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Volume 52, Issue 1
Displaying 1-8 of 8 articles from this issue
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Clinical Study
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Hitotaka TAKASAKI, Ayumi NUMATA, Takayoshi TACHIBANA, Masatsugu TANAKA ...2011 Volume 52 Issue 1 Pages 1-7
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL RESTRICTED ACCESSTo assess the relationship between early lymphocyte recovery and outcomes after allogeneic hematopoietic stem cell transplantation (SCT) for acute leukemia in remission, 79 adult patients (AML: 48, ALL: 31) who received transplantation between January 2000 and November 2009 were retrospectively analyzed. The median lymphocyte count on day 30 after SCT (LC30) was 465/μl (range, 10∼2640). On comparison of clinical outcomes between patients with low (LC30<400/μl) and high (LC30≥400/μl) counts, the 5-year overall survival (OS) was significantly better in high LC30 group than in low LC30 group (81.6 vs. 52.6%, p=0.014), but the cumulative relapse rate (RR) and non-relapse mortality (NRM) at 5 years did not differ between the two groups. On multivariate analysis, low LC 30 (HR, 2.44; 95% CI, 1.02∼5.88; p=0.046) and grade II∼IV acute graft-versus-host disease (HR, 2.41; 95% CI, 0.99∼5.90, p=0.0053) were significantly associated with worse OS. However, LC30 was not a risk factor for RR or NRM. These findings suggest that LC30 may be one of the outcome predictors for patients receiving SCT.View full abstractDownload PDF (859K)
Case Reports
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Mariko USHIKI, Michiaki KOIKE, Toshihiro AKIYAMA, Satoshi WATANABE, Hi ...2011 Volume 52 Issue 1 Pages 8-13
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL RESTRICTED ACCESSA 60-year-old man demonstrated a bleeding tendency at enterostomy about 7 months after aortic arch replacement. Abdominal muscle hematoma and pelvic hematoma were also detected. He was diagnosed as having acquired hemophilia A based on prolonged APTT (65.9 sec), reduced FVIII activity (>1%), and the presence of FVIII inhibitor (19.5 BU/ml). Severe anemia was recognized. Recombinant activated factor FVIII (9.6 mg) was administered 25 times, combined with steroid pulse therapy. Usually postoperative acquired hemophilia is recognized in the immediate postoperative period or about 3 months later, while in this case, acquired hemophilia appeared 7 months postoperatively.View full abstractDownload PDF (1320K) -
Kuniyoshi FUKUDA, Yasuhisa YOKOYAMA, Yuhei KAMADA, Kenichi TAOKA, Kazu ...2011 Volume 52 Issue 1 Pages 14-17
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL RESTRICTED ACCESSWe report a rare case of autoimmune hemolytic anemia (AIHA) complicated by idiopathic interstitial pneumonia (IIP). A sixty-year-old man was diagnosed as having IIP in January 2009. In March, when he was hospitalized for the introduction of home oxygen therapy, severe anemia was detected. Based on the findings showing elevated levels of lactate dehydrogenase and indirect bilirubin, a decreased level of haptoglobin, positive Coombs test, and splenomegaly, a diagnosis of AIHA was made. Although anti-DNA antibody was found, diagnostic criteria for systemic lupus erythematosus and other collagen diseases were not fulfilled. Therefore, we concluded that AIHA coexisted with IIP. Treatment with prednisolone led to improvement of both AIHA and IIP. There has not been any exacerbation even after a gradual reduction of prednisolone to 7.5 mg/day. Coexistence of AIHA and IIP is rare, and accumulation of case reports is needed to gain a better understanding of this condition.View full abstractDownload PDF (1016K) -
Haruko TASHIRO, Koichi UMEZAWA, Michihiko SHIROTA, Yoko OKA, Ryosuke S ...2011 Volume 52 Issue 1 Pages 18-22
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL RESTRICTED ACCESSWe report here a 35-year-old pregnant woman with acute myelogenous leukemia (AML). She was diagnosed with AML (M2) in August 2009, coinciding with the 26th week of pregnancy. She underwent a cesarean section at 27 weeks gestation, delivering a very low birth weight male infant (1,066 g). One week later, she received induction chemotherapy with idarubicin and cytarabine. She achieved complete remission after two courses of chemotherapy. The incidence of acute leukemia during pregnancy is low. Chemotherapy after the 2nd trimester is not associated with an increased rate of fetal malformation. However, there are some reports that in utero exposure to chemotherapy during any trimester of pregnancy carries a significant risk for an unfavorable outcome including low birth weight, fetal or neonatal death, and intrauterine growth retardation. Decision on the choice of treatment for acute leukemia during pregnancy should be case-dependent. If an infant has grown sufficiently to be viable outside uterus and the patient does not demonstrate a severe bleeding tendency, delivery by cesarean section preceding chemotherapy is one option.View full abstractDownload PDF (727K) -
Yasufumi KAWASAKI, Tatsuki NAKAZORA, Munehiro SUZUKAWA, Takayuki TOMIN ...2011 Volume 52 Issue 1 Pages 23-27
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL RESTRICTED ACCESSA 67-year-old female was admitted with a diagnosis of acute leukemia. Immature blasts did not show cytoplasmic granules and were POX(−), ES(−), and PAS(+). Flow cytometry of leukemic cells demonstrated positivity for CD7, CD10, CD19, CD13, CD34, HLA-DR, and coexpression of CD7 and CD34, CD10 and HLA-DR, and CD19 and CD13. Cytogenetic analysis demonstrated -7 and t(9;22)(q34;q11.2), and genomic studies demonstrated minor BCR/ABL chimeric mRNA and rearrangements of IgH and TCR. These findings indicated the clonal proliferation of leukemic blasts that expressed a mixed phenotype. Acute leukemia of ambiguous lineage was diagnosed, although the significance of the specificity of lineage markers remains unclear. The differential diagnosis included CML and B-ALL. The patient was treated according to Ph+ALL. However, the hematological response was poor, with persistent residual blasts and severe pancytopenia. The subsequent administration of imatinib mesylate led to a complication of heart failure, and the patient died on the 19th hospital day.View full abstractDownload PDF (1912K) -
Yuji MIYAJIMA, Yuma KITASE, Seiji MIZUNO, Haruya SAKAI, Naomichi MATSU ...2011 Volume 52 Issue 1 Pages 28-31
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL RESTRICTED ACCESSWe report a rare case of acute lymphoblastic leukemia (ALL) in a 7-year-old boy with Marfan's syndrome. He was diagnosed as having Marfan's syndrome by clinical findings at the age of 2 years, and the diagnosis was confirmed by the detection of gene mutation in FBN1. He was referred to our hospital because of the swelling of cervical lymph nodes at the age of 7 years. Findings on bone marrow examination demonstrated T lymphoblastic ALL. He obtained complete remission after induction therapy, and had no serious side effects including cardiotoxicity during chemotherapy. He has remained in continuous complete remission for 34 months following diagnosis. To our knowledge, only three cases of leukemia in patients with Marfan's syndrome were reported previously. We speculate that increased activity of TGF-β, which is known as a tumor suppressor factor, in patients with Marfan's syndrome may diminish the risk of developing leukemia, although such a thesis was not proven in this case.View full abstractDownload PDF (961K) -
Ken-ichiro KOBAYASHI, Tamae HAMAKI, Akira OHWADA, Junji TOMIYAMA, Ryok ...2011 Volume 52 Issue 1 Pages 32-36
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL RESTRICTED ACCESSWe encountered a patient with cold agglutinin disease (CAD) that worsened after Salmonella gastroenteritis. A 52-year-old male complained pain in the left fingers with cyanosis and was admitted in a local hospital. After treatment for ischemia, he demonstrated diarrhea with fever. Because of progressive anemia, he was referred to our hospital. Salmonella gastroenteritis was diagnosed based on the results of microbiological examination. Severe hemolysis was noted at admission, and Coombs test was positive (IgG-, C3d+). Cold agglutinin titer was elevated (x256). There were no findings of malignancy or infection demonstrating CA. A diagnosis of CAD with Salmonella gastroenteritis was made. Because spherocytosis was noted during admission, we measured the mean channel fluorescence (MCF) of eosin-5-maleimide (EMA) in erythrocytes from patients. MCF of EMA of the patient's erythrocytes was similar to that of normal subjects. Therefore, we concluded that coexisting hereditary spherocytosis was unlikely. We also examined the in vitro hemolytic effect of Salmonella infection on his blood and on blood from normal subjects. Treatment with Salmonella enteritidis isolated from this patient was found to induce hemolysis in the patient's blood, but not in blood from a normal subject. Moreover, treatment with Salmonella increased the titer of cold agglutinin in vitro. These data suggested that Salmonella infection might worsen hemolysis in CAD.View full abstractDownload PDF (1089K) -
Hiroyuki TAKAHASHI, Rika SAKAI, Yukako HATTORI, Rika OHSHIMA, Maki HAG ...2011 Volume 52 Issue 1 Pages 37-40
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL RESTRICTED ACCESSA 50-year-old male was admitted to our hospital with pancytopenia. Peripheral blood examination showed pancytopenia (WBC 450/μl, Hb 7.3 g/dl, Plt 3,000/μl) and elevated FDP. Bone marrow examination demonstrated 38% blasts, 20% promyelocytes and Faggot cells. Cytogenetic analysis demonstrated the following: 46, XY, t(15;17)(q22;q12)[9]/46, XY, del(6)(q?), t(9;22)(q34;q11.2)[1]/46, XY[10]. PML/RARA and minor BCR/ABL were also detected by quantitative reverse transcription polymerase chain reaction of bone marrow cells (52,000 copies/μgRNA and 650 copies/μgRNA, respectively). The patient was diagnosed with acute promyelocytic leukemia. He was treated with all-trans retinoic acid monotherapy and achieved complete hematological remission 51 days after the initial treatment. Post-induction bone marrow examination demonstrated 46, XY[20] and PML/RARA 240 copies/μgRNA, whereas minor BCR/ABL was not detected. The patient's initial cytogenetic analysis suggested the presence of two distinct clones with t(15;17) and t(9;22), which to our knowledge have not previously been reported.View full abstractDownload PDF (1508K)
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