It is now more than forty years since the first allogeneic hematopoetic stem cell transplantation in Japan. In our institute, those of are about 400 cases since 1986 of the first experience. Expanded HLA mismatch such as haplo identical donor in patient family member is available recently and various immunosupressant of prevention for graft-versus-host disease are developed. Simultaneously, donor coordinate system which works as Japan Marrow Donor Program (JMDP) is an aggressive society for unrelated donor including cord blood stem cell transplant.
Autologous Peripheral Blood Stem Cell Transplantation (APBSCT) and Allogeneic Hematopoietic Stem Cell Transplantation (Allo HSCT) is the only curative option for many patients with relapsed or refractory non-Hodgkin′s lymphoma. Several prospective randomized studies have documented the superiority of APBSCT over salvage chemotherapy in patients with relapsed lymphomas. However the role of APBSCT as an upfront therapy for patients with high-risk lymphomas remains unclear. In Japan, there are a few consensuses which patient with lymphoma is adapted by APBSCT and Allo HSCT, so we introduce them.
Autologous peripheral blood stem cell transplantation for multiple myeloma and the impact novel therapies after APBSCT improve survival. But upper limit of age who indicate APBSCT is under 65-year-old. Recently, tandem stem cell transplantation such as auto-allo, or double APBSCT are more improves outcome of patient with high risk. Also bortezomib and immunomodulatory drugs are powerful tool after transplantation maintenance therapy.
The Japanese Data Center for Hematopoietic Cell Transplantation shows that over 3,500 cases of allogeneic hematopoietic stem cell transplantation (HSCT) are performed every year in Japan, nowadays. Several complications after HSCT, such as graft-versus host disease, sinusoidal obstruction syndrome and thrombotic microangiopathy, are well known and sometimes life-threatening. We review those complications, mainly the pathophysiology of them.
Cell processing procedure is the most important area for autologous peripheral blood stem cell transplantation (APBSCT) or allogeneic peripheral blood stem cell collection (Allo PBSCT). Donor Lymphocyte cell collection (DLI) is one option therapy of relapse after allogeneic stem cell transplantation. Granulocyte transfusion (GTx) is also one rescue option for severe infection status or after intensive chemotherapy in case of related donor.
The stem cell transplant nursing team has been assuming leadership in an effort to facilitate improved care for acute graft-versus-host disease (GVHD) such as skin, gut. And in chronic GVHD support, a long term followup (LTFU) team educate our patients and their family. As a New support area, hematopoietic cell transplant coordinator (HCTC) has been started since 2010 by The Japan Society of Hematopoietic cell transplantation. Now our Itabashi Hospital, we have seven members for LTFU in out patient clinic or bedside.
Background: Recent studies have implicated systemic inflammation in the genesis and maintenance of atrial arrhythmias. This study was designed to assess whether the inflammatory state influences the recurrence of atrial fibrillation (AF) after cardioversion for persistent AF (PerAF). Methods and Results: Twelve patients referred for cardioversion of PerAF lasting more than 2 months (mean duration: 16.8 ± 19.7 months) were included in the study. Body mass index (BMI), serum high-sensitivity C-reactive protein (hs-CRP), atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and left ventricular ejection fraction (LVEF) were measured before cardioversion. Cardioversion was successful in all patients, but AF recurred in 7 patients (58%) during the 6-month follow-up period. There were no significant differences in age, AF duration, LVEF, or ANP or BNP levels between patients with and without recurrent AF. However, the BMI was significantly higher in the patients with recurrent AF than in those without (27.5 ± 4.0 vs. 22.3 ± 2.8, respectively, P = 0.04). The hs-CRP concentration was also significantly higher in the patients with recurrent AF compared with those without (1461 ± 1013 vs. 225 ± 77 ng/mL, respectively, P = 0.04). The left atrial diameter was also significantly greater in patients with recurrence compared with those without (48.3 ± 8.5 vs. 38.3 ± 4.1 mm, respectively, P = 0.02). Conclusion: Inflammation may contribute to the pathogenesis of AF and may be useful in identifying patients most likely to not benefit from cardioversion.
Although transplantation of mature adipocyte-derived dedifferentiated fat (DFAT) cells into ischemic tissue enhances angiogenesis and increases vascular flow, there is little information regarding how DFAT cells interact with vascular endothelial cells. We examined the effect of green fluorescent protein (GFP)-labeled DFAT cell or adiposederived stem cell (ASC) co-culture on proliferation and tube formation of vascular endothelial cells. In the co-culture system, we also examined the potential of DFAT cells or ASCs to differentiate into pericytes by immunocytochemistry and real-time RT-PCR. We found that DFAT cells and ASC co-culture promoted proliferation and tube formation of vascular endothelial cells to similar degrees. Expression of the pericyte markers, NG2 and PDGFR-β, in DFAT cells was increased significantly by co-culture with vascular endothelial cells. These findings suggest that DFAT cells are a useful cell source for therapeutic angiogenesis.
Dedifferentiated fat (DFAT) cells are multipotent cells that can be prepared from mature adipocytes by the ceiling culture method. In the present study, we examined the chondrogenic differentiation potential of human DFAT cells. We employed a pellet culture system to induce chondrogenic differentiation. After 3 weeks of pellet culture, DFAT cells formed cartilaginous micromass pellets that were positive for aggrecan and type II collagen. To test whether DFAT cell-derived micromass pellets could form cartilage-like tissue in vivo, the pellets were implanted subcutaneously into immuno-deficient SCID mice. Two weeks after transplantation, the removed implants exhibited well-differentiated elastic cartilage-like tissue. These results indicate that human DFAT cells exhibit high chondrogenic differentiation potential both in vitro and in vivo. DFAT cells may be an attractive cell source for cell-based therapy for cartilage tissue regeneration.
We experienced a case of mucinous carcinoma that occurred near a fibroadenoma. A 39-year-old woman presented to our hospital with the chief complaint of spontaneous nipple discharge. Ultrasonographic examination revealed two lesions in her right breast. The two lesions exhibited similar ultrasonographic features. Core needle biopsy was performed for one lesion, which led to the pathological diagnosis of fibroadenoma. Three years later, three tumors were found in her right breast. Core needle biopsy was performed for the newly-developed lesion. The tumor was diagnosed as mucinous carcinoma of the breast. Breast-conserving surgery with sentinel lymph node biopsy was performed. The pathological diagnosis was multiple mucinous carcinoma and fibroadenoma. It is necessary to perform core needle biopsies for each lesion in the diagnosis of multiple lesions of the breast.
Mitral isthmus ventricular tachycardia (VT) involves a reentrant circuit with a critical isthmus of conduction bounded proximately by the mitral valve and distally by the remote inferior infarct scar. Successful catheter ablation requires placement of a lesion that transects the isthmus and thus prevents wave-front propagation. We report two cases of mitral isthmus-dependent VT. Electroanatomic mapping revealed a VT isthmus in each case, and linear lesions placed from the edge of the inferior infarct scar (as determined on a three-dimensional electroanatomic voltage map) to the base of the mitral valve eliminated the VT. Electroanatomic mapping can be used to identify isthmus boundaries and thus guide successful ablation.
A 64-year-old woman was admitted to our hospital with abdominal pain and vomiting. She had no history of abdominal surgery or injury. Abdominal contrast CT scan revealed expansion of the small intestine, and stenosis of the pelvic intestinal tract. The patient underwent conservative therapy by an ileus tube to decompress the small intestine, but there was no obvious improvement. Intramesosigmoid hernia was suspected with angiography from an ileus tube and abdominal contrast CT, laparoscopic surgery was performed on the 9th day after admission. The postoperative course was uneventful and she was discharged from the hospital on the 10th post operative day. Intestinal hernia without history of abdominal surgery, particularly associated with intramesosigmoid hernia, is rare. Herein, we describe our experience with a case of intramesosigmoid hernia and present a discussion of intramesosigmoid hernia with a review of the literature.
The patient was an 86-year-old male who had experienced intermittent lower abdominal pain with persistent constipation. After medical consultation, his symptoms improved initially, but subsequently relapsed, with the patient exhibiting bowel obstruction, and he was admitted to hospital. Computed tomography showed a lesion comprised of jejunal stenosis and wall thickening. Despite conservative treatment with an ileus tube, the bowel obstruction did not improve. Therefore, laparoscopic surgery was performed. Histological examination revealed the definitive diagnosis of ischemic enteritis of the jejunum. Ischemic enteritis is common in colonic lesions, but is rare in the development of collateral blood flow in the small intestine. Laparoscopic surgery for ischemic enteritis was able to observe the abdominal cavity widely in a good visual field and enabled easy resection of the lesion outside of the abdominal cavity.