Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
Volume 50, Issue 11
Displaying 1-13 of 13 articles from this issue
The 69th Annual Meeting of the Japanese Society of Hematology/
The 49th Annual Meeting of the Japanese Society of Clinical Hematology
Special Award Received Lecture
Case Reports
  • Yuichi YAHAGI, Noriko USUI, Yuko YAMAGUCHI, Nobuaki DOBASHI, Shingo YA ...
    2009 Volume 50 Issue 11 Pages 1601-1606
    Published: 2009
    Released on J-STAGE: December 15, 2009
    JOURNAL FREE ACCESS
    It is difficult to decide an appropriate treatment strategy for elderly leukemia patients with other complications. We encountered 2 cases of refractory acute myeloid leukemia and safely treated the patients with fractionated administration of gemtuzumab ozogamicin (GO). Standard induction therapies were not effective for these patients. Moreover, they suffered from complications due to which their treatment options were restricted. Fractionated administration of GO (GO 3 mg/m2 on days 1, 3 and 5) was accomplished safely and alleviated the patients' conditions. After treatment, these patients were followed by outpatient basis. We consider that this is an impressive treatment because fractionated administration of GO is potentially less toxic. Further, it will be helpful to maintain or improve the QOL of patients who are unable to receive intensive chemotherapy. These cases were significant because fractionated GO treatment is potentially less toxic and it will be helpful to maintain or improve the QOL of patients who can not receive intensive chemotherapy.
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  • Dai ASADA, Hiroshi MATSUBARA, Itaru KATO, Kazuko OSADA, Kumiko URYU, M ...
    2009 Volume 50 Issue 11 Pages 1607-1611
    Published: 2009
    Released on J-STAGE: December 15, 2009
    JOURNAL FREE ACCESS
    High-dose methotrexate (HD-MTX) is an important treatment for Burkitt lymphoma, but can cause hepatic and renal toxicity when its clearance is delayed. We report a case of acute renal failure after HD-MTX therapy in a patient with ileostomy, The patient was a 3-year-old boy who had received a living-related liver transplantation for congenital biliary atresia. At day 833 after the transplantation, he was diagnosed with PTLD (post-transplantation lymphoproliferative disorder, Burkitt-type malignant lymphoma). During induction therapy, he suffered ileal perforation and ileostomy was performed. Subsequent HD-MTX therapy caused acute renal failure that required continuous hemodialysis. We supposed that intravascular hypovolemia due to substantial drainage from the ileostoma caused acute prerenal failure. After recovery of his renal function, we could safely treat the patient with HD-MTX therapy by controlling drainage from ileostoma with total parenteral nutrition.
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  • Nobuhiko IMAHASHI, Masahiro TOKUNAGA, Satoshi NISHIWAKI, Mayumi YANAGI ...
    2009 Volume 50 Issue 11 Pages 1612-1615
    Published: 2009
    Released on J-STAGE: December 15, 2009
    JOURNAL FREE ACCESS
    The prognosis of patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL) relapsing after allogeneic hematopoietic stem cell transplantation is dismal. Here we describe a patient with post-transplant relapse of Ph+ALL, who has remained in complete remission (CR) for 30 months after relapse. A 55-year-old woman with Ph+ALL received allo-HSCT from an unrelated donor during first CR. The conditioning regimen consisted of fludarabine+melphalan, and graft-versus-host disease (GVHD) prophylaxis consisted of tacrolimus and short-term methotrexate. She achieved and maintained molecular remission without developing GVHD after transplantation, but suffered a hematologic relapse on day 871. She received imatinib-combined chemotherapy, and again achieved molecular remission. Since the completion of imatinib-combined chemotherapy, she has been receiving imatinib monotherapy. Although it has been reported that chemotherapy and imatinib are effective only transiently in patients with relapsed Ph+ALL, our patient has remained in molecular remission for 30 months after post-transplant relapse at the time of this report. Our case suggests that by continuing imatinib after the induction of molecular remission by imatinib-combined chemotherapy, the antileukemic activity of imatinib could achieve durable remission in combination with the graft-versus-leukemia effect. However, this needs to be investigated in studies involving a large number of patients.
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  • Shingen NAKAMURA, Toshiaki TAKEICHI, Chihiro YAMANAKA, Kana SHICHIJO, ...
    2009 Volume 50 Issue 11 Pages 1616-1620
    Published: 2009
    Released on J-STAGE: December 15, 2009
    JOURNAL FREE ACCESS
    In May 2006, a 72-year-old man with acute myelogenous leukemia (M4Eo) was admitted to our hospital. He had been receiving antiandrogen treatment for prostate cancer (after an operation in 1998) and treatment for diabetes mellitus. He received chemotherapy according to the JALSG GML200 protocol, which led to complete remission; however, in January 2007, his leukemia recurred. CAG combination chemotherapy also resulted in complete remission by May 2007. In August 2007, he developed multiple liver tumors, abdominal pain, and fever. Contrast-enhanced computed tomography revealed hypovascular tumors in both early and delayed phases. Angiography showed ring-like tumor staining and a massive tumor, similar to those seen in metastatic hepatocellular carcinomas (HCCs). He eventually died because of aggressive enlargement of liver tumors during the following month accompanied by the simultaneous recurrence of leukemia and unsuccessful embolization of the hepatic artery. Autopsy specimens showed fibrosis and considerable iron deposition in the liver, suggested secondary hemochromatosis due to transfusion. We also detected multiple moderately differentiated primary HCCs. Secondary hemochromatosis, androgen imbalance, and humoral factors from leukemic cells were believed to be the causes of the rapid onset and development of HCCs.
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  • Takahide SASAKI, Shunsuke OHNISHI, Reizo ONISHI, Ryou TAKEMURA, Yoshim ...
    2009 Volume 50 Issue 11 Pages 1621-1625
    Published: 2009
    Released on J-STAGE: December 15, 2009
    JOURNAL FREE ACCESS
    A 59-year-old woman presented with ascites and intraperitoneal lymph node swelling. Pathological examination of the lymph node revealed follicular lymphoma. After a lymph node biopsy, she developed atypical genital bleeding, multiple endocrine disorders, polyneuropathy with a high plasma level of vascular endothelial growth factor (VEGF), and was diagnosed with POEMS syndrome. Following administration of methyl prednisolone, ascites immediately decreased and her performance status improved; however, about 18 months later, renal failure occurred, and she died despite increased steroid dosage. Lymph node swelling is often found in POEMS syndrome; however, its histological appearance is not well known, and it is very rare to be concomitant with malignant lymphoma. Therefore, it is important to perform a lymph node biopsy and investigate it in relation with VEGF.
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  • Hiroshi OKABE, Takahiro SUZUKI, Tsukasa OMORI, Masaki MORI, Eisuke UEH ...
    2009 Volume 50 Issue 11 Pages 1626-1629
    Published: 2009
    Released on J-STAGE: December 15, 2009
    JOURNAL FREE ACCESS
    Deferasirox (DFX) is a newly developed oral iron chelator that enables effective chelation with once daily administration. We describe here a case of transfusional-iron overloaded patient who experienced hematopoietic recovery after DFX administration. A 75-year-old woman with iron overload, who had been diagnosed with MDS (RCMD) and had received a transfusion of red blood cells and platelets regularly for 3 years, enrolled in the phase I clinical trial of ICL670 (DFX) in Japan. DFX administration steadily decreased her serum ferritin levels and chelated overloaded iron effectively. Interestingly, a year after initiation of the trial, she needed fewer blood transfusions, and no more transfusions after the 17th month of the trial. Even after suspending transfusions, her hemoglobin level and platelet count increased continuously, and she now has stable disease without blood transfusions. She has not received any specific treatment for MDS during this period. Examination of the bone marrow aspirates in the 35th month revealed dysplastic cells, indicating no remarkable change in the state of MDS. This case suggests that excess iron hampers hematopoiesis and that adequate iron chelation may improve hematological data in some iron-overloaded patients.
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  • Kenichi TAHARA, Akihiko YOKOHAMA, Hiroshi HANDA, Takayuki SAITOH, Hide ...
    2009 Volume 50 Issue 11 Pages 1630-1634
    Published: 2009
    Released on J-STAGE: December 15, 2009
    JOURNAL FREE ACCESS
    Ten years after being diagnosed with polycythemia vera, a 55-year-old woman required frequent blood transfusion due to secondary myelofibrosis. She underwent reduced-intensity stem cell transplantation (RIST) from an HLA-identical sibling donor. Since mixed chimerae were identified in the peripheral blood at day 35, cyclosporine was withdrawn. At day 73, she developed acute graft-versus-host disease of the liver, while simultaneous resolution of splenomegaly occurred and complete donor chimerism in the peripheral blood was achieved. Frequent red blood cell transfusion was required until day 300 after transplantation. Thus, RIST for an older patient with secondary myelofibrosis was successful without severe treatment-related morbidity. This case suggests that RIST could be an effective treatment modality for secondary myelofibrosis.
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  • Takeshi SAWADA, Yuho NAJIMA, Kazuteru OHASHI, Ikuma KATO, Maho MIYAZAW ...
    2009 Volume 50 Issue 11 Pages 1635-1640
    Published: 2009
    Released on J-STAGE: December 15, 2009
    JOURNAL FREE ACCESS
    We herein describe a rare case of multiple myeloma with an aggressive clinical course and the unusual manifestation of multiple organ involvement by plasma cells. A 58-year-old man noted difficulty in walking due to progressive swelling of his left lower limb. CT scan revealed a huge mass in the inguinal region in addition to masses located on the head, and in the aero-digestive tract and spinal canal. The pathological diagnosis of plasmacytoma was made on biopsied specimens of these masses, while plasma cells did not increase (5.8%) in aspirated bone marrow obtained at the same time. Serum IgG level was 6,387 mg/dl and immunoelectrophoresis demonstrated monoclonal IgG-kappa in the serum. Chemotherapy with vincristine, adriamycin, dexamethasone, subsequent high-dose cyclophosphamide, and irradiation involving both thoracic vertebral canal and inguinal regions resulted in improvement of initial symptoms. However, the patient relapsed soon after; new lesions developed in various parts of the body, including the left thigh and body trunk. Salvage therapy including bortezomib was no longer effective, and he eventually died 10 months after the initial diagnosis. Autopsy revealed the diffuse involvement of plasma cells of multiple organs, including the liver, spleen, abdominal lymph node, and bone marrow in addition to the left leg.
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  • Yuya NAGAI, Minako MORI, Daichi INOUE, Takaharu KIMURA, Sonoko SHIMOJI ...
    2009 Volume 50 Issue 11 Pages 1641-1646
    Published: 2009
    Released on J-STAGE: December 15, 2009
    JOURNAL FREE ACCESS
    A 62-year-old man was diagnosed with human immunodeficiency virus (HIV) infection while suffering from recurrent herpes zoster infection. Laboratory examination revealed CD4+ lymphocyte count 16 cells/μl and HIV loading 150,000 copies/ml at presentation. In addition, he had multiple lymph node swelling. Histologic diagnosis of a biopsied lymph node was diffuse, large, B cell-type malignant lymphoma. The karyotype of the lymphoma cells was t(8;14)(q24;q32), which was confirmed by G-banding and fluorescent in situ hybridization. Positron emission tomography (PET)-combined CT scanning revealed systemic extranodal tumors involving the gastrointestinal tract, pancreas, and bone marrow. The clinical stage of the lymphoma was IVB and the international prognosis index was categorized as high. Complete remission (CR) of the lymphoma was obtained after 2 courses of CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone) chemotherapy and 4 subsequent courses of rituximab-combined CHOP (R-CHOP). Highly active antiretroviral therapy (HAART) was started at the initiation of CHOP. Because of the poor prognosis of AIDS-related lymphoma, he received autologous peripheral blood stem cell transplantation with the MEAM protocol (ranimustine, etoposide, cytarabine, melphalan) as a conditioning procedure without a severe infectious episode. He remains in CR 24 months after the transplantation.
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  • Seiichiro YOSHIZAWA, Daigo AKAHANE, Hiroaki FUJIMOTO, Moritaka GOTOH, ...
    2009 Volume 50 Issue 11 Pages 1647-1651
    Published: 2009
    Released on J-STAGE: December 15, 2009
    JOURNAL FREE ACCESS
    A 60-year-old woman was admitted with acute heart failure and was diagnosed as having primary systemic AL amyloidosis with cardiac involvement by endomyocardial biopsy. Electrophoresis revealed an IgG-λ monoclonal component and amyloidosis was evident in the gastric and rectal mucosa. Her cardiac function at diagnosis was poor, including an ejection fraction of 59% and IVS of 19 mm, and serum cardiac troponin T (cTnT) was elevated (0.12 ng/ml). She was treated with melphalan-dexamethasone (Mel-Dex) therapy once a month. After more than a year, cardiac function and performance status were maintained, with decreasing levels of cTnT, indicating that Mel-Dex represents a feasible and effective therapeutic option for patients with AL amyloidosis with cardiac dysfunction.
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Short Reports
  • Yasuo AOTA, Shuichi KODAMA, Naoyuki KITAGAWA, Sohya KAWABATA, Akihiko ...
    2009 Volume 50 Issue 11 Pages 1652-1654
    Published: 2009
    Released on J-STAGE: December 15, 2009
    JOURNAL FREE ACCESS
    A 48-year-old man presented with consciousness disturbance with vasogenic edema in the occipital lobe on brain CT. The diagnosis of reversible posterior leukoencephalopathy syndrome (RPLS) was made. His hypertension was refractory to treatment, and his neurological disabilities and CT abnormalities, along with renal dysfunction, became worse. Hemodialysis and strict management of blood pressure resolved the neurological findings and the lesions on brain CT. However, one week later, consciousness disturbance and brain CT abnormalities recurred. At that time, hemolytic anemia with fragmented erythrocytes, thrombocytopenia, and renal dysfunction became apparent. We therefore diagnosed thrombotic thrombocytopenic purpura (TTP). Plasma exchange and vincristine administration improved not only the clinical findings of TTP, but also consciousness disturbance and brain CT abnormalities. We concluded that latent TTP had caused RPLS in this patient.
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  • Rena MORITA, Satoshi HASHINO, Kohei OKADA, Mutsumi TAKAHATA, Masahiro ...
    2009 Volume 50 Issue 11 Pages 1655-1657
    Published: 2009
    Released on J-STAGE: December 15, 2009
    JOURNAL FREE ACCESS
    A 53-year-old woman had demonstrated idiopathic thrombocytopenic purpura (ITP) and iron deficiency anemia (IDA) since 1978. Although she was treated with prednisolone for ITP and oral iron compounds for IDA, neither ITP nor IDA showed any improvement. Since her 13C-urea breath test was positive, Helicobacter pylori (H. pylori) eradication therapy was performed in 2001. The therapy was effective for IDA but not for ITP. Analysis of cases such as this will be useful for clarifying the mechanisms underlying the development of ITP and IDA associated with H. pylori.
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