Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 53, Issue 7
Displaying 1-12 of 12 articles from this issue
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Picture in Clinical Hematology No.56
The 72nd Annual Meeting of the Japanese Society of Hematology
Special Award Received Lecture
The 73rd Annual Meeting of the Japanese Society of Hematology
Symposium6
Clinical Study
  • The efficacy and safety of piperacillin-tazobactam for febrile neutropenic patients in Japan
    Koji MIYAZAKI, Hirotoshi KAMATA, Hirokazu KIMURA, Sosei OKINA, Ryuji I ...
    2012 Volume 53 Issue 7 Pages 686-690
    Published: 2012
    Released on J-STAGE: September 04, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.686
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    The IDSA guideline for management of febrile neutropenic patients updated in 2010 recommends monotherapy with anti-pseudomonal-lactam agents, including piperacillin-tazobactam (PIPC/TAZ) for high-risk patients. However, clinical studies of PIPC/TAZ are limited in Japanese patients. In this study, we conducted an open-labeled non-randomized prospective trial to examine the efficacy and safety of PIPC/TAZ as an empirical treatment for Japanese patients with febrile neutropenia. Forty-nine febrile episodes in neutropenic patients excluding those undergoing allogeneic stem cell transplantation (high risk 36, low risk 13) were analyzed. The overall response rate was 71%, and no significant differences between the high-risk and the low-risk group were observed (high risk 72%, low risk 69%). Neither PS nor usage of G-CSF affected the response rate. No major side effects were observed in the study. The efficacy and the safety profile of PIPC/TAZ treatment were comparable to those in other previous Western studies. In conclusion, this study suggests PIPC/TAZ is effective and well tolerated as an initial empirical treatment for febrile neutropenic Japanese patients.
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  • Survey on examinations for diagnosis of bone marrow failure in Japan: a report from the Japanese National Research Group on Idiopathic Bone Marrow Failure Syndromes
    Kayano ARASEKI, Akira MATSUDA, Kaoru TOHYAMA, Takayuki ISHIKAWA, Hiros ...
    2012 Volume 53 Issue 7 Pages 691-697
    Published: 2012
    Released on J-STAGE: September 04, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.691
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    Using a registration sheet of a prospective registration system for aplastic anemia (AA)/myelodysplastic syndromes (MDS), by the National Research Group on Idiopathic Bone Marrow Failure Syndromes, Japan, we carried out a survey on examinations for diagnosis of bone marrow failure. Bone marrow trephine biopsy was performed in 66 of 105 cases (63%) [Original diagnosis: AA 51 cases (80%), MDS 12 (32%), undiagnosable 3 (75%)]. Bone marrow aspiration was performed in all cases, and aspiration was performed at least twice in 36 cases (34%). The first-line anatomic site for bone marrow aspiration was the posterior iliac crest (62%). Cytogenetic examination was performed in 93%. The concordance rate between the original and the central review diagnosis was 93% among the studied cases: AA, Idiopathic cytopenia of undetermined significance (ICUS) and MDS in total. Flow cytometry analysis to detect paroxysmal nocturnal hemoglobinuria (PNH)-type blood cells was performed in 32%.
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  • Retrospective analysis of treatment outcomes in 70 patients with t(8;21) acute myeloid leukemia
    Ayumi NUMATA, Katsumichi FUJIMAKI, Tomohiro AOSHIMA, Makoto ONIZUKA, M ...
    2012 Volume 53 Issue 7 Pages 698-704
    Published: 2012
    Released on J-STAGE: September 04, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.698
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    We conducted a retrospective study to evaluate outcomes and prognostic factors of newly diagnosed patients with t(8;21) acute myeloid leukemia (AML). There were 70 patients (43 men and 27 women) with a median age of 48 years old (range, 17∼76 years old). Sixty-five patients achieved complete remission (CR) after induction chemotherapy. Fifty-seven patients received consolidation chemotherapy based on the policy of not performing allogeneic hematopoietic stem cell transplantation (allo-HSCT) at the time of first CR. Twenty-seven of the 57 patients relapsed (relapse rate, 47%). The median time from the achievement of the first CR to relapse was 307 days (96∼1,256 days). A white blood cell count of more than 25,400/μl at diagnosis was associated with a higher relapse rate than a white blood cell count of less than or equal to 25,400/μl (75% vs. 43%, P=0.04). Nineteen of the 25 relapsed patients who received re-induction therapy experienced a second CR (second CR rate, 76%). Twenty-six patients (5 with first CR, 12 with second CR, and 9 without remission) received allo-HSCT. The five-year overall survival and disease-free survival rates were 61% and 45%, respectively. Patients with t(8;21) AML had a high CR rate, but about half of them relapsed. However, this report could not show prognostic factors for the identification of patients who should receive allo-HSCT at the time of their first CR.
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Case Reports
  • CD20-positive peripheral T-cell lymphoma, not otherwise specified
    Honoka ARAI, Kazuhiro MAKI, Jiro TADOKORO, Tomoyuki HANDA, Yuko NAKAMU ...
    2012 Volume 53 Issue 7 Pages 705-709
    Published: 2012
    Released on J-STAGE: September 04, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.705
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    We report a 69-year-old male with CD3-positive peripheral T-cell lymphoma, not otherwise specified (PTCL-nos). Interestingly, tumor cells slightly expressed CD20 as well. Southern analyses of the tumor cells showed rearrangement for only the T cell receptor gene but not the immunoglobulin genes. This patient achieved partial remission with a treatment regimen of THP-COP excluding prednisolone, but died of pneumonia. Although CD20-positive PTCL is rare, a review of the reported cases suggests that CD20-positive PTCL has a poor prognosis and that bone marrow infiltration of tumor cells results in a poorer prognosis in CD20-positive PTCL than in usual PTCL. By accumulating cases of this rare entity of lymphoma, we need to clarify the biological nature of the tumor cells and usefulness of rituximab combined with standard chemotherapy.
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  • Clinical analysis of autologous stem cell transplantation for nine cases of cardiac amyloidosis
    Mizuki OGURA, Rieko SEKINE, Sayuri NISHIYAMA, Yu ABE, Hiromitsu IIZUKA ...
    2012 Volume 53 Issue 7 Pages 710-715
    Published: 2012
    Released on J-STAGE: September 04, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.710
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    Long-term survival remains poor for patients with cardiac amyloidosis. High-dose melphalan (MEL) with stem cell transplantation (HDM/SCT) is an effective treatment for AL amyloidosis, but patients with cardiac involvement are ineligible because of high therapy-related mortality. Here we report detailed HDM/SCT outcomes of 9 patients with cardiac failure. Their median age was 56 years (range, 45∼66). After a median follow-up of 15 months (range 9∼32), three died of multiorgan failure within the early phase after HDM/SCT, and the other six including poor risk patients are alive at present. Their symptoms of cardiac decompensation have improved. Decreases in interventricular septum thickness were confirmed in 4 patients 6∼12 months after HDM/SCT by echocardiography. One-year overall survival rate was 67%, longer than previously reported rates. HDM/SCT may lead to improvements in quality of life and extended survival in cardiac amyloidosis patients. Meanwhile, the median dosage of MEL in our procedure was 103 mg/m2 (range 68∼180), less than the recommended dose, and patients were maintained on miscellaneous therapies. Further studies are required to clarify an effective MEL dose and to refine selection criteria for patients undergoing HDM/SCT.
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  • Lupus anticoagulant-hypoprothrombinemia syndrome with a false-positive test for coagulation factor inhibitors
    Shingo MORINAGA, Yoko IDE, Masaru KUSUMOTO, Mika OGATA, Kazutaka TAKAK ...
    2012 Volume 53 Issue 7 Pages 716-720
    Published: 2012
    Released on J-STAGE: September 04, 2012
    DOIhttps://doi.org/10.11406/rinketsu.53.716
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    We report a case of a 1-year-old boy diagnosed with lupus anticoagulant-hypoprothrombinemia syndrome (LA-HPS), which is a rare disorder. His initial presentation of sinusitis was accompanied by hemorrhagic episodes including ecchymoses and epistaxis 6 months after antibiotic therapy. Laboratory results revealed prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT) that did not correct with mixing studies. Factors II, VIII, IX, X, XI, and XII activities were 20%, 44%, 42.5%, 59%, 4%, and 10%, respectively. The Bethesda inhibitor assay showed inhibitors against multiple coagulation factor. APTT, mixing studies, diluted Russell's viper venom time, and the Bethesda inhibitor assay detected LA. LA-HPS with a suspected false-positive test for coagulation factor inhibitors was diagnosed. Bleeding stopped and results of coagulation studies returned to normal without therapy 2 months after onset of the disease.
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