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Volume 43, Issue 7
Displaying 1-13 of 13 articles from this issue
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...2002 Volume 43 Issue 7 Pages 505-514
Published: 2002
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSDownload PDF (777K) -
[in Japanese], [in Japanese]2002 Volume 43 Issue 7 Pages 515-519
Published: 2002
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSDownload PDF (447K)
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Hiroshi MATSUBARA, Atsushi MAKIMOTO, Mutsuro OHIRA, Yoshinobu KANDA, M ...2002 Volume 43 Issue 7 Pages 520-526
Published: 2002
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSForty children with hematological malignancies, who underwent allogeneic hematopoietic stem cell transplants between September 1994 and May 2001, were divided into 2 groups according to their infection control procedure; the standard protective isolation and the efficient protective isolation groups. Efficient protective isolation procedures included well-cooked foods and oral prophylaxis with new quinolones and antifungal drugs, while inhalation of antibiotics and antifungal drugs was suspended. We then compared the febrile index (=X/Y) [febrile period (X) of >38.5°C and the days (Y) with a post-transplant neutrophil count<500/μl] between the two groups. We discovered no significant difference between the febrile index of the two groups (0.25 vs. 0.38, p=0.08), regardless of the type of transplantation (0.36 vs. 0.38, p=0.14). The efficient protective isolation procedure was therefore feasible in this clinical setting.View full abstractDownload PDF (523K) -
Takaharu MATSUYAMA, Koji KATO, Ryoji HANADA, Keisei KAWA, Jun OKAMURA, ...2002 Volume 43 Issue 7 Pages 527-537
Published: 2002
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA multicenter comparative study was carried out to investigate the efficacy and safety of hematopoietic stem cell transplantation with conditioning regimens containing melphalan in pediatric patients with acute lymphoblastic leukemia. One hundred twenty three patients at a variety of remission stages were eligible for study participation. Eighty-nine were transplanted with allogeneic grafts and 34 patients with autologous grafts (23 cases with bone marrow and 11 cases with peripheral blood stem cells). Conditioning regimens used were as follows: (A) melphalan and busulfan for 40 patients, (B) melphalan, busulfan and TBI for 44 patients, (C) other regimens for 39 patients. To accelerate engraftment G-CSF (lenograstim) was administered as a 1-hour or 24-hour drip infusion daily at 5 μg/kg from day 5 until hematological recovery. The five year disease free survival (DFS) was 63% for 42 patients at CR1, 41% for 41 patients at CR2 and 33% for 40 patients at other stages. There was no significant difference in the DFS between allogeneic-transplantation and autologous-transplantation in all disease stages. In patients at remission stage for CR1 and CR2, the 5-year DFS by conditioning regimen was 63% for regimen (A), 54% for regimen (B) and 54% for regimens with melphalan and TBI. There was no significant difference in the DFS between the groups. Serious complications such as renal failure were observed in 11%, veno-occlusive disease in 9%, and interstitial pneumonia in 9%. The most dominating cause of death was relapse in the disease (48% of deaths) which was most commonly observed in autologous transplantation. Contrary to that, treatment related toxic death was the most frequent cause of deaths in allogeneic-transplantation.View full abstractDownload PDF (821K)
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Yasushi HASEGAWA, Shinya SHIRAI, Takayuki MISHINA, Masanobu NAKATA, Ke ...2002 Volume 43 Issue 7 Pages 538-542
Published: 2002
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSWe report on an elderly patient with a malignant lymphoma forming a huge mass in the heart. An 82-year-old woman became aware of general fatigue and a cough in August 1999. Her right supraclavicular, bilateral axillary, and right inguinal lymph nodes were swollen. A hypodermical mass in the right frontal chest was detected. Her left axillary lymph node was biopsied. She was diagnosed as having non-Hodgkin lymphoma, diffuse large cell type, B-cell type. Computed tomography scans showed a markedly thickened right ventricular wall of the heart, swollen lymph nodes of the mediastinum, bilateral pleural effusions, and a tumor in the spleen. Lymphoma cells were found in the pleural effusion, and the lymphoma was diagnosed as clinical stage IV. Hypofunction of the heart, ejection fraction (EF) 49%, was demonstrated with transthoracic echocardiography. EF increased to 70% after 3 courses of chemotherapy with CHOP regimen. All lesions disappeared after 6 courses of chemotherapy were completed. After consolidative radiotherapy with a total dose of 37 Gy to the mediastinum and heart, bilateral pleural effusions, elevation of the patient's lactate dehydrogenase level and soluble IL-2 receptor value were recognized, which suggested relapse of the lymphoma, although histopathological confirmation could not be realized.View full abstractDownload PDF (447K) -
Yoshio HATAE, Kazuyori YAGYU, Noriko YANAZUME, Yuuko CHOU, Susumu IIZU ...2002 Volume 43 Issue 7 Pages 543-547
Published: 2002
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSPhenotypic switch in acute leukemia is a rare phenomenon. We report on a female infant with minimally differentiated acute leukemia (M0) which underwent a lineage switch on relapse. In March 1997, a 1-year-8-month old girl was admitted to our hospital with a high-grade fever and generalized purpura. Bone marrow showed 84% blasts. The blasts were negative for peroxidase, periodic acid-Schiff and alpha-naphthyl butyrate esterase. Immunophenotypic analyses of the blast cells were positive for CD13, CD33 antigens, as well as CD34. Lymphoid markers all were negative. Though some blasts morphologically demonstrated cytoplasmic blebs, CD41 was negative and ultrastructural platelet peroxidase was absent. Based on these hematological features, the patient was diagnosed as having AML-M0. She was treated according to the Children's Cancer and Leukemia Study Group schedule and a complete remission was achieved 1.5 months after starting induction therapy. However, she relapsed in spite of continued chemotherapy in July 1997, when the cytomorphological pattern changed and the patient was diagnosed both morphologically and immunologically as having M7. Electron microscopy revealed platelet peroxidase (+) and CD41 (+). Cytogenetic studies on relapse demonstrated inv(3)(q21p25). We attempted aggressive reinduction therapy, but without effect. The patient simultaneously developed severe pneumonia and died in February, 1998. A lineage switch on relapse and resistance to chemotherapy may be associated with the occurrence of genetic aberration.View full abstractDownload PDF (441K) -
Minoru SAIKI, Takashi SAITOH, Mitsuru INOUE, Yoshihiro HATTA, Tetsuo Y ...2002 Volume 43 Issue 7 Pages 548-553
Published: 2002
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 58-year-old HIV-negative woman was admitted to our hospital with abdominal distension. She had a 5-year history of hypothyroidism and a 4-year history of diabetes mellitus. Physical examination revealed ascites. There was no lymphadenopathy or splenomegaly. Laboratory examination showed elevated levels of serum LDH and Al-p, polyclonal hypergammaglobulinemia, and was positive for anti-nuclear antibody, several autoantibodies and HCV-RNA. A computed tomographic scan of the abdomen and chest showed massive ascites, but there was no evidence of tumor masses or lymph node enlargement. Cytologic examination of the ascitic fluid revealed numerous abnormal lymphocytes which by flow cytometry demonstrated expression of CD5, CD19, CD20, and CD4. Cytogenetical analysis demonstrated a hyperdiploid karyotype, with numerical abnormalities. Southern blot analysis demonstrated rearranged monoclonal bands in JH and c-mycgenes. Polymerase chain reaction (PCR) analysis failed to detect the genomes of EBV and HHV-8 in the abnormal lymphocytes. A diagnosis of primary effusion lymphoma of B cell lineage was made. Following abdominal paracentesis, the patient remained in complete clinical remission for 7 months and died of an unrelated cause (cerebral bleeding). The present case demonstrated an HIV-, HHV-8-, and EBV-negative, and HCV-positive primary effusion lymphoma of B cell lineage, with a unique clinical course.View full abstractDownload PDF (529K) -
Kenji ISHITSUKA, Atae UTSUNOMIYA, Shin-ichiro AOSAKI, Yukie TASHIRO, T ...2002 Volume 43 Issue 7 Pages 554-559
Published: 2002
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 75-year-old man visited our hospital complaining of heartburn in November 1997. Gastroscopical examination revealed ulcerous protruding extended from the gastric antrum to body and a flat, elevated lesion in the greater curvature of the stomach. Biopsy specimens revealed a CD4-positive malignant lymphoma. The serum anti-human T-lymphotrophic virus type I (HTLV-I) antibody test was positive. He was diagnosed as having primary gastric adult T-cell leukemia/lymphoma (ATLL; acute type). Complete remission was achieved with chemotherapy. In December 1998, the patient experienced a relapse. The lesions were limited to the region between the upper gastric body and the fornix and disappeared with radiation therapy. A second relapse was detected in the gastric greater curvature and descending portion of the duodenum in May 1999 but spontaneously disappeared in 5 months. The third relapse in May 2000 was systemic. Monoclonal integration of the HTLV-I provirus was observed in DNA extracted from ascitic lymphocytes. Chemotherapy was resumed, but the response was poor. The patient subsequently died of respiratory failure as a result of pneumonia. Although gastrointestinal involvement is frequent in ATLL, this appears to be a rare case of an idolent clinical course with lesions limited to the stomach and duodenum for 30 months.View full abstractDownload PDF (547K) -
Etsuko SATO, Michiyo TAKAIRA, Reiko GOHARA, Nobuko ARAKI, Kazuhiro MAS ...2002 Volume 43 Issue 7 Pages 560-566
Published: 2002
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 46-year-old woman was diagnosed as having acute myeloid leukemia (M1) with translocation t(16;21)(p11;q22). The leukemic cells were positive for CD13, CD33, CD34, CD41, CD56 and HLA-DR. After induction chemotherapy, the patient achieved complete remission (CR). However, 8 months later she relapsed with various additional chromosomal abnormalities. Although the patient achieved a 2nd CR after re-induction chemotherapy, the patient had extramedullary tumors in the right breast twice and relapse occurred frequently. The tumor cells were characterized by the same immunophenotypes and t(16;21) with additional 1 q trisomy. Although there was no evidence of hematological relapse, another type of 1 q trisomy was observed. Furthermore, an increase of abnormalities with 1 q trisomy was noted concomitant with re-increase in the number of blasts. The patient underwent allogeneic bone marrow transplantation (BMT), but she died from BMT complications. The case could have been a karyotype of t(16;21) with additional chromosomal abnormalities through consecutive approaches. Because of the high occurrence rate of relapse, we consider various additional chromosomal abnormalities and the expression of CD56 as prognostic factors of this condition.View full abstractDownload PDF (602K) -
Yutaka OKAWA, Noriko USUI, Shinji UNO, Nobuaki DOBASHI, Kinuyo KASAMA, ...2002 Volume 43 Issue 7 Pages 567-572
Published: 2002
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSThe intravascular large B cell lymphoma (IVL) is a rare subtype characterized by the presence of lymphoma cells in the lumina of small vessels. Reported here is the case of a 68-year-old woman with a high-grade fever uncontrolled by antibiotics or antipyretic drugs, and elevation of the serum LDH and sIL-2R levels. After she was admitted, dyspnea, hypoxia, and severe body weight gain with leg edema gradually developed. Chest computed tomography (CT) revealed a characteristic migratory local high density area typical of atelectasis. A diagnosis of IVL was made with a transbronchial lung biopsy (TBLB) and immunohistochemical analysis. The patient was treated with combination chemotherapy (modified CHOP), and her symptoms of dyspnea, hypoxia, pyrexia and leg edema were quickly resolved. The level of LDH and sIL-2R returned to normal, and a complete response was obtained. Although diagnosis of IVL is difficult, an early and appropriate diagnostic procedure (biopsy of tissue with vessels, such as lung and skin, is required) will improve the prognosis of IVL.View full abstractDownload PDF (653K) -
Hirohisa NAKAMAE, Takahisa YAMANE, Yasutaka AOYAMA, Ryousuke YAMAMURA, ...2002 Volume 43 Issue 7 Pages 573-577
Published: 2002
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSA 54-year-old woman with chronic myelogenous leukemia was admitted to our hospital on February 15th, 2001 to undergo allogeneic bone marrow transplantation (BMT). We started the transplantation preconditioning with busulfan and high-dose cyclophosphamide on February 22nd, 2001. However, symptoms of a psychiatric nature, such as hallucination, persecution complex, auditory hallucination and sleeplessness, occurred by the third day of treatment with busulfan. Thus, we decided to discontinue conditioning and stopped the administration of BMT at that point. However, pancytopenia persisted for more than 20 days. She finally underwent BMT followed by reduced-intensity conditioning with fludarabine and ATG from a sex-mismatched, HLA-identical sibling donor on April 19th, 2001. To prevent any exacerbation of the psychotic symptoms, the patient was hospitalized in a laminar flow instead of a bio-free room. Graft-versus-host disease occurred on the 32nd hospital day, and was brought under control by steroid treatment. Achievement of complete chimeras was confirmed on the 54th hospital day. Her mental condition was kept stable with antidepressant drugs and tranquilizers, although minor changes in the combination of drugs were required to treat transient exacerbation of psychosis after a short period at home. She was discharged on September 1st, 2001. We think that non-myeloablative stem cell transplantation is a useful treatment for patients with hematological malignancy complicated with psychiatric disorders.View full abstractDownload PDF (411K) -
Tohru TAKAHASHI, Yoshie KAZAMA, Suguru ISHII, Haruo SHIMIZU, Mitsuru Y ...2002 Volume 43 Issue 7 Pages 578-582
Published: 2002
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSAn 84-year-old woman was admitted because of anemia and marked leukocytosis. The white cell count was 237,660/μl, with 93% abnormal lymphoid cells. The cells had abundant cytoplasm and prominent nucleoli. They were positive for CD5, 19, 20, 22, 23, HLA-DR, IgM, IgD and κ chain. Thus, a diagnosis of B-cell PLL was made. Chromosome analysis disclosed a complex karyotypic abnormality. Massive splenomegaly was detected by abdominal computed tomography. No external or internal lymphadenopathy was found. The patient was intermittently treated with etoposide. Although the white cell counts had been suppressed, she refused to take the drug because of side effects. When the white cell count exceeded more than 200,000/μl again, she developed severe headache, diplopia, nausea, and vomiting. A lumber puncture disclosed infiltration of the prolymphocytes in the cerebrospinal fluid. Though intrathecal chemotherapy alleviated the symptoms and the leukemic cells disappeared, the effects were transient. When the therapy was withheld because of bone marrow suppression, the meningitis recurred and the symptoms progressed. The patient died six months after the initial presentation.View full abstractDownload PDF (419K)
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Tadashi NAGAI, Tohru IZUMI, Kaoru NOBORIO, Masaaki TAKATOKU, Tetsuya O ...2002 Volume 43 Issue 7 Pages 583-585
Published: 2002
Released on J-STAGE: July 28, 2009
JOURNAL RESTRICTED ACCESSThe hairy cell leukemia prolymphocytic variant, a subtype of hairy cell leukemia, is an extremely rare disease, especially in Japan. We report a case in which treatment with 2'-deoxycoformycin (DCF) improved the clinical features of the disease. The patient, a 70-year-old female, was first treated with 2-chlorodeoxyadenosine, but showed only transient improvement in the hematological findings. DCF was then administered every week. Following the start of this treatment, the leukemia cell count rapidly decreased and the platelet count simultaneously increased. This effect of DCF has so far been long term. More clinical studies are needed to confirm the therapeutic value of DCF.View full abstractDownload PDF (297K)
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