High-intermediate (HI)- and high (H)-risk non-Hodgkin lymphoma was treated with front-line intensive chemotherapy followed by autologous peripheral blood stem cell transplantation (auto-PBSCT). Twenty-eight cases were enrolled after obtaining informed consent, from November, 1998 to October, 2003. Initial treatment was 2 or 3 cycles of CHOP-V regimen, followed by three high-dose therapy, one each of cyclophosphamide, methotrexate and etoposide. The final high-dose therapy was a combination of ranimustine, ifosphamide and etoposide, which was followed by auto-PBSCT. Patients with a bulky mass received involved-field radiation therapy (IF-RT) after auto-PBSCT. Complete remission (CR) was achieved in 16 cases (57%) and partial remission (PR) in 9 cases (32%), after auto-PBSCT. The final responses after IF-RT were CR in 20 cases (71%) and PR in 5 cases (18%). Overall survival of cases with 2 cycles of CHOP-V regimen was 56% after a median observation time of 30 months, compared with 82% in cases with 3 cycles (p=0.0732). The results suggested that the reduction of tumor size with the initial CHOP-V treatment was most important. In all cases, progression-free survival was 64% and the overall survival was 74% after a median observation time of 30 months, which showed a good outcome compared with that of HI- and H-risk group defined by the age-adjusted international prognostic index reported by Shipp et al.

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A 59-year-old man presented in January 2003 with generalized lymphadenopathy. An inguinal lymph node biopsy showed mantle cell lymphoma (MCL). After four courses of Rituximab-CHOP therapy were administered, complete response (CR) was achieved. However, in August 2003, he presented with neck lymphadenopathy and was found to have relapsed. Several salvage therapies (ESHAP, Hyper-CVAD/MTX-ara-C) were administered, but CR was not achieved. After two courses of single-agent chemotherapy with CPT-11 (40 mg/m²) were administered on days 1, 2, 3, 8, 9, and 10, CR was achieved. Several studies reveal that the long-term prognosis for MCL with conventional therapy is poor. This report describes CPT-11 therapy for MCL and provides evidence that CPT-11 is another therapeutic option in refractory cases of MCL.

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A 51-year-old woman with severe aplastic anemia underwent allogeneic peripheral blood stem cell transplantation using blood stem cells from an HLA-identical sibling. Adenovirus type 11 hemorrhagic cystitis developed and progressed to nephritis and hemophagocytic syndrome. Oral ribavirin was effective not only for the hemorrhagic cystitis and nephritis but also for the hemophagocytic syndrome. Since therapeutic strategies for adenovirus infection after hematopoietic stem cell transplantation have not been established, we present our case and discuss the therapeutic approach.

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A 77-year-old woman was admitted to our hospital because of pneumonia and heart failure in July 2002. She had been diagnosed as having with Sézary syndrome in 1993, and had been treated with a combination of prednisolone, methotrexate, and cyclosporin A with subsequent stable disease but persistent generalized erythroderma. On admission, the white blood count was 23.9×10⁹/L with 28% Sézary cells, and serum creatinine levels were within normal limits. One month after admission, the pneumonia and heart failure improved remarkably with antibiotics and diuretics. However, at the same time, her renal function deteriorated with increasingly high serum creatinine levels. She died of anuria in September, 2002. An autopsy showed marked perivascular and peritubular infiltration of abnormal lymphocytes with degenerative nephrotubuli in the kidneys. This patient may be the first reported case of Sézary syndrome with renal failure caused by leukemic infiltration.

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A 51-year-old man had been diagnosed with severe aplastic anemia (AA) at the age of 9 years. He was treated with occasional transfusions for the next 35 years. Following initiation of cyclosporin A (CsA), the patient became transfusion-independent at 44-years-old. Anemia improved after cessation of CsA and no therapy was required for the next 5 years. However, severe pancytopenia suddenly developed at the age of 51. Bone marrow aspiration revealed myelodysplastic syndrome (MDS) with der(1;7). The ineffectiveness of CsA for MDS led to resumed dependence on transfusion. This case suggests that the appearance of MDS clones might have contributed to transient hematological improvement. Bone marrow aspiration should be considered in patients with AA if unexpected hematological improvement appears.

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