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Volume 37, Issue 1
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[in Japanese]1996 Volume 37 Issue 1 Pages 1-6
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSDownload PDF (684K)
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Tohru IZUMI, Shigehiko IMAGAWA, Kazuo MUROI, Ritsuko SHIMIZU, Hironori ...1996 Volume 37 Issue 1 Pages 7-13
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSWe retrospectively analyzed the clinical data of the 21 patients with follicular lymphoma admitted to our institution from 1977 to 1994. The frequency of follicular lymphoma was 9.1% in the 231 patients with non-Hodgkin's lymphoma. Overall survival rates at 1 year, 3 years, and 5 years were 90.2%, 78.2%, and 52.1%, respectively. The median follow-up of surviving patients and time to treatment failure (TTF) was 43 months and 30 months, respectively. The median time from disease progression to death was 171 days. In univariate analysis, factors associated with poor survival were stage IV (Ann Arbor staging system), anemia (hemoglobin level less than 10g/dl), bone marrow involvement, two or more extranodal sites, and failure in induction of complete remission (CR) in the entire course. Factors associated with short TTF were anemia, bone marrow involvement, and failure in induction of CR. In multivariate analysis, induction of CR affected survival and TTF independently.View full abstractDownload PDF (534K) -
Rika SAKAI, Atsuo MARUTA, Jun TAGUCHI, Naoto TOMITA, Hiroyuki FUJITA, ...1996 Volume 37 Issue 1 Pages 14-21
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSWe evaluated the efficacy of ganciclovir to prevent the development of cytomegalovirus interstitial pneumonitis (CMV-IP) in patients with bone marrow transplants. Of 35 patients enrolled in this study, 33 were seropositive for CMV or had seropositive donors, and two were seronegative befor transplant but were positive for CMV examined by polymerase chain reaction (PCR) on days 30∼37. Ganciclovir was given at a dose of 250mg/body daily from day 30∼37 to day 70. Blood, throat swabs, urine and bronchoalveolar-lavage fluid (BALF) were screened for CMV by PCR on days 30∼37, 70 and 100. CVM-IP developed in two of 35 patients (5.7%) who received ganciclovir for prophylaxis, as compared with six of 39 historical controls who did not receive ganciclovir. A significant reduction of CMV detection by PCR in blood, throat swabs, and BALF was observed after administration of ganciclovir, on day 70. The incidence of neutropenia, thrombopenia and renal impairment in the study period showed no difference between the study group and the historical control. Early prophylactic use of ganciclovir appears to reduce the risk of CMV disease in allogeneic transplant recipients with positive serology or positive CMV-PCR.View full abstractDownload PDF (565K) -
Yasuro MIYAIRI, Kazunori MURAI, Taiju UTSUGISAWA, Yasushi NARIGASAWA, ...1996 Volume 37 Issue 1 Pages 22-28
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA therapeutic trial of interleukin-3 (IL-3) was carried out in four patients with aplastic anemia refractory to the prior therapies. Daily subcutaneous doses of 2.5, 5.0 or 7.5μg/kg was given for 7 or 14 days. In a patient who had co- and immediate boost-administration of granulocyte colony-stimulating factor (G-CSF) and/or erythropoietin (Epo) and another who had sequential administration of G-CSF and Epo two weeks after IL-3, definite hematological response was obtained during the course after IL-3. In one patient, moderate to severe side effects consisting of facial edema, conjunctival bleeding, chills and fever, were observed after two days' administration of IL-3. Co- or sequential administration of other hemopoietic factor (s) may be essential in IL-3 therapy for aplastic anemia.View full abstractDownload PDF (716K)
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Masao OGATA, Noritaka UNO, Eiichi OHTSUKA, Hiroshi KIKUCHI, Masaru NAS ...1996 Volume 37 Issue 1 Pages 29-34
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 76-year-old man was admitted to our hospital in February, 1994 because of fever and general fatigue. The patient had received radical gastrectomy for gastric cancer in August, 1987 and was subsequently treated with adjuvant chemotherapy using UFT for 25 months. On admission, the leukocyte count was 57,700/μl with 74% blasts. Bone marrow aspiration revealed proliferation of blasts with marked giant cells and polynucleolar cells. The diagnosis of T-lineage of acute lymphoblastic leukemia (ALL) was then made by analysis of surface markers and T-cell recepter rearrangement. Although combination chemotherapy was initially effective, blasts rapidly reappeared in the peripheral blood, and the patient died of pneumonia in Augst, 1994. In the presented case, blasts showed marked morphologic abnormalities. It is well known that most cases of therapy-related leukemia deviate from the myeloid lineage, and rarely from the lymphoid lineage. In addition, morphologic abnormalities are rare in de novo ALL. Since such abnormalities were demonstrated in our patient, and UFT was administered for a long period, it is possible that this leukemia occurred as a second malignancy related to UFT treatment.View full abstractDownload PDF (545K) -
Akira YOKOTA, Motoharu HUKAZAWA, Chiaki NAKASEKO, Akihiro ISHII, Tomoy ...1996 Volume 37 Issue 1 Pages 35-39
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 36 year-old man had suffered from psoriasis vulgaris for about 25 years. He had received corticosteroids ointment and PUVA therapy with partial response. In 1987, he was diagnosed as having aplastic anemia (AA) and treated with various medications, but failed to respond. He received an allogeneic bone marrow transplantation (BMT) from his histocompatible sister in 1993. Conditioning regimen of BMT consisted of total lymphoid irradiation (7.5 Gy) and cyclophosphamide (200 mg/kg). Cyclosporin A and methotrexate were given for prophylaxis of graft-versus-host disease. On day 24, bone marrow examination disclosed normocellular marrow and karyotypic analysis completely confirmed the donor's origin. Before BMT, he had systemic psoriatic plaques with scales, together with nail involvement. After BMT, psoriatic plaques disappeared and nail deformity improved. He has remained in remission of his AA and completely free of psoriasis in the absence of immunosupressive or other treatments. The cause of psoriasis is thought to be an immune-mediated disorder. Our case supports the observation that changing the host's immune system through allogeneic BMT can achieve remission of psoriasis. It is suggested that allogeneic BMT may be one strategy for the treatment of intractable immune-mediated disorders.View full abstractDownload PDF (567K) -
Kazuki KOIZUMI, Kouji YOKOYAMA, Mitsufumi NISHIO, Shingo SHIBATA, Kuni ...1996 Volume 37 Issue 1 Pages 40-45
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 60-year-old male was admitted to our hospital complaining abdominal pain and fatigue. Complete blood count showed as follows; WBC 3,900/μl (48% of monocytes), Hb 11.5 g/dl, Plt 0.9×104/μl. Marrow smears showed the presence of phagocytic histiocytes that consist 22.4% of total nuclear cells. Labolatory findings showed as follows; BUN 109.5 mg/dl, Creatinine 7.4 mg/dl, CPK 1,259 IU/l, Aldolase 195 IU/l, Myoglobin 4,200 mg/dl. Serological studies showed a 16-fold increase in herpes-simplex virus (HSV) antibody titers 4 weeks after admission. So we diagnosed his illness as virus-associated hemophagocytic syndrome (VAHS) and rhabdomyolysis that were associated with HSV. We performed three times of hemodialysis for acute renal failure and used prednisolone for VAHS. These treatments were successful, and he made a complete recovery from illness. VAHS complicated by rhabdomyolysis is very rare, and we think this case is full of suggestions.View full abstractDownload PDF (547K) -
Michihiko YOSHIDA, Seiji UEDA, Hiroshi HARANO, Etsuko YAMAZAKI, Kazuno ...1996 Volume 37 Issue 1 Pages 46-52
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 26-year-old male with chronic myelocytic leukemia was admitted for unrelated allogeneic bone marrow transplantation (BMT). After BMT, he developed swelling of biateral submandibular glands accompanied with pneumonitis possibly due to cytomegalovirus (CMV). Biopsy from the left submandibular gland showed giant cells with nuclear inclusion bodies that were positive for anti-CMV-IE monoclonal antibody, there fore cytomegalic sialoadenitis was diagnosed. The administration of ganciclovir resulted in resolution of the pnumonitis and submandibular gland swelling. Although cytomegalic sialoadenitis is not a life-threating complication in BMT patients, it should be noted that biopsy is very useful for the diagnosis of systemic cytomegalovirus infection.View full abstractDownload PDF (606K) -
Atsushi TAKAHASHI, Haruhisa NAGOSHI, Tamami YAMAKAWA, Reiko FUKUMURA, ...1996 Volume 37 Issue 1 Pages 53-59
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSMyelodysplastic syndrome (MDS) was sorted out two types; primary type and secondary type caused by irradiation or several drugs. Clinical features and chromosomal analysis were investigated in two patients with secondary MDS, caused by cyclophosphamide (CPM) or rifampicin (RFP) respectively, and fourteen cases of primary MDS hospitalized from 1988 to 1993. Two cases of secondary MDS progressed refractory anemia with excess of blasts (RAEB), however two of 14 patients with primary MDS progressed to acute leukemia. Median survival was similar in two groups. In cytogenitic anylysis, complex abnormalities including -5/5q- and/or -7/7q- have two cases of secondary MDS and nine out of 14 cases of primary MDS. Complex chromosomal abnormalities did not improve following chemotherapy In this study, clinical features and cytogenetic analysis demonstrated no significant difference between primary and secondary MDS.View full abstractDownload PDF (535K) -
Akira MATSUDA, Shuya KUSUMOTO, Katsuro ITO, Harue YOKOO, Taro MARUYAMA ...1996 Volume 37 Issue 1 Pages 60-64
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 76-year-old male was kept under observation for idiopathic interstitial peumonitis in our hospital from August 1992. Laboratory data revealed a slightly high level of HbF (2.7%) but normal values of other hematological examination. The level of HbF increased slowly, and in April 1994, pancytopenia appeared for the first time. Bone marrow was normocellular with myelodysplasia and 9% blasts. Cytogenetic analysis revealed 46, XY, del(20)(q11;q13). He was diagnosed as having myelodysplastic syndrome (MDS), refractory anemia with excess of blasts. At diagnosis of MDS, the level of HbF was 20.0%. He developed acute myelocytic leukemia 3 months later. It has been reported that approximately 40% of patients with MDS have higher HbF levels than normal, which is considered to be functional abnormality of the MDS clone. It is suggested that the MDS clone had already increased in this patient at presentation, 32 months before pancytopenia appeared.View full abstractDownload PDF (380K) -
Successful Combination Chemotherapy including Deoxycoformycin in A Case of Cutaneous T Cell LymphomaKazuya KODAMA, Takuji YAMADA, Kyoko KAWAKAMI, Kenichi YASUI, Tetsuhiko ...1996 Volume 37 Issue 1 Pages 65-71
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 44-year-old woman was admitted to our department because of fever and skin eruptions on August, 1991. Physical examination revealed superficial lymph node swelling, hepatosplenomegaly and generalized erythroderma. Laboratory findings were as follows; WBC 21,490/μl with 67% lymphocytes including flower cells. The surface phenotype of lymphocytes was positive for CD2, CD4, CD25, CD29 suggesting helper-inducer T cell. Skin and lymph node biopsies revealed the infiltration of T cells with indented nuclei. Anti-HTLV-1 antibodies in the serum and HTLV-1 proviral DNA analysis by PCR method were negative. She was diagnosed as CTCL, and she was treated with prednisolone. However, her erythroderma deteriorated gradually, in spite of well-controlled lymphocyte counts. Combination chemotherapy, utilizing vincristine, etoposide and cyclophosphamide, was effective against organomegaly but not against generalized erythroderma. After DCF was initiated at a weekly dose of 7.5 mg, her erythroderma improved rapidly and markedly with the disappearance of severe itching, and she achieved complete remission. Our results suggest that DCF is benefical for chemotherapy-resistant generalized erythroderma in CTCL.View full abstractDownload PDF (1027K) -
Takahiro OKAMOTO, Mikio MARUMO, Kaname SAHEKI, Masaya OKADA, Kohtaro K ...1996 Volume 37 Issue 1 Pages 72-76
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 16-year old girl was diagnosed as having severe aplastic anemia (SAA) had received emergency complicated by severe pneumonia. She had an HLA-identical younger brother and been urgently transplantation with her brother's marrow following a preparative regimen of CY+rabbit antithymocyte globulin (ATG). Granulocyte transfusions carried out before and after the transplant prevented exacerbation of the pneumonia. The pneumonia was cured in association with the hematopoietic recovery after BMT. No signs or symptoms of acute or chronic graft-versus-host disease were recognized and her hematological data are normal. The rabbit ATG was thought to be effective in preventing rejection and could be used in the preparative regimen instead of total body irradiation.View full abstractDownload PDF (517K) -
Ayako WATANABE, Yasunori KAWACHI, Toshio NISHIHARA, Takaaki MIYAKE, Ta ...1996 Volume 37 Issue 1 Pages 77-81
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 56-year-old woman developed mixed warm and cold antibody type autoimmune hemolytic anemia (mixed AIHA) associated with systemic lupus erythematosus. The patient was admitted to our hospital for acrocyanosis and shortness of breath. High fever and jaundice were observed. Urinalysis revealed protein and hemoglobin, and the sediment contained granular and hyaline casts. Her erythrocytes agglutinated markedly at room temperature. Her hemoglobin was 5.6 g/dl and reticulocytes were 19.3%. Total bilirubin, GOT and LDH were elevated, while haptoglobin and complements were abnormally reduced. Polyclonal increase of immunoglobulin, ANA and anti-Sm antibody were detected. The direct antiglobulin test was positive; IgG1, IgG3 and C3d were detected on the red cell surface. The cold agglutinin (CA) titer was 4096, showing anti-I blood group specificity, and was still active at 30°C. Upon administration of prednisolone gradual increase of hemoglobin and decrease of reticulocytes were observed, indicating the healing of hemolysis. CA disappeared but the direct antiglobulin test remained positive. Mixed AIHA has been defined as the presence of both warm and cold antibodies. In addition, the presence of symptoms of cold agglutinin disease, or low-titer and high thermal amplitude CA might be necessary for the diagnosis of mixed AIHA.View full abstractDownload PDF (437K)
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Katsuhiko YOSHIDA, Nobutaka KAWAI, Akira MATSUDA, Ikuo MUROHASHI, Itsu ...1996 Volume 37 Issue 1 Pages 82-85
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 33-year-old man was admitted to our hospital because of thrombocytopenia found on a periodic physical examination. Splenomegaly was recognied Peripheral blood showed WBC 4,510/μl, Hb 12.5 g/dl, and Plt 40,000/μl. Increased serum levels of acid phosphatase and angiotensin converting enzyme were observed on laboratory tests. Bone marrow aspirate revealed Gaucher cells. Decreased β-glucosidase activity was demonstrated in blood leukocytes, cultured blood lymphocytes, and cultured bone marrow fubroblasts from the patient. His glucocerebrosidase genotype was T1448C/C1504T (L444P/R463C). Since neurological examination and skeletal X ray results were normal, Gaucher disease type 1 was diagnosed.View full abstractDownload PDF (491K)
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