Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
Volume 42, Issue 6
Displaying 1-14 of 14 articles from this issue
  • Yuichiro NAWA, Toshiyuki NOGUCHI, Kensuke KOJIMA, Masamichi HARA
    2001 Volume 42 Issue 6 Pages 481-487
    Published: 2001
    Released on J-STAGE: July 28, 2009
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    We investigated the graft-versus-myeloma effect (GVM) after allogeneic bone marrow transplantation (allo-BMT). Three patients with refractory multiple myeloma (MM) underwent related allo-BMT. Two of the patients showed disappearance of serum M protein 4 and 5 months after transplantation, respectively. One of them has remained in complete remission for more than 22 months after allo-BMT, with accompanying chronic GVHD. Two patients with relapse and disease progression after allo-BMT underwent donor lymphocyte infusion (DLI). Although one patient did not respond to DLI, the other developed acute GVHD after 4 weeks and achieved a 75% reduction in serum M protein. DLI did not produce severe acute GVHD or myelosuppression. These findings suggest the presence of a GVM effect. DLI may be an effective therapy for patients with MM who have relapsed after allo-BMT. Furthermore, non-myeloablative stem cell transplantation (mini-transplantation) for refractory MM should be investigated further as a potentially curative option.
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  • Tatsuo FURUKAWA, Shigeo HASHIMOTO, Koichi INANO, Fusako YAMAZAKI, Hiro ...
    2001 Volume 42 Issue 6 Pages 488-495
    Published: 2001
    Released on J-STAGE: July 28, 2009
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    Serial monitoring of chimerism after allogeneic hematopoietic stem cell transplantation (HSCT) can be performed easily and rapidly using PCR-based assays analyzing informative tandem repeat genetic markers. Sequential analysis of individual chimerism status was performed in 34 patients who underwent myeloablative allo-HSCT using a commercial multiplex short tandem repeat (STR) kit. Mixed chimerism (MC) was found in 14 of the patients for more than one month. The incidence of MC seemed to be dependent on the type of disease or pretransplantation regimen. There was no significant difference in relapse rates between MC and complete donor chimerism (CC) in all patients. However, the relapse rate was significantly higher in MC than in CC among patients with acute leukemia. The severity of acute graft-versus-host disease (aGVHD) was significantly reduced in the patients with MC. Most of the MC patients with hematologic malignancies had transient mixed T-lymphoid chimerism, and CC was achieved within 6 months after HSCT in such cases. Patients with MC beyond 6 months after HSCT and patients with reappearance of autologous signals (MC after CC) may have an enhanced risk of relapse.
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  • Chie ITO, Kosuke TSUBOI, Fumiaki YOSHIBA, Nobuyuki KUBOTA, Kei TAZUME, ...
    2001 Volume 42 Issue 6 Pages 496-501
    Published: 2001
    Released on J-STAGE: July 28, 2009
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    A 23-year-old man first visited a local hospital in 1998 because of exertional dyspnea. Peripheral blood examination revealed mild leukocytosis with 82% eosinophils, and he was treated with prednisolone. As the eosinophilia did not improve, he was referred to Tokai University Hospital in March 1999 for further diagnosis and treatment. The patient was diagnosed as having hypereosinophilic syndrome (HES) because of unexplained hypereosinophilia persisting for more than 6 months, resulting in cardiac dysfunction. His disease was progressive in spite of immunosuppressive therapy, interferon-α and cytotoxic chemotherapy. Since he had an HLA-identical brother, allogeneic bone marrow transplantation (BMT) was performed in October 1999. After completion of the immunosuppressive therapy on day 79 after BMT, the number of eosinophils gradually increased again. Although we suspected recurrence of the disease, DNA fingerprinting revealed that the peripheral granulocytes were 100% donor type. An increase of interleukin-5 (IL-5) produced by peripheral lymphocytes and a decrease of the Th1/2 ratio suggested that the eosinophilia was related to GVHD. The eosinophilia was eventually controlled by cyclosporin. We conclude that DNA fingerprinting and examination of the IL-5 level and Th1/2 ratio are useful for differentiating between relapse and GVHD in cases of eosinophilia occurring after BMT for HES.
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  • Yoko FUKUSHIMA, Noriko FUJII, Yasuhiro TABATA, Yasutaka NISHIMURA, Toh ...
    2001 Volume 42 Issue 6 Pages 502-506
    Published: 2001
    Released on J-STAGE: July 28, 2009
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    A 3-year-old boy with poorly prognostic acute megakaryoblastic leukemia (AML M7) showing t(16;21)(p11;q22) karyotype underwent unrelated bone marrow transplantation (U-BMT) during his first hematological remission. The conditioning regimen consisted of BU, VP-16 and L-PAM. Engraftment was smooth, but the patient developed grade I acute GVHD. During hematological remission before U-BMT, the TLS/FUS-ERG chimeric transcript of t(16;21)(p11;q22) was consistently detectable as minimal residual disease (MRD) by RT-PCR. However, after U-BMT it soon became undetectable. There was no detectable MRD until 7 months after U-BMT, but bone marrow relapse occurred 10 months after U-BMT. We consider that U-BMT is a promising treatment for t(16;21)(p11;q22) AML. However, an intensified conditioning regimen or modification of GVHD prophylaxis is needed.
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  • Takashi SAITOH, Minoru SAIKI, Umihiko SAWADA, Naoki KAWAMURA, Hiroya T ...
    2001 Volume 42 Issue 6 Pages 507-511
    Published: 2001
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 70-year-old man was admitted to our hospital because of right hemiparesis. He had no allergies or previous exposure to radiographic contrast medium, and the platelet count on admission was within the normal range. On day 8 of hospitalization, he underwent computed tomography of the brain with 100 ml of iopamidol administered intravenously. Three hours later, his platelet count fell to 5,000/μl, and he developed purpura. Because drug-induced thrombocytopenia was suspected, platelet transfusion was undertaken and corticosteroids were administered. The platelet count returned gradually to normal in 2 days. At the time, we were unable to ascertain the cause of the thrombocytopenia. To clarify whether the contrast medium had been responsible, iopamidol was added to the patient's heparinized whole blood. Subsequent platelet aggregation was observed microscopically and the platelet count decreased, suggesting that the thrombocytopenia had been due to contrast medium-induced platelet aggregation. Although thrombocytopenia after injection of contrast medium is extremely rare, such cases should be evaluated carefully because the condition can be life-threatening if severe.
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  • Michio SAWADA, Hisashi TSURUMI, Toshiki YAMADA, Takeshi HARA, Hisataka ...
    2001 Volume 42 Issue 6 Pages 512-514
    Published: 2001
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 69-year-old woman who had had λ-type primary macroglobulinemia (PMG) since December 1993 was admitted in October 1997 because of obstructive jaundice due to compression of the common bile duct by a retroperitoneal tumor. A biopsy sample was obtained by exploratory laparotomy, and from this a diagnosis of diffuse large cell lymphoma (DLCL) expressing cytoplasmic IgM/κ was made. Partial remission was obtained after 6 courses of combination chemotherapy consisting of pirarubicin, cyclophosphamide, vincristine and prednisolone. However, the DLCL was generally progressive, and the patient died in August 1998 due to multiple organ failure. There was no difference in the plasma monoclonal IgM/λ level before and during the course of DLCL. The clone of the DLCL may have been different from that of the PMG.
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