human leukocyte antigen（HLA）半合致移植や臍帯血移植は比較的容易にドナーが得られ，短期間で移植可能である。近年，感染症やgraft-versus-host disease（GVHD）に対する管理が進歩し，これらHLA不一致移植が増加している。HLA-Flow法はドナーとレシピエントの不一致HLAをそれぞれ特異的な抗HLA抗体で染め分け，フローサイトメトリーでキメリズムを解析する方法である。レシピエント由来細胞が検出された場合はそのフェノタイプも解析できるので，生着不全と再発の早期診断や，腫瘍細胞量のモニタリングを迅速かつ簡便に行える。ドナー特異的HLAと腫瘍マーカーを組合せると，腫瘍細胞におけるHLA欠失の有無を評価できる。本法は高精度かつ高感度のため，臓器移植後の末梢血のマイクロキメリズムの検出も可能である。市販されているアフィニティーの低いIgM型の抗HLA抗体に代わり，染色性の良好なIgG型抗体を作製できれば，HLA-Flow法のより広範な普及が期待できる。

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 Adult T-cell leukemia-lymphoma (ATL) is a mature T-cell neoplasm caused by human T-cell leukemia virus type-Ⅰ (HTLV-1) that has a poor prognosis. Median overall survival (OS) of patients with aggressive ATL treated by chemotherapy alone is about 1 year. Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) has helped achieve OS improvement in aggressive ATL, transplant-related mortality (TRM) is high. To reduce TRM in allo-HSCT, prospective studies of reduced-intensity stem cell transplantation (RIST) using hematopoietic stem cells from peripheral blood, bone marrow, and umbilical cord blood have been conducted. The results suggest that RIST is feasible for elderly patients with ATL, and the existence of mild graft-versus-host disease contributes to better survival outcomes. It has been also demonstrated that Tax-specific T-cell responses might be associated with the graft-versus-ATL effect in patients with relapsed ATL who received RIST. Lack of immunity to viruses, such as cytomegalovirus, in patients who received allo-HSCT is a critical matter. Donor selection in allo-HSCT for ATL is also important, especially with respect to HTLV-1 carrier donor cell-derived ATL. An appropriate combination of allo-HSCT and molecularly targeted therapy is needed to improve OS in patients with ATL.

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 This retrospective study evaluated the clinical significance of post-allogeneic hematopoietic cell transplantation serum ferritin (SF) levels and liver iron content (LIC), measured using liver magnetic resonance imaging (MRI). Twenty-three transplant recipients with hematologic diseases were included. The median duration from transplant to LIC measurement was 13.4 months (range: 2.2-84.6 months). The median SF and LIC values were 947ng/mL (range: 191-8,082ng/mL) and 250µmol/gdw (range: 60-360µmol/gdw), respectively. LIC was moderately correlated to SF (r=0.53) and the units of transfused red blood cells (r=0.50). SF was moderately correlated to the units of RBCs (r=0.45), transferrin (r=-0.43), unsaturated iron binding capacity (r=-0.50), and C-reactive protein (r=0.40). In conclusion, in post-transplant recipients, it is suggested that SF reflects a combination of factors including iron overload and inflammation or hepatitis, while LIC seems to be a good non-invasive technique to quantify total body iron stores.

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 Adult T cell leukemia/lymphoma (ATLL) is an aggressive peripheral T-cell neoplasm. Humanized anti-CC chemokine receptor 4 monoclonal antibody (mogamulizumab) has been shown to be effective for relapsed/refractory ATLL. However, the effects of mogamulizumab application before allogeneic stem cell transplantation are uncertain. Here, we present an ATLL patient who was administered mogamulizumab and suffered from refractory acute graft-versus-host disease (GVHD) following umbilical cord blood transplantation (UCBT). This was accompanied by delayed reconstitution and a long-lasting reduction of regulatory T cells (Tregs). We suggest that this attenuation of Tregs influenced the clinical course of the severe/refractory GVHD following UCBT in a patient pretreated with mogamulizumab therapy.

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