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Volume 37, Issue 12
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[in Japanese], [in Japanese]1996 Volume 37 Issue 12 Pages 1353-1361
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSDownload PDF (791K)
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Ritsuro SUZUKI, Hiroatsu IIDA, Hirofumi TAJI, Makoto MURATA, Takuro SU ...1996 Volume 37 Issue 12 Pages 1362-1370
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSWe compared the outcome of bone marrow transplantation (BMT) with that of maintenance chemotherapy for adults with acute leukemia who achieved first remission in Japanese Red Cross Nagoya First Hospital. From 1976 to 1993, 17 patients with acute myelogenous leukemia (AML) and 10 patients with acute lymphoblastic leukemia (ALL) recieved allogeneic BMT from HLA genotypically identical siblings in first remission, 4 patients with ALL undertook purged autologous BMT using monoclonal antibody and complement, and 55 patients with AML and 27 patients with ALL were treated with maintenance chemotherapy. The estimated 6-year disease free survival (DFS) of AML patients was significantly higher in the BMT group than in the chemotherapy group (77.3% vs 42.6%; p<0.01). For ALL patients, the estimated 6-year DFS was 72.5% in the allo-BMT group and 100% for the auto-BMT group, but no patient was disease free more than 2 years in the chemotherapy group (p<0.0001). We conclude that BMT after several courses of consolidation chemotherapy is the optimal treatment of choice in patients with AML and ALL in first remission. A prospective study is needed to confirm the efficacy of BMT after intensive consolidation chemotherapy.View full abstractDownload PDF (603K)
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Kinya HATTORI, Hiromasa YABE, Miharu YABE, Tsuyoshi MORIMOTO, Katuhiko ...1996 Volume 37 Issue 12 Pages 1371-1376
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA five-year-old boy with acute myelogenous leukemia in relapse was treated by HLA-matched cord blood stem cell transplantation. The patient was preconditioned with 16 mg/kg of busulfan, 15 mg/kg of thiotepa and 90 mg/kg of cyclophosphamide and 2.45×107/kg of cord blood mononuclear cells were infused to the patient on October 19th 1995 without the prophylaxis of graft-versus-host disease (GVHD). From the fifth day following the transplant, rG-CSF was administered at a dose of 300 μg/m2/day. Hematopoietic recovery was obtained as following; WBC over 1000/μl was on +18 day, neutrophil over 500/μl was on +20 day, reticulocyte over 20‰ was on +28 day and platelet over 50×103μl was on +91 day. Engraftment was confirmed by DNA restriction fragment length polymorphism (VNTR) on +28 day. In spite of absence of prophylaxis of GVHD, the patient did not develop any signs of GVHD, and leukemia relapsed on +105 day. The patient died of leukemia relapse on +251 day. This is the first case of cord blood stem cell transplantation in Japan.View full abstractDownload PDF (439K) -
Yasunori KAWACHI, Ayako WATANABE, Toshio NISHIHARA, Tatsumi UCHIDA, Ka ...1996 Volume 37 Issue 12 Pages 1377-1382
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 34-year-old man was admitted to our hospital for a headache in March, 1995. The patient's hemoglobin was 7.5 g/dl, platelet count was 1.8×104/μl and white blood cell (WBC) count was 12,400/μl with 99% myeloblasts. Myeloblasts were agranular or hypogranular but electron microscopy revealed microgranules in cytoplasm, and a few faggots were observed. The bone marrow was hyperplastic due to myeloblasts and chromosomal abnormality was recogniged: 46, XY, t(15;17)(q22;q12). PML-RARα with intron 3 breakpoint of the PML locus, and rearrangements of the T-cell receptor β and γ genes were detected. These cells were positive for CD2 (63%), CD8 (47%), CD13 (87%) and CD33 (99%). Microgranular variant type of acute promyelocytic leukemia (APL) was diagnosed. Disseminated intravascular coagulation (DIC) was also present. The patient was treated with enocitabine, daunorubicin, 6-mercaptopurine, dalteparin sodium, anti-thrombin III concentrates and gabexate mesilate with prophylactic frozen transfusions of fresh plasma and platelet transfusions for 5 days, but WBC count did not decrease and DIC did not improve. The patient died of cerebral hemorrhage 7 days after diagnosis of APL. APL with CD8 expression has never been reported. We suggest that therapy should be modified in this type of APL and conclusions concerning the most appropriate therapeutic strategy will depend on the results of treatment of similar cases in the future.View full abstractDownload PDF (677K) -
Keiji HASEYAMA, Junko WATANABE, Takanori ODA, Shizue KATOH, Nobuhiro S ...1996 Volume 37 Issue 12 Pages 1383-1388
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 13-yr-old boy was diagnosed as T cell lymphoma. After the second remission, he underwent BMT from an HLA-identical, MLC negative sibling donor. After BMT, he developed grade II acute GVHD. GVHD was improved by pulsed steroid therapy using prednisolone. About 12 months after BMT, he developed bronchiolitis obliterans, sicca syndrome, and leukoderma, which were related to chronic GVHD. Pulsed steroid therapy was carried out twice, and his condition improved. Twenty-seven months after BMT, he developed nephrotic syndrome. A renal biopsy was performed, and the diagnosis was histologically membranous nephropathy and focal glomerular sclerosis. The response to steroids was not satisfactory. After 5 weeks, dipyridamole was added, but proteinuria persisted. Proteinuria disappeared 8 weeks after the addition of cyclosporine. The second biopsy after 5 months of treatment revealed an improvement in the renal lesions. The patient showed a low T4 to T8 ratio of T-lymphocytes at the onset of nephrotic syndrome. However after treatment with cyclosporine, the ratio gradually increased. These findings suggested the nephrotic syndrome in this patient was related to renal involvement in the course of chronic GVHD.View full abstractDownload PDF (1008K) -
Tsuyoshi SUZUKI, Tatsuyuki HAYASHI, Yasunobu NONAKA, Masanori HIRANO, ...1996 Volume 37 Issue 12 Pages 1389-1394
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSHemolytic anemia and possible aplastic crisis with symptoms including jaundice, general fatigue and dark urine developed in a man being treated only by lansoprazole. Five days later, he was treated with antibiotics. The next day, he was admitted to our hospital because of jaundice. On admission, the hemoglobin was 14.0 g/dl, reticulocyte count 8‰, plateletes 79×109/l and total bilirubin 12.4 mg/dl (indirect bilirubin 9.5 mg/dl). The above medications were discontinued. The direct Coombs antiglobulin test was positive. Examination of the complement revealed a C3 fiter at the upper limit of normal and an increased C4 and CH50. Three days after admission, he had a severe anemia. The hemoglobin was 3.3 g/DL. We thought it possible that aplastic crisis had followed the hemolytic anemia induced by lansoprazole.
He was treated with blood transfusions and corticosteroids. He recovered from anemia within three weeks. Exhaustive studies to identify the casue of the hemolytic anemia were undertaken with negative results. We detected IgG antibody to lansoprazole. We believe that the hemolytic anemia was induced by lansoprazole.View full abstractDownload PDF (451K) -
Yasunobu ABE, Hiroshi TAKATSUKI, Yasuyo OKADA, Yuji YUFU, Toshinari KI ...1996 Volume 37 Issue 12 Pages 1395-1399
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 48-year-old female was admitted to our hospital because of pancytopenia and pneumonia in February, 1993. The increase of abnormal promyelocytes with t(15;17) and PML-RAR mRNA was detected in bone marrow aspirate and a diagnosis of acute promyelocytic leukemia was made. She obtained complete remission after the administration of all-trans retinoic acid (ATRA) and following chemotherapy. Then she received peripheral blood stem cell transplantation in September, 1993. However she noticed a umbilical tumor in June, 1995. Abnormal promyelocytes were demonstrated not only in bone marrow aspirate but also in the umbilical tumor. Because of the poor response to ATRA and development of fever, a side effect of ATRA, G-CSF and prednisolone were administrated together with ATRA. After the combined therapy, umbilical tumor disappeared and she obtained complete remission again. These findings suggest that combined therapy of ATRA and G-CSF is effective to the low responder to ATRA and that combined use of ATRA and prednisolone reduces the side effect of ATRA without diminishing the favorable effect on differentiation.View full abstractDownload PDF (624K) -
Yasuo TAKIMOTO, Fumio IMANAKA, Koji NANBA1996 Volume 37 Issue 12 Pages 1400-1404
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 69-year-old woman was admitted with generalized lymph node swelling and huge splenomegaly. CD5 (+), Sm-IgM (+) and SmIgD (+) lymphocytes were increased in lymph nodes, spleen and bone marrow, and she was diagnosed as having mantle cell lymphoma. A diagnosis of hyper-IgE syndrome was also made, because IgE was markedly increased (174,780 u/ml) and chronic dermatitis, which was often complicated with infection, occuered repeatedly on her extremities. In this case, interleukin-4 was considered to be one of the factors involoved in the hyper-IgE syndrome, because increased IgG1 and reduced IgG2 were observed. Immunological abnormality associated with the hyper-IgE syndrome seemed to contribute to the development malignant lymphoma in this case.View full abstractDownload PDF (1031K) -
Yukari ARAI, Michihiko MASUDA, Takamitu OKAMURA, Makio WADA, Toshiko M ...1996 Volume 37 Issue 12 Pages 1405-1409
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 54-year-old woman with leukocytosis, was referred to our clinic in February 1982. Based on findings of pancytosis, high NAP score, high serum vitamin B12, increase in total red cell volume and splenomegaly, she was diagnosed as having polycythemia vera (PV). Since then, she has been treated with pipobroman, hydroxycarbamide and phlebotomy. Leukocytosis with increase in blastic cells and thrombocytopenia was noted in August 1995, and she was admitted to our hospital. Since the blastic cells were CD10+19+20+, she was diagnosed as having acute lymphoblastic leukemia and treated with vincristine and prednisolone, resulting in remission. This case suggests that PV is a disease of multipotent stem cells including those with a lymphoid lineage.View full abstractDownload PDF (386K) -
Yoshio HATAE, Hisaya NAKADATE, Susumu IIZUKA, Takeo TAKEDA, Takaaki SH ...1996 Volume 37 Issue 12 Pages 1410-1415
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSWe treated two children with acute promyelocytic leukemia (APL) in whom complete remission was successfully induced by oral administration of all-trans retinoic acid (ATRA). We followed these patients with conventional chemotherapy. The first patient has remained in continuous complete remission. However, the other patient relapsed during the maintenance therapy and died of progressive disease in spite of a second treatment with ATRA and chemotherapy. From a clinical point of view, the latter case had a hyperleucocytosis on admission. Also morphologically speaking, this patient had a different M3 variant than the first case. There are two major isoforms of PML/RARα transcripts, so called short and long type transcripts, according to the breakpoints in the PML genes. In the first case the ‘long type’ isoform was detected by reverse transcriptase polymerase chain reaction (RT/PCR) amplificatoin. On the other hand the ‘short type’ isoform was observed in the latter case. Also the second case became PCR positive at relapse, although the detectable isoform was negative during remission. The ‘short type’ isoform may be related to the poor prognosis and RT/PCR analyses may be a poweful to detect early relapse.View full abstractDownload PDF (557K) -
Tadashi KANOH1996 Volume 37 Issue 12 Pages 1416-1421
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSThe author has recently observed an unusual case of multiple myeloma, which was diagnosed by a noticeable decrease in the serum monoclonal IgG (κ) level in close association with Bence Jones escape. [Case Report] In June 1986, a 61-year-old woman was noticed to have monoclonal gammopathy of undetermined significance (MGUS) at a local hospital. Bence Jones escape was found in association with a decrease in the serum M-component level in April 1991, when a diagnosis of indolent multiple myeloma was made. In April 1993, the daily amount of Bence Jones proteins excreted in the urine was 1 g. Examination of bone marrow aspirate demonstrated immature plasma cells in clusters. The patient was diagnosed of having overt multiple myeloma. The double immunofluorescence studies on the bone marrow plasma cells were performed. Only 40 percent of cells producing κ light chains were found to be positive for γ heavy chains, while all of γ heavy chain-positive cells contained κ light chains. κ light chain-positive cells were stained neither with anti-α, nor with anti-μ. From the above-mentioned data, the proportion was about two cells producing IgG (κ) to three cells producing κ light chain alone. Thus, myeloma cells contained two morphologically identical but immunologically diverse subpopulations. Conceivably, the subclone producing κ light chain alone could be derived from the original clone producing monoclonal IgG (κ). Bence Jones escape of this type has not hitherto been described.View full abstractDownload PDF (769K)
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Yasuo TAKIMOTO, Fumio IMANAKA1996 Volume 37 Issue 12 Pages 1422-1424
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 68-year-old female diagnosed as having Sézary syndrome because of generalized erythroderma and increased lymphocytes with convoluted nuclei in 1988 was treated with steroids. However she did not respond to therapy and died due to pneumonia and aggravation of Sézary syndrome in September, 1994. Dyspeptic diarrhea was observed for two months before she died. Autopsy revealed local deposition of amyloid A protein in the mucosa of the small intestine, which might have been the cause of dyspeptic diarrhea. This was a rare case which Sézary syndrome accompanied by localized amyloidosis.View full abstractDownload PDF (337K) -
Hiroko OTSUBO, Ken KAITO, Mayumi YOSHIDA, Takaki SHIMADA, Hidekazu MAS ...1996 Volume 37 Issue 12 Pages 1425-1427
Published: 1996
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSSevere anemia A 37 year-old male with therapy resistant multicentric Castleman's disease (MCD) anemia was treated by subcutaneous injection of erythropoietin. Although immunoglobulin and CRP concentration increased, anemia obviously improved with hemoglobin levels increasing from 4.8 g/dl to 8.5 g/dl without any side effects. Colony assay revealed that the bone marrow mononuclear cells responded to erythropoietin in a dose dependent manner. The mechanism of anemia of MCD is not clearly understood, and treatment is sometimes very difficult. There is no other previous report concerning erythropoietin as a treatment for anemia in MCD.View full abstractDownload PDF (204K)
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