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Volume 40, Issue 10
Displaying 1-12 of 12 articles from this issue
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Fumio KAWANO, Tetsuyuki KIYOKAWA, Katsuji SHINAGAWA, Katsuto TAKENAKA, ...1999 Volume 40 Issue 10 Pages 1051-1057
Published: 1999
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSWe performed a multicenter, an early phase II clinical trial to evaluate the feasibility, safety and efficacy of myeloablative therapy supported by autologous peripheral blood stem cell transplantation (auto-PBSCT) for the treatment of acute myelogenous leukemia (AML) in first remission. A total of 105 patients were enrolled in the study, and 56 patients in first complete remission received auto-PBSCT. The median age was 44 years. Of the 56 patients, 34 (60.7%) had M2 or M3 AML by the French-American-British Classification system. The median concentration of infused CD34+ cells was 2.3×106/kg by recipient body weight. Median days to reach an absolute neutrophil count > 500/μl and a platelet count > 20000/μl were 14 and 16, respectively. The median disease-free survival rate was estimated to be 62.0% at a median follow-up time of 534 days.
Although the study enrolled a small number of patients and the follow-up period was relatively short, the preliminary results were encouraging and indicated that myeloablative chemotherapy with auto-PBSCT is feasible and can be performed safely as a post-remission therapy for AML. A prospective randomized clinical trial of auto-PBSCT versus standard chemotherapy alone will be necessary to assess the efficacy of high-dose therapy facilitated by auto-PBSCT as a post-remission therapy for AML.View full abstractDownload PDF (561K) -
Takaaki CHOU, Takuro ISHIGURO, Kenji IMAJO, Fumio KAWANO, Hisashi GOND ...1999 Volume 40 Issue 10 Pages 1058-1067
Published: 1999
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSWe conducted a multicenter early phase II study to evaluate the feasibility and therapeutic efficacy of high-dose chemotherapy supported by autologous peripheral blood stem cell transplantation (auto-PBSCT) for the treatment of intermediate grade non-Hodgkin's lymphoma (IG-NHL). High-dose etoposide or cyclophosphamide followed by G-CSF was used for PBSC mobilization, and a sufficient number of CD34+ cells (>1×106/kg) were collected.
Out of 81 enrolled patients, 50 received high-dose chemotherapy with auto-PBSCT; Hematologic recovery after transplantation was rapid. The incidence of grade III/IV toxicity (Bearman) was about 6%; treatment-related mortality was 6% (3/50). The Disease-free survival rate for the patients in complete remission who received high-dose chemotherapy with auto-PBSCT was better than that for the patients who were treated with conventional chemotherapy (57% vs 35%). These preliminary results indicated that high-dose chemotherapy with auto-PBSCT is feasible and effective. A prospective randomized phase III clinical trial will be required to assess the efficacy of high-dose chemotherapy with auto-PBSCT as a post-remission therapy for IG-NHL.View full abstractDownload PDF (684K) -
—Long-term Effectiveness and Possible Mechanisms—Akira HIRASAWA, Tadatsugu SATO, Yasushi KAWABUCHI, Tetsuo NISHIKAWA, S ...1999 Volume 40 Issue 10 Pages 1068-1074
Published: 1999
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSEight patients with idiopathic thrombocytopenic purpura (ITP) refractory to corticosteroids were given oral diaminodiphenyl sulfone (DDS) (75 mg to 150 mg/day). Responses to DDS were observed in 5 patients, and their platelet counts significantly increased to more than 10×104/μl. The duration of treatment required to obtain platelet counts of more than 10×104/μl ranged from 35 to 64 days. In 3 of the 5 responsive patients, platelet counts stabilized at over 10×104/μl during DDS therapy for 3 to 6 years. Although adverse effects including local skin rash and itching were observed in 3 patients, they disappeared after suspension of DDS or in response to medication with antihistamines.
Although the exact mechanism by which it increases the platelet counts in ITP patients is still obscure, DDS may inhibit the reticuloendothelial system by excessive red blood cell destruction.
We concluded that DDS therapy is well-tolerated and seems to be an effective alternative treatment for patients with ITP that is refractory to other conventional therapies.View full abstractDownload PDF (482K)
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Atsuo OKAMURA, Toshimitsu MATSUI, Akinori YAMAGUCHI, Shinichi SHIMIZU, ...1999 Volume 40 Issue 10 Pages 1074-1080
Published: 1999
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 71-year-old man presented with epigastralgia and tarry stool. Laboratory examination showed anemia (Hb 7.1 g/dl) due to hemorrhagic gastric ulcer and positive Coombs' test without features of hemolysis. Initial bone marrow smears disclosed normal granulocytes and megakaryocytes, but only erythroid hyperplasia with multinuclearity and megaloblastosis was identified. Cytogenetic studies revealed normal karyotype. Congenital dyserythropoietic anemia (CDA) type II was initially suspected. Serologically, however, acid hemolysis and anti-I·i tests were negative as were the results of another Coombs' test. The second bone marrow aspiration disclosed a marked decrease in multinucleated erythroblasts together with an increase in those that had internuclear chromatin bridges. Electron microscopy of bone marrow specimens demonstrated morphological features of CDA types I and II, thus yielding a final diagnosis of elderly dyserythropoietic anemia, which is similar to both CDA types. It was suggested that the reactive secretion of erythropoietin due to bleeding played a role in these pathologic changes.View full abstractDownload PDF (878K) -
Akio MAEDA, Yukio KOBAYASHI, Takeshi SAITO, Kazuto TOGITANI, Nobuko KA ...1999 Volume 40 Issue 10 Pages 1081-1086
Published: 1999
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 22-year-old woman with fever and bleeding tendency was given a diagnosis of acute promyelocytic leukemia (APL) on the basis of laboratory findings including a WBC count of 106×103/μl (90% blasts) and a platelet count of 1.6×104/μl. Induction therapy was started with all-trans retinoic acid (ATRA) and cytotoxic chemotherapy. After the patient achieved complete remission, ATRA was discontinued and consolidation chemotherapy was started. However, 4 months after onset, leukemic blasts were detected in cerebrospinal fluid. Temporal central nervous system remission was induced by intrathecal chemotherapy only. However, 2 months later, multiple focal mass lesions had developed in the brain. ATRA (45 mg/m2) was restarted together with multiple intrathecal injections of anticancer drugs, and a third remission was achieved. It is conceivable that the incorporation of ATRA in induction chemotherapy is related to the development of this rather rare complication of APL. The outcome in this case suggested orally administered ATRA may be effective in treating brain metastasis of APL.View full abstractDownload PDF (823K) -
Tsutomu KUBOKI, Takumi KUDO, Nobuko IWATA, Ippei MORIMOTO1999 Volume 40 Issue 10 Pages 1087-1092
Published: 1999
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 67-year-old woman with bullous pemphigoid (who had no history of hemorrhagic disease or blood transfusion) experienced extensive ecchymosis of the trunk and extremities and marked submucosal bleeding of the pharynx and larynx with risk of obstruction and suffocation. This bleeding tendency was the manifestation of a coagulation disorder due to factor VIII inhibitor. Immunosuppressive therapy, steroid pulse therapy, prednisolone (PSL), and cyclophosphamide (CPA) alleviated the bleeding and yielded negative assays for factor VIII inhibitor. However, because the patient stopped treatment, the bleeding recurred and was especially severe from a large hematoma with ruptured skin on the right hand. The bleeding was mitigated by transfusion of factor VIII concentrate combined with steroid pulse therapy. This was followed by CPA pulse therapy and oral PSL and CPA, resulting in the disappearance of factor VIII inhibitor again.
We reported this case because factor VIII inhibitor complication of bullous pemphigoid is very rare and immunosuppressive therapy consisting of PSL, CPA, and pulse therapy was effective.View full abstractDownload PDF (426K) -
Mami TAKANASHI, Yohsuke KADONO, Yasuhiro TABATA, Shigeyoshi HIBI1999 Volume 40 Issue 10 Pages 1093-1099
Published: 1999
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSWe encountered a patient with hypoplastic myelodysplastic syndrome (MDS) who responded to immunosuppressive therapy including antithymocyte globulin and cyclosporin A (CsA). A 13-year-old girl was referred to our hospital because of pancytopenia. Bone marrow smears disclosed extreme hypocellularity without cellular atypism. A diagnosis of aplastic anemia was made, and immunosuppressive therapy consisting of ATG, CsA, granulocytecolony-stimulating factor (G-CSF), methylprednisolone, and danazol was started. A month later dysplastic cells appeared in the bone marrow. The karyotype of pretreatment bone marrow cells was 46, XX, del (13)(q12;q14). Therefore, the final diagnosis was hypoplastic MDS. CsA and danazol were continued. The patient became transfusion-independent 1 month later and dysplastic cells disappeared from bone marrow 3 months later. The chromosomal abnormality also became undetectable 6 months after the initiation of treatment. These findings indicated that immunosuppressive therapy is benefical for patients with hypoplastic MDS.View full abstractDownload PDF (607K) -
Ryohei NAWATA, Kenji SHINOHARA, Toru TAKAHASHI, Tetsuya YAMADA, Kensak ...1999 Volume 40 Issue 10 Pages 1100-1104
Published: 1999
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA man with refractory anemia and trisomy 8 complained of repeated febrile episodes. He exhibited oral aphtha, exanthema, genital ulcer, and epididymitis. Laboratory data obtained during febrile episodes revealed leukocytosis with elevated CRP and ESR. Repeated examinations for infectious bacterial agents were negative. HLA analysis detected HLA-B51. Behçet's disease of incomplete type was diagnosed and successfully treated with prednisolone. It was speculated that the repeated febrile episodes may have been a manifestation of neutrophil hyper-function induced by increased blood levels of inflammatory cytokines, including IL-6, IL-8 and G-CSF, in association with rare complications of Behçet's disease.View full abstractDownload PDF (370K) -
Masaki MORI, Takayuki TANAKA, Youichi AKIFUJI, Juichi UEKI, Shu NAKAMO ...1999 Volume 40 Issue 10 Pages 1105-1109
Published: 1999
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 53-year-old woman with moderate aplastic anemia (AA) was treated with antithymocyte globulin (ATG). However, on the 4th day of treatment, ATG was discontinued because of bloody vomiting and melena. The patient improved with conservative treatment but complained of abdominal pain when the prednisolone (PSL) dose was decreased. Crohn's disease was finally diagnosed on the basis of upper and lower gastrointestinal X-ray studies. The patient responded well to ATG with hematologic improvement, and maintained remission with low-dose PSL and nutritional support. Drug-induced AA may occur during treatment for Crohn's diseases. The association of AA and Crohn's disease is rare, and to our knowledge, has not yet been reported in the literature. We discussed the pathogenesis of Crohn's disease during immunotherapy for AA.View full abstractDownload PDF (480K) -
Masahide YAMAZAKI, Tomoe MIZUTANI, Minori KATO, Yasuo ONTACHI, Masanor ...1999 Volume 40 Issue 10 Pages 1110-1115
Published: 1999
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSIt is well known that the administration of high-dose γ-globulin concentrate is effective in alleviating thrombocytopenia in patients with idiopathic thrombocytopenic purpura (ITP). Howerer, treatment can sometimes induce aseptic meningitis. A 25-year-old Japanese woman with antiphospholipid syndrome and ITP was conditioned with high-dose γ-globulin concentrate prior to splenectomy. Three days after the initial γ-globulin course, she experienced severe headache, vomiting, and high-grade fever. Cerebrospinal fluid examination yielded a diagnosis of aseptic meningitis. The patient's clinical symptoms and abnormal cerebrospinal fluid findings disappeared immediately after the discontinuation of γ-globulin therapy. Cases of aseptic meningitis induced by high-dose γ-globulin therapy are uncommon in the literature, and most involve children. Moreover, to our knowledge, only 1 Japanese adult ITP case of γ-globulin-induced aseptic meningitis has been reported to date. Aseptic meningitis may be one of the important adverse effects of the administration of high-dose γ-globulin concentrate to pediatric as well as adult ITP patients.View full abstractDownload PDF (458K) -
Katsuhisa KOGAWA, Tsutomu SATO, Tatsuya INOHARA, Kageaki Kuribayashi, ...1999 Volume 40 Issue 10 Pages 1116-1123
Published: 1999
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSA 62-year-old man was given a diagnosis of Waldenström macroglobulinemia (WM) in January 1995. He was treated with melphalan and corticosteroid until January 1996, when he experienced high fever and weight loss. The patient visited a nearby hospital, received a diagnosis of liver abscess, and was referred to our hospital on February 23, 1996. Computed axial tomographic scans demonstrated multiple isodensity masses in the liver, left adrenal region, and right kidney hilum. Needle biopsy specimens of a liver mass revealed infiltration of diffuse large B-cell lymphoma (REAL classification), suggesting that non-Hodgkin's lymphoma supervened WM. Despite multiple cycles of chemotherapy, the lymphoma responded poorly. The patient died of pneumonia and sepsis on May 10, 1996 and an autopsy disclosed broad involvement of liver and spleen with lymphoma. Southern blot analysis of DNA samples obtained from the patient's bone marrow at the time of the initial diagnosis of WM, and later from the needle biopsy specimen of liver mass, displayed different patterns of immunoglobulin heavy chain gene rearrangement. We therefore concluded that in this patient the lymphoma was not a progression of WM, but rather, an independent B-cell malignancy.View full abstractDownload PDF (954K)
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Takeshi TAKETANI, Ryoji HANADA, Hiroyuki KAWAGUCHI, Kohmei IDA, Keiko ...1999 Volume 40 Issue 10 Pages 1124-1126
Published: 1999
Released on J-STAGE: April 28, 2009
JOURNAL RESTRICTED ACCESSThree patient with hemophilia B who developed anti-factor IX antibodies were reported. All 3 had allergic and/or anaphylactoid symptoms when the antibodies were found. The antibodies were noted between 4 and 17 days after exposure to factor IX. It was suggested that the anaphylactoid symptoms were closely related to the occurrence of anti-factor IX antibodies.View full abstractDownload PDF (210K)
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