuri Kumiai General Hospital, Yurihonjo, Japan
| | - Tomoko Hata
- Department of Hematology, Atomic Bomb Disease and Hibakusya Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hirohisa Nakamae
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Atsuko Mugitani
- Department of Hematology, Seichokai Fuchu Hospital, Izumi, Japan
| | - Takahiko Nakane
- Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yasushi Miyazaki
- Department of Hematology, Atomic Bomb Disease and Hibakusya Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takenori Niioka
- Department of Pharmacy, Akita University Hospital, Akita, Japan
| | - Masatomo Miura
- Department of Pharmacy, Akita University Hospital, Akita, Japan
| | - Kenichi Sawada
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
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Hishiki K, Toyama M, Sato R, Suzuki I, Kisugi R, Koike M, Nishiwaki K, Masuoka H, Yoshida H. [Draft proposal to estimate true values of serum potassium in samples from patients with myeloproliferative neoplasma]. Rinsho Byori 2012; 60:516-522. [PMID: 22880228] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The pseudohyperkalemia in thrombocytosis is assumed to be due to potassium released from blood cells during blood clotting as reported previously, but its mechanisms remain to be cleared. Although plasma potassium measurements with blood collection tubes containing heparin are performed in many hospitals to avoid pseudohyperkalemia, the burden on patients may come out with further blood sampling by another heparinized tube. Taken together, we investigated laboratory data possibly involved in pseudohyperkalemia in 184 samples from patients with myeloproliferative neoplasma (MPN), and studied estimation capability for true values of serum potassium, driving a correction formula by means of several laboratory data to explain the difference of measured potassium values (K-difference: serum value minus plasma value). Platelet count and mean corpuscular volume (MCV) were adopted as significant variables correlated to K-difference as a result of multiple regression analysis. A correction formula was driven by multiple regression equation with these two variables as follows: y = 0.0006 x 1+0.0004 x 2-0.177 (r= 0.885; x 1, platelet count; x 2, MPV). The correction formula was considered to be useful for estimating the true value of serum potassium in samples from patients with MPN because the corrected serum potassium value correlated highly with plasma potassium value (r = 0.885). These results propose that true values of serum potassium can be estimated by the correction of measured serum potassium values with platelet count and MCV, suggesting that not only quantitative factors but also qualitative factors may be involved in pseudohyperkalemia.
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Affiliation(s)
- Kotaro Hishiki
- Department of Laboratory Medicine, Jikei University Kashiwa Hospital, Kashiwa 277-8567, Japan.
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Miyabe-Nishiwaki T, Masui K, Kaneko A, Nishiwaki K, Nishio T, Kanazawa H. Evaluation of the predictive performance of a pharmacokinetic model for propofol in Japanese macaques (Macaca fuscata fuscata). J Vet Pharmacol Ther 2012; 36:169-73. [PMID: 22568878 DOI: 10.1111/j.1365-2885.2012.01404.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Propofol is a short-acting intravenous anesthetic used for induction/maintenance anesthesia. The objective of this study was to assess a population pharmacokinetic (PPK) model for Japanese macaques during a step-down infusion of propofol. Five male Japanese macaques were immobilized with ketamine (10 mg/kg) and atropine (0.02 mg/kg). A bolus dose of propofol (5 mg/kg) was administrated intravenously (360 mg/kg/h) followed by step-down infusion at 40 mg/kg/h for 10 min, 20 mg/kg/h for 10 min, and then 15 mg/kg/h for 100 min. Venous blood samples were repeatedly collected following the administration. The plasma concentration of propofol (Cp) was measured by high-speed LC-FL. PPK analyses were performed using NONMEM VII. Median absolute prediction error and median prediction error (MDPE), the indices of prediction inaccuracy and bias, respectively, were calculated, and PE - individual MDPE vs. time was depicted to show the variability of prediction errors. In addition, we developed another population pharmacokinetic model using previous and current datasets. The previous PK model achieved stable prediction of propofol Cp throughout the study period, although it underestimates Cp. The step-down infusion regimen described in this study would be feasible in macaques during noninvasive procedures.
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Affiliation(s)
- T Miyabe-Nishiwaki
- Center of Human Evolution Modeling Research, Primate Research Institute, Aichi University, Kyoto, Japan
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45
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Tanaka R, Kimura S, Ashihara E, Yoshimura M, Takahashi N, Wakita H, Itoh K, Nishiwaki K, Suzuki K, Nagao R, Yao H, Hayashi Y, Satake S, Hirai H, Sawada KI, Ottmann OG, Melo JV, Maekawa T. Rapid automated detection of ABL kinase domain mutations in imatinib-resistant patients. Cancer Lett 2011; 312:228-34. [DOI: 10.1016/j.canlet.2011.08.009] [Citation(s) in RCA: 15] [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: 04/05/2011] [Revised: 07/03/2011] [Accepted: 08/10/2011] [Indexed: 11/29/2022]
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Yano S, Minami J, Nishiwaki K, Shimada T, Dobashi N, Yahagi Y, Takei Y, Takahara S, Ogasawara Y, Sugiyama K, Yamaguchi Y, Saito T, Kasama K, Yokoyama H, Machishima T, Katsube A, Usui N, Aiba K. Rapid progression and unusual premortal diagnosis of mucormycosis in patients with hematologic malignancies: analysis of eight patients. Int J Hematol 2011; 93:344-350. [DOI: 10.1007/s12185-011-0780-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 01/25/2011] [Accepted: 01/26/2011] [Indexed: 11/30/2022]
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Miyabe-Nishiwaki T, Kaneko A, Nishiwaki K, Watanabe A, Watanabe S, Maeda N, Kumazaki K, Morimoto M, Hirokawa R, Suzuki J, Ito Y, Hayashi M, Tanaka M, Tomonaga M, Matsuzawa T. Tetraparesis resembling acute transverse myelitis in a captive chimpanzee (Pan troglodytes): long-term care and recovery. J Med Primatol 2011; 39:336-46. [PMID: 20444005 DOI: 10.1111/j.1600-0684.2010.00415.x] [Citation(s) in RCA: 10] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND A 24-year-old, male chimpanzee (Pan troglodytes) developed acute tetraparesis. Magnetic resonance imaging showed a diffuse T2-weighted hyperintensive lesion, indicating inflammation at the C1-2 level. All infective, autoimmune, and vascular investigations were unremarkable. RESULTS AND CONCLUSIONS The chimpanzee's condition most resembled acute transverse myelitis (ATM) in humans. The chimpanzee was in severe incapacitated neurological condition with bedridden status and required 24-hour attention for 2 months followed by special care for over a year. Initially, corticosteroid therapy was performed, and his neurological symptoms improved to some extent; however, the general condition of the chimpanzee deteriorated in the first 6 months after onset. Pressure ulcers had developed at various areas on the animal's body, as the bedridden status was protracted. Supportive therapy was continued, and the general condition, appetite, mobility, and pressure ulcers have slowly but synergistically recovered over the course of 2 years.
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Affiliation(s)
- T Miyabe-Nishiwaki
- Center for Human Evolution Modeling Research, Primate Research Institute, Kyoto University, Inuyama, Aichi, Japan
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Nishiwaki K, Hiramatsu S, Yano K. Tremor Suppression using Proxy-based Sliding-Mode Control for a Meal-Assist Robot. Robotics 2010. [DOI: 10.2316/p.2010.703-041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
The present paper presents an online walking control system that frequently generates and updates dynamically stable motion patterns with a cycle time of 20 ms. We show that frequently updating the motion pattern contributes to maintaining long-term balance while performing online walking control. In addition, the system enables a robot to respond quickly to changes in the commanded walking direction. Using preview control theory, we generate dynamically stable walking patterns. We propose a method to adjust the future desired zero moment point (ZMP) by modifying the foot landing position in order to maintain the dynamic balance of the generated motion pattern. This technique can be used to filter input commands that would result in sudden changes to the foot landing position, which would result in dynamic instability. The method is also used to compensate for errors between the actual and desired ZMP due to disturbances encountered while walking. We also present an extension of the short cycle pattern generation method that can accommodate external forces measured online. Experimental results for activities such as pushing a table are demonstrated on the full-size humanoid HRP-2 to evaluate the performance of the proposed walking control system.
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Affiliation(s)
- K. Nishiwaki
- Digital Human Research Center, National Institute of Advanced Industrial Science and Technology (AIST), 2-41-6, Aomi, Koto-ku, Tokyo 135-0064 Japan
| | - S. Kagami
- Digital Human Research Center, National Institute of Advanced Industrial Science and Technology (AIST), 2-41-6, Aomi, Koto-ku, Tokyo 135-0064 Japan
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50
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Fujiwara Y, Sato Y, Shibata Y, Asakura Y, Nishiwaki K, Komatsu T. A greater decrease in blood pressure after spinal anaesthesia in patients with low entropy of the RR interval. Acta Anaesthesiol Scand 2007; 51:1161-5. [PMID: 17714571 DOI: 10.1111/j.1399-6576.2007.01435.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The objective of this study was to determine whether pre-operative heart rate variability (HRV) estimated using the newly developed MemCalc method predicts hypotension after spinal anaesthesia (SA). METHOD Fifty-two patients with American Society of Anesthesiologists physical status I or II, aged 38-84 years, scheduled to undergo elective transurethral surgery were investigated in this study. Ultra short-term entropy (UsEn) as a non-linear index of HRV was estimated before and after SA using the MemCalc method. The patients were then assigned to two groups (Group LO and HI) according to pre-operative UsEn. SA was performed by intrathecal injection of 17.5 mg of isobaric bupivacaine via interlumbar spaces L3-4 or L4-5. After SA, the haemodynamic fluctuations were recorded and compared between the two groups. RESULTS SA significantly decreased LF/HF (a ratio of the low frequency component of HRV to that of the high frequency component) but did not affect UsEn. The percentage decrease in systolic blood pressure (SBP) after SA was 11.4 (9.9)% in group HI, whereas it was 17.5 (9.8)% in group LO (P < 0.05). Furthermore, the number of patients who developed hypotension was significantly higher in group LO. CONCLUSION SA significantly decreased LF/HF without affecting UsEn. Patients with a low UsEn developed a greater decrease in SBP after SA. Furthermore, the incidence of hypotension after SA was higher in patients with a low UsEn.
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Affiliation(s)
- Y Fujiwara
- Department of Anaesthesiology, Aichi Medical University, Nagakute, Aichi, Japan.
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