Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 55, Issue 2
Displaying 1-18 of 18 articles from this issue
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Picture in Clinical Hematology
Feature Articles: Hematological disorders —Current therapeutic strategy (Hematopoietic stem cell transplantation)—
Feature Articles: Hematological disorders —Current therapeutic strategy (Lymphoid diseases)—
Case Reports
  • Hemostatic treatment for intractable traumatic hemorrhage using fibrinogen concentrates and recombinant activated factor VII
    Teruhisa FUJII, Seiji SAITO
    2014 Volume 55 Issue 2 Pages 234-238
    Published: 2014
    Released on J-STAGE: March 05, 2014
    DOIhttps://doi.org/10.11406/rinketsu.55.234
    JOURNAL RESTRICTED ACCESS
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    A male patient in his thirties presented to the emergency room of our hospital after a traffic injury. He was in hemorrhagic shock and was diagnosed with a pelvic bone fracture by computed tomography. Despite a massive transfusion of red cells, platelets, and fresh frozen plasma, the bleeding was determined to be continuous because his blood pressure remained unstable and his platelet count and coagulation parameters did not improve. Because ordinary replacement therapy was ineffective, the patient was infused with fibrinogen concentrates and recombinant activated factor VII (rFVIIa), although these are off-label indications in Japan. He recovered from the hemorrhagic shock immediately after the infusion. Although there have been several reports on the management of intractable hemorrhage secondary to severe trauma using rFVIIa, we have experienced few such cases. This patient was rescued by hemostatic treatment with fibrinogen concentrates and rFVIIa.
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  • Development of cytomegalovirus antigenemia in 3 patients with B cell lymphoma treated with bendamustine monotherapy
    Toru MITSUMORI, Yuki SUEKI, Ichiro KAWASHIMA, Takeo YAMAMOTO, Yumi NOZ ...
    2014 Volume 55 Issue 2 Pages 239-243
    Published: 2014
    Released on J-STAGE: March 05, 2014
    DOIhttps://doi.org/10.11406/rinketsu.55.239
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    Bendamustine is one of the new key drugs for patients with indolent lymphoma. Bendamustine, together with rituximab, significantly improves the treatment outcomes of these patients. In addition, previous clinical studies have shown the complication rate of severe infection in bendamustine-containing regimens to be relatively low as compared to those of conventional chemotherapeutic regimens such as CHOP. However, some clinical case reports have raised the possibility that bendamustine may abrogate the immune responses of patients and trigger opportunistic infections including cytomegalovirus reactivation. Herein, we report three indolent lymphoma cases becoming positive on cytomegalovirus antigenemia assay during bendamustine monotherapy. All events occurred after more than three courses of treatment with bendamustine. One patient showed decreased CD4 positive T lymphocytes before the development of cytomegalovirus antigenemia. All three patients were successfully treated with valganciclovir. Although the precise risk is unknown, it should be noted that bendamustine can potentially cause reactivation of/infection with cytomegalovirus and physicians should pay attention to the possibility of this infection during treatment with bendamustine-containing regimens.
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  • Relapsed primary intraocular lymphoma treated with intravitreal methotrexate and high-dose chemotherapy followed by autologous stem cell rescue
    Tadashi KAMIO, Akihiko YOKOHAMA, Toshimasa HAYASHI, Kotaro TOYAMA, Hir ...
    2014 Volume 55 Issue 2 Pages 244-248
    Published: 2014
    Released on J-STAGE: March 05, 2014
    DOIhttps://doi.org/10.11406/rinketsu.55.244
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    A 58-year-old woman with primary intraocular lymphoma (PIOL) of her right eye was treated with combination chemotherapy (methotrexate, procarbazine and vincristine) followed by irradiation to her brain and right eye. However, the disease recurred in the right eye four months later. She was treated with intravitreal injection of methotrexate and high-dose chemotherapy in combination with autologous stem cell transplantation after salvage therapy consisting of cytarabine, etoposide and rituximab. With this treatment strategy, she has been in remission for more than one year with no deterioration of either leukoencephalopathy or cognitive function. Intravitreal injection of methotrexate and high-dose chemotherapy may now be regarded as one of the treatment choices for relapsed PIOL.
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  • Posterior reversible encephalopathy syndrome following paralytic ileus caused by vincristine in a patient with T cell lymphoblastic lymphoma
    Eiko HAYASE, Junichi SUGITA, Katsuya FUJIMOTO, Ko EBATA, Tomohiro YAMA ...
    2014 Volume 55 Issue 2 Pages 249-253
    Published: 2014
    Released on J-STAGE: March 05, 2014
    DOIhttps://doi.org/10.11406/rinketsu.55.249
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    A 22-year-old woman presented with high fever, chest tightness and cough in January 20XX. Since CT scans revealed an anterior mediastinal mass, percutaneous needle biopsies of the mass were performed and she was diagnosed with T-cell lymphoblastic lymphoma (T-LBL). After the immunophenotype of lymphocytes in her pleural effusion had been identified, she received CHOP therapy because her dyspnea worsened, and induction therapy for acute lymphoblastic leukemia was subsequently performed after confirmation of her diagnosis as T-LBL. During this induction therapy, she developed paralytic ileus. One week thereafter, she suddenly exhibited visual disturbance, headache and nausea. Her cerebrospinal fluid was normal. Magnetic resonance imaging showed symmetrical high signal intensities on T2-weighted and fluid-attenuated inversion recovery images, and low signal intensities on T1-weighted images in the cortical and subcortical white matter of the posterior parietal and occipital lobes. Based on these findings, she was diagnosed as having posterior reversible encephalopathy syndrome (PRES). During chemotherapy for hematologic malignancies, some patients with PRES reportedly develop paralytic ileus or tumor lysis syndrome. PRES should be considered in patients with neurological abnormalities following such complications during chemotherapy.
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