Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 54, Issue 2
Displaying 1-19 of 19 articles from this issue
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Picture in Clinical Hematology
Feature Articles: The future directions of clinical hematology in 2013—hematopoietic stem cell transplantation—
Feature Articles: The future directions of clinical hematology in 2013—hemostatic and thrombotic diseases—
Case Reports
  • Rituximab for managing refractory thrombotic thrombocytopenic purpura: a report of three cases
    Jun YAMANOUCHI, Takaaki HATO, Kazuhiro MIYOSHI, Shinji KOBAYASHI, Taic ...
    2013 Volume 54 Issue 2 Pages 205-209
    Published: 2013
    Released on J-STAGE: March 06, 2013
    DOIhttps://doi.org/10.11406/rinketsu.54.205
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    About 20% of TTP are resistant to plasma exchange. As reported in a few case reports and small case series, rituximab has been used in the treatment of TTP with some benefit. However, the optimal dosing, frequency, and timing of rituximab remain to be determined. We treated three cases of refractory TTP with rituximab. Case 1 exhibited brain sequelae probably due to the late administration of rituximab, case 2 died before the expected effect of rituximab could occur, and case 3 recovered completely because of the early administration of rituximab. These results suggest that rituximab should be given as early as possible in TTP, but large clinical studies are required to determine the optimal use of rituximab in TTP.
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  • Sustained molecular remission with a tyrosine kinase inhibitor alone for seven months in a patient with Philadelphia chromosome-positive acute lymphoblastic leukemia
    Toru TAKAHASHI, Toru SHIGEOKA, Munehiro SUZUKAWA, Aki ISHIDO, Takahiro ...
    2013 Volume 54 Issue 2 Pages 210-213
    Published: 2013
    Released on J-STAGE: March 06, 2013
    DOIhttps://doi.org/10.11406/rinketsu.54.210
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    Herein, we report the case of a 28-year-old man with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL). The patient received induction chemotherapy, including imatinib (IM) therapy, which required early cessation because of a severe infection. After the resolution of the infection, general flaccid paralysis was observed, which was diagnosed as critical illness myopathy (CIM). Ph+ALL showed molecular remission (MR) on day 42. We intended to maintain MR with only IM therapy for several months until the improvement of CIM; however, owing to the patient's intolerance to IM, therapy was changed to dasatinib. Because the symptoms of myopathy gradually improved and disappeared completely, the patient was able to undergo one course of intensive chemotherapy and allogeneic stem cell transplantation from an HLA-matched sibling donor, 8 months after admission (7 months after the re-administration of IM). Thus, this case report suggests that a tyrosine kinase inhibitor is an alternative therapy for maintaining the response of Ph+ALL patients who refrain from conventional chemotherapy.
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  • Emergence of donor-derived anti-HLA antibody and subsequent transfusion-refractory thrombocytopenia after allogeneic hematopoietic stem cell transplantation from an HLA-matched sibling donor in a patient with acute myeloid leukemia
    Yuri UCHIYAMA, Takumi HOSHINO, Masahiro MIHARA, Takeki MITSUI, Hiromi ...
    2013 Volume 54 Issue 2 Pages 214-218
    Published: 2013
    Released on J-STAGE: March 06, 2013
    DOIhttps://doi.org/10.11406/rinketsu.54.214
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    A 45-year-old woman with acute myelogenous leukemia developed platelet transfusion refractoriness (PTR) after the engraftment of an allogeneic peripheral blood stem cell transplantation (PBSCT) from her multiparous sister, which was attributed to HLA antibodies that could not be detected in the patient's serum before transplantation. She achieved neutrophil engraftment by day 18 and megakaryocytopoiesis and complete donor chimerism was confirmed in the bone marrow on day 21. IgG-class HLA antibodies were detected in her serum on day 24 after PBSCT; however, on day 15, no HLA antibodies were detected. The specificity of the antibodies that emerged in the patient closely resembled that of the antibodies found in the donor. The donor had probably been immunized during pregnancy by their partner's HLA-antigens expressed by the fetus. Consequently, transplanted donor-derived cells provoked HLA antibodies in the recipient early after PBSCT, and those HLA antibodies induced PTR. The presence of HLA antibodies should be examined at least in pregnant female donors whose recipients developed PTR attributable to HLA antibodies after SCT.
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  • Streptococcal toxic shock-like syndrome caused by Streptococcus dysgalactiae subsp. equisimilis in a patient with acute myeloid leukemia at diagnosis
    Minako MORI, Tomoya KITAGAWA, Yuya SASAKI, Takashi ONAKA, Akihito YONE ...
    2013 Volume 54 Issue 2 Pages 219-223
    Published: 2013
    Released on J-STAGE: March 06, 2013
    DOIhttps://doi.org/10.11406/rinketsu.54.219
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    A 46-year-old woman was urgently admitted to our hospital due to acute renal failure, liver dysfunction, disseminated intravascular coagulation, shock status, and impaired consciousness. About 1 day prior to admission, she developed a high-grade fever, bilateral lower leg pain, and multiple small papules. She was diagnosed with streptococcal toxic shock syndrome (STSS) caused by Streptococcus dysgalactiae subsp. equisimilis (SDSE) associated with acute myeloid leukemia. The emm gene type of the isolated SDSE was shown to be stG2078. Her invasive streptococcal infection resolved with immediate administration of meropenem and continuous hemodiafiltration. However, she died of septic shock caused by multidrug-resistant Pseudomonas aeruginosa one month after admission. Recently, epidemiological studies have shown increasing numbers of invasive SDSE infections, including STSS and necrotizing fasciitis, often among immunocompromised patients. This suggests that hematologists as well as primary care doctors need to be aware of the possibility of the invasive infections caused by SDSE. An influenza-like illness consisting of a fever, lower extremity pain, and diarrhea are common initial symptoms in STSS patients. Awareness of these prodromal symptoms could lead to the early diagnosis of the illness and prompt initiation of antibiotic treatment.
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  • Loss of CD23 expression after bortezomib plus dexamethasone therapy in CCND1/IGH-positive multiple myeloma
    Akihito FUJIMI, Akari HASHIMOTO, Yuji KANISAWA, Toshinori OKUDA, Shiny ...
    2013 Volume 54 Issue 2 Pages 224-228
    Published: 2013
    Released on J-STAGE: March 06, 2013
    DOIhttps://doi.org/10.11406/rinketsu.54.224
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    A 69-year-old male was referred to our hospital because of anemia, renal insufficiency, and a positive urine test for Bence-Jones protein. A bone marrow examination showed 73.7% of myeloma cells with lymphoplasmacytic morphology, the strong expressions of CD20 and CD23 by flow cytometry, and the chromosomal aberration of CCND1/IGH by FISH analysis. He was diagnosed with multiple myeloma, IgG-λ type. The initial treatment with bortezomib plus dexamethasone (BD) provided a rapid decrease in the level of IgG; however, he developed bortezomib-induced recurrent paralytic ileus accompanied by aspiration pneumonia during the second course. Interestingly, CD23 expression on myeloma cells decreased from 87.7% to 2.2% after 2 courses of BD. Negative CD23 expression was maintained following lenalidomide plus dexamethasone therapy. There are extremely few reports on CD23 expression on myeloma cells, and this is the first case report of multiple myeloma in which CD23 expression was lost after BD therapy.
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A Short Report
  • Successful treatment with rituximab for autoimmune hemolytic anemia associated with chronic lymphocytic leukemia
    Yuko TANAKA, Yoshikazu ITO, Sei-ichiro YOSHIZAWA, Hiroaki FUJIMOTO, Mo ...
    2013 Volume 54 Issue 2 Pages 229-231
    Published: 2013
    Released on J-STAGE: March 06, 2013
    DOIhttps://doi.org/10.11406/rinketsu.54.229
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    A 68-year-old man was diagnosed with chronic lymphocytic leukemia (CLL) 3 years ago. His course was progressive, and he was complicated with autoimmune hemolytic anemia (AIHA). After the lack of efficacy of prednisone and cyclo-phosphamide, rituximab (375mg/m2) was administered based on the presence of CD20 positive leukemic cells by flow cytometric analysis of bone marrow. During 4 courses of rituximab administration, both anemia and hemolysis improved dramatically. Furthermore, the percentage of CLL cells in his peripheral blood was reduced. Rituximab may be one of the effective treatments for CLL associated AIHA in Japan as well as in foreign countries.
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