1
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Ohba R, Usui N, Ito Y, Yamauchi H, Machishima T, Ishii H, Fukushima R, Yokoyama H, Shiota Y, Yahagi Y, Yano S, Dobashi N, Aiba K. Myelodysplastic syndrome with myelofibrosis in which azacitidine therapy was effective and cord blood transplantation was carried out. Rinsho Ketsueki 2017; 58:601-606. [PMID: 28679989 DOI: 10.11406/rinketsu.58.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Myelodysplastic syndrome with myelofibrosis (MDS-F) is a disease with a poor prognosis, and patients with this condition are at an increased risk of engraftment failures after allogeneic hematopoietic stem cell transplantation (SCT). Azacitidine (AZA) is effective in high-risk MDS patients. However, the effects of AZA on MDS-F have not been elucidated. AZA was administered to a 62-year-old male with MDS-F for 7 days at a dose of 75 mg/m2. Hematological improvements were observed after only 1 course of treatment. No suitable donor was found through the Japan Marrow Donor Program; therefore, the patient underwent umbilical cord blood transplant (UCBT). Neutrophil engraftment was observed on day 21 after the transplant procedure. He developed acute graft versus host disease (GVHD) of the skin (stage 3/grade II), but it could be controlled using prednisolone. Chronic GVHD was not observed and he was discharged in good general condition on day 68. While treatment prior to allogeneic SCT of MDS-F has not been established, in the present case, the hematological improvement brought about by AZA likely contributed to the patient's positive response to UCBT.
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Affiliation(s)
- Rie Ohba
- Department of Clinical Oncology and Hematology, The Jikei University Daisan Hospital
| | - Noriko Usui
- Department of Clinical Oncology and Hematology, The Jikei University Daisan Hospital
| | - Yuta Ito
- Department of Clinical Oncology and Hematology, The Jikei University Daisan Hospital
| | - Hirofumi Yamauchi
- Department of Clinical Oncology and Hematology, The Jikei University Daisan Hospital
| | - Tomohito Machishima
- Department of Clinical Oncology and Hematology, The Jikei University Hospital
| | - Hiroto Ishii
- Department of Clinical Oncology and Hematology, The Jikei University Daisan Hospital
| | - Ryoko Fukushima
- Department of Clinical Oncology and Hematology, The Jikei University Daisan Hospital
| | - Hiroki Yokoyama
- Department of Clinical Oncology and Hematology, The Jikei University Hospital
| | - Yuko Shiota
- Department of Clinical Oncology and Hematology, The Jikei University Daisan Hospital
| | - Yuichi Yahagi
- Department of Clinical Oncology and Hematology, The Jikei University Daisan Hospital
| | - Shingo Yano
- Department of Clinical Oncology and Hematology, The Jikei University Hospital
| | - Nobuaki Dobashi
- Department of Clinical Oncology and Hematology, The Jikei University Daisan Hospital
| | - Keisuke Aiba
- Department of Clinical Oncology and Hematology, The Jikei University Hospital
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2
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Yamasaki R, Kanda J, Akahoshi Y, Nakano H, Ugai T, Wada H, Kawamura K, Ishihara Y, Sakamoto K, Sato M, Ashizawa M, Machishima T, Terasako-Saito K, Kimura SI, Kikuchi M, Nakasone H, Yamazaki R, Kako S, Nishida J, Kanda Y. Comparison of levofloxacin and garenoxacin for antibacterial prophylaxis during neutropenia. Int J Hematol 2017; 105:835-840. [PMID: 28168415 DOI: 10.1007/s12185-017-2188-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 11/28/2022]
Abstract
Levofloxacin (LVFX) is widely used for antibacterial prophylaxis during neutropenia. Garenoxacin (GRNX), which has been investigated in Japan, has stronger antibacterial activity than LVFX against gram-positive bacteria; however, no studies have compared the effectiveness of LVFX and GRNX. We retrospectively analyzed 42 patients with acute leukemia and 32 patients who underwent hematopoietic cell transplantation. Thirty-one patients before September 2009 received GRNX, and subsequent 43 patients received LVFX. We compared the cumulative incidences of positive blood and stool cultures. There was no significant difference in the incidence of bacteremia between the GRNX and LVFX groups. However, while gram-negative bacteria were detected in 80% of the patients with bacteremia in the GRNX group, they were detected in only 33% of the patients with bacteremia in the LVFX group. Patients in the GRNX group more frequently experienced positive stool cultures than those in the LVFX group, and this was confirmed by a multivariate analysis. Gram-negative bacteria accounted for 100 and 67% of the stool culture results in the GRNX and LVFX groups, respectively. While both fluoroquinolones may be appropriate antibacterial prophylactic agents for neutropenia patients with hematological malignancies, vigilance for gram-negative bacterial infections should be exercised when GRNX is used as prophylaxis.
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Affiliation(s)
- Ryoko Yamasaki
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Junya Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Yu Akahoshi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Hirofumi Nakano
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Tomotaka Ugai
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Hidenori Wada
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Koji Kawamura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Yuko Ishihara
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Kana Sakamoto
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Miki Sato
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Masahiro Ashizawa
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Tomohito Machishima
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Kiriko Terasako-Saito
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Misato Kikuchi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Hideki Nakasone
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Rie Yamazaki
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Shinichi Kako
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Junji Nishida
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
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Mashima K, Yano S, Yokoyama H, Saito T, Machishima T, Shimada T, Yahagi Y, Takahara S, Sugiyama K, Ogasawara Y, Minami J, Kamiyama Y, Katsube A, Suzuki K, Ohshima S, Yamada H, Usui N, Aiba K. Epstein-Barr Virus-associated Lymphoproliferative Disorder with Encephalitis Following Anti-thymocyte Globulin for Aplastic Anemia Resolved with Rituximab Therapy: A Case Report and Literature Review. Intern Med 2017; 56:701-706. [PMID: 28321074 PMCID: PMC5410484 DOI: 10.2169/internalmedicine.56.7722] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Epstein-Barr virus (EBV)-associated lymphoproliferative disorders (LPDs) sometimes occur following Anti-thymocyte globulin (ATG) administration for allogenic stem cell transplantation but are rare in aplastic anemia (AA) patients. A 55-year-old woman with AA following ATG developed refractory fever and was diagnosed with EBV-LPD. She was successfully treated with weekly rituximab monotherapy; however, she developed EBV encephalitis. She was admitted to the intensive care unit and finally recovered from unconsciousness. EBV-LPD should be considered after ATG for AA when symptoms appear. Because EBV-LPD following ATG for AA can rapidly progress, weekly monitoring of EBV-DNA and early intervention may be necessary.
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Affiliation(s)
- Kiyomi Mashima
- Department of Oncology and Hematology, The Jikei University School of Medicine, Japan
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4
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Suzuki K, Yano S, Nishiwaki K, Sano K, Shimada T, Yahagi Y, Ogasawara Y, Sugiyama K, Takahara S, Saito T, Kasama K, Minami J, Yokoyama H, Kamiyama Y, Katsube A, Masuoka H, Katori M, Machishima T, Ouchi A, Dobashi N, Kaito K, Usui N, Aiba K. Clinical significance of granule-containing myeloma cells in patients with newly diagnosed multiple myeloma. Cancer Med 2016; 5:3051-3058. [PMID: 27734595 PMCID: PMC5119959 DOI: 10.1002/cam4.875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 12/16/2022] Open
Abstract
The clinical features and prognostic significance of myeloma cells containing granules remain unclear. The purpose of this retrospective study was to investigate the clinical significance of granule-containing myeloma cells in patients with newly diagnosed multiple myeloma (NDMM). We retrospectively analyzed the records of 122 patients diagnosed with NDMM between January 2007 and December 2013. Granule-containing myeloma cells were defined as myeloma cells that exhibited three or more granules in their cytoplasm by May-Giemsa staining. The patients were classified into two groups, the granule-containing myeloma (GM) and nongranule-containing myeloma (non-GM) groups, depending on the proportion of myeloma cells that contained granules (cut-off value: 10%). There were 25 (20.5%) patients in the GM group. Patients in the GM group displayed significantly higher CD56 and CD49e expression than those in the non-GM group (t-test, P = 0.027 and 0.042). None of the patient characteristics differed significantly between the two groups. There was no significant difference in the chemotherapy profiles of the two groups, and the overall response rates of the two groups were similar. During the median follow-up period of 33.9 months, the overall survival (OS) in the GM group was similar to that in the non-GM group; 4-year OS of the GM and non-GM groups were 78.5% and 51.9%, respectively (P = 0.126). We concluded that cases of NDMM involving granule-containing myeloma cells are not infrequent. Moreover, CD56 and CD49e expression was significantly higher in the presence of myeloma cell populations, and the presence of granules did not affect survival.
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Affiliation(s)
- Kazuhito Suzuki
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Shingo Yano
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Kaichi Nishiwaki
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Koji Sano
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Takaki Shimada
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Yuichi Yahagi
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Yoji Ogasawara
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Katsuki Sugiyama
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Shinobu Takahara
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Takeshi Saito
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Kinuyo Kasama
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Jiro Minami
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Hiroki Yokoyama
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Yutaro Kamiyama
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Atsushi Katsube
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Hidekazu Masuoka
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Mitsuji Katori
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Tomohito Machishima
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Aya Ouchi
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Nobuaki Dobashi
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Ken Kaito
- Central Clinical LaboratoryThe Jikei University HospitalTokyoJapan
| | - Noriko Usui
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
- Division of Transfusion MedicineThe Jikei University School of MedicineTokyoJapan
| | - Keisuke Aiba
- Division of Clinical Oncology/HematologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
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Ouchi A, Sano K, Tanoue S, Machishima T, Katori M, Masuoka S, Nishiwaki K, Usui N, Aiba K. Reversible posterior leukoencephalopathy syndrome during R-ICE therapy for malignant lymphoma. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv472.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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6
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Ogasawara Y, Machishima T, Shimada T, Takahashi H, Fukunaga M, Mizoroki F, Dobashi N, Usui N, Aiba K. [Human herpesvirus 8-negative primary effusion lymphoma-like lymphoma with t(8;14)(q24;q32)]. Rinsho Ketsueki 2015; 56:1082-1088. [PMID: 26345571 DOI: 10.11406/rinketsu.56.1082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Primary effusion lymphoma (PEL) is a large B-cell lymphoma proliferating only in the body cavity effusion. It often occurs in advanced AIDS patients and is associated with human herpesvirus 8 (HHV-8). On the other hand, HHV-8 negative effusion lymphoma, which is different from PEL in many ways, has also been reported and is referred to as HHV8-unrelated PEL-like lymphoma. This lymphoma is very rare and its clinical characteristics have not yet been fully clarified. We therefore report an HIV seronegative elderly patient with HHV8-unrelated PEL-like lymphoma. An 89-year-old woman was admitted to our hospital due to general fatigue and dyspnea. The patient presented with left pleural effusion in the absence of lymphadenopathy and tumor masses. The pathological examination of the pleural effusion showed proliferation of atypical large lymphoid cells, which were positive for CD19, CD20, CD10, CD38, CD7, BCL2 and BCL6 but negative for CD5, CD30, MUM1, surface immunoglobulin, HHV-8 and EBV. Cytogenetic analysis showed a complex karyotype including t(8;14)(q24;q32). The pleural effusion decreased in response to monotherapy with oral low-dose etoposide, but recurrence was detected 7 months later. Rituximab was transiently effective for the recurrent pleural effusion, but the patient died of lymphoma exacerbation 13 months after the diagnosis.
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Affiliation(s)
- Yoji Ogasawara
- Division of Clinical Oncology / Hematology, Department of Internal Medicine, The Jikei University School of Medicine
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7
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Suzuki K, Yano S, Shimada T, Takahara S, Kasama K, Machishima T, Inui Y, Kawashima M, Usui N, Aiba K. Correlation of Laboratory Data for Renal Function in Newly Diagnosed Multiple Myeloma. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu436.37] [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: 11/14/2022] Open
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8
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Kawamura K, Wada H, Yamasaki R, Ishihara Y, Sakamoto K, Ashizawa M, Sato M, Machishima T, Terasako K, Kimura SI, Kikuchi M, Nakasone H, Yamazaki R, Kanda J, Kako S, Tanihara A, Nishida J, Kanda Y. Prophylactic role of long-term ultra-low-dose acyclovir for varicella zoster virus disease after allogeneic hematopoietic stem cell transplantation. Int J Infect Dis 2014; 19:26-32. [DOI: 10.1016/j.ijid.2013.09.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 09/09/2013] [Accepted: 09/27/2013] [Indexed: 01/01/2023] Open
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9
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Nakasone H, Terasako-Saito K, Yamazaki R, Sato M, Tanaka Y, Sakamoto K, Kurita M, Yamasaki R, Wada H, Ishihara Y, Kawamura K, Machishima T, Ashizawa M, Kimura SI, Kikuchi M, Tanihara A, Kanda J, Kako S, Nishida J, Yamada S, Kanda Y. Impact of high-/middle-molecular-weight adiponectin on the synthesis and regulation of extracellular matrix in dermal fibroblasts. Exp Hematol 2014; 42:261-73. [PMID: 24407161 DOI: 10.1016/j.exphem.2013.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 11/16/2013] [Accepted: 12/15/2013] [Indexed: 12/21/2022]
Abstract
Adiponectin has been shown to play a critical role in immunity. Recently, we reported that the adiponectin levels after allogeneic stem cell transplantation were higher in recipients with chronic graft-versus-host disease (cGVHD). However, the effects of adiponectin on extracellular matrix (ECM) and regulatory factors in dermal fibroblasts remain unclear. We compared the messenger RNA (mRNA) levels of collagen type1 (COL1A), fibronectin 1 (FN1), matrix metalloproteinase (MMP)1, MMP3, tissue inhibitor of metalloproteinase (TIMP)1, TIMP3, transforming growth factor-β (TGF-β), and TGF-β receptor 2 (TGF-βR2) in human normal dermal fibroblasts cultured with and without adiponectin, and we assessed the degree of synthesis of ECMs by immunofluorescent microscopy. Furthermore, we also assessed these mRNA levels after blocking of TGF-βR2. Adiponectin induced higher mRNA levels of FN1, MMP1, MMP3, TIMP1, TIMP3, and TGF-βR2 in a dose-dependent manner, but did not significantly affect COL1A or TGF-β. In addition, adiponectin was shown to upregulate FN1, MMPs, and TIMPs after blocking of TGF-βR2. Immunofluorescent microscopy revealed that adiponectin promoted a greater synthesis of ECMs than in the control in vitro. The finding that adiponectin upregulated ECM-associated factors might mean that high levels of adiponectin could modulate dermal fibrosis was observed in recipients with cGVHD. Further basic investigation is warranted to elucidate whether the adiponectin-pathway could be a target for the treatment of sclerotic cGVHD.
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Affiliation(s)
- Hideki Nakasone
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kiriko Terasako-Saito
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Rie Yamazaki
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Miki Sato
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yukie Tanaka
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kana Sakamoto
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masakazu Kurita
- Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Ryoko Yamasaki
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hidenori Wada
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuko Ishihara
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koji Kawamura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Tomohito Machishima
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masahiro Ashizawa
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Misato Kikuchi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Aki Tanihara
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Junya Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shinichi Kako
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Junji Nishida
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shigeki Yamada
- Department of Pathology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
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10
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Kimura SI, Wada H, Ishihara Y, Kawamura K, Sakamoto K, Yamasaki R, Ashizawa M, Machishima T, Sato M, Terasako K, Nakasone H, Kikuchi M, Okuda S, Kako S, Kanda J, Yamazaki R, Tanihara A, Nishida J, Kanda Y. D-index dose not predict the development of pulmonary infection in acute myeloid leukemia patients undergoing consolidation chemotherapy with high-dose cytarabine. ACTA ACUST UNITED AC 2013; 19:107-12. [PMID: 23683842 DOI: 10.1179/1607845413y.0000000103] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The D-index is calculated as the area over the neutrophil curve during neutropenia. We investigated the impact of the D-index on pulmonary infection in 33 acute myeloid leukemia patients undergoing consolidation chemotherapy with high-dose cytarabine. There was no difference in the D-index between chemotherapies with and without pulmonary infection. The cumulative D-index (c-D-index) until the development of infection exceeded 4000 in four of five patients with pulmonary infection. Although there was no difference in the total D-index throughout the overall consolidation chemotherapy, the total D-index from induction to consolidation and the D-index at induction chemotherapy were higher in patients with pulmonary infection during consolidation than in those without it (P = 0.014 and 0.019, respectively). Our results showed that the cumulative effect of neutropenia might determine the risk of pulmonary infection in consolidation chemotherapy. We are planning a clinical trial of c-D-index-guided preemptive antifungal therapy.
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11
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Kawamura K, Kikuchi M, Terasako K, Wada H, Yamasaki R, Ishihara Y, Sakamoto K, Ashizawa M, Sato M, Machishima T, Kimura SI, Nakasone H, Okuda S, Yamazaki R, Kanda J, Kako S, Tanaka Y, Tanihara A, Nishida J, Kanda Y. Comparison of the efficacy of peripheral blood stem cell mobilization using G-CSF alone from healthy donors and patients with hematologic malignancies. Transfus Apher Sci 2013; 49:334-40. [DOI: 10.1016/j.transci.2013.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 05/20/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
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12
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Machishima T, Kako S, Wada H, Yamasaki R, Ishihara Y, Kawamura K, Sakamoto K, Sato M, Ashizawa M, Terasako K, Kimura SI, Kikuchi M, Nakasone H, Kanda J, Yamazaki R, Nishida J, Kanda Y. The safety and efficacy of acute graft-versus-host disease prophylaxis with a higher target blood concentration of cyclosporine around 500 ng/mL. Clin Transplant 2013; 27:749-56. [PMID: 24033855 DOI: 10.1111/ctr.12213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2013] [Indexed: 11/28/2022]
Abstract
Cyclosporine (CsA) is the most widely used immunosuppressive agent for the prevention of acute graft-versus-host disease (GVHD). In a previous report, the incidence of acute GVHD was decreased by increasing the target blood concentration of CsA during a continuous infusion from 300 to 500 ng/mL without excessive toxicities. To confirm these results, we retrospectively analyzed 69 patients who received a continuous infusion of CsA at a higher target CsA level between 450 and 550 ng/mL (CsA500 group) and compared the clinical outcome with 29 patients who received CsA with a lower target concentration between 250 and 350 ng/mL (CsA300 group). The target concentration was determined based on the status of background diseases. Multivariate analysis revealed that the incidence of grade III-IV acute GVHD was significantly lower in the CsA500 group, although the incidence of grade II-IV acute GVHD was not different. Toxicities were equivalently observed between the two groups. Concomitant administration of voriconazole or itraconazole and higher hematocrit were identified as independent significant factors for higher concentration/dose ratio of CsA. The average dose of CsA to maintain CsA level around 500 ng/mL was higher compared with the previous study (3.4 mg/kg vs. 2.7 mg/kg at three wk), probably due to the difference in measuring method of CsA concentration. We conclude that continuous infusion of CsA with a target level between 450 and 550 ng/mL is a feasible and effective GVHD prophylaxis, but caution should be paid for the difference in measuring method.
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Affiliation(s)
- Tomohito Machishima
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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13
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Sakamoto K, Nakasone H, Wada H, Yamasaki R, Ishihara Y, Kawamura K, Ashizawa M, Sato M, Terasako-Saito K, Machishima T, Kimura SI, Kikuchi M, Kako S, Kanda J, Yamazaki R, Tanihara A, Nishida J, Kanda Y. Evaluation of the validity of preemptive therapy against cytomegalovirus disease based on antigenemia assay with a cutoff of 20 positive cells per two slides. PLoS One 2013; 8:e73754. [PMID: 24040054 PMCID: PMC3764037 DOI: 10.1371/journal.pone.0073754] [Citation(s) in RCA: 19] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/21/2013] [Indexed: 02/07/2023] Open
Abstract
Background Preemptive therapy with ganciclovir (GCV) based on the results of a cytomegalovirus (CMV) antigenemia assay is a standard strategy for preventing CMV disease after allogeneic hematopoietic cell transplantation (HCT). However, the appropriate threshold of antigenemia-positive cells for deciding when to start GCV remains unclear. Patients This retrospective study included 80 recipients who received HCT from an alternative donor between 2007 and 2011. In 2009, we switched the threshold from 3 (3A group, n=24) to 20 (20A group, n=56) antigenemia-positive cells per two slides for preemptive therapy after HCT from an alternative donor. Results Early CMV disease within 100 days after HCT was observed in one patient in the 20A group. Antiviral agents including GCV, val-GCV, and foscarnet were given in 17 (71%) and 36 (64%) patients in the 3A and 20A groups, respectively (p=0.23). In 13 (23%) patients in the 20A group, the initiation of preemptive therapy was avoided because of the change in the cutoff value for CMV antigenemia. However, the total dose of GCV was not different between the two groups. The use of steroid was significantly associated with CMV antigenemia of at least 20 positive cells among patients with low-level antigenemia at the first detection. Conclusion The increased threshold up to 20 positive cells for starting preemptive therapy was not associated with a significant increase in CMV disease, but the total dose of GCV was not reduced and there was one early CMV disease in the 20A group. We should explore how to identify patients who are at high risk for increased antigenemia among patients with low-level antigenemia, but at least, preemptive therapy should not be withheld in patients who are already receiving systemic steroid.
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Affiliation(s)
- Kana Sakamoto
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideki Nakasone
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hidenori Wada
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Ryoko Yamasaki
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuko Ishihara
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koji Kawamura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masahiro Ashizawa
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Miki Sato
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kiriko Terasako-Saito
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Tomohito Machishima
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Misato Kikuchi
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shinichi Kako
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Junya Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Rie Yamazaki
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Aki Tanihara
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Junji Nishida
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
- * E-mail:
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14
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Nakasone H, Tanaka Y, Yamazaki R, Terasako K, Sato M, Sakamoto K, Yamasaki R, Wada H, Ishihara Y, Kawamura K, Machishima T, Ashizawa M, Kimura SI, Kikuchi M, Tanihara A, Kanda J, Kako S, Nishida J, Kanda Y. Single-cell T-cell receptor-β analysis of HLA-A*2402-restricted CMV- pp65-specific cytotoxic T-cells in allogeneic hematopoietic SCT. Bone Marrow Transplant 2013; 49:87-94. [DOI: 10.1038/bmt.2013.122] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/19/2013] [Accepted: 05/23/2013] [Indexed: 11/09/2022]
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15
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Kawamura K, Wada H, Yamasaki R, Ishihara Y, Sakamoto K, Ashizawa M, Sato M, Machishima T, Terasako K, Kimura SI, Kikuchi M, Nakasone H, Yamazaki R, Kanda J, Kako S, Tanihara A, Nishida J, Kanda Y. Low-dose acyclovir prophylaxis for the prevention of herpes simplex virus disease after allogeneic hematopoietic stem cell transplantation. Transpl Infect Dis 2013; 15:457-65. [PMID: 23895431 DOI: 10.1111/tid.12118] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 01/22/2013] [Accepted: 02/17/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Currently, acyclovir (ACV) at 1000 mg/day is widely used as prophylaxis in the early phase of hematopoietic stem cell transplant (HSCT) in Japan. However, low-dose ACV (200 mg/day) has been shown to prevent varicella zoster virus reactivation in the middle and late phases of HSCT. METHODS Therefore, in this study, we decreased the dose of ACV to 200 mg/day in the early phase after HSCT. We analyzed 93 consecutive herpes simplex virus (HSV)-seropositive patients who underwent allogeneic HSCT for the first time in our center between June 2007 and December 2011. RESULTS Before August 2009, 38 patients received oral ACV at 1000 mg/day (ACV1000) until day 35 after HSCT, whereas 55 patients received oral ACV at 200 mg/day (ACV200) after September 2009. We compared the cumulative incidence of HSV infection in the 2 groups. Oral ACV was changed to intravenous administration because of intolerance in 66% and 45% of the patients in the ACV1000 and ACV200 groups, respectively (P = 0.060). The probability of severe stomatitis (Bearman grade II-III) was 76% and 60% in the ACV1000 and ACV200 groups, respectively (P = 0.12). The number of patients who developed HSV disease before day 100 after HSCT was 0 in the ACV1000 group and 2 in the ACV200 group, with a cumulative incidence of 3.6% (P = 0.43). HSV disease in the latter 2 patients was limited to the lips and tongue and was successfully treated with ACV or valacyclovir at a treatment dose. CONCLUSION ACV at 200 mg/day appeared to be effective for preventing HSV disease in the early phase after HSCT.
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Affiliation(s)
- K Kawamura
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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16
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Kanda Y, Wada H, Yamasaki R, Kawamura K, Ishihara Y, Sakamoto K, Ashizawa M, Sato M, Machishima T, Terasako-Saito K, Kimura SI, Nakasone H, Kikuchi M, Yamazaki R, Kanda J, Kako S, Nishida J, Tsunoda H, Omori Y, Nakazawa M, Tanaka O. Protection of ovarian function by two distinct methods of ovarian shielding for young female patients who receive total body irradiation. Ann Hematol 2013; 93:287-92. [PMID: 23892927 DOI: 10.1007/s00277-013-1852-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 07/15/2013] [Indexed: 12/19/2022]
Abstract
To prevent ovarian dysfunction due to total body irradiation, we started ovarian shielding at our center (Saitama Medical Center, Jichi Medical University (SMC-JMU)) with a long source axis distance, which is different from the original method used at the University of Tokyo Hospital (UTH). We retrospectively analyzed the outcome of eight patients with a median age of 20.5 years from SMC-JMU and compared the results with the published data for eight patients with a median age of 22 years from UTH. The recovery of ovarian function was observed in five and six patients, respectively. The cumulative incidence of ovarian recovery, while treating relapse and death without ovarian recovery as competing risks, was 68.8 % at 2 years after transplantation in the total population, and there was no statistically significant difference between the two institutions (p = 0.85). Age and the history of previous chemotherapy did not affect the incidence of ovarian recovery. Two patients from each center had a relapse of leukemia. Overall, among the 11 patients who have survived without relapse, only one has not achieved ovarian recovery. In conclusion, ovarian shielding with both methods strongly protected ovarian function. However, we should continue to monitor the relapse rate among patients who undergo this procedure.
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Affiliation(s)
- Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma Omiya-ku, Saitama, Saitama, 330-8503, Japan,
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17
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Sato M, Nakasone H, Wada H, Yamasaki R, Ishihara Y, Sakamoto K, Kawamura K, Ashizawa M, Machishima T, Terasako K, Kimura SI, Kikuchi M, Tanihara A, Yamazaki R, Tanaka Y, Kanda J, Kako S, Nishida J, Kanda Y. Prediction of infectious events by the high-sensitivity C-reactive protein level before autologous hematopoietic cell transplantation for lymphoma and multiple myeloma. Transpl Infect Dis 2013; 15:E169-71. [PMID: 23782409 DOI: 10.1111/tid.12102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/04/2013] [Accepted: 03/27/2013] [Indexed: 11/30/2022]
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18
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Yamazaki R, Nakasone H, Tanaka Y, Sato M, Terasako K, Wada H, Ishihara Y, Kawamura K, Sakamoto K, Ashizawa M, Machishima T, Kimura SI, Kikuchi M, Okuda S, Kako S, Kanda J, Tanihara A, Nishida J, Kanda Y. Allotype analysis to distinguish the origin of varicella-zoster virus immunoglobulin G after allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2013; 19:1013-20. [PMID: 23583826 DOI: 10.1016/j.bbmt.2013.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 04/05/2013] [Indexed: 11/30/2022]
Abstract
Varicella-zoster virus (VZV) reactivation is a frequent complication after allogeneic hematopoietic stem cell transplantation (HSCT). Although previous studies have revealed that cellular immunity is important for suppressing reactivation, the role of humoral immunity against VZV has been poorly evaluated. We analyzed inherited polymorphisms in the immunoglobulin G (IgG) heavy chain constant regions of 50 HSCT recipient-donor pairs to distinguish donor-derived and recipient-derived antibodies. Twelve pairs were informative regarding the origin of IgG, since either the donors (n = 3) or recipients (n = 9) were homozygous null for the IgG1m(f) allotype. In these 9 homozygous-null recipients, allotype-specific IgG against VZV were measured by enzyme-linked immunosorbent assay and compared with measles-IgG. All 9 homozygous-null recipients were monitored for more than 1 year after HSCT, with (n = 4, localized zoster) or without (n = 5) clinical VZV disease. In 3 patients with VZV disease, donor-derived IgG against VZV was elevated between 500 to 700 days after HSCT after the episode of VZV disease. In 1 patient who suffered from VZV disease just before HSCT, donor-derived VZV IgG was elevated within 3 months after HSCT. On the other hand, 2 patients who received reduced-intensity conditioning (RIC) transplantation from an IgG1m(f) null donor maintained recipient-derived IgG against VZV for more than 1 year, whereas it was decreased within 3 months in 1 recipient who received conventional conditioning. In conclusion, the production of anti-VZV IgG by recipient plasma cells persists long after RIC. In patients without symptomatic VZV reactivation, donor-derived anti-VZV IgG did not reach titers comparable to those measured in healthy virus carriers.
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Affiliation(s)
- Rie Yamazaki
- Division of Hematology, Department of Internal Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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19
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Tanaka Y, Nakasone H, Yamazaki R, Wada H, Ishihara Y, Kawamura K, Sakamoto K, Ashizawa M, Machishima T, Sato M, Terasako K, Kimura SI, Kikuchi M, Okuda S, Kako S, Kanda J, Tanihara A, Nishida J, Kanda Y. Long-term persistence of limited HTLV-I Tax-specific cytotoxic T cell clones in a patient with adult T cell leukemia/lymphoma after allogeneic stem cell transplantation. J Clin Immunol 2012; 32:1340-52. [PMID: 22763862 DOI: 10.1007/s10875-012-9729-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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: 03/08/2012] [Accepted: 06/21/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Adult T cell leukemia/lymphoma (ATL) is a highly aggressive malignancy of T cells caused by human T cell lymphotropic virus type 1 (HTLV-1). Recent clinical studies have suggested that allogeneic stem cell transplantation (HSCT) improves the clinical course of ATL by harnessing a graft-versus-ATL effect, and that donor-derived HTLV-1 Tax-specific CD8(+) cytotoxic T cells (CTLs) contribute to the graft-versus-ATL effect after HSCT. However, little is known about the immunological characteristics of Tax-specific CTLs in ATL patients who underwent HSCT. METHODS We serially analyzed frequencies, differentiation, functions and clonal dynamics of Tax-specific CTLs in paired samples of peripheral blood (PB) and bone marrow (BM) from an ATL patient after HSCT at the single-cell level. We used flowcytometric and single-cell T cell receptor (TCR) repertoire analysis methods without culture steps. RESULTS Donor-derived Tax-specific CTLs effectively suppressed HTLV-1 replication in both PB and BM at least during chronic graft-versus-host disease after HSCT. Furthermore, Tax-specific CTLs had comparable properties between BM and PB, except for preferential accumulation in BM rather than PB. Tax-specific CTLs persistently existed as less-differentiated CD45RA(-)CCR7(-) effector memory CTLs based on predominant phenotypes of CD27(+), CD28(+/-) and CD57(+/-). Our approach using single-cell TCR repertoire analysis method showed highly restricted oligoclonal responses of Tax-specific CTLs, and TCR BV7- or BV30- expressing two predominant CTL clones persistently existed and maintained strong cytotoxic activities against HTLV-1 in both PB and BM over three years after HSCT. CONCLUSIONS These findings about Tax-specific CTLs provide insights into future directions for studies on immunotherapy against ATL.
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Affiliation(s)
- Yukie Tanaka
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, Saitama, 330-8503, Japan
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20
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Ashizawa M, Oshima K, Wada H, Ishihara Y, Kawamura K, Sakamoto K, Sato M, Terasako K, Machishima T, Kimura S, Kikuchi M, Nakasone H, Okuda S, Kako S, Kanda J, Yamazaki R, Tanihara A, Nishida J, Kanda Y. Hyperbilirubinemia in the early phase after allogeneic HSCT: prognostic significance of the alkaline phosphatase/total bilirubin ratio. Bone Marrow Transplant 2012; 48:94-8. [PMID: 22750996 DOI: 10.1038/bmt.2012.130] [Citation(s) in RCA: 3] [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: 01/06/2023]
Abstract
Hyperbilirubinemia in the early phase after allogeneic hematopoietic SCT (HSCT) is due to various causes. One of the most important causes of hyperbilirubinemia is veno-occlusive disease/sinusoidal obstructive syndrome (VOD/SOS). However, the prognosis of patients who are clinically diagnosed as SOS varies. We retrospectively evaluated 82 patients who underwent their first allogeneic HSCT. GVHD prophylaxis was a combination of short-term MTX and CsA (n=77) or tacrolimus (n=5). Thirty-three patients developed hyperbilirubinemia, with a bilirubin level of at least 2 mg/dL, within 20 days after HSCT. Of these patients, 24 were diagnosed as VOD/SOS using the modified Seattle criteria. Twenty-six recovered to a bilirubin level of <2 mg/dL. We focused on the serum alkaline phosphatase/total bilirubin ratio (ALP/TB) at the onset of hyperbilirubinemia and found that it significantly predicted the recovery from hyperbilirubinemia. OS was significantly higher in patients with a lower ALP/TB ratio (P=0.00056). In addition, a lower ALP/TB ratio was associated with better survival even in patients who were clinically diagnosed as SOS (P<0.001). The ALP/TB ratio at the onset of hyperbilirubinemia may be a useful predictor for the prognosis of hyperbilirubinemia and SOS early after HSCT.
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Affiliation(s)
- M Ashizawa
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
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21
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Terasako K, Oshima K, Wada H, Ishihara Y, Kawamura K, Sakamoto K, Ashizawa M, Sato M, Machishima T, Nakasone H, Kimura SI, Kikuchi M, Okuda S, Kako S, Yamazaki R, Takeuchi K, Nishida J, Yamada S, Tanaka O, Kanda Y. Fulminant hepatic failure caused by adenovirus infection mimicking peliosis hepatitis on abdominal computed tomography images after allogeneic hematopoietic stem cell transplantation. Intern Med 2012; 51:405-11. [PMID: 22333378 DOI: 10.2169/internalmedicine.51.6432] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Disseminated adenovirus disease after allogeneic hematopoietic stem cell transplantation (HSCT) is lethal in most cases, especially when it develops as fulminant hepatic failure. We encountered a patient who developed fulminant hepatic failure caused by adenovirus infection. She did not show manifestations of graft-versus-host disease and the results of serum tests for viral infection were all negative. Abdominal computed tomography (CT) findings were consistent with peliosis hepatitis. She died of fulminant hepatic failure, however, and pathological examinations of the liver specimen obtained after her death revealed adenovirus infection. In this report, we review the clinical characteristics and imaging findings of fulminant hepatic failure caused by adenovirus infection.
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Affiliation(s)
- Kiriko Terasako
- Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan
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22
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Yano S, Minami J, Nishiwaki K, Shimada T, Dobashi N, Yahagi Y, Takei Y, Takahara S, Ogasawara Y, Sugiyama K, Yamaguchi Y, Saito T, Kasama K, Yokoyama H, Machishima T, Katsube A, Usui N, Aiba K. Rapid progression and unusual premortal diagnosis of mucormycosis in patients with hematologic malignancies: analysis of eight patients. Int J Hematol 2011; 93:344-350. [DOI: 10.1007/s12185-011-0780-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 01/25/2011] [Accepted: 01/26/2011] [Indexed: 11/30/2022]
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23
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Yano S, Saito T, Yokoyama H, Machishima T, Yahagi Y, Sugiyama K, Ogasawara Y, Kasama K, Katsube A, Usui N, Aiba K, Mori S. A Pilot Study of Once-Daily Modified Release Formulation Tacrolimus Hydrate (Graceptor®) and Pharmacokinetic Evaluation in Unrelated Hematopoietic Stem Cell Transplant Recipients. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.513] [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: 11/15/2022]
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24
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Usui N, Dobashi N, Yano S, Yahagi Y, Takei Y, Otsubo H, Takahara S, Yamaguchi Y, Saito T, Minami J, Kamiyama Y, Morikawa N, Machishima T, Osawa H, Aiba K. [High-dose methotrexate followed by whole-brain irradiation for primary central nervous system lymphoma patients--a retrospective study in a single institute]. Gan To Kagaku Ryoho 2010; 37:1277-1282. [PMID: 20647709] [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: 05/29/2023]
Abstract
This study analyzed retrospectively the clinical efficacy of combined therapy consisting of high-dose methotrexate (MTX), administered at a dose of 4 g/m2 every 2 weeks (maximum of 4 courses), followed by whole-brain irradiation for newly diagnosed primary central nervous system lymphoma (PCNSL) patients. Fifteen patients (median age: 59 years old; range: 26-79) were diagnosed by histological examinations or imaging techniques in our hospital. Of 15 patients, 12 (6: complete response; 6: partial response) achieved objective response, and the response rate was 80% (95% CI, 51.9-95.7%). The median follow-up time was 20 (range: 3-81) months, and the 3-year survival rate was 76%. The overall survival time was 71 months (95% CI, 23. 7-118.3 months), and the progression free survival was 15 months (95% CI, 0-43.8 months). The major toxicity (grade>or=3) of high-dose MTX included cytopenia (20%), acute respiratory distress syndrome (6.7%), and liver damage (6.7%). No patient evidenced complicated leukoencephalopathy in the follow-up time. The combined therapy of high-dose MTX followed by whole-brain irradiation showed a substantial antitumor efficacy in PCNSL patients. Prospective studies are required to determine the suitable treatment schedule for MTX and irradiation.
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Affiliation(s)
- Noriko Usui
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine
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25
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Yamaguchi Y, Usui N, Dobashi N, Yano S, Yahagi Y, Takei Y, Sugiyama K, Ogasawara Y, Saito T, Minami J, Kobayashi T, Katsube A, Kamiyama Y, Machishima T, Morikawa N, Otsubo H, Kaito K, Asai O, Aiba K. Gemtuzumab ozogamicin (GO) in relapsed/refractory patients with acute myeloid leukemia. Gan To Kagaku Ryoho 2009; 36:1105-1109. [PMID: 19620797] [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: 05/28/2023]
Abstract
OBJECTIVE Gemtuzumab ozogamicin (GO) is a humanized anti-CD33 antibody, linked to calicheamicin, which has been approved in Japan recently. We conducted to evaluate the efficacy and toxicity of GO in our patients with relapsed or refractory AML retrospectively. PATIENTS AND METHODS Data were collected between March 1, 2000, and March 1, 2006, on 10 patients with relapsed or refractory AML(excluding FAB: M3). Scheduled treatment was two doses of GO monotherapy, 14-28 days apart. RESULTS Of the 10 assessable patients, two patients achieved CR. CR duration of one patient lasted for 52 months with post-remission treatment. Grade 4 neutropenia occurred in 9 patients, and the incidence of grade 3 or 4 thrombocytopenia was 100%, with no severe bleeding events. Two patients developed infusion-related adverse events that included grade 3 allergic reaction with shock status. Liver damage (grade 3 or 4) were observed in 40% of patients after GO treatment. No patient developed hepatic veno-occlusive disease including 2 patients who underwent HSCT. CONCLUSION GO is a valuable new treatment option for relapsed or refractory AML patients, however, the benefit from single agent appears insufficient. On going clinical trials including combination with other antileukemic agents might better define the role of GO.
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Affiliation(s)
- Yuko Yamaguchi
- Department of Oncology and Hematology, Jikei University School of Medicine, Komae-shi, Tokyo, Japan
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