Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 53, Issue 5
Displaying 1-14 of 14 articles from this issue
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Picture in Clinical Hematology No.54
The 73rd Annual Meeting of the Japanese Society of Hematology
Symposium 2
Symposium 3
Symposium 4
Case Reports
  • Increased level of KL-6 in a BJP-λ-type multiple myeloma patient with poor prognosis
    Yasunori NAKAGAWA, Hiromitsu IIZUKA, Sayuri NISHIYAMA, Yu ABE, Sayaka ...
    2012 Volume 53 Issue 5 Pages 521-525
    Published: 2012
    Released on J-STAGE: June 08, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.521
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    A 63-year-old female with BJP-multiple myeloma (Durie-Salmon stage III B, International Staging System III) showed an increased level of KL-6, a sialylated carbohydrate antigen that is a MUC1 molecule expressed in type II pneumocytes and reflects activity of interstitial pneumonia. At the time of diagnosis, KL-6 was as high as 22,030 U/ml; however, surfactant protein D (SP-D) was normal, and stroma-related pneumonia was not indicated on CT images. Expression of KL-6 in multiple myeloma cells was detected by immunostaining and the patient was diagnosed with KL-6-positive multiple myeloma. Usually, MUC1 is encoded by chromosome 1q21, but the karyotypic analysis of the patient's bone marrow cells lacked chromosome 1. KL-6 increased as the disease progressed. The patient did not respond to chemotherapy, including bortezomib, showed an increase of pleural effusion, and died. For this patient, multiple myeloma with high KL-6 was refractory to chemotherapy, suggesting that new treatment strategies, including transplantation of hematopoietic stem cells, are required.
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  • Marked reactive plasmacytosis accompanied by drug eruption in a patient with aplastic anemia
    Masahide YAMAMOTO, Hanae KUMEKAWA, Koji SASAKI, Yutaka MURATA, Manabu ...
    2012 Volume 53 Issue 5 Pages 526-530
    Published: 2012
    Released on J-STAGE: June 08, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.526
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    A 61-year-old woman with aplastic anemia was admitted to our hospital in October 2009 because of fever and abdominal pain. She had been treated with cyclosporin A without showing any effect. On admission, uterine cancer was diagnosed and the left uterine appendages were swollen. She was treated with cefepime for febrile neutropenia without effect, and left-sided adnexitis was diagnosed. After cefepime was changed to meropenem, marked plasmacytosis was observed in the peripheral blood (23%) and bone marrow (79%) with the appearance of skin eruption. Although the plasma cells were morphologically abnormal, the cytoplasmic immunoglobulin light chain deviation was not detected by flow cytometric analysis, and M protein was not found by serum immunoelectrophoresis. She was diagnosed with reactive plasmacytosis and treated with dexamethasone. The drug eruption and plasmacytosis improved soon after starting the treatment. Although reactive plasmacytosis is observed with a variety of conditions, including infection, neoplasms, autoimmune disorders, and hemolytic anemia, it has not been reported to accompany drug eruption. Reactive plasmacytosis is sometimes not possible to distinguish from plasma cell neoplasms on morphology alone and needs to be diagnosed comprehensively by using flow cytometric analysis and immunohistochemical evaluation.
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  • Fulminant hepatitis possibly caused by L-asparaginase during induction chemotherapy in a patient with acute lymphoblastic leukemia
    Miyuki TSUTSUI, Michiaki KOIKE, Norio KOMATSU
    2012 Volume 53 Issue 5 Pages 531-534
    Published: 2012
    Released on J-STAGE: June 08, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.531
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    We report a 44-year-old man with acute lymphoblastic leukemia (ALL) presenting with fever and lymphadenopathy. Induction chemotherapy was initialed according to the JALSG ALL202 protocol, and L-asparaginase (L-asp) was given on days 20, 22, and 24 of therapy. Abrupt elevations of liver transaminase and bilirubin levels were observed on day 26. On day 30, coagulopathy and hepatic encephalopathy appeared. He was diagnosed with fulminant hepatitis and plasma exchange was performed, but he died on day 32, possibly due to L-asp-induced hepatitis. The common side effects of L-asp are hypersensitivity, ammonemia, coagulopathy, pancreatitis, convulsions, anaphylaxis, hepatotoxicity, and thrombosis. Although rare, reports of deaths due to hepatic failure during treatment with L-asp exist. L-asp is currently used for treatment of a wide range of hematological malignancies such as ALL and NK/T-cell lymphoma. A retrospective analysis of patients treated with L-asp should be carried out to elucidate the incidence and risk factors of liver dysfunction and fulminant hepatitis during L-asp treatment.
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  • Successful treatment with low-dose etoposide for hemophagocytic syndrome following reduced-intensity conditioning for cord blood transplantation in a patient with acute myelgenous leukemia
    Junji TOKUSHIGE, Toshimitsu UEKI, Keijiro SATO, Yuko FUJIKAWA, Ikuo SH ...
    2012 Volume 53 Issue 5 Pages 535-539
    Published: 2012
    Released on J-STAGE: June 08, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.535
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    A 56-year-old man was diagnosed with acute myeloid leukemia with myelodysplasia-related changes. Chromosomal analysis showed a complex karyotype. Complete remission could not be achieved even after several induction chemotherapy regimens, and the patient suffered from invasive pulmonary aspergillosis. He was transferred to our hospital and underwent reduced-intensity conditioning cord blood transplantation (RIC-CBT) in a non-remission state. The conditioning regimen involved fludarabine 125 mg/m2 combined with melphalan 140 mg/m2 and total body irradiation (4 Gy). GVHD prophylaxis was tacrolimus alone at relatively low concentrations (app. 5 ng/ml). On days 6 and 9 after CBT, he experienced a pre-engraftment immune reaction and hemophagocytic syndrome (HPS). We started steroid pulse therapy, but this failed to resolve the symptoms. We then administered low-dose etoposide (50 mg/m2). The symptoms gradually resolved after three administrations of etoposide and engraftment was achieved on day35. Satisfactory hematological recovery was noted on day 300 after CBT and the patient has maintained complete remission to date. HPS is one of the most serious complications following CBT and often results in engraftment failure. This case suggests that repeated administration of etoposide may safely and effectively overcome this serious complication in some cases.
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Short Reports
  • Contingent diagnosis of sarcoidosis by 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) after completion of chemotherapy for malignant lymphoma
    Masaki IINO, Chifumi IIZUKA
    2012 Volume 53 Issue 5 Pages 540-542
    Published: 2012
    Released on J-STAGE: June 08, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.540
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    A 55-year-old man with bilateral cervical lymphadenopathy was diagnosed with diffuse large B-cell lymphoma, stage IIA, and underwent sequential chemoradiotherapy (R-CHOP, 3 courses followed by 30 Gy cervical irradiation). Chemotherapy response was evaluated by 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET). 18F-FDG uptake of the primary lesion was completely diminished; however, a new paratracheal uptake was observed. FDG-PET-guided biopsy revealed sarcoidosis. Sarcoidosis with lymphoma is a rare condition, and it is difficult to distinguish early-stage sarcoidosis from lymphoma without biopsy. Routine FDG-PET significantly increases the detection of unexpected diseases. Physicians should perform biopsies of lesions or follow them carefully in lymphoma patients with unexpected 18F-FDG uptake.
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  • Spontaneous remission of cytomegalovirus-related immune thrombocytopenia in a healthy adult
    Eri YOKOO, Takahiro TSUJI, Hiroshi YAMASAKI, Hiroyuki TSUDA
    2012 Volume 53 Issue 5 Pages 543-545
    Published: 2012
    Released on J-STAGE: June 08, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.543
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    A previously healthy 59-year-old woman was admitted to our hospital due to petechiae. Investigations showed profound thrombocytopenia (1.5×104/μl) and mild elevation of transaminases. The serological examination revealed acute cytomegalovirus (CMV) infection. We intermittently measured CMV load in her clinical course. The petechiae improved with no therapy. One month later, the platelet count was increased up to 7.6×104/μl and CMV-DNA was reduced to undetectable levels. CMV-induced thrombocytopenia in an immunocompetent adult is rare. We also recognized the association of platelet counts and virus load in the natural course of this patient with CMV-induced thrombocytopenia.
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