【Background】Infertility is one of the serious problems associated with the quality of life of patients who receive hematopoietic stem cell transplantation (HSCT). However, there have been no previous reports about surveys on infertility counseling for HSCT patients with highest risk of infertility conducted among healthcare providers and patients. 【Aim】The aims of this study are to know our current status and patient’s needs with respect to obtaining information regarding infertility counseling and to examine nurses’role concerning the same in the future. 【Method】We conducted a questionnaire survey of 10 doctors and 20 nurses as well as 37 patients who received HSCT in our institution from 2011 to 2014. 【Result and Discussion】Doctors believe that they provide information about infertility and fertility preservation to all patients, while only 72% of patients recognized that they received this information. Most patients hope to obtain information at an early stage. Moreover, most nurses have not addressed this problem so far in our institute. Therefore, nurses should coordinate between doctors and patients along with catering to patient’s needs and support their decision making for fertility preservation.
While the importance of long-term follow-up (LTFU) programs after allogeneic hematopoietic cell transplantation (HCT) has been recognized, their role after autologous HCT is less apparent. To evaluate patients’ need for a LTFU program after autologous HCT and the incidence of late effects, we conducted a single-center cross-sectional questionnaire survey. We included adult patients who received autologous HCT for hematological malignancies at our hospital from January 1993 through February 2014, who remained free of disease progression, and who made regular visits to our clinic. Among 231 patients who received autologous HCT, 114 were alive and free of relapse. Questionnaires were mailed to 71 patients who had visited our clinic, and 43 (61%) responded. Twenty-eight patients (65%) reported 53 disorders that were diagnosed after discharge. The most frequent of these was infection (n=23), with varicella zoster virus accounting for 13 cases. More than 80% of the participants reported experiencing conditions other than the primary disease after discharge, and 91% suggested the need for a LTFU program after autologous HCT. Although we acknowledge the risk of selection bias and under- or overestimation due to the small cohort size, these results may provide a foundation for constructing a LTFU program after autologous HCT.
Extramedullary (EM) relapses after allogeneic hematopoietic stem cell transplantation (HSCT) are among the major causes of treatment failure. We retrospectively analyzed 174 patients with myeloid leukemia and myelodysplastic syndrome who underwent HSCT at the Hematology and Oncology Department of the Kyoto University Hospital between 1990 and 2009 to evaluate the incidence of EM relapses and determine its clinical features and appropriate treatment strategies. Of 53 patients who had a relapse after HSCT, 10 had an EM relapse, including 7 patients with a multiple-site EM relapse and 4 patients with an accompanied bone marrow (BM) relapse. Longer latency between HSCT and occurrence of relapse (486.5 versus 251 days) and a higher incidence of chronic graft-versus-host-disease (GVHD) before relapse (70% versus 26%) were observed for EM relapses than for BM relapses. Interestingly, EM relapses developed shortly after the intensification of the treatment for chronic GVHD (median 63 days, range: 28-339), indicating that immunosuppressive therapy triggers EM relapses. At 1 year, the survival rate after relapse was 46.7% for EM relapses. Therefore, effective management of EM relapses, frequently accompanied by chronic GVHD, is warranted.
The prognosis of patients with central nervous system lymphoma (CNSL) is poor, and high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a treatment option for these patients. In the present retrospective study, we investigated the safety and efficacy of busulfan (BU)-based conditioning regimens for treating CNSL in eight patients who underwent ASCT at Tokyo Medical and Dental University Hospital from April 2009 to March 2016. Four patients had primary CNSL and four had secondary CNSL. Four patients received BU/thiotepa (TT)/cyclophosphamide (CY) and four received BU/etoposide (VP)/ranimustine (MCNU). All patients showed partial or complete response after undergoing ASCT, and the 1-year progression-free survival rate was 75% among the patients receiving the conditioning regimens. As regimen-related toxicities, diarrhea, liver dysfunction, and acute neurotoxicity were seen among patients receiving BU/TT/CY. For patients with CNSL, BU-containing regimens are effective.
Aleukemic and tumor-forming Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) is very rare. A 54-year-old woman with a medical history of chemo-radiotherapy for breast cancer was admitted because of the right side pleural effusion and possible malignant lymphoma of the right supraclavicular lymph node. Positron emission tomography showed the accumulation at the right pleura, mesenteric lymph nodes, and the left iliac bone. WBC and its differential counts were normal, and the anemia and thrombocytopenia were not noted. A bone marrow aspirate showed abundant blasts of immature B cell lineage, and the karyotype was a complex karyotype including t (9 ; 22). PCR examination demonstrated minor bcr-abl transcript. In the pleural effusion, small number of blasts with the same phenotype was observed. Immunopathologic re-examination of the biopsied lymph mode revealed to be lymphoblastic lymphoma with the same phenotype of morrow blasts. A diagnosis of aleukemic and tumor-forming Ph+ ALL was made. She was treated with 2courses of Hyper-CVAD with dasatinib with disappearance of minor bcr-abl transcript from the bone marrow and pleural effusion. We performed allogeneic peripheral blood hematopoietic stem cell transplantation from an HLA-matched sibling with uneventful engraftment. One year after the transplantation, she is maintaining remission with mild skin GVHD.