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Volume 39, Issue 8
Displaying 1-11 of 11 articles from this issue
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]1998 Volume 39 Issue 8 Pages 553-564
Published: 1998
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSDownload PDF (1102K)
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Masahito TSURUSAWA, Naoyuki KATANO, Takahisa HIROTA, Syouichi KOIZUMI, ...1998 Volume 39 Issue 8 Pages 565-573
Published: 1998
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSTo clarify the efficacy of modern intensive chemotherapy for ALL patients with unfavorable features, we compared the time to failure and initial clinical features of children who relapsed in the bone marrow or combined sites, as documented by early CCLSG studies (H811 and H851; 1981∼1987) and later studies (H874 and H/HH911; 1987∼1993) concerning high-risk ALL patients. In the later studies patients outcomes with new intensive regimens employing early intensification and reinduction therapy were apparently better than those of patients in the early studies with conventional regimens. When we compared the number of relapsed patients based on duration of first remission, we found that the improved outcomes for patients in the later studies were due to a decrease in the number who relapsed 7∼36 months after the start of treatment (intermediate relapse), and that the percentage of those who relapsed within the first 6 months of therapy (early relapse) was higher. Patients with high initial WBC counts tended to relapse much earlier than those with low initial WBC counts. However, in the later studies, patients with high WBC counts often relapsed after the termination of therapy (late relapse). These results suggest that the intensive chemotherapy regimens used in the later studies can prevent the development of drug resistant leukemic clones, except in extremely high-risk patients likely to relapse within the first 6 months of therapy.View full abstractDownload PDF (642K) -
Tetsuya NISHIDA, Masataka HANEDA, Tadaharu KANIE, Makoto MURATA, Motoh ...1998 Volume 39 Issue 8 Pages 574-579
Published: 1998
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSEleven leukemia patients who had undergone bone marrow tranplants from HLA-A, B, DR genotypically mismatched unrelated donors received FK506 and short-term methotrexate as prophylaxis for graft-versus-host disease (GVHD). Grade III-IV acute GVHD developed in 2 of the patients, and chronic GVHD developed in 4 of the other patients. Adverse drug reaction included reversible nephrotoxicity, hyperglycemia (all patients) and hypertension (9 patients). Hyperglycemia and hypertension of grade 3 or higher occurred mostly in the patients who were on supplemental steroids. However, severe nephrotoxicity was not observed. Complications included cystitis (4 patients), cytomegalovirus colitis (3 patients), Interstitial Pneumonitis (IP) (3 patients), tuberculosis (1 patient), and thrombotic microangiopathy (1 patient). None of patients relapsed. Although close monitoring of FK506 blood concentration and patient clinical signs are required, we concluded that FK506 is effective for GVHD prophylaxis after bone marrow transplantation from HLA-A, B, DR genotypically mismatched unrelated donors, and that adverse reactions due to FK506 are controllable. To determine the long-term effectiveness of this drug, it will be necessary to conduct prospective randomized studies that compare it with cyclosporin A as a preventive treatment against GVHD in patients who receive bone marrow transplants from HLA genotypically mismatched unrelated donors.View full abstractDownload PDF (465K)
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Mitsufumi NISHIO, Ken-ichi SAWADA, Kazuki KOIZUMI, Tomoyuki ENDOH, Hid ...1998 Volume 39 Issue 8 Pages 580-585
Published: 1998
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 35-year-old man with non-Hodgkin's lymphoma (NHL) (follicular small cleaved, B cell, stage IVB) received double myeloablative chemotherapy with syngeneic peripheral blood stem cell transplantation (PBSCT). Although platelet recovery was delayed until day 29 after the second transplantation, thereafter trilineage hematopoietic reconstitution was achieved. The evaluation after PBSCT did not detect any residual tumor. The patient was in good health until day 138, when his platelet count suddenly began falling; on day 150, it had fallen to 1.5×104/μl, and the patient was re-admitted for treatment. The bone marrow was normocellular with a normal count and megakaryocyte structure. Other examinations, including serological tests and computed tomography of the neck, chest, abdomen, and retroperitoneum, did not indicate a recurrence of NHL or reveal the cause of thrombocytopenia. The patient's platelet-associated IgG (PAIgG) level was at 70.9 ng/107 platelets (normal range: 9∼25 ng/107 platelets); a diagnosis of thrombocytopenia due to an autoimmune mechanism such as idiopathic thrombocytopenic purpura (ITP) was made. Prednisolone therapy increased the platelet count and reduced the PAIgG level. Thrombocytopenia with an ITP-like mechanism rarely occurs more than 100 days after autologous or syngeneic stem cell transplantation, and should be taken into consideration as a late complication of PBSCT.View full abstractDownload PDF (514K) -
Yukiko ONISHI, Soichi HOTTA, Hiroyuki IWAMOTO, Toshiro KAMOSHIDA, Atsu ...1998 Volume 39 Issue 8 Pages 586-592
Published: 1998
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 66-year-old Japanese man was admitted to Hitachi General Hospital because of fatigue, fever, edema, and icterus. A blood examination showed anemia, leukocytosis, and hyperbilirubinemia. Antibiotics did not alleviate the inflammatory symptoms. On the 13th hospital day, the patient demonstrated mental confusion, with progessive anemia and thrombocytopenia. Bone marrow aspiration revealed an increase of macrophages showing erythrophagocytosis. A diagnosis of hemophagocytic syndrome was made, but no viral infection or hematological malignancy could be detected. The patient was treated with γ-globulin and methylprednisolone for hemophagocytic syndrome, but died of respiratory insufficiency with progressive hyperbilirubinemia and trombocytopenia on the 29th hospital day, A postmortem examination showed proliferation of lymphoma cells within the small blood vessels of the brain, lungs, liver, and many other organs, but the bone marrow was not involved. An immunohistochemical examination resulted in a diagnosis of intravascular malignant lymphomatosis (IML) of B cell origin. No viral infection was detected with in situ hybridization methods. Although IML occasionally accompanies thrombocytopenia, infiltration of lymphoma cells in the bone marrow is rare. Lymphoma associated hemophagocytic syndrome may cause cytopenia in some patients with IML, as indicated in this case.View full abstractDownload PDF (699K) -
Ishikazu MIZUNO, Tohru MURAYAMA, Chiho OBAYASHI, Kentaro TAKAHASHI, Yo ...1998 Volume 39 Issue 8 Pages 593-599
Published: 1998
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 51-year-old woman was admitted to a local hospital because of pneumonia, and received a diagnosis of cervical lymphadenopathy, anemia, and hyperimmunoglobulinemia with suspected multicentric Castleman's disease (MCD). At the age of 53 she was transferred to our hospital because of numbness and muscle weakness. Polyclonal hyperimmunoglobulinemia was observed, and biopsy specimens of lymph node tissue revealed infiltration of plasma cells in the interfollicular areas, thus leading to a diagnosis of MCD. A chest computed tomography scan revealed diffuse nodular shadows in all lung fields, and a transbronchial lung biopsy disclosed infiltration of plasma cells in the alveolar septa. Together, these findings indicated lymphoid interstitial pnreumonia (LIP). Polyneuropathy was diagnosed by neurological examination and nerve conduction studies. Treatment with prednisolone and cyclophosphamide was ineffective against LIP probably because the patient had coexising pulmonary fibrosis. Since pulmonary complications of MCD determine its prognosis, their early detection and treatment are essentital.View full abstractDownload PDF (707K) -
Jun SHIRAISHI, Yoshikazu SUDO, Yukiko KATORI, Maki AKIYAMA, Osamu TAKA ...1998 Volume 39 Issue 8 Pages 600-605
Published: 1998
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 46-year-old man who had been treated with azathioprine (150mg/day) and prednisolone (7.5∼10mg/day) for 16 years after allogeneic renal transplantation was admitted to our hospital in July 1996 for evaluation of pancytopenia. Three years earlier he had been given a diagnosis of renal pelvic and ureteral cancer, and underwent left nephrectomy with total uretectomy. His bone marrow was normocellular with excess of blasts (27.6%), and displayed trilineage myelodysplasia. A chromosomal analysis of the bone marrow revealed 43∼45, XY with del(1)(p13), -5, del(7)(q22), -17, -18, and -19. The patient was given a diagnosis of refractory anemia with excess of blasts in transformation (RAEB in T), and treated with idarubicin and cytosine arabinoside. Two months later, overt acute leukemia developed and reinduction chemotherapy was started, but the patient died of cerebral hemorrhage in October. This case suggests that immunosuppressive agents such as azathioprine might play an important role in the pathogenesis of MDS (RAEB in T) and renal pelvic and ureteral cancer after renal transplantationView full abstractDownload PDF (648K) -
Jun YAMANOUCHI, Takanori OKADA, Atsuhiko HASEGAWA, Hiromi IWASAKI, Yuu ...1998 Volume 39 Issue 8 Pages 606-610
Published: 1998
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSAn 82-year-old man was admitted to our hospital in September 1996 due to dysphagia and cardiomegaly. Physical examination detected the fourth heart sound and a Levine III/VI systolic murmur in the cardiac apex. Surface lymph nodes were not palpable. LDH 662 IU/I was detected by laboratory examinations, and ultrasound cardiography showed grade 3 mitral regurgitation. Computed tomography revealed a huge mass in the posterior mediastinum, pressing the heart from the posterior direction. Thereafter, a left pleural effusion developed and aspiration was performed. Cytological examination of the fluid showed clusters of lymphoid cells with a positive immunophenotype for CD10, CD19 and HLA-DR. Chromosome analysis revealed complex abnormal karyotypes including t(8;14)(q24;32). A diagnosis of B cell lymphoma was made, and combination chemotherapy consisting of cyclophosphamide, THP-adriamycin, vincristine, and prednisolone was initiated. The patient's mass disappeared promptly, and his mitral reguration subsided. We reported this case because malignant lymphoma of the posterior mediastinum is rare, and because we are unaware of any previous reports of malignant lymphoma causing acute mitral regurgitation.View full abstractDownload PDF (880K)
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Tadanobu OHTA, Manabu HIRAI, Takuya KISHIDA, Noriyuki TATSUMI1998 Volume 39 Issue 8 Pages 611-613
Published: 1998
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 55-year-old woman was admitted because of progressive jaundice. Blood examination on admission revealed markedly elevated serum levels of CA19-9 and SPAN-1. Abdominal computed tomography revealed a large tumor in the head of the pancreas. Although the patient's jaundice and elevated CA19-9 decreased after percutaneous franshepatic cholangio-drainage, her SPAN-1 level remained elevated. Open biopsy of the pancreatic tumor revealed non-Hodgkin's lymphoma (NHL) (diffuse medium, B cell type), Complete remission was obtained after one course of CHOP therapy. This case suggests that pancreatic tumor with elevated serum CA19-9 and SPAN-1 levels may involve NHL, and may be curable with chemotherapy.View full abstractDownload PDF (357K) -
Nobuhiko UOSHIMA, Teruaki AKAOGI, Hideo HAYASHI, Yutaka KOBAYASHI, Mot ...1998 Volume 39 Issue 8 Pages 614-616
Published: 1998
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 77-year old woman with myelodysplastic syndrome required platelet transfusion. However, she complained of facial flushing and dyspnea immediately after the initiation of an infusion of platelet concentrations (PC) utilizing a Pall PL-PXL8H filter with a negatively charged surface. The same symptoms recurred following a transfusion of washed PC with saline. However, an infusion utilizing a Sepacell PLX5A-W with a positively charged surface caused no problems. Furthermore, the patient demonstrated the same adverse reaction after administration of prostaglandin F2α. This case suggested that special caution is warranted when patients who have an allergic history receive PC infusions through leukocyte-reduction filters with negatively charged surfaces.View full abstractDownload PDF (236K) -
Yasuhiro ISHIZUKA, Akira YOKOTA, Tomoko SHIGA, Jyumei SATO, Hakumei OH ...1998 Volume 39 Issue 8 Pages 617-620
Published: 1998
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 60-year-old woman was admitted in August 1995 complaining of abdominal pain. A diagnosis of essential thrombocythemia had been made in 1987, and myelofibrosis developed in the patient thereafter. Phisical examination revealed massive hepatosplenomegaly, and the peripheral blood showed leukoerythroblastosis with chromosomal abnormalities in peripheral blood cells. In May, 1996, blastic trasformation occurred. Based on the findings of surface marker analysis, the blasts met the diagnostic criteria for acete myelogenous leukemia because they were negative for peroxidase and positive for CD13. In June, the patient died of multiple organ failure. Postmortem examination revealed multiple tumor emboli.View full abstractDownload PDF (540K)
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