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Volume 41, Issue 8
Displaying 1-13 of 13 articles from this issue
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Hiroshi FUJII, Yutaka UEDA, Hitoshi NAKAGAWA2000 Volume 41 Issue 8 Pages 621-627
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSWe investigated the incidence of post-transplant solid tumors in a cohort of 109 patients who had undergone auto-peripheral blood stem cell transplantation (PBSCT) for acute myelogenous leukemia (n=18), acute lymphoblastic leukemia (n=7), non-Hodgkin's lymphoma (n=52), Hodgkin's disease (n=5), multiple myeloma (n=16), chronic myelogenous leukemia (n=1), myelodysplastic syndrome (n=3) and solid tumors (n=7). The patients were followed up for a median of 32 months after PBSCT. Five second solid malignancies developed in 4 patients within 14 to 43 months after PBSCT: large cell carcinoma of the lung, adenocarcinoma of the rectum, cholangiocellular carcinoma of the liver, squamous cell carcinoma of the mouth, and adenocarcinoma of the gallbladder. The affected patients were 3 of 52 with non-Hodgkin's lymphoma and one of 16 with multiple myeloma. One of the patients was in the 5th decade of life (n=31) and 3 were in the 6th decade (n=31). The cumulative actuarial risk for developing post-transplant solid tumors was 8% at 8 years. Elderly patients (≥60 year old) who have undergone PBSCT need to be observed carefully for second neoplasms because of their increased risk of post-transplant solid tumors.View full abstractDownload PDF (458K)
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Toshimitsu MATSUI, Ryuichi INOUE, Kazuyoshi KAJIMOTO, Akira TAMEKANE, ...2000 Volume 41 Issue 8 Pages 628-634
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 40-year-old man received blood transfusion in December 1998 because of gastric bleeding from a peptic ulcer. One month later, he developed febrile hemolytic anemia. Administration of high doses of glucocorticoid significantly reduced the hemolysis, but did not cure the disease. To investigate the cause of the hemolysis, the patient was transferred to our hospital in May 1999. Giemsa-stained peripheral blood smears showed Babesia parasites in the red blood cells (RBC), and PCR analysis confirmed the presence of Babesia microti DNA. The parasitemia disappeared hematologically after 2 weeks of quinine and clindamycin therapy. However, parasite DNA was still detectable in the RBC. Although treatment with oral atovaquone was given for 2 weeks, parasitemia and febrile hemolysis recurred within a month after the last treatment. Fortunately, complete remission was obtained after a second 12-week course of therapy with quinine and clindamycin. PCR analysis revealed asymptomatic Babesia infection in one of eight samples from the original blood donor. The initial steroid therapy given to the patient without an accurate diagnosis seemed to have delayed augmentation of the specific antibodies (IgG) against Babesia microti, thus prolonging the parasitemia after the initial acute stage of babesiosis.View full abstractDownload PDF (573K) -
Motoaki TANIGAWA, Sigehisa TAMAKI, Atsushi FUJIEDA, Hiroyuki MIYASHITA ...2000 Volume 41 Issue 8 Pages 635-640
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 52-year-old woman complained of lower back pain and gluteal pain in April 1997, and was found to have anemia, hypercalcemia and renal disorder. In September of the same year, she was diagnosed as having IgA-λmyeloma (stage IIIA). VMMD-IFN therapy was started in November, 1997, and this resulted in improvement of the M-protein level, and relief of the pain in the lower back and gluteal region. A second course of VMMD-IFN therapy was also effective. In April 1998, however, the back pain worsened, and in July the patient suffered a fall and fractured her left femur. Upon readmission to our hospital, the level of M-protein was lower, and high fever, hypercalcemia, renal disorder, elevation of the LDH level, anemia and thrombocytopenia were observed. Bone marrow examination revealed 30% atypical large-sized CD19−, CD38+, CD56+ myeloma cells and chromosomal abnormalities. Although the symptoms were improved temporarily after a third course of VMMD therapy, disease aggravation occurred again, and extramedullary masses appeared on the head, face and pelvis. VAD therapy was performed without effect, and the patient died about 2 months after recurrence. This was a comparatively rare case of fulminant multiple myeloma occurring in the terminal stage.View full abstractDownload PDF (582K) -
Yasushi TERASAKI, Yukio KONDO, Chika UOTANI, Masatoshi KANNO, Masahide ...2000 Volume 41 Issue 8 Pages 641-647
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSCouple 1: A 74-year-old woman was diagnosed as having diffuse large B-cell lymphoma (DLBL) by left axillary lymph node biopsy. About 6 months later, DLBL was also diagnosed in her 79-year-old husband by right submandibular lymph node biopsy. Although the wife achieved partial remission with chemotherapy, she died due to disease progression. The husband's disease was chemotherapy-resistant, and he died of renal failure. Couple 2: An 86-year-old man was diagnosed as having DLBL by left axillary lymph node biopsy. About 4 years later, DLBL was also diagnosed in his 86-year-old wife by left axillary lymph node biopsy. Both the husband and the wife received chemotherapy. The husband is currently alive in complete remission, and although the wife achieved partial remission, she died due to disease progression. In both of these couples, it was considered unlikely that Epstein-Barr virus or human T-cell lymphotropic virus type I was related to the development of non-Hodgkin's lymphoma, and no environmental factors were confirmed to be involved. It is postulated that other unknown factors or agents may be associated with the development of lymphoma in married couples.View full abstractDownload PDF (449K) -
Tsutomu SATO, Katsuhisa KOGAWA, Yasuo HIRAYAMA, Yasushi SATO, Atsushi ...2000 Volume 41 Issue 8 Pages 648-652
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 48-year-old woman, who had been suffering from systemic lupus erythematosus (SLE), developed normochromic normocytic anemia after receiving clomipramine hydrochloride. Her reticulocyte count was low, and a bone marrow aspirate revealed erythroid hypoplasia without involvement of other cell lines. Thus a diagnosis of pure red cell aplasia (PRCA) was made. The anemia gradually resolved following withdrawal of the drug. Although several drugs are known to cause PRCA, this is the first time that clomipramine hydrochloride has been reported to have such an effect. The underlying SLE in this case suggested the possible immunological pathogenesis of drug-induced PRCA.View full abstractDownload PDF (343K) -
Rieko MACHII, Akihiro MUTO, Yutaka OKANO, Masashi AKIZUKI, Yasushi KAT ...2000 Volume 41 Issue 8 Pages 653-657
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 73-year-old man was admitted because of back pain and paralysis of the lower extremities. Magnetic resonance imaging of the spine at the Th4∼6 level, obtained after gadolinium injection, demonstrated abnormal signal intensity within the Th5∼6 vertebral bodies and an extradural soft-tissue mass on the right posterior side of the spinal canal, compressing the thecal sac. The patient underwent prompt decompression with laminectomy, but this was unsuccessful. A biopsy sample of the mass revealed the histological features of granulocytic sarcoma, including diffuse infiltration of numerous cells containing cytoplasmic granules and immunohistochemical positivity for myeloperoxidase. Two months later, a subcutaneous soft-tissue mass appeared at the anterior chest wall, and this was confirmed to be granulocytic sarcoma by microscopic examination. Both of these tumors were radiosensitive, but the patient died of septic shock. Granulocytic sarcoma usually occurs in association with leukemia or other myeloproliferative disorders. However, it is rarely found before leukemia becomes evident in the peripheral blood or bone marrow; only eight such instances have been reported previously.View full abstractDownload PDF (481K) -
Akira SAKAI, Yuta KATAYAMA, Akiko MIZUNO, Ken KURAMOTO, Yasuo TAKIMOTO ...2000 Volume 41 Issue 8 Pages 658-663
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 72-year-old woman, who has been administered predonisolone and azathioprine with diagnoses of idiopathic thrombocytopenic purpura (ITP) and autoimmune hepatitis (AIH), underwent a complete medical examination because of monoclonal gammopathy (IgG-κ). Tumors were found in the ileum and descending colon. Pathological examination of biopsy specimens suggested a diagnosis of marginal zone B-cell lymphoma of the MALT type with a high-grade component. Flow cytometric analysis by two-color staining revealed that the neoplastic B cells expressed CD38, CD19, IgG and κ, but not CD5 or CD10. There were no abnormal plasma cells in bone marrow smears. The patient achieved complete remission after receiving three cycles of THP-COP chemotherapy, which resulted in a decrease of the IgG level to within the normal range. These findings indicated that monoclonal IgG-κ might be produced by lymphoma cells. However, the relationship of the immunosuppressive agents to the pathogenesis of the MALT lymphoma remains to be clarified.View full abstractDownload PDF (804K) -
Hiroshi GOMYO, Tohru MURAYAMA, Junko KOHFUKU, Ishikazu MIZUNO, Kazuyos ...2000 Volume 41 Issue 8 Pages 664-670
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 51-year-old man was admitted for treatment of severe thrombocytopenia in May 1997. A diagnosis of MDS RA (refractory thrombocytopenia; RTC) was made by bone marrow examination, which revealed mild marrow hypoplasia and a reduced number of megakaryocytes accompanied by micromegakaryocytes and hypolobular megakaryocytes. Chromosome analysis demonstrated 46, XY, t(5;7)(q31;q22) in all 20 cells examined. The patient received only supportive therapy including platelet transfusion, until leukocytosis and monocytosis gradually developed in November 1998. In view of a marked increase in the number of monocytes (more than 3,000/μl), a diagnosis of CMML was made in December 1998. As the leukocytosis progressed, various inflammatory symptoms such as facial erythema and endophthalmitis developed. Administration of interferon alpha (IFNα) unexpectedly worsened the leukocytosis and monocytosis, suggesting abnormal responses of these cells to IFNα. Detailed molecular analysis of these cells might reveal a novel mechanism of leukemogenesis associated with 5q31.View full abstractDownload PDF (594K) -
Mayumi HATSUSE, Akira OKANO, Akio OKAMOTO, Kazuho SHIMURA, Ryoichi TAK ...2000 Volume 41 Issue 8 Pages 671-675
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 21-year-old man, diagnosed in March 1997 as having chronic myelogenous leukemia (CML), received hydroxyurea followed by daily interferon (IFN) until December 1998, when the additional chromosome abnormality of +8 appeared. As no suitable matched donor was available, the patient received mobilization therapy consisting of mini-ICE (idarubicin, cytarabine, etoposide) followed by G-CSF subcutaneously. During hematopoietic recovery, a total of 12×106/kg CD34-positive cells were harvested. Cytogenetic analysis of peripheral blood stem cell (PBSC) products using FISH revealed 1% BCR/ABL fusion signals. In March 1999, he received conditioning therapy consisting of busulfan (16 mg/kg) and cyclophosphamide (120 mg/kg) followed by infusion of 5×106/kg CD34-positive cells. A neutrophil count of 500/μl and a platelet count of 5×104/μl were attained by days 20 and 38, respectively. Bone marrow aspirates showed 2.6% BCR/ABL fusion signals on day 35 after autologous PBSC transplantation, and the patient remained in chronic phase until the sixth month, when a cytogenetic relapse (Ph, +8: 4/20) occurred. These observations suggest that Ph-negative progenitor cells can be harvested using a mini-ICE regimen followed by G-CSF, and that autologous PBSC transplantation is feasible in patients with CML resistant to IFN.View full abstractDownload PDF (369K) -
Mitsuko YAMAGUCHI, Kaoru NAGATA, Hiroyuki HAMAGUCHI2000 Volume 41 Issue 8 Pages 676-680
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 19-year-old girl was admitted to our hospital because of general fatigue, headache and purpura. A number of her laboratory findings suggested hemolytic anemia and thrombocytopenia. Direct/indirect Coombs tests gave negative results. Although the patient had no neurological or renal abnormalities, peripheral blood smears showed marked red cell fragmentation, and therefore she was diagnosed as having thrombotic thrombocytopenic purpura (TTP). Fresh frozen plasma (FFP) was transfused daily. The thrombocytopenia and hemolysis immediately improved, but worsened again after reduction of the FFP transfusion. Plasma exchange was instituted every other day, but the patient's condition worsened. Palsy and consciousness disturbance developed, and finally she lapsed into a coma. Daily plasma exchange and methylprednisolone pulse therapy were performed, together with weekly vincristine therapy, and this led to a gradual improvement in the patient's condition. However, several attempts at weaning from plasma exchange resulted in exacerbation of the TTP activity. Therefore oral cyclosporine A was started and splenectomy was performed. After these interventions, despite transient relapse, the patient was successfully weaned off the FFP transfusion, and she is now in remission. Because in this case splenectomy and cyclosporine A resulted in sustained remission of TTP that was refractory to intensive plasma therapy, an autoimmune mechanism may have been involved in the pathogenesis.View full abstractDownload PDF (392K) -
Tomoyuki ENDO, Ken-ichi SAWADA, Katsuya FUJIMOTO, Satoshi YAMAMOTO, Hi ...2000 Volume 41 Issue 8 Pages 681-686
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSClinical use of CD34+ cells positively selected from cryopreserved peripheral blood stem cells (PBSC) has been limited, and there have been only a few reports of this procedure, mainly because clump formation decreases the proportion of CD34+ cells that can be recovered. A 49-year-old Japanese woman with non-Hodgkin's lymphoma (NHL) (follicular mixed, B cell, stage IVA) was treated with seven cycles of conventional chemotherapy and achieved partial remission. During hematopoietic recovery after the seventh course of chemotherapy, PBSC were harvested by continuous leukapheresis and cryopreserved. However, clonal rearrangement of the immunoglobulin heavy chain gene was detected in the PBSC by Southern blot analysis. After high-dose chemotherapy, CD34+ cells were positively immunoselected from the cryopreserved PBSC and infused into the patient at 1.97×106/kg. The overall purity and recovery rate of the CD34+ cells were 72.2% and 65.0%, respectively. There were no severe adverse effects after PBSC transplantation, and the time required for recovery of neutrophils to over 0.5×109/l and platelets to over 50×109/l was 11 and 21 days, respectively. Transplantation of CD34+ cells positively selected from cryopreserved PBSC provides engraftment ability similar to that of unmanipulated PBSC.View full abstractDownload PDF (495K)
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Yuji KANISAWA, Nanae KAWANISHI, Hiroyuki HISAI, Hideji ARAYA, Takehide ...2000 Volume 41 Issue 8 Pages 687-689
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 54-year-old man was referred to our hospital because of petechiae and pancytopenia. Bone marrow aspiration showed a normocellular marrow with 92.4% promyelocytes. PML/RARα mRNA was detected by reverse transcription polymerase chain reaction. On the basis of the above data, a diagnosis of acute promyelocytic leukemia (APL) was made, and treatment with all-trans retinoic acid (ATRA) at a dose of 60 mg/day was begun. Fourteen days after the start of treatment, the patient developed paralytic ileus, accompanied by hyperleukocytosis, high fever, renal dysfunction and elevation of the serum FDP level. There was no evidence of infection. At this time, retinoic acid syndrome was suspected, and therefore steroid pulse therapy was started, which led to an improvement of the symptoms within four days. This case suggests that ATRA may have an adverse effect on the small intestine, causing paralytic ileus.View full abstractDownload PDF (297K)
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2000 Volume 41 Issue 8 Pages 690-699
Published: 2000
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSDownload PDF (949K)
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