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Edahiro Y, Ochiai T, Hashimoto Y, Ichii M, Okatani T, Omura H, Nakajima K, Sasaki M, Ando J, Takaku T, Koike M, Izumiyama K, Hiraga J, Yano T, Usuki K, Ohtsuka E, Yokoyama K, Oyake T, Takahashi N, Nishida T, Nakao T, Fukuda Y, Akasaka T, Mugitani A, Ando M, Komatsu N. Real-world status of treatment for lymphoid neoplasms developed during the course of myeloproliferative neoplasms in Japan. Hematology 2024; 29:2340149. [PMID: 38626148 DOI: 10.1080/16078454.2024.2340149] [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: 12/07/2023] [Accepted: 04/02/2024] [Indexed: 04/18/2024] Open
Abstract
OBJECTIVES Patients with myeloproliferative neoplasms (MPNs) are at higher risk of developing secondary malignancies. In this study, we focused on patients with MPNs that complicated lymphoid neoplasms. To analyze the real-world status of lymphoid neoplasm treatment in patients with pre-existing MPNs in Japan, we conducted a multicenter retrospective study. METHODS Questionnaires were sent to collect the data on patients who were first diagnosed with either polycythemia vera, essential thrombocythemia or myelofibrosis and who later were complicated with lymphoid neoplasms defined as malignant lymphoma, multiple myeloma, or chronic lymphocytic leukemia/small cell lymphoma. RESULTS Twenty-four patients with MPNs complicated by lymphoid neoplasms were enrolled (polycythemia vera, n = 8; essential thrombocythemia, n = 14; and primary myelofibrosis, n = 2). Among these, diffuse large B-cell lymphoma (DLBCL) was the most frequently observed (n = 13, 54.1%). Twelve (92.3%) of the patients with DLBCL received conventional chemotherapy. Among these 12 patients, regarding cytoreductive therapy for MPNs, 8 patients stopped treatment, one continued treatment, and two received a reduced dose. Consequently, most patients were able to receive conventional chemotherapy for DLBCL with a slightly higher dose of granulocyte colony-stimulating factor support than usual without worse outcomes. All 3 patients with multiple myeloma received a standard dose of chemotherapy. CONCLUSION Our data indicate that if aggressive lymphoid neoplasms develop during the course of treatment in patients with MPNs, it is acceptable to prioritize chemotherapy for lymphoma.
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Affiliation(s)
- Yoko Edahiro
- Department of Advanced Hematology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
- Laboratory for the Development of Therapies against MPN, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomonori Ochiai
- Department of Advanced Hematology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
- Laboratory for the Development of Therapies against MPN, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshinori Hashimoto
- Department of Advanced Hematology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Hematology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Michiko Ichii
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Okatani
- Division of Hematology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Hiromi Omura
- Department of Hematology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Kei Nakajima
- Department of Hematology/Oncology, University of Yamanashi, Yamanashi, Japan
| | - Makoto Sasaki
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Jun Ando
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
- Division of Cell Therapy & Blood Transfusion Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomoiku Takaku
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Michiaki Koike
- Department of Hematology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Hokkaido, Japan
| | - Junji Hiraga
- Department of Hematology, Toyota Kosei Hospital, Aichi, Japan
| | - Tomofumi Yano
- Internal Medicine Department, Okayama Rosai Hospital, Okayama, Japan
| | - Kensuke Usuki
- Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Eiichi Ohtsuka
- Department of Hematology, Oita Prefectural Hospital, Oita, Japan
| | - Kenji Yokoyama
- Department of Hematology/Oncology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Tatsuo Oyake
- Division of Hematology and Oncology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Naoki Takahashi
- Department of Hematopoietic Tumor, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Tetsuya Nishida
- Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Takafumi Nakao
- Department of Hematology, Osaka City General Hospital, Osaka, Japan
| | - Yasutaka Fukuda
- Department of Hematology, Juntendo University Nerima Hospital, Tokyo, Japan
| | | | - Atsuko Mugitani
- Department of Hematology, Seichokai Fuchu Hospital, Osaka, Japan
| | - Miki Ando
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Norio Komatsu
- Department of Advanced Hematology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
- Laboratory for the Development of Therapies against MPN, Juntendo University Graduate School of Medicine, Tokyo, Japan
- PharmaEssentia Japan KK, Tokyo, Japan
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Kobayashi M, Mori A, Oda Y, Yokoyama E, Kanaya M, Izumiyama K, Saito M, Tanaka S, Morioka M, Kondo T. New onset of hypomegakaryocytic thrombocytopenia with the potential for progression to aplastic anemia after BNT162b2 mRNA COVID-19 vaccination. Int J Hematol 2023; 118:477-482. [PMID: 37219678 PMCID: PMC10203663 DOI: 10.1007/s12185-023-03618-7] [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: 03/24/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/24/2023]
Abstract
Vaccination with a coronavirus disease-2019 (COVID-19) vaccine is an effective public health measure for reducing the risk of infection and severe complications from COVID-19. However, serious hematological complications after COVID-19 vaccination have been reported. Here, we report a case of new-onset hypomegakaryocytic thrombocytopenia (HMT) with the potential for progression to aplastic anemia (AA) that developed in a 46-year-old man 4 days after the fourth mRNA COVID-19 vaccination. Platelet count rapidly decreased after vaccination and white blood cell count declined subsequently. Bone marrow examination immediately after disease onset showed severely hypocellular marrow (cellularity of almost 0%) in the absence of fibrosis, findings that were consistent with AA. Since the severity of pancytopenia did not meet the diagnostic criteria for AA, the patient was diagnosed with HMT that could progress to AA. Treatment with eltrombopag and cyclosporine was started immediately after diagnosis and cytopenia improved. Although it is difficult to determine whether the post-vaccination cytopenia was vaccine induced or accidental because the association was chronological, vaccination with an mRNA-based COVID-19 vaccine may be associated with development of HMT/AA. Therefore, physicians should be aware of this rare, but serious adverse event and promptly provide appropriate treatment.
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Affiliation(s)
- Mirei Kobayashi
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan.
| | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan
| | - Yoshitaka Oda
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Emi Yokoyama
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan
| | - Minoru Kanaya
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan
| | - Makoto Saito
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo, Japan
| | - Masanobu Morioka
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan
| | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan
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Saito M, Mori A, Kajikawa S, Yokoyama E, Kanaya M, Izumiyama K, Morioka M, Kondo T, Tanei ZI, Shimizu A. Helicobacter pylori eradication treatment for primary gastric diffuse large B-cell lymphoma: A single-center analysis. World J Clin Cases 2023; 11:6424-6430. [PMID: 37900236 PMCID: PMC10600996 DOI: 10.12998/wjcc.v11.i27.6424] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/11/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Unlike the already established effect of Helicobacter pylori (H. pylori) eradication on gastric mucosa-associated lymphoid tissue (MALT) lymphoma, its therapeutic effect on primary gastric diffuse large B-cell lymphoma (DLBCL) is still unclear. AIM To clarify the efficacy of H. pylori eradication treatment for primary gastric DLBCL. METHODS We reported on 3 new cases, and added them to 3 previously reported cases. We analyzed the usefulness of H. pylori eradication treatment for gastric DLBCL for a total of 6 cases at our center. RESULTS Of the 6 patients (27-90 years old, 3 males and 3 females), all 3 patients with single lesions (one transformed from MALT lymphoma) achieved complete remission (CR) after H. pylori eradication. Regarding the 2 newly reported cases, CR was maintained for more than 6 years with eradication treatment alone. In contrast, none of the 3 patients with 2 lesions achieved CR. In 1 newly reported case, endoscopic CR was achieved in one lesion, while stable disease was obtained in the other lesion. Two patients with progressive disease responded to standard chemotherapy ± radiation and remained in CR for more than 6 years. CONCLUSION We believe it is worthwhile to attempt H. pylori eradication for elderly patients with primary gastric DLBCL in a single lesion with a small tumor burden.
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Affiliation(s)
- Makoto Saito
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Sayaka Kajikawa
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Emi Yokoyama
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Minoru Kanaya
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Masanobu Morioka
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Hokkaido, Japan
| | - Zen-Ichi Tanei
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo 060-8638, Hokkaido, Japan
| | - Ai Shimizu
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo 060-8648, Hokkaido, Japan
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Kobayashi M, Yokoyama E, Izumiyama K, Mori A, Saito M, Morioka M, Kondo T. [Brentuximab Vedotin, Doxorubicin, Vinblastine, Dacarbazine(A+AVD)Therapy for Classical Hodgkin Lymphoma- A Single-Institution Experience]. Gan To Kagaku Ryoho 2023; 50:979-983. [PMID: 37800293] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
The JSH Practical Guidelines for Hematological Malignancies, 2018 expanded edition, newly adopted brentuximab vedotin, doxorubicin, vinblastine, dacarbazine(A+AVD)protocol as a standard treatment for advanced-stage classical Hodgkin lymphoma(CHL). Therefore, this retrospective analysis compared 15 patients who received A+AVD therapy with 21 patients who received doxorubicin, bleomycin, vinblastine, dacarbazine(ABVD)therapy. All patients were newly diagnosed with CHL and received induction therapy between April 2015 and June 2022 in our hospital. All except 1 patient of the A+AVD group had advanced-stage CHL. The median age was 63(23-85)years. The estimated 2-year overall survival of the A+AVD group was better than that of the ABVD group which included 6 patients with clinical stage Ⅲ or higher CHL (100% vs 66.7%, p=0.047). In contrast, there was no significant difference in the complete response rate(53.8% vs 100%, p=0.109)between the 2 groups. The overall response rate after first-line treatment(69.2% vs 100%, p=0.255), and the estimated 2-year progression-free survival(70.1% vs 66.7%, p=0.321)between the A+AVD and the ABVD groups were similar.
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Mori A, Onozawa M, Kobayashi M, Tsukamoto S, Senjo H, Ishio T, Yokoyama E, Kanaya M, Izumiyama K, Saito M, Muraki H, Morioka M, Teshima T, Kondo T. Booster effect of a third mRNA-based COVID-19 vaccine dose in patients with myeloid malignancies. Cancer Med 2023; 12:16881-16888. [PMID: 37409608 PMCID: PMC10501249 DOI: 10.1002/cam4.6314] [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: 03/01/2023] [Revised: 05/26/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND We have reported that seroconversion rates after the second dose of mRNA-based COVID-19 vaccines for myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) were 100% and 95% respectively, with no significant difference from healthy controls (HCs).However, there are very limited data for the response to a third vaccine dose in those patients. AIMS In this complementary study, we investigated the booster effect of a third mRNA-based COVID-19 vaccine dose in patients with myeloid malignancies. MATERIALS & METHODS A total 58 patients including 20 patients with MDS and 38 patients with AML were enrolled. Anti-SARS-CoV-2S immunoassays were performed at 3, 6, and 9 months after the second vaccine dose. RESULTS Seventy-five percent of the MDS patients and 37% of the AML patients were receiving active treatment at the time of the third vaccination. Both the initial and third vaccine response in AML patients were comparable to those in HCs. In MDS patients, although the initial vaccine immunogenicity was inferior to that in HCs and AML patients, the third vaccine improved the response to a level not inferior to those in HCs and AML patients. Of note, the third vaccine resulted in a significant increase of antibodies in actively treated MDS patients who had shown a response inferior to that in untreated patients after two doses of vaccination. DISCUSSION In patients with myeloid malignancies, the third vaccine dose showed a booster effect, and disease- and therapy-related factors associated with the booster response have been identified. CONCLUSION The third dose of an mRNA-based COVID-19 vaccine showed a booster effect in patients with myeloid malignancies. Such a good booster response has not been reported in other haematological malignancies.
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Affiliation(s)
- Akio Mori
- Blood Disorders CenterAiiku HospitalSapporoJapan
| | - Masahiro Onozawa
- Department of HematologyHokkaido University Faculty of MedicineSapporoJapan
| | | | | | - Hajime Senjo
- Blood Disorders CenterAiiku HospitalSapporoJapan
- Department of HematologyHokkaido University Faculty of MedicineSapporoJapan
| | | | - Emi Yokoyama
- Blood Disorders CenterAiiku HospitalSapporoJapan
| | | | | | - Makoto Saito
- Blood Disorders CenterAiiku HospitalSapporoJapan
| | - Haruna Muraki
- Division of LaboratoryAiiku HospitalSapporoJapan
- Sapporo Clinical Laboratory Inc.SapporoJapan
| | | | - Takanori Teshima
- Department of HematologyHokkaido University Faculty of MedicineSapporoJapan
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6
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Ishio T, Tsukamoto S, Yokoyama E, Izumiyama K, Saito M, Muraki H, Kobayashi M, Mori A, Morioka M, Kondo T. Anti-CD20 antibodies and bendamustine attenuate humoral immunity to COVID-19 vaccination in patients with B-cell non-Hodgkin lymphoma. Ann Hematol 2023; 102:1421-1431. [PMID: 37041299 PMCID: PMC10089694 DOI: 10.1007/s00277-023-05204-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 11/11/2022] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
Serologic responses of COVID-19 vaccine are impaired in patients with B-cell lymphoma, especially those who had recently been treated with anti-CD20 monoclonal antibodies. However, it is still unclear whether those patients develop an immune response following vaccination. We investigated the efficacy of vaccination against SARS-CoV-2 in 171 patients with B-cell non-Hodgkin lymphoma (B-NHL) who received two doses of an mRNA-based COVID-19 vaccine and we compared the efficacy of vaccination to that in 166 healthy controls. Antibody titers were measured 3 months after administration of the second vaccine dose. Patients with B-NHL showed a significantly lower seroconversion rate and a lower median antibody titer than those in healthy controls. The antibody titers showed correlations with the period from the last anti-CD20 antibody treatment to vaccination, the period from the last bendamustine treatment to vaccination and serum IgM level. The serologic response rates and median antibody titers were significantly different between diffuse large B-cell lymphoma (DLBCL) patients in whom anti-CD20 antibody treatment was completed within 9 months before vaccination and follicular lymphoma (FL) patients in whom anti-CD20 antibody treatment was completed within 15 months before vaccination. Moreover, the serologic response rates and median antibody titers were significantly different among FL patients in whom bendamustine treatment was completed within 33 months before vaccination. We demonstrated that B-NHL patients who were recently treated with anti-CD20 antibodies and bendamustine had a diminished humoral response to COVID-19 vaccination. UMIN 000,045,267.
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Affiliation(s)
- Takashi Ishio
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan.
| | | | - Emi Yokoyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Makoto Saito
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Haruna Muraki
- Division of Laboratory, Aiiku Hospital, Sapporo, Japan
| | | | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | | | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
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Mori A, Onozawa M, Kobayashi M, Tsukamoto S, Senjo H, Ishio T, Yokoyama E, Izumiyama K, Saito M, Muraki H, Morioka M, Teshima T, Kondo T. Humoral response to mRNA-based COVID-19 vaccine in patients with immune thrombocytopenia. Br J Haematol 2023; 200:717-721. [PMID: 36442510 PMCID: PMC9877767 DOI: 10.1111/bjh.18578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/30/2022]
Abstract
Data for COVID-19 vaccine response in patients with immune thrombocytopenia (ITP) are very limited. In a study of 28 patients with ITP, anti-severe acute respiratory syndrome coronavirus 2 spike antibody titres were measured after vaccination. The seroconversion rate for ITP patients was 91.3%, comparable to that in healthy controls (HCs). However, the antibody titre in ITP patients was significantly lower than that in HCs and declined with ageing. Furthermore, the antibody titre in ITP patients who received a minimum prednisolone dose of at least 5 mg/day at any time-point at or after initial vaccination was lower than that in other patients.
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Affiliation(s)
- Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Masahiro Onozawa
- Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | | | | | - Hajime Senjo
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan.,Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Takashi Ishio
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Emi Yokoyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Makoto Saito
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Haruna Muraki
- Division of Laboratory, Aiiku Hospital, Sapporo, Japan.,Sapporo Clinical Laboratory, Inc., Sapporo, Japan
| | | | - Takanori Teshima
- Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
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Mori A, Onozawa M, Kobayashi M, Tsukamoto S, Ishio T, Yokoyama E, Izumiyama K, Saito M, Muraki H, Morioka M, Teshima T, Kondo T. Humoral response to mRNA-based COVID-19 vaccine in patients with de novo and pre-existing immune thrombocytopenia with exacerbation of thrombocytopenia after vaccination. Br J Haematol 2022; 199:627-630. [PMID: 36096497 PMCID: PMC9538325 DOI: 10.1111/bjh.18447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Masahiro Onozawa
- Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | | | | | - Takashi Ishio
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Emi Yokoyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Makoto Saito
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Haruna Muraki
- Division of Laboratory, Aiiku Hospital, Sapporo, Japan.,Sapporo Clinical Laboratory, Inc., Sapporo, Japan
| | | | - Takanori Teshima
- Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
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Saito M, Mori A, Tsukamoto S, Ishio T, Yokoyama E, Izumiyama K, Morioka M, Kondo T, Sugino H. Duodenal-type follicular lymphoma more than 10 years after treatment intervention: A retrospective single-center analysis. World J Gastrointest Oncol 2022; 14:1552-1561. [PMID: 36160741 PMCID: PMC9412938 DOI: 10.4251/wjgo.v14.i8.1552] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/29/2022] [Accepted: 07/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Duodenal-type follicular lymphoma (D-FL) has been recognized as a rare entity that accounts for approximately 4% of primary gastrointestinal lymphomas. D-FL follows an indolent clinical course compared with common nodal FL and is generally considered to have a better prognosis. Therefore, the “watch and wait” approach is frequently adopted as the treatment method. Alternatively, there is an option to actively intervene in D-FL. However, the long-term outcomes of such cases are poorly understood.
AIM To clarify the clinical outcomes after long-term follow-up in cases of D-FL with treatment intervention.
METHODS We retrospectively analyzed patients who met the following criteria: the lesion was confirmed by endoscopy, the diagnosis of D-FL was confirmed histopathologically, and the patient was followed-up for more than 10 years after the intervention at our center.
RESULTS We identified 5 cases of D-FL. Two patients showed a small amount of bone marrow involvement (Stage IV). Rituximab was used as a treatment for remission in all 5 patients. It was also used in combination with chemotherapy in 2 Stage IV patients as well as for maintenance treatment. Radiation therapy was performed in 2 cases, which was followed by complete remission (CR). Eventually, all 5 patients achieved CR and survived for more than 10 years. However, 3 patients experienced recurrence. One patient achieved a second CR by retreatment, and in another case, the lesion showed spontaneous disappearance. The remaining patient had systemic widespread recurrence 13 years after the first CR. Biopsy results suggested that the FL lesions were transformed into diffuse large B-cell lymphoma. The patient died 4 years later despite receiving various chemotherapies.
CONCLUSION In this study, the treatment for patients of D-FL in Stage IV was successful. In the future, criteria for how to treat “advanced” D-FL should be established based on additional cases. This study of patients with D-FL indicates that whole-body follow-up examinations should continue for a long time due to a fatal recurrence 13 years after reaching CR.
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Affiliation(s)
- Makoto Saito
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Japan
| | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Japan
| | | | - Takashi Ishio
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Japan
| | - Emi Yokoyama
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Japan
| | | | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Japan
| | - Hirokazu Sugino
- Department of Cancer Pathology, Hokkaido University, Faculty of Medicine, Sapporo 060-8638, Japan
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Saito M, Egami H, Kato T, Yokoyama E, Izumiyama K, Mori A, Morioka M, Kondo T, Tanei ZI. Synchronous colon cancer after treatment for rectal follicular lymphoma: A case report. Mol Clin Oncol 2022; 17:129. [PMID: 35832471 PMCID: PMC9264324 DOI: 10.3892/mco.2022.2562] [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: 04/25/2022] [Accepted: 06/01/2022] [Indexed: 11/12/2022] Open
Abstract
Colorectal follicular lymphoma (FL) is rare. In addition, it is even rarer that colon cancer develops synchronously with colorectal lymphoma. The present study reports a case of sigmoid colon cancer that developed 6 months after endoscopic resection of rectal FL. A 71-year-old man with a history of developing mucosa-associated lymphoid tissue lymphoma in his stomach at age 48, right neck region at age 59 (the latter later modified as FL) and lung adenocarcinoma at age 60 now suffers from rectal FL. Endoscopic submucosal dissection (ESD) was performed at our hospital (Aiiku Hospital), and 6 months after the treatment, sigmoid colon cancer was confirmed by colonoscopy for the follow-up study. The patient was successfully curatively resected by ESD plus local resection and has survived without a recurrence for >3 years with no treatment. It was speculated that in the present case, cancer-related genes were changed as a carcinogenic mechanism due to decreased immune function associated with the onset of lymphoma.
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Affiliation(s)
- Makoto Saito
- Blood Disorders Center, Aiiku Hospital, Sapporo, Hokkaido 064‑0804, Japan
| | - Hiroki Egami
- Department of Gastroenterology, Aiiku Hospital, Sapporo, Hokkaido 064‑0804, Japan
| | - Takashi Kato
- Department of Gastroenterology, Aiiku Hospital, Sapporo, Hokkaido 064‑0804, Japan
| | - Emi Yokoyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Hokkaido 064‑0804, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Hokkaido 064‑0804, Japan
| | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo, Hokkaido 064‑0804, Japan
| | - Masanobu Morioka
- Blood Disorders Center, Aiiku Hospital, Sapporo, Hokkaido 064‑0804, Japan
| | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo, Hokkaido 064‑0804, Japan
| | - Zen-Ichi Tanei
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido 060‑8638, Japan
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11
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Mori A, Onozawa M, Tsukamoto S, Ishio T, Yokoyama E, Izumiyama K, Saito M, Muraki H, Morioka M, Teshima T, Kondo T. P559: HUMORAL RESPONSE TO MRNA-BASED COVID-19 VACCINE IN PATIENTS WITH MYELOID MALIGNANCIES. Hemasphere 2022. [DOI: 10.1097/01.hs9.0000845124.08444.37] [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: 11/25/2022] Open
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12
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Mori A, Onozawa M, Tsukamoto S, Ishio T, Yokoyama E, Izumiyama K, Saito M, Muraki H, Morioka M, Teshima T, Kondo T. Humoral response to mRNA-based COVID-19 vaccine in patients with myeloid malignancies. Br J Haematol 2022; 197:691-696. [PMID: 35226358 PMCID: PMC9111452 DOI: 10.1111/bjh.18138] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 01/31/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/01/2022]
Abstract
Data on the response to the COVID‐19 vaccine in patients with myeloid malignancy, who are at severe risk in case of infection, have not emerged. In a study of 69 patients with myeloid malignancies, including 46 patients with acute myeloid leukaemia (AML) and 23 patients with myelodysplastic syndrome (MDS), anti‐spike SARS‐CoV‐2 antibody titres were measured 3 months after the second mRNA‐based vaccination. Seroconversion rates for AML and MDS were 94.7% and 100% respectively, with no significant difference from healthy controls (HCs). Patients with MDS showed a significantly lower antibody titre than that in HCs or AML patients. In AML patients, the antibody titres were comparable to those in HCs when treatment was completed, but lower in patients under maintenance therapy. The response to COVID‐19 vaccine appears to be related to disease and treatment status. Patients with myeloid malignancies may be more responsive to vaccines than patients with lymphoid malignancies.
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Affiliation(s)
- Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Masahiro Onozawa
- Department of Hematology, Hokkaido University, Faculty of Medicine, Sapporo, Japan
| | | | - Takashi Ishio
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Emi Yokoyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Makoto Saito
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Haruna Muraki
- Division of Laboratory, Aiiku Hospital, Sapporo, Japan.,Sapporo Clinical Laboratory Inc, Sapporo, Japan
| | | | - Takanori Teshima
- Department of Hematology, Hokkaido University, Faculty of Medicine, Sapporo, Japan
| | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
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13
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Miyajima T, Harada S, Ogasawara R, Yokoyama E, Izumiyama K, Mori A, Saito M, Morioka M, Chi S, Minami Y, Kondo T. [Successful treatment with gilteritinib for relapsed acute myeloid leukemia with FLT3-N676K mutation]. Rinsho Ketsueki 2022; 63:51-54. [PMID: 35135952 DOI: 10.11406/rinketsu.63.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The patient was a 68-year-old woman, diagnosed with acute myelomonocytic leukemia with normal karyotype and FLT3-ITD-negative status in May 2019. She had achieved complete remission (CR) after "7+3" intensive induction chemotherapy and maintained CR by consolidation chemotherapy. However, she relapsed with swelling of the lips and gums in January 2020. She did not achieve CR by salvage chemotherapy with cytarabine-aclarubicin-G-CSF regimen. Comprehensive genomic analysis of leukemic cells revealed the presence of FLT3-N676K mutation, which was undetectable by companion diagnostics at the time. Complete remission with incomplete count recovery was obtained on day 28 after initiation of gilteritinib monotherapy, and the lip and gum swelling improved rapidly. However, she relapsed on day 106 after gilteritinib administration, and gilteritinib was discontinued. Genomic analysis at recurrence revealed NRAS mutation for the first time. Finally, the patient died of the uncontrolled primary disease. This is a case in which comprehensive gene mutation analysis was useful in determining a treatment strategy.
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Affiliation(s)
| | - Shinpei Harada
- Department of Hematology, Hokkaido University Faculty of Medicine and Graduate School of Medicine
| | | | | | | | - Akio Mori
- Blood Disorders Center, Aiiku Hospital
| | | | | | - SungGi Chi
- Department of Hematology and Oncology, National Cancer Center Hospital East
| | - Yosuke Minami
- Department of Hematology and Oncology, National Cancer Center Hospital East
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14
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Saito M, Tsukamoto S, Ishio T, Yokoyama E, Izumiyama K, Mori A, Morioka M, Kondo T, Sugino H. Multiple Colorectal Mucosa-Associated Lymphoid Tissue Lymphoma Successfully Treated with Chemotherapy. Case Rep Oncol 2021; 14:1761-1767. [PMID: 35082637 PMCID: PMC8739633 DOI: 10.1159/000520428] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/19/2021] [Indexed: 11/19/2022] Open
Abstract
The standard treatment for colorectal mucosa-associated lymphoid tissue (MALT) lymphoma has not yet been established due to the rarity of the disease. Here, we report a case of long-term response to chemotherapy for colorectal MALT lymphoma (stage I). A 77-year-old frail female patient with diabetes mellitus and dementia developed melena of unknown etiology, and a colonoscopy was performed at a nearby hospital. A biopsy suggested malignant lymphoma, and she was referred to our department. As a result of re-examination of colonoscopy, a total of 3 submucosal tumor-like lesions were confirmed. Of these, a biopsy of the lesions in the ascending colon and rectum was performed, and MALT lymphoma was diagnosed on the basis of the histopathological findings. Following close examination, no other lymphoma lesions were found, and the patient was diagnosed with primary colorectal MALT lymphoma, stage I. After 1 course of R-THP-COP chemotherapy (rituximab + cyclophosphamide, pirarubicin, vincristine, and prednisone), the rectal lesion was confirmed to have almost disappeared endoscopically, and lymphoma cells were not found histopathologically. The patient was determined to be in complete remission (CR). However, due to hematological toxicity and a slight worsening of glucose control, the second chemotherapy course was changed to the BR regimen (rituximab + bendamustine), and 4 courses were performed (5 total courses of chemotherapy). Currently, >3 years have passed since reaching CR, and the patient is alive without recurrence.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
- *Makoto Saito,
| | - Shihori Tsukamoto
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Takashi Ishio
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Emi Yokoyama
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Akio Mori
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Takeshi Kondo
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Hirokazu Sugino
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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15
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Mori A, Onozawa M, Hidaka D, Yokoyama S, Miyajima T, Yokoyama E, Ogasawara R, Izumiyama K, Saito M, Fujisawa S, Ota S, Kakinoki Y, Tsutsumi Y, Yamamoto S, Miyagishima T, Nagashima T, Iwasaki H, Kobayashi H, Haseyama Y, Kurosawa M, Morioka M, Teshima T, Kondo T. Non-age-related neoplastic loss of sex chromosome correlated with prolonged survival in real-world CBF-AML patients. Int J Hematol 2021; 115:188-197. [PMID: 34739701 DOI: 10.1007/s12185-021-03238-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022]
Abstract
In this real-world clinical study, in which we determined eligibility for allogenic hematopoietic stem cell transplantation by prognostic factors and minimal residual disease status, we retrospectively evaluated cytogenetic, genetic, and clinical features in 96 patients with core-binding factor acute myeloid leukemia (CBF-AML) including 62 patients with RUNX1/RUNX1T1 and 34 patients with CBFβ/MYH11. Multivariate analyses for 5-year overall survival (OS) in CBF-AML patients revealed that age of 50 years or older (HR: 3.46, 95% CI 1.47-8.11, P = 0.004) and receiving 2 or more induction cycles (HR: 3.55, 95% CI 1.57-8.05, P = 0.002) were independently associated with worse OS and that loss of sex chromosome (LOS) was independently associated with better OS (HR: 0.09, 95% CI 0.01-0.71, P = 0.022). At the time of complete remission, all 21 karyotyped patients with LOS had a normal karyotype. Furthermore, in all 9 patients with LOS who had a mosaic of metaphase cells with and without t(8;21) or inv(16), the metaphase cells without t(8;21)/inv(16) showed a normal karyotype. These results proved that LOS was not age-related and physiological, but rather a neoplastic chromosomal abnormality.
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Affiliation(s)
- Akio Mori
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan.
| | - Masahiro Onozawa
- Department of Hematology, Graduate School of Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Daisuke Hidaka
- Department of Hematology, Graduate School of Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Shota Yokoyama
- Department of Hematology, Graduate School of Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Toru Miyajima
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan
| | - Emi Yokoyama
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan
| | - Reiki Ogasawara
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan
| | - Makoto Saito
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan
| | - Shinichi Fujisawa
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | | | - Yutaka Tsutsumi
- Department of Hematology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Satoshi Yamamoto
- Department of Hematology, Sapporo City General Hospital, Sapporo, Japan
| | | | - Takahiro Nagashima
- Department of Internal Medicine/General Medicine, Kitami Red Cross Hospital, Kitami, Japan
| | - Hiroshi Iwasaki
- Department of Hematology, Sapporo Kosei General Hospital, Sapporo, Japan
| | - Hajime Kobayashi
- Department of Hematology, Obihiro Kosei Hospital, Obihiro, Japan
| | | | - Mitsutoshi Kurosawa
- Department of Hematology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Masanobu Morioka
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan
| | - Takanori Teshima
- Department of Hematology, Graduate School of Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, S4W25, Chuo-ku, Sapporo, 064-0804, Japan
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16
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Saito M, Morioka M, Izumiyama K, Mori A, Kondo T. Severe Portal Vein Thrombosis During Eltrombopag Treatment Concomitant Splenectomy for Immune Thrombocytopenia. Cureus 2021; 13:e17478. [PMID: 34589366 PMCID: PMC8464653 DOI: 10.7759/cureus.17478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 11/05/2022] Open
Abstract
The treatment of immune thrombocytopenia (ITP) has recently changed; however, each treatment has not only advantages, but also disadvantages, and may have unexpected complications. We describe an instructive case of ITP that was complicated by severe portal vein thrombosis during treatment with eltrombopag, an oral thrombopoietin-receptor agonist (TPO-RA) drug, plus prednisolone (PSL) concomitant splenectomy. A male ITP patient who had been receiving eltrombopag treatment for more than four years at our department underwent a splenectomy at the age of 51. Soon after splenectomy, splenic vein and portal vein thrombosis developed, while splenectomy was ineffective. The patient resumed eltrombopag treatment after thrombosis disappeared. Although fluctuations in PLT were observed, eltrombopag and PSL were used together for a while. Subsequently, lower-limb deep vein thrombosis recurred, and edoxaban tosylate was administered for a total of 8.4 months. More than three years after splenectomy, at the age of 54, abdominal computed tomography (CT) revealed a continuous thrombus extending from the intrahepatic portal vein to the superior mesenteric vein. In patients with ITP in whom splenectomy fails and treatment with a TPO-RA ± PSL needs to be continued, clinicians should be aware of the possibility of abdominal thrombotic adverse events, such as severe portal vein thrombosis, by following-up on CT imaging, not only in the short term but also in the medium-long term.
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Affiliation(s)
- Makoto Saito
- Internal Medicine and Hematology, Aiiku Hospital, Sapporo, JPN
| | | | - Koh Izumiyama
- Internal Medicine and Hematology, Aiiku Hospital, Sapporo, JPN
| | - Akio Mori
- Internal Medicine and Hematology, Aiiku Hospital, Sapporo, JPN
| | - Takeshi Kondo
- Internal Medicine and Hematology, Aiiku Hospital, Sapporo, JPN
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17
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Saito M, Morioka M, Izumiyama K, Mori A, Ogasawara R, Kondo T, Miyajima T, Yokoyama E, Tanikawa S. Phlegmonous gastritis developed during chemotherapy for acute lymphocytic leukemia: A case report. World J Clin Cases 2021; 9:6493-6500. [PMID: 34435017 PMCID: PMC8362572 DOI: 10.12998/wjcc.v9.i22.6493] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/26/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Phlegmonous gastritis (PG) is a rare bacterial infectious disease characterized by neutrophil-based purulent inflammation of the gastric wall. The most representative causative bacterium is Streptococcus pyogenes, followed by Staphylococcus, Pneumococcus and Enterococcus. Hepatic portal venous gas (HPVG) is considered a potentially fatal condition and is rarely associated with PG.
CASE SUMMARY The white blood cell count of a 70-year-old woman with acute lymphocytic leukemia in complete remission dropped to 100/μL after consolidation chemotherapy. Her vital signs were consistent with septic shock. Venous blood culture revealed the presence of Bacillus cereus. Abdominal computed tomography (CT) and esophagogastroduodenoscopy (EGD) showed marked thickening of the gastric wall. As with the other findings, CT was suggestive of HPVG, and EGD showed pseudomembrane-like tissue covering the superficial mucosa. Histopathological examination of gastric biopsy specimens showed mostly necrotic tissue with lymphocytes rather than neutrophils. Culture of gastric specimens revealed the presence of Bacillus cereus. We finally diagnosed this case as PG with Bacillus cereus-induced sepsis and HPVG. This patient recovered successfully with conservative treatment, chiefly by using carbapenem antibiotics.
CONCLUSION The histopathological finding of this gastric biopsy specimen should be called "neutropenic necrotizing gastritis".
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Akio Mori
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Reiki Ogasawara
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Takeshi Kondo
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Toru Miyajima
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Emi Yokoyama
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
| | - Satoshi Tanikawa
- Department of Cancer Pathology, Hokkaido University, Faculty of Medicine, Sapporo 0608638, Hokkaido, Japan
- Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo 001-0021, Hokkaido, Japan
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18
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Saito M, Miyajima T, Ogasawara R, Yokoyama E, Izumiyama K, Mori A, Morioka M, Kondo T. [Therapy-Related Acute Myeloid Leukemia with 11q23 Abnormality That Developed after Chemotherapy for Colorectal Cancer]. Gan To Kagaku Ryoho 2021; 48:971-974. [PMID: 34267039] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The patient developed Stage Ⅳ transverse colon cancer at the age of 72 years and was treated with an 8-course XELOX regimen(capecitabine and oxaliplatin)every 3 weeks after resection. Six years and 9 months after the end of treatment, at the age of 79 years, WBC levels were found to have markedly increased to 10×104/µL in the patient, and acute leukemia was suspected; subsequently, the patient was hospitalized. Bone marrow was aspirated and analyzed, and the results showed that 95% of leukemic cells were positive for esterase staining. Chromosomal examination revealed t(6 ; 11)(q27 ; q23), ie, the diagnosis of therapy-related acute myeloid leukemia(t-AML)with 11q23 abnormality. CR was achieved by chemotherapy, but the disease soon recurred; the patient died 7 months after the onset of t-AML, with the cause being t- AML with 11q23 abnormality that developed 6 years and 9 months after treatment for colorectal cancer with oxaliplatin and capecitabine without undergoing MDS. Since there is a possibility of leukemia induction following oxaliplatin treatment, more such cases need to be monitored in the future.
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Affiliation(s)
- Makoto Saito
- Dept. of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital
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19
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Saito M, Morioka M, Izumiyama K, Mori A, Kondo T. Autoimmune Gastritis With Progression of Leukemic Non-Nodal Mantle Cell Lymphoma. Cureus 2021; 13:e15762. [PMID: 34290938 PMCID: PMC8288829 DOI: 10.7759/cureus.15762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2021] [Indexed: 11/09/2022] Open
Abstract
The pathogenesis of autoimmune gastritis (AIG) remains unclear. In addition, it is difficult to follow the process of AIG onset endoscopically. Leukemic non-nodal mantle cell lymphoma (MCL) was newly added as a subtype of MCL in the fourth revised edition of the World Health Organization (WHO) classification (2017). Here, we report a case of AIG associated with the progression of leukemic non-nodal MCL. A 74-year-old woman who had been followed up in a nearby hospital for chronic B-cell lymphoproliferative disorder with no treatment for six years presented with fever and fatigue in the previous one month. The patient was admitted to our department and was diagnosed with leukemic non-nodal MCL. Positron emission tomography-computed tomography examination, which indicated no abnormalities in the six preceding years, revealed uptake in the bone marrow and spleen. Since MCL was progressing, esophagogastroduodenoscopy (EGD), which showed almost no abnormal findings in the gastric mucosa 13 preceding months, was conducted again to search for lesions involving gastrointestinal MCL. Lymphoma lesions were not found, but wide atrophic mucosal changes in the stomach were revealed mainly in the corpus, and patchy redness was also observed in the pylorus, consistent with AIG. The patient tested positive for an anti-gastric parietal cell antibody (×80), her gastrin level was significantly elevated (5,280 pg/mL), and her pepsinogen (PG) I/PG II was considerably less than 1.0 (>3.1). Although no pathological confirmation was obtained by biopsy, the patient was clinically diagnosed with AIG. In our patient, AIG was revealed to be associated with the progression of leukemic non-nodal MCL in this short period.
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Affiliation(s)
- Makoto Saito
- Internal Medicine and Hematology, Aiiku Hospital, Sapporo, JPN
| | | | - Koh Izumiyama
- Internal Medicine and Hematology, Aiiku Hospital, Sapporo, JPN
| | - Akio Mori
- Internal Medicine and Hematology, Aiiku Hospital, Sapporo, JPN
| | - Takeshi Kondo
- Internal Medicine and Hematology, Aiiku Hospital, Sapporo, JPN
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20
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Kondo T, Onozawa M, Fujisawa S, Harada S, Ogasawara R, Izumiyama K, Saito M, Morioka M, Mori A, Teshima T. Myelomonocytic differentiation of leukemic blasts accompanied by differentiation syndrome in a case of FLT3-ITD-positive AML treated with gilteritinib. ACTA ACUST UNITED AC 2021; 26:256-260. [PMID: 33631087 DOI: 10.1080/16078454.2021.1889111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/31/2022]
Abstract
Fms-like tyrosine kinase 3 (FLT3) is one of the most frequently mutated genes in acute myelogenous leukemia (AML) and the mutation is associated with poor prognosis of patients. Two distinct types of activating mutations have been identified in AML samples. One is internal tandem duplications in the juxtamembrane domain (FLT3-ITD) and the other is point mutations in the tyrosine kinase domain (FLT3-TKD). Gilteritinib is a FLT3 inhibitor that inhibits both FLT3-ITD and FLT3-TKD. It was reported that differentiation of leukemic blasts accompanied by differentiation syndrome occurs in some patients treated with gilteritinib. However, information about the precise clinical course is limited, and appropriate management of differentiation syndrome has not been established. We report a case of relapsed AML with FLT3-ITD that was treated with gilteritinib. Analysis of the FLT3-ITD variant allele frequency (VAF) revealed that FLT3-ITD VAF was not decreased despite achievement of complete remission with incomplete hematologic recovery. Remarkable increases of monocytes and granulocytes accompanied by differentiation syndrome were observed at 6 months after the initiation of gilteritinib treatment. Intermittent chemotherapy with low-dose cytarabine and mitoxantrone was effective for reducing myelomonocytosis and resolving differentiation syndrome.
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Affiliation(s)
- Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Masahiro Onozawa
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinichi Fujisawa
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | | | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Makoto Saito
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | | | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Takanori Teshima
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
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21
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Saito M, Mori A, Ogasawara R, Izumiyama K, Morioka M, Kondo T, Miyashita K. Progression of Primary Gastric Diffuse Large B-Cell Lymphoma after Helicobacter pylori Eradication. Case Rep Gastroenterol 2020; 14:534-539. [PMID: 33250694 PMCID: PMC7670362 DOI: 10.1159/000508849] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Abstract
In Helicobacter pylori−positive, localized primary gastric diffuse large B-cell lymphoma (DLBCL), an increasing number of reports have recently been published on the effectiveness of H. pylori eradication (HPE). However, HPE treatment strategies for gastric DLBCL, including its indications, have yet to be examined. No detailed report has been published on a case of gastric DLBCL unsuccessfully treated by HPE. A 64-year-old female and a 70-year-old male were pathologically diagnosed with chronic active gastritis and mucosa-associated lymphoid tissue lymphoma, respectively. Both patients were positive for H. pylori, so HPE was employed. The disease progressed within 1 year, and both patients were pathologically diagnosed with DLBCL by endoscopic biopsy. On reviewing the first pathology slide, both patients were diagnosed with DLBCL. That is, the 2 patients had primary gastric DLBCL; however, they exhibited progressive disease after HPE. This failure of HPE treatment may be due to the initial lymphomas being multiplex ulcerative lesions. In both cases, complete remission was achieved by chemotherapy (plus radiation therapy) without recurrence for more than 3 years.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Akio Mori
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Reiki Ogasawara
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Takeshi Kondo
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
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22
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Matsukawa T, Suto K, Kanaya M, Izumiyama K, Minauchi K, Yoshida S, Oda H, Miyagishima T, Mori A, Ota S, Hashimoto D, Teshima T. Validation and comparison of prognostic values of GNRI, PNI, and CONUT in newly diagnosed diffuse large B cell lymphoma. Ann Hematol 2020; 99:2859-2868. [PMID: 32970194 DOI: 10.1007/s00277-020-04262-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 07/09/2020] [Accepted: 09/07/2020] [Indexed: 01/06/2023]
Abstract
Diffuse large B cell lymphoma (DLBCL) is the most common type of aggressive non-Hodgkin lymphoma. Emerging evidence indicates that poor nutritional status determined with nutritional indices such as geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and controlling nutritional status score (CONUT) was associated with poor prognosis of DLBCL. We conducted this multicenter retrospective study to validate and compare prognostic values of the three indices in 615 newly diagnosed DLBCL patients. The overall survival (OS) in patients with poor nutritional status determined with each of these nutritional indices were significantly inferior compared with that in those without nutritional risks (5-year OS in patients with GNRI < 95.7 and GNRI ≥ 95.7 were 56.4% and 83.5%, P < 0.001; PNI < 42.4 and PNI ≥ 42.4 were 56.1% and 81.0%, P < 0.001; CONUT > 4 and CONUT ≤ 4 were 53.1% and 77.1%, P < 0.001). GNRI and CONUT were independent prognostic predictors for OS (GNRI < 95.7, hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.22-2.74, P = 0.0032; CONUT > 4, HR 1.53, 95% CI 1.05-2.23, P = 0.028) after multivariate analyses. Nutritional status determined with GNRI affected OS more strongly in the patients with nongerminal center B cell-like (nonGCB) DLBCL compared with that in those with GCB-type DLBCL. In conclusion, baseline poor nutritional status determined based on GNRI or CONUT was an independent risk factor of newly diagnosed DLBCL, and GNRI was also useful as an independent prognostic factor for patients with nonGCB-type DLBCL.
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Affiliation(s)
- Toshihiro Matsukawa
- Department of Internal Medicine/Hematology, Kushiro Rosai Hospital, 13-23 Nakazono-Cho, Kushiro, 085-8533, Japan.
| | - Keito Suto
- Department of Internal Medicine/Hematology, Kushiro Rosai Hospital, 13-23 Nakazono-Cho, Kushiro, 085-8533, Japan.,Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Minoru Kanaya
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | | | - Shota Yoshida
- Department of Internal Medicine/Hematology, Kushiro Rosai Hospital, 13-23 Nakazono-Cho, Kushiro, 085-8533, Japan
| | - Hisashi Oda
- Department of Internal Medicine/Hematology, Kushiro Rosai Hospital, 13-23 Nakazono-Cho, Kushiro, 085-8533, Japan
| | - Takuto Miyagishima
- Department of Internal Medicine/Hematology, Kushiro Rosai Hospital, 13-23 Nakazono-Cho, Kushiro, 085-8533, Japan
| | - Akio Mori
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Daigo Hashimoto
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takanori Teshima
- Department of Hematology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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23
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Saito M, Harada S, Ogasawara R, Izumiyama K, Mori A, Morioka M, Kondo T. Disseminated Gonococcal Infection Associated with Eculizumab Therapy for Paroxysmal Nocturnal Hemoglobinuria: A Case Report and Literature Review. Int J Gen Med 2020; 13:403-406. [PMID: 32765045 PMCID: PMC7372493 DOI: 10.2147/ijgm.s255298] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/03/2020] [Indexed: 11/25/2022] Open
Abstract
Eculizumab has been developed as a breakthrough treatment for paroxysmal nocturnal hemoglobinuria (PNH). Not only for breakthroughs, eculizumab therapy is also known to increase the risk of invasive meningococcal infection. It has also been recently reported that, although rarely, administration of eculizumab may result in disseminated gonococcal infection (DGI). We report here a case in which a young patient who had used eculizumab for PNH developed DGI. A 22-year-old Japanese male with PNH who had been treated with eculizumab complained of high fever, mild nausea, headache and right knee joint pain. The patient was admitted and suspected to have sepsis due to meningococcal infection and began to receive ceftriaxone (CTRX). Gonococci were detected in a venous blood culture a few days later, and this case was diagnosed as DGI. CTRX was effective, and the patient was discharged. However, four weeks later, he complained of the same subjective symptoms as at the beginning and was hospitalized again. The presence of gonococcus was proven by venous blood culture, CTRX was re-administered and the patient responded. After discharge, he was counseled on safer sexual activity, including accurate and consistent use of condoms, by urologists. He has not relapsed with DGI for more than one year. When serious signs of infection occur in patients receiving eculizumab, it is recommended to consider DGI as well as invasive meningococcal infection, and CTRX should be given.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology, Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Shinpei Harada
- Department of Internal Medicine and Hematology, Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Reiki Ogasawara
- Department of Internal Medicine and Hematology, Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology, Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Akio Mori
- Department of Internal Medicine and Hematology, Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology, Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Takeshi Kondo
- Department of Internal Medicine and Hematology, Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
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24
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Shimono J, Izumiyama K, Ito S, Tsutsmi Y, Kondo T, Kakinoki Y, Teshima T. Lymphocyte-monocyte ratio (LMR) can predict bendamustine therapeutic efficacy in low-grade B-cell lymphoma. Int J Lab Hematol 2020; 42:431-438. [PMID: 32343486 DOI: 10.1111/ijlh.13216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/24/2020] [Accepted: 04/06/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Bendamustine has been reported to be effective against low-grade B-cell lymphoma. We examined the effect of bendamustine on the lymphocyte-monocyte ratio (LMR) in low-grade B-cell lymphoma patients. METHODS We retrospectively reviewed 127 cases of first line or relapse/refractory low-grade B-cell lymphoma in three individual institutions (Asahikawa Municipal Hospital, Aiiku Hospital, and Hakodate Municipal Hospital). Only patients who had received at least three courses of bendamustine therapy were selected; the LMR was evaluated at starting the initial course of bendamustine therapy. Time to next treatment (TTNT) was used to ascertain the efficacy of bendamustine therapy. RESULTS Follicular lymphoma (FL), at 68.5% (87/127), is the most common histological subtype of low-grade B-cell lymphoma. The receiver operating characteristic (ROC) curve for the LMR showed a cutoff value of 2.0, and 33 cases (26.0%) had an LMR ≤2.0. Cases with LMR ≤2.0 had a significantly earlier progression than those with LMR > 2.0, based on the TTNT (P = .0007). Additionally, LMR ≤2.0 indicates earlier progression in TTNT when comparing only FL and low-grade B-cell lymphoma cases without FL (P = .007, 0.002). For multivariate analysis, the factors associated with an LMR ≤2.0 (HR, 2.741; 95% CI, 1.4330-5.245; P = .002) were considered as early progression factors with regard to the TTNT. CONCLUSION Lymphocyte-monocyte ratio effectively predicts the efficacy of bendamustine therapy for low-grade B-cell lymphoma, particularly FL; its application may improve treatment strategies for this disease.
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Affiliation(s)
- Joji Shimono
- Department of Hematology, Asahikawa Municipal Hospital, Asahikawa, Japan.,Department of Hematology, Graduate School of Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Koh Izumiyama
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Shinichi Ito
- Department of Hematology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Yutaka Tsutsmi
- Department of Hematology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Takeshi Kondo
- Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Yasutaka Kakinoki
- Department of Hematology, Asahikawa Municipal Hospital, Asahikawa, Japan
| | - Takanori Teshima
- Department of Hematology, Graduate School of Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
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25
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Saito M, Izumiyama K, Ogasawara R, Mori A, Kondo T, Tanaka M, Morioka M, Miyashita K, Tanino M. ALK-positive anaplastic large cell lymphoma presenting multiple lymphomatous polyposis: A case report and literature review. World J Clin Cases 2019; 7:2049-2057. [PMID: 31423437 PMCID: PMC6695535 DOI: 10.12998/wjcc.v7.i15.2049] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/11/2019] [Accepted: 06/21/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anaplastic large cell lymphoma (ALCL) is a type of T-cell lymphoma that can be divided into two categories: anaplastic lymphoma kinase-positive (ALK+) and ALK-negative. Gastrointestinal ALK+ ALCL is rare. Multiple lymphomatous polyposis (MLP) is thought to be a representative form of gastrointestinal lesion in mantle cell lymphoma, and T-cell lymphomas seldom show this feature. Here, we report the first known case of ALK+ ALCL with gastroduodenal involvement to present with MLP.
CASE SUMMARY The patient was a 43-year-old man who was complained of a mass in the left inguinal area and was performed open biopsy. ALK+ ALCL was diagnosed pathologically. Computed tomography scan demonstrated multiple lymph node lesions in the abdomen - pelvis/inguinal region, and scattered nodular lesions in both lung fields. He did not complain of gastrointestinal symptoms. While, esophagogastroduodenoscopy identified MLP lesions from the antrum of the stomach to the descending portion of the duodenum and mild thickened folds on the corpus of the stomach, and biopsy showed invasion of ALK+ ALCL. We treated this patient with six cycles of CHOEP (Cyclophosphamide, Doxorubicin, Vincristine, Etoposide, and Prednisone) chemotherapy. At the conclusion of treatment, there was complete remission. Numerous white scars were found on the stomach, endoscopically consistent with a remission image of lymphoma. The endoscopic features of this case were thought to be similar to those of MCL.
CONCLUSION The macroscopic/endoscopic features of gastrointestinal ALK+ ALCL may be more similar to those of B-cell lymphomas rather than T-cell lymphomas.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Reiki Ogasawara
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Akio Mori
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Takeshi Kondo
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Masanori Tanaka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Kencho Miyashita
- Department of Gastroenterology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Mishie Tanino
- Department of Surgical Pathology, Asahikawa Medical University Hospital (formerly Department of Cancer Pathology, Hokkaido University, Faculty of Medicine), Asahikawa 0788510, Japan
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26
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Saito M, Miyashita K, Miura Y, Harada S, Ogasawara R, Izumiyama K, Mori A, Tanaka M, Morioka M, Kondo T. Successful Treatment of Gastrosplenic Fistula Arising from Diffuse Large B-Cell Lymphoma with Chemotherapy: Two Case Reports. Case Rep Oncol 2019; 12:376-383. [PMID: 31182954 PMCID: PMC6547279 DOI: 10.1159/000500505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 12/19/2022] Open
Abstract
Gastrosplenic fistula (GSF) is a rare condition arising from gastric or splenic lymphomas. Surgical resection is the most common treatment, as described in previous reports. We report two cases of GSF in diffuse large B-cell lymphoma (DLBCL) patients that were successfully treated with chemotherapy and irradiation without surgical resection. Case 1 was of a 63-year-old man who had primary gastric DLBCL with a large lesion outside the stomach wall, leading to a spontaneous fistula in the spleen. Case 2 was of a 59-year-old man who had primary splenic DLBCL, which proliferated and infiltrated directly into the stomach. In both cases, chemotherapy comprising rituximab + dose-adjusted EPOCH regimen (etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin) was administered. Case 1 had significant bleeding from the lesion of the stomach during the treatment cycle; however, endoscopic hemostasis was achieved. Case 2 developed a fistula between the stomach and the spleen following therapeutic chemotherapy; however, no complications related to the fistula were observed thereafter. In both cases, irradiation was administered, and complete remission was achieved.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | | | - Yosuke Miura
- Department of Internal Medicine, Megumino Hospital, Eniwa, Japan
| | - Shinpei Harada
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Reiki Ogasawara
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Akio Mori
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Masanori Tanaka
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
| | - Takeshi Kondo
- Department of Internal Medicine and Hematology/Blood Disorders Center, Aiiku Hospital, Sapporo, Japan
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27
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Senjo H, Kanaya M, Izumiyama K, Minauchi K, Hirata K, Mori A, Saito M, Tanaka M, Iijima H, Tsukamoto E, Itoh K, Ota S, Morioka M, Hashimoto D, Teshima T. Serum level of soluble interleukin-2 receptor is positively correlated with metabolic tumor volume on 18 F-FDG PET/CT in newly diagnosed patients with diffuse large B-cell lymphoma. Cancer Med 2019; 8:953-962. [PMID: 30790452 PMCID: PMC6434200 DOI: 10.1002/cam4.1973] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/23/2018] [Revised: 11/27/2018] [Accepted: 12/21/2018] [Indexed: 01/19/2023] Open
Abstract
Diffuse large B‐cell lymphoma (DLBCL) is the most frequent subtype of non‐Hodgkin lymphoma. High total metabolic tumor volume (TMTV) calculated using 18F‐FDG PET/CT images at diagnosis predicts poor prognosis of patients with DLBCL. However, high cost and poor access to the imaging facilities hamper wider use of 18F‐FDG PET/CT. In order to explore a surrogate marker for TMTV, we evaluated the correlation between the serum levels of soluble interleukin‐2 receptor (sIL‐2R) and TMTV in 64 patients with DLBCL, and the results were verified in an independent validation cohort of 86 patients. Serum levels of sIL‐2R were significantly correlated with TMTV. ROC analysis revealed that the cutoff value of TMTV ≥150 cm3 or sIL‐2R ≥ 1300 U/mL could predict failure to achieve EFS24 with areas under the curve (AUC) 0.706 and 0.758, respectively. Each of TMTV ≥150 cm3 and sIL‐2R ≥1300 U/mL was significantly associated with worse 5‐year overall survival and event‐free survival. Importantly, each of sIL‐2R <1300 U/mL or TMTV <150 cm3 identified patients with favorable prognosis among NCCN‐IPI high‐intermediate and high‐risk group. Serum level of sIL‐2R represents a convenient surrogate marker to estimate metabolic tumor burden measured by 18F‐FDG PET/CT that can predict treatment outcomes of patients with DLBCL.
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Affiliation(s)
- Hajime Senjo
- Department of Hematology, Aiiku Hospital, Sapporo, Japan.,Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Minoru Kanaya
- Department of Hematology, Aiiku Hospital, Sapporo, Japan
| | - Koh Izumiyama
- Department of Hematology, Aiiku Hospital, Sapporo, Japan
| | | | - Kenji Hirata
- Department of Nuclear Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akio Mori
- Department of Hematology, Aiiku Hospital, Sapporo, Japan
| | - Makoto Saito
- Department of Hematology, Aiiku Hospital, Sapporo, Japan
| | | | - Hiroaki Iijima
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | | | - Kazuo Itoh
- Department of Radiology, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | | | - Daigo Hashimoto
- Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takanori Teshima
- Department of Hematology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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28
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Saito M, Ogasawara R, Izumiyama K, Mori A, Kondo T, Tanaka M, Morioka M, Ieko M. Acquired hemophilia A in solid cancer: Two case reports and review of the literature. World J Clin Cases 2018; 6:781-785. [PMID: 30510943 PMCID: PMC6264993 DOI: 10.12998/wjcc.v6.i14.781] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 02/05/2023] Open
Abstract
Acquired hemophilia A (AHA) is a rare, hemorrhagic autoimmune disease, whose pathogenesis involves reduced coagulation factor VIII (FVIII) activity related to the appearance of inhibitors against FVIII. Common etiological factors include autoimmune diseases, malignancy, and pregnancy. We report two cases of AHA in solid cancer. The first case is a 63-year-old man who developed peritoneal and intestinal bleeding after gastrectomy for gastric cancer. He was diagnosed with AHA, and was treated with prednisone, followed by cyclophosphamide. In the second case, a 68-year-old man developed a subcutaneous hemorrhage. He was diagnosed with AHA in hepatocellular carcinoma on CT imaging, and treated with rituximab alone. Hemostasis was achieved for both patients without bypassing agents as the amount of inhibitors was reduced and eradicated. However, both patients died within 1 year due to cancer progression. Successful treatment for AHA in solid cancer can be difficult because treatment of the underlying malignancy is also required.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Reiki Ogasawara
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Akio Mori
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Takeshi Kondo
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Masanori Tanaka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Japan
| | - Masahiro Ieko
- Department of Internal Medicine, Health Sciences University of Hokkaido, Toubetsu 0610293, Japan
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29
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Saito M, Miyashita K, Miura Y, Ogasawara R, Kanaya M, Izumiyama K, Mori A, Kondo T, Tanaka M, Morioka M, Tanaka S. Coexistence of primary colorectal follicular lymphoma and multiple myeloma: a case report. Int J Gen Med 2018; 11:363-367. [PMID: 30254481 PMCID: PMC6140731 DOI: 10.2147/ijgm.s171387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Colorectal follicular lymphoma (FL) occurs less frequently than duodenal-type FL, which is an established entity, and primary multiple FL only involving the colon is rare. Furthermore, the coexistence of lymphoma and multiple myeloma (MM) within the same patient is rare and the current study reports such a case. The patient was an asymptomatic 62-year-old man. He underwent colonoscopy screening, which revealed at least five polypoid tumors from the cecum to the rectum. Biopsy samples stained positive for CD20 and B-cell lymphoma 2 (BCL2) but stained negative for CD10, and fluorescence in situ hybridization analysis identified IGH/BCL2 in 95.2% of the tumor cells. Based on these findings, the patient was diagnosed with FL. On the bone marrow aspirate, the plasma cell count was 30% of all nucleated cells. Bence-Jones κ-type protein was detected by protein electrophoresis in serum and urine. The serum-free light chain κ/λ level was significantly elevated (484.3). Thus, the patient was also diagnosed with MM. Both FL and MM were targeted therapeutically; rituximab and bendamustine were effective for FL, and lenalidomide and low-dose dexamethasone were effective for MM. The patient was treated for 3 years and 7 months and, until now, was off-treatment for 4 years without rapid progression of the two malignancies. Although both diseases are still present, the patient has maintained stable disease. Our findings suggest that lymphoma and MM should be targeted separately as independent hematological malignancies when they occur concurrently.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo, Japan,
| | | | - Yosuke Miura
- Department of Internal Medicine, Megumino Hospital, Eniwa, Japan
| | - Reiki Ogasawara
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo, Japan,
| | - Minoru Kanaya
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo, Japan,
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo, Japan,
| | - Akio Mori
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo, Japan,
| | - Takeshi Kondo
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo, Japan,
| | - Masanori Tanaka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo, Japan,
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo, Japan,
| | - Shinya Tanaka
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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30
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Saito M, Senjo H, Kanaya M, Izumiyama K, Mori A, Tanaka M, Morioka M, Ieko M. Acquired hemophilia A developing cerebral infarction 36 days after the frequent administration of bypass hemostatic agents. Hematol Rep 2018; 10:7453. [PMID: 30283617 PMCID: PMC6151351 DOI: 10.4081/hr.2018.7453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/16/2017] [Accepted: 06/24/2018] [Indexed: 02/06/2023] Open
Abstract
A 74-years-old male who was a smoker and received treatment for hypertension, dyslipidemia, peripheral arterial disease and idiopathic interstitial pneumonia complained of subcutaneous hemorrhage of the right lower thigh. Marked anemia (hemoglobin 5.5 g/dL) and prolonged activated partial thromboplastin time (≥130 seconds) were noted. The factor VIII activity level was reduced to 1.2%, and the factor VIII inhibitor titer was 285.3 BU/mL, a diagnosis of acquired hemophilia A (AHA) was made. Then, hematomas of 5 intra-muscles were recurred. Hemostasis became difficult despite frequent and high-dose administration of recombinant human coagulation factor VIIa (total: 18 days, 305 mg). Hemostasis was achieved by switching to activated prothrombin complex concentrate (for 3 days, 18,000 units), however, cerebral infarction occurred after 36 days. After the frequent administration of bypass hemostatic agents on elderly AHA patients with several risk factors for ischemic stroke, the risk of subsequent thrombotic events may persist for 1 month.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology, Aiiku Hospital
| | - Hajime Senjo
- Department of Internal Medicine and Hematology, Aiiku Hospital
| | - Minoru Kanaya
- Department of Internal Medicine and Hematology, Aiiku Hospital
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology, Aiiku Hospital
| | - Akio Mori
- Department of Internal Medicine and Hematology, Aiiku Hospital
| | - Masanori Tanaka
- Department of Internal Medicine and Hematology, Aiiku Hospital
| | | | - Masahiro Ieko
- Department of Internal Medicine, Health Sciences University of Hokkaido, Japan
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Saito M, Senjo H, Kanaya M, Izumiyama K, Mori A, Tanaka M, Morioka M, Miyashita K, Ishida Y. Late duodenal metastasis from renal cell carcinoma with newly developed malignant lymphoma: A case report. Mol Clin Oncol 2018; 8:549-552. [PMID: 29556388 DOI: 10.3892/mco.2018.1563] [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: 10/11/2017] [Accepted: 12/06/2017] [Indexed: 11/06/2022] Open
Abstract
Duodenal metastasis from renal cell carcinoma (RCC) is rare. The current case report presents a very rare case of late duodenal metastasis from RCC with newly developed malignant lymphoma (diffuse large B-cell lymphoma: DLBCL) at the same time. A 64-year-old man with systemic lymph nodes swelling who had undergone left nephrectomy for RCC 25 years previously, was admitted to the present hospital. Inguinal lymph node biopsy was performed, leading to a diagnosis of DLBCL. fluorine-18-fluorodeoxy-glucose (18F-FDG)-positron emission tomography (PET)/computed tomography (CT) revealed multiple lymph nodes, spleen, and ileocecal lesions. CT revealed an obvious hypervascular tumor involving the duodenum/pancreatic head. The tumor was false-negative on 18F-FDG-PET/CT. On esophagogastroduodenoscopy, the tumor was detected in the descending portion of the duodenum and was observed to be consistent with the submucosal tumor with a central ulcer, resembling those of ulcer-forming DLBCL. A biopsy was then performed carefully, and a clear cell RCC-derived metastatic cancer was diagnosed. Ileocolonoscopy revealed mucosal thickening of the terminal ileum, and led to a diagnosis of DLBCL infiltration with biopsy. To the best of the author's knowledge, this is the first case report of the coexistence of metastatic cancer from RCC and malignant lymphoma in the small intestine simultaneously. It was necessary to make a careful differential diagnosis in the imaging studies.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 064-0804, Japan
| | - Hajime Senjo
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 064-0804, Japan
| | - Minoru Kanaya
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 064-0804, Japan
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 064-0804, Japan
| | - Akio Mori
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 064-0804, Japan
| | - Masanori Tanaka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 064-0804, Japan
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 064-0804, Japan
| | - Kencho Miyashita
- Department of Gastroenterology, Aiiku Hospital, Sapporo 064-0804, Japan
| | - Yusuke Ishida
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Sapporo 064-0804, Japan
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Senjo H, Mori A, Kanaya M, Izumiyama K, Okada K, Takeyabu K, Tobioka H, Saito M, Tanaka M, Teshima T, Morioka M. [Pyothorax-associated lymphoma with the expression of Epstein-Barr virus latent genes]. Nihon Ronen Igakkai Zasshi 2018; 55:143-147. [PMID: 29503358 DOI: 10.3143/geriatrics.55.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An 84-year-old man, who had received artificial pneumothorax for pulmonary tuberculosis 67 years previously, complained of severe chest pain. Chest CT revealed chronic pyothorax with multiple heterogeneously enhanced cavity lesions in the wall of the right intrathoracic space. 18FDG-PET revealed that the lesions showed an abnormal uptake. CT-guided biopsy was performed and he was diagnosed with pyothorax-associated lymphoma (PAL); the histological diagnosis was diffuse large B cell lymphoma (DLBCL). Furthermore, immunohistochemical staining revealed that the tumor cells were positive for EBNA-2 and LMP-1, suggesting that the latent gene products of Epstein-Barr virus were associated with the development of PAL. The patient was treated with chemotherapy, including rituximab; however, the treatment was discontinued due to the development of severe delirium after chemotherapy. We should keep in mind that elderly patients with a long history of chronic pyothorax are at risk of developing malignant lymphoma. We report the present case with a brief review of the literature.
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Affiliation(s)
| | - Akio Mori
- Department of Hematology, Aiiku Hospital
| | | | | | - Kohei Okada
- Department of Hematology, Hokkaido University
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Saito M, Kanaya M, Izumiyama K, Mori A, Irie T, Tanaka M, Morioka M, Ieko M. Treatment of bleeding in acquired hemophilia A with the proper administration of recombinant activated factor VII: single-center study of 7 cases. Int J Gen Med 2016; 9:393-399. [PMID: 27843336 PMCID: PMC5098745 DOI: 10.2147/ijgm.s118422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 12/27/2022] Open
Abstract
Recombinant activated factor VII (rFVIIa) is the bypassing agent used in the first-line hemostatic therapy for acquired hemophilia A (AHA); however, the occurrence of thrombotic complications in rFVIIa-treated AHA patients was recently reported to be 2.9–6.5%. Therefore, the investigation of the proper administration of rFVIIa for AHA is needed. In the present study, we retrospectively investigated the clinical features of AHA with regards to the use of rFVIIa (presence or absence of use and total amount) in 7 AHA patients encountered in our department for 7 years between January 2008 and December 2014. Ages were 63–89 years old (median: 79 years old), and there were 5 male and 2 female patients. The coexistence of cardiovascular risk factors and arteriosclerotic diseases, such as hypertension, diabetes mellitus, and cerebral infarction were present in 6 patients. Anemia progressed to less than 7 g/dL of hemoglobin and required red blood cell transfusion in 5 patients, showing “severe” hemorrhage. Factor VIII inhibitors were removed by immunological treatments in 6 patients. As a hemostatic therapy, rFVIIa was used in 4 patients. rFVIIa was not administered or was administered at a very low dose (20 mg) to 3 and 1 patient, respectively, and bleeding stopped as inhibitor titers decreased and disappeared in these patients. Inhibitors did not disappear in 1 patient and the control of hemostasis became poor and was accompanied by intestinal hemorrhage. Although a large amount of rFVIIa (265 mg in total) was administered, the patient bled to death. Therefore, bleeding may be stopped without the administration of rFVIIa in some AHA cases, while the dose of rFVIIa is not necessarily related to hemostatic effects in other cases. Since the main aim of AHA treatments is the removal of inhibitors, caution is needed to ensure that more than the necessary amount of rFVIIa is not administered.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology, Aiiku Hospital, Japan
| | - Minoru Kanaya
- Department of Internal Medicine and Hematology, Aiiku Hospital, Japan
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology, Aiiku Hospital, Japan
| | - Akio Mori
- Department of Internal Medicine and Hematology, Aiiku Hospital, Japan
| | - Tatsuro Irie
- Department of Internal Medicine and Hematology, Aiiku Hospital, Japan
| | - Masanori Tanaka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Japan
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology, Aiiku Hospital, Japan
| | - Masahiro Ieko
- Department of Internal Medicine, Health Sciences University of Hokkaido, Japan
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Saito M, Masutani M, Mabe K, Izumiyama K, Mori A, Irie T, Tanaka M, Morioka M, Tanino M. Regression of gastric de novo diffuse large B-cell lymphoma following Helicobacter pylori eradication: a case report. Acta Gastroenterol Belg 2016; 79:367-369. [PMID: 27821034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We report a case of primary gastric diffuse large B-cell lymphoma (DLBCL), de novo DLBCL without the features of mucosa-associated lymphoid tissue (MALT) lymphoma, which regressed after Helicobacter pylori (HP) eradication. A 27-year-old Japanese female with epigastralgia was revealed to have ulcerated lesions in the angle and antral regions on gastroscopy. Biopsy specimen was consistent with a diagnosis of DLBCL without MALT lymphoma component, indicating de novo development. Her clinical staging on the Lugano system was Stage I. HP was positive on a rapid urease test, and she received HP eradication therapy twice, because the first therapy was not successful. On gastroscopy performed 1 month after the second HP eradication therapy, no ulcerated lesion was noted, and the lymphoma cells had regressed histopathologically. (Acta gastro-enterol. belg., 2016, 79, 367-369A).
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Saito M, Miyazaki M, Tanino M, Tanaka S, Miyashita K, Izumiyama K, Mori A, Irie T, Tanaka M, Morioka M, Tsukamoto E. 18F-FDG PET/CT imaging for a gastrointestinal mantle cell lymphoma with multiple lymphomatous polyposis. World J Gastroenterol 2014; 20:5141-5146. [PMID: 24803832 PMCID: PMC4009554 DOI: 10.3748/wjg.v20.i17.5141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 01/10/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
Multiple lymphomatous polyposis (MLP) is an uncommon type of gastrointestinal lymphoma characterized by the presence of multiple polyps along the gastrointestinal tract. Most of this entity is in fact considered the counterpart of gastrointestinal tract involvement for mantle cell lymphoma (MCL). To our knowledge, there have been no reports on [fluorine-18]-fluorodeoxy-glucose (18F-FDG)-positron emission tomography (PET)/computed tomography (CT) imaging for gastrointestinal MCL with MLP. We present the results of 18F-FDG PET/CT imaging in a patient with gastrointestinal tract involvement of MCL showing continuous MLP from the stomach to the rectum and intestinal intussusception. FDG-PET/CT findings were false negative in typical MLP spreading widely over the gastrointestinal tract, but uptake was noted in large lesions with deep infiltration considered atypical as MLP. On FDG-PET/CT imaging, the Ki-67 proliferative index, which is a cell proliferation marker, showed neither correlation with the presence of uptake nor the maximum standardized uptake value.
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Saito M, Izumiyama K, Mori A, Irie T, Tanaka M, Morioka M, Saga A, Musashi M, Kato T, Meguro T, Tanino M. [Intestinal bleeding in patients with chronic myelogenous leukemia treated with tyrosine kinase inhibitors]. Rinsho Ketsueki 2014; 55:130-132. [PMID: 24492046] [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: 06/03/2023]
Abstract
Tyrosine kinase inhibitors (TKIs) are highly effective in the treatment of chronic myelogenous leukemia (CML), but there have been a few adverse event reports describing gastrointestinal bleeding. We clinically analyzed two patients who developed intestinal bleeding during the administration of TKIs for CML. Platelet counts of both patients were normal. The patients showed endoscopic findings characterized by mildly hemorrhagic mucosa. The imatinib patient was diagnosed by capsule endoscopy of the small intestine, and required frequent blood transfusions. The dasatinib patient showed occult bleeding due to CD8-positive colitis. We should adequately recognize that gastrointestinal bleeding may occur during the administration of TKIs.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology, Aiiku Hospital
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Saito M, Izumiyama K, Mori A, Irie T, Tanaka M, Morioka M, Musashi M. Biphenotypic Acute Leukemia with t(15;17) Lacking Promyelocytic-retinoid Acid Receptor α Rearrangement. Hematol Rep 2013; 5:e16. [PMID: 24416501 PMCID: PMC3883063 DOI: 10.4081/hr.2013.e16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/04/2013] [Accepted: 10/17/2013] [Indexed: 11/23/2022] Open
Abstract
Biphenotypic acute leukemias (BAL) account for less than 4% of all cases of acute leukemia. Philadelphia chromosome and 11q23 rearrangement are the most frequently found cytogenetic abnormalities. Since t(15;17) is almost always associated with acute promyelocytic leukemia, t(15;17) in BAL cases is extremely uncommon. We report here a rare and instructive case of BAL with t(15;17) and the successful treatment approach adopted. A 55-year old woman was referred to our hospital for an examination of elevated white blood cell (WBC) counts with blasts (WBC 13.4×10(9)/L; 76% blasts). The blasts with acute lymphoblastic leukemia (ALL-L2, FAB) morphology co-expressed B-lymphoid and myeloid lineages, and a cytogenetic study revealed 4q21 abnormalities and t(15;17). However, promyelocytic-retinoid acid receptor α rearrangement was not detected by fluorescence in situ hybridization on interphase nuclei. Our patient was treated with chemotherapy for ALL and gemtuzumab ozogamicin without all-trans-retinoic acid, and has remained in hematologic first complete remission for more than 3.7 years.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology, Aiiku Hospital , Sapporo
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology, Aiiku Hospital , Sapporo
| | - Akio Mori
- Department of Internal Medicine and Hematology, Aiiku Hospital , Sapporo
| | - Tatsuro Irie
- Department of Internal Medicine and Hematology, Aiiku Hospital , Sapporo
| | - Masanori Tanaka
- Department of Internal Medicine and Hematology, Aiiku Hospital , Sapporo
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology, Aiiku Hospital , Sapporo
| | - Manabu Musashi
- Department of Internal Medicine, Sapporo Hanazono Hospital , Sapporo, Japan
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Saito M, Morioka M, Wakasa K, Izumiyama K, Mori A, Irie T, Tanaka M, Tanaka S. In Japanese patients with type A gastritis with pernicious anemia the condition is very poorly associated with Helicobacter pylori infection. J Infect Chemother 2013; 19:208-10. [DOI: 10.1007/s10156-012-0476-6] [Citation(s) in RCA: 6] [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: 03/01/2012] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
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Shimizu H, Beppu M, Arai T, Kihara H, Izumiyama K. Ultrasonographic findings in cubital tunnel syndrome caused by a cubitus varus deformity. Hand Surg 2012; 16:233-8. [PMID: 22072453 DOI: 10.1142/s0218810411005473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 03/22/2011] [Accepted: 03/22/2011] [Indexed: 12/23/2022]
Abstract
We have retrospectively reviewed the clinical, preoperative ultrasonographic, and operative findings of eight patients who had tardy ulnar nerve palsy caused by a cubitus varus deformity. The mean varus angle on the affected side was 23°. With preoperative ultrasonography, the anterior dislocation of the ulnar nerve from the medial epicondyle was detected in dynamic scanning of short-axis images, and long-axis images revealed nerve compression and kinking in the proximal border of the flexor carpi ulnaris. Operative findings revealed compression of the ulnar nerve by a fibrous band, which was released in all cases. The cause of the tardy ulnar nerve palsy in this series of patients was constriction by a fibrous band and kinking in the proximal border of the flexor carpi ulnaris due to ulnar nerve dislocation from compression resulting from the forward movement of the medial head of the triceps brachii muscle.
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Affiliation(s)
- H Shimizu
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki 211-8511, Japan.
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Hashino S, Fujisawa F, Takahata M, Izumiyama K, Yonezumi M, Chiba K, Kondo T, Suzuki S, Asaka M. Clonal switch of leukemic myeloblasts after chemotherapy in a patient with chronic myeloproliferative disorder. Acta Haematol 2009; 122:29-30. [PMID: 19696476 DOI: 10.1159/000235615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 06/14/2009] [Indexed: 11/19/2022]
Affiliation(s)
- Satoshi Hashino
- Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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41
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Hashino S, Morioka M, Irie T, Shiroshita N, Kawamura T, Suzuki S, Iwasaki H, Umehara S, Kakinoki Y, Kurosawa M, Kahata K, Izumiyama K, Kobayashi H, Onozawa M, Takahata M, Fujisawa F, Kondo T, Asaka M. Cost benefit and clinical efficacy of low-dose granulocyte colony-stimulating factor after standard chemotherapy in patients with non-Hodgkin's lymphoma. Int J Lab Hematol 2008; 30:292-9. [PMID: 18665826 DOI: 10.1111/j.1751-553x.2007.00955.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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
High costs of molecule-targeted drugs, such as rituximab, ibritumomab, and tositumomab have given rise to an economical issue for treating patients with non-Hodgkin's lymphoma (NHL). Granulocyte colony-stimulating factors (G-CSFs), which are also expensive, are widely used for treating neutropenia after chemotherapy. In Japan, lenograstim at 2 microg/kg (about 100 microg/body) or filgrastim at 50 microg/m(2) (about 75 microg/body) is commonly administered for patients with NHL after chemotherapy. Therefore, cost-effectiveness is an important issue in treatment for NHL. Patients with advanced-stage NHL who needed chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or a CHOP-like regimen with or without rituximab were enrolled in this randomized cross-over trial to investigate the efficacy and safety of low-dose G-CSF. Half of the patients were administered 75 microg filgrastim in the first course after neutropenia and 50 microg lenograstim in the second course, and the other half were crossed over. Forty-seven patients were enrolled in this cross-over trial, and 24 patients completed the trial. Frequencies and durations of grade 4 leukocytopenia and neutropenia were similar in the two groups. Severe infection was rare and was observed at similar frequency. Frequencies of antibiotics use were also similar. The total cost of G-CSF (cost/drug x duration of administration) was significantly lower in patients who received 50 microg lenograstim. Hence, a low dose of lenograstim might be safe, effective and pharmaco-economically beneficial in patients with advanced-stage NHL.
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Affiliation(s)
- S Hashino
- Department of Gastroenterology and Hematology, Hokkaido University School of Medicine, Sapporo, Japan.
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42
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Hashino S, Kobayashi S, Takahata M, Onozawa M, Nakagawa M, Kawamura T, Fujisawa F, Izumiyama K, Kahata K, Kondo T, Asaka M. Graft-versus-tumor effect after reduced-intensity allogeneic hematopoietic stem cell transplantation in a patient with advanced colon cancer. Int J Clin Oncol 2008; 13:176-80. [PMID: 18463966 DOI: 10.1007/s10147-007-0716-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 08/02/2007] [Indexed: 01/15/2023]
Abstract
A 27-year-old man with advanced colon cancer that was resistant to conventional chemoradiotherapies was treated with reduced-intensity allogeneic peripheral blood stem cell transplantation (PBSCT). After obtaining complete donor-type chimerism, there was an apparent graft-versus-tumor effect accompanied by severe hepatic graft-versus-host disease (GVHD) showing hyperbilirubinemia, resulting in a stable disease condition that lasted for 18 months, which had not been seen previously in his previous disease history. The antitumor effect observed in this patient was insufficient for the patient to achieve complete remission, because the disease was at an already widespread and treatment-resistant stage. He finally died of hepatic failure due to extensive liver GVHD 65 months after the diagnosis of the advanced colon cancer and 29 months after the allogeneic PBSCT. Prospective studies are necessary to achieve better clinical results in patients with advanced colon cancer.
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Affiliation(s)
- Satoshi Hashino
- Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8648, Japan.
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Fujieda Y, Kasahara I, Takeda T, Yanagisawa H, Kikuchi H, Izumiyama K, Hata D, Kikuchi K. [Asian variant of intra-vasclular large B-cell lymphoma presented with polyarteritis nodosa like symptoms]. Nihon Naika Gakkai Zasshi 2008; 97:147-9. [PMID: 18283902 DOI: 10.2169/naika.97.147] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yuichiro Fujieda
- Third Department of Internal Medicine, Obihiro Kosei General Hospital, Obihiro
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44
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Hashino S, Morita L, Takahata M, Onozawa M, Nakagawa M, Kawamura T, Fujisawa F, Kahata K, Izumiyama K, Yonezumi M, Chiba K, Kondo T, Asaka M. Administration of micafungin as prophylactic antifungal therapy in patients undergoing allogeneic stem cell transplantation. Int J Hematol 2007; 87:91-7. [DOI: 10.1007/s12185-007-0011-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 09/19/2007] [Accepted: 09/21/2007] [Indexed: 10/22/2022]
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Nakagawa M, Hosokawa Y, Yonezumi M, Izumiyama K, Suzuki R, Tsuzuki S, Asaka M, Seto M. MALT1 contains nuclear export signals and regulates cytoplasmic localization of BCL10. Blood 2005; 106:4210-6. [PMID: 16123224 DOI: 10.1182/blood-2004-12-4785] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [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: 02/07/2023] Open
Abstract
MALT1, BCL10 (B-cell lymphoma 10), and API2 (apoptosis inhibitor 2)-MALT1 are key molecules in mucosa-associated lymphoid tissue (MALT) lymphomagenesis. We previously reported that MALT1 and API2-MALT1 were localized only in cytoplasm, where we suggested that both molecules were likely to be active. In the study presented here, we further examined the localization-determining region by generating various mutants and were able to demonstrate that there were nuclear export signal (NES)-containing domains in the MALT1 C-terminal region. The use of leptomycin B, an NES-specific inhibitor, demonstrated that both MALT1 and API2-MALT1 were predominantly retained in the nuclei, indicating that these molecules were shuttling between nucleus and cytoplasm in an NES-dependent manner. It was also found that MALT1 was involved in the nuclear export of BCL10, which is originally localized in both nucleus and cytoplasm. These results correlate well with the nuclear BCL10 expression pattern in both t(1;14) and t(11;18) MALT lymphomas. The nucleocytoplasmic shuttling of MALT1 and BCL10 complex may indicate that these molecules are involved not only in the nuclear factor kappaB (NF-kappaB) pathway but also in other biologic functions in lymphocytes.
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Affiliation(s)
- Masao Nakagawa
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
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Onozawa M, Hashino S, Sogabe S, Haneda M, Horimoto H, Izumiyama K, Kondo T, Aldana LP, Hamada K, Asaka M. Side Effects and Good Effects from New Chemotherapeutic Agents. J Clin Oncol 2005; 23:2425-6. [PMID: 15800335 DOI: 10.1200/jco.2005.04.054] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Masahiro Onozawa
- Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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47
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Onozawa M, Hashino S, Izumiyama K, Kahata K, Chuma M, Mori A, Kondo T, Toyoshima N, Ota S, Kobayashi S, Hige S, Toubai T, Tanaka J, Imamura M, Asaka M. Progressive Disappearance of Anti-Hepatitis B Surface Antigen Antibody and Reverse Seroconversion after Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Previous Hepatitis B Virus Infection. Transplantation 2005; 79:616-9. [PMID: 15753855 DOI: 10.1097/01.tp.0000151661.52601.fb] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [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: 12/16/2022]
Abstract
Reactivation of resolved hepatitis B virus (HBV) infection, which is known as reverse seroconversion (RS), has been reported as a rare complication of allogeneic hematopoietic stem cell transplantation. We retrospectively studied HBV serologic markers in 14 recipients with pretransplant anti-hepatitis B surface antigen antibody (anti-HBs). Progressive decreases in anti-HBs titer were observed in all cases. In 12 cases, anti-HBs titer had decreased to under the protective value. RS occurred in seven cases after disappearance of anti-HBs. Although reseroconversion occurred in five cases, two cases remained in an HBV-carrier status after resolution of hepatitis. In the other five cases, RS did not occur even after disappearance of anti-HBs. The actual risks of anti-HBs disappearance and RS were estimated to be 75.0% and 39.8% at 2 years and 100.0% and 70.0% at 5 years, respectively. In conclusion, RS is a late-onset complication with high frequency that can be predicted by careful monitoring of progressive decrease in anti-HBs titer.
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Affiliation(s)
- Masahiro Onozawa
- Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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48
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Onozawa M, Hashino S, Kanamori H, Izumiyama K, Yonezumi M, Chiba K, Kondo T, Fukuhara T, Tanaka J, Imamura M, Asaka M. Aleukemic leukemia cutis in a patient with Philadelphia chromosome-positive biphenotypic leukemia. Int J Hematol 2004; 80:278-80. [PMID: 15540904 DOI: 10.1532/ijh97.04010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 11/20/2022]
Abstract
Aleukemic leukemia cutis is a rare condition characterized by the invasion of leukemic blasts into the skin before their appearance in the peripheral blood. Leukemia cutis usually occurs in patients with myeloid leukemia, especially the myelomonocytic and monocytic types of acute myeloblastic leukemia. We describe the case of a 62-year-old woman with aleukemic leukemia cutis who developed Philadelphia-positive acute leukemia 1 month after skin involvement. Leukemic cells expressed both myeloid and B-cell lineage surface markers, and monoclonal rearrangement of the immunoglobulin heavy chain was detected by Southern blot analysis. This report is the first of a case of aleukemic leukemia cutis preceding Philadelphia-positive biphenotypic leukemia.
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Affiliation(s)
- Masahiro Onozawa
- Departments of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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49
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Morita R, Hashino S, Sogabe S, Dazai M, Onozawa M, Izumiyama K, Kondo T, Ota S, Kobayashi S, Imamura M, Asaka M. [Imatinib mesylate plus G-CSF therapy for chronic myelogenous leukemia in the blastic crisis]. Rinsho Ketsueki 2004; 45:1105-10. [PMID: 15553045] [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: 05/01/2023]
Abstract
Imatinib mesylate (imatinib) has shown significant effects in patients with chronic myelogenous leukemia. However, hematological toxicity often occurs and requires dosage reduction or discontinuation of imatinib treatment. A patient with chronic myelogenous leukemia in the blastic crisis received granulocyte-colony stimulating factor (G-CSF) simultaneously with imatinib. The patient was continuously treated with imatinib and G-CSF and achieved remission without any severe infection or neutropenia. There are a few reports on the efficacy of combined therapy with G-CSF and imatinib; however, the results in our case are rare suggesting that the use of G-CSF is effective for preventing severe infection. G-CSF enables continuous treatment with high-dose imatinib.
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Affiliation(s)
- Rena Morita
- Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine
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50
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Onozawa M, Yonezumi M, Kawarazaki M, Izumiyama K, Chiba K, Kondo T, Ota S, Kobayashi S, Kato M, Hashino S, Tanaka J, Imamura M, Asaka M. Usefulness of magnifying endoscopic evaluation of the terminal ileum for a patient with graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. Ann Hematol 2004; 84:106-9. [PMID: 15300409 DOI: 10.1007/s00277-004-0915-2] [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] [Received: 12/25/2003] [Accepted: 04/08/2004] [Indexed: 12/30/2022]
Abstract
The gastrointestinal tract is one of the common targets of acute graft-versus-host disease (GVHD), but accurate diagnosis is difficult because of the nonspecific nature of complicated diseases and the lack of diagnostic findings by conventional endoscopy. Recently, a magnifying endoscope has been developed and used for examining microstructures of the mucosa. Herein, we report the first use of a magnifying endoscope for a patient with gastrointestinal (GI) GVHD. Magnified endoscopic findings of atrophic and coalescent villi of the terminal ileum reflect histological findings of GVHD. Magnifying endoscopy of the terminal ileum may be useful for early detection and follow-up of GI GVHD.
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Affiliation(s)
- Masahiro Onozawa
- Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
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