Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 54, Issue 12
Displaying 1-13 of 13 articles from this issue
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Picture in Clinical Hematology
Clinical Study
  • Outcome of patients with relapsed/refractory adult T-cell leukemia-lymphoma after salvage therapy
    Hiroaki TANIGUCHI, Yoshitaka IMAIZUMI, Junya MAKIYAMA, Hidehiro ITONAG ...
    2013 Volume 54 Issue 12 Pages 2159-2166
    Published: 2013
    Released on J-STAGE: January 23, 2014
    DOIhttps://doi.org/10.11406/rinketsu.54.2159
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    We retrospectively analyzed 81 relapsed or refractory adult T-cell leukemia-lymphoma (ATL) patients who received salvage therapy in our institution between 2000 and 2010. These patients had received chemotherapy, radiation, or hematopoietic stem cell transplantation (HSCT) as an initial treatment, and were then given chemotherapy, radiation, HSCT, or donor lymphocyte infusion (DLI) as salvage therapy. Median survival time was 3.9 months. Of 5 long-term survivors, who survived more than 2 years after the first salvage therapy, 4 patients received HSCT or DLI, and the other was given mogamulizumab as the salvage therapy. For patients with relapsed or refractory ATL, HSCT/DLI is a promising treatment for achieving long-term survival. Mogamulizumab may be the good choice for those who are ineligible for HSCT.
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Case Reports
  • Acute monoblastic leukemia with MLL/AF9 rearrangement which developed 18 months after myeloid sarcoma onset
    Yuya SATO, Atsuko NAKAZAWA, Hidemitsu KUROSAWA, Keitaro FUKUSHIMA, May ...
    2013 Volume 54 Issue 12 Pages 2167-2170
    Published: 2013
    Released on J-STAGE: January 23, 2014
    DOIhttps://doi.org/10.11406/rinketsu.54.2167
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    We describe a 36-month-old boy with acute monoblastic leukemia (AMoL M5a) and mixed-lineage leukemia (MLL)-AF9 rearrangement. At 18 months of age, he presented with swelling on the back of his hand that was considered to be an inflammatory change, but no hematological abnormalities were found. However, blasts with MLL-AF9 rearrangement were detected in biopsied tissue taken at the time and in peripheral blood samples taken 18 months later. These findings indicate that myeloid sarcoma with MLL-AF9 rearrangement may ultimately, though slowly, progress to AMoL.
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  • Rapidly progressive AL amyloidosis in a patient with relapsed multiple myeloma after achieving a complete response to tandem autologous PBSCT
    Hikaru YAGI, Shuji OZAKI, Etsuko SEKIMOTO, Hironobu SHIBATA, Toshio SH ...
    2013 Volume 54 Issue 12 Pages 2171-2176
    Published: 2013
    Released on J-STAGE: January 23, 2014
    DOIhttps://doi.org/10.11406/rinketsu.54.2171
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    A 56-year-old male presented with pathological rib fracture and lumbago in 2006. He was diagnosed with multiple myeloma (IgG-lambda type, D&S stage IIIA, ISS 2). He was treated with VAD therapy and tandem auto-PBSCT, and achieved CR in 2007. He was followed without chemotherapy, but relapsed in 2009. He received lenalidomide plus dexamethasone and bortezomib plus dexamethasone and achieved PR which was sustained for 25 months. In 2012, he developed edema of the lower legs and pleural effusion, and was diagnosed as having nephrotic syndrome and heart failure due to AL amyloidosis. He died of renal failure and heart failure 3 months after this diagnosis. Autopsy findings showed amyloid deposition in many organs including the heart, kidneys, liver, spleen, and intestines. Development of rapidly progressive AL amyloidosis is a rare complication of relapse after the achievement of CR, but careful monitoring is needed in patients with multiple myeloma.
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  • Successful treatment with azacitidine for a patient with relapsed myelodysplastic syndrome after cord blood transplantation
    Satomi UEDA, Shigesaburo MIYAKOSHI, Aki CHIZUKA, Rie KOJIMA, Toshie OG ...
    2013 Volume 54 Issue 12 Pages 2177-2181
    Published: 2013
    Released on J-STAGE: January 23, 2014
    DOIhttps://doi.org/10.11406/rinketsu.54.2177
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    A 72-year-old man visited our hospital in July 2009 with a major complaint of lightheadedness. Based on bone marrow aspiration, myelodysplastic syndrome (MDS), refractory anemia with excessive blast-2 was diagnosed. Complete remission (CR) was achieved after low-dose cytarabine and aclarubicin therapy. After two courses of low-dose cytarabine therapy, at the first CR, cord blood transplantation (CBT) was performed after reduced-intensity conditioning in January 2010. However, recurrence was found in September 2011. Azacitidine (AZA) was administered subcutaneously daily for either 7 or 5 days and repeated every 4 weeks at doses of 100 mg/day. During nine cycles of AZA treatment, no graft-versus-host disease was observed and no transfusions of red cells/platelet concentrate were required. As of 1 year after the relapse was detected, the patient remains alive with stable disease. As there are few reports on AZA treatment for patients with MDS who experience relapse after CBT, the efficacy of this approach remains unclear. Further clinical trials including dose, duration, and number of cycles of AZA for MDS patients who relapse after transplantation are required.
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  • Latent malignant lymphoma diagnosed at autopsy in a patient with cold agglutinin disease coexisting thrombotic thrombocytopenic purpura
    Toru SHIGEOKA, Hiroki YAMAGATA, Aki ISHIDO, Takayuki TOMINAGA, Toshiak ...
    2013 Volume 54 Issue 12 Pages 2182-2186
    Published: 2013
    Released on J-STAGE: January 23, 2014
    DOIhttps://doi.org/10.11406/rinketsu.54.2182
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    An 89-year-old woman presented to our hospital with hemolytic anemia and a high titer of cold agglutinins. Red cell agglutination was observed on a blood smear. Agglutination visibly decreased after warming the blood; therefore, the patient was diagnosed with cold agglutinin disease (CAD). Bone marrow aspiration revealed no infiltration of malignant cells. Computed tomography indicated moderate splenomegaly. The patient had neither an infection nor autoimmune disease. Initial steroid therapy was ineffective and hemolysis worsened. Meanwhile, thrombocytopenia, delirium, fever, and schistocytes in the blood were observed. The progression of hemolysis was attributed not only to CAD but also to coexisting thrombotic thrombocytopenic purpura (TTP) because of the decreased ADAMTS 13 level. Autopsy revealed mild paraaortic lymphadenopathy and splenomegaly. Microscopic examination revealed lymphoma cell infiltration in the spleen, liver, bone marrow, and paraaortic lymph nodes. These observations suggested that TTP and CAD were both secondary complications. This case highlights the importance of an autopsy for the detection of latent lymphoma, which can be difficult to diagnose before the patient's death. Careful examination to exclude lymphomas is important in patients with CAD at the time of diagnosis.
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  • Sodium-losing nephropathy caused by tacrolimus after allogeneic hematopoietic stem cell transplantation
    Sayako YUDA, Takehiko MORI, Jun KATO, Yuya KODA, Sumiko KOHASHI, Taku ...
    2013 Volume 54 Issue 12 Pages 2187-2191
    Published: 2013
    Released on J-STAGE: January 23, 2014
    DOIhttps://doi.org/10.11406/rinketsu.54.2187
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    A 39-year-old woman (Case 1) and a 57-year-old woman (Case 2) underwent allogeneic bone marrow transplantation for acute lymphoblastic leukemia and follicular lymphoma, respectively. Both patients had received tacrolimus orally for treatment of or prophylaxis against graft-versus-host disease. Seventeen months (Case 1) and 2 months (Case 2) post-transplantation, when the trough level of tacrolimus was maintained around 10 ng/ml, the serum sodium levels of Cases 1 and 2 decreased to 123.5 mEq/l and 125.6 mEq/l, respectively. Urinary sodium excretions increased to 186.8 mEq/day and 375.7 mEq/day, respectively. Sodium-losing nephropathy due to tacrolimus was diagnosed, and reducing the dose of tacrolimus with no other intervention resulted in resolution of the hyponatremia. Although sporadic kidney transplantation cases with sodium-losing nephropathy due to tacrolimus have been reported, no prior cases with this complication after hematopoietic stem cell transplantation (HSCT) have been reported. Sodium-losing nephropathy should be recognized as one of the renal toxicities of tacrolimus in HSCT as well as kidney recipients.
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  • Primary myelofibrosis complicated by acquired hemophilia A and subsequent development of acute myeloid leukemia
    Hiroyuki KURODA, Kazuma ISHIKAWA, Wataru JOMEN, Masahiro YOSHIDA, Mich ...
    2013 Volume 54 Issue 12 Pages 2192-2198
    Published: 2013
    Released on J-STAGE: January 23, 2014
    DOIhttps://doi.org/10.11406/rinketsu.54.2192
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    A 77-year-old man diagnosed with primary myelofibrosis (PMF), successfully controlled by thalidomide and prednisolone, was referred to us for massive subcutaneous bleeding involving the face, body, and all four limbs. Hemostatic studies showed prolonged activated partial thromboplastin time, decreased factor VIII coagulation, and a high factor VIII inhibitor titer, resulting in a diagnosis of acquired hemophilia A (AHA) for which he was treated with prednisolone and cyclophosphamide on admission. He developed right femoral intramuscular hemorrhage soon after immunosuppressive therapy and was treated with rituximab combined with activated prothrombin complex concentrates. Furthermore, he suffered complications of respiratory failure with increasing throat hemorrhaging. Recombinant activated factor VII (rFVIIa) was administered combined with methylprednisolone pulse therapy. Bleeding, including respiratory failure, was ameliorated with rFVIIa. Immunosuppressive rituximab therapy resolved AHA with marked efficacy. He died of Pneumocystis jiroveci pneumonitis. Autopsy showed transformation from PMF to acute myeloid leukemia.
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