A 67-year-old man was diagnosed with a submucosal primary gastric T-cell lymphoma (PGTL) via upper gastroenteroscopy following an annual health check-up. He received six cycles of CHOP and achieved a complete remission. However, the patient relapsed 4 months post therapy. A second remission, which was maintained for years, was achieved after surgical gastrectomy followed by adjuvant chemotherapies. Prior reports have shown that surgery combined with chemotherapies was curative for patients with newly-diagnosed PGTL. In this report, surgery combined with chemotherapies was successfully applied for early-relapsed PGTL.
We report the case of a 58-year-old woman with multiple myeloma who relapsed after the first autologous peripheral blood stem cell transplantation. She was refractory to new drugs and underwent a haploidentical allogeneic hematopoietic stem cell transplantation (haplo-HSCT) by administering post-transplantation cyclophosphamide (PTCy) after the second autologous peripheral blood stem cell transplantation. Neutrophil and platelet engraftment were achieved on days 22 and 55, respectively. Grade II cutaneous acute graft-versus-host disease was observed, which was resolved by systemic steroid treatment. Post-transplant bone marrow examination confirmed donor chimerism replacement and immunophenotypic complete response, and the patient is alive and disease-free. Although haplo-HSCT using PTCy for multiple myeloma has not been reported in Japan, it could be performed safely. Here, we report our results with literature review.
Erdheim-Chester disease (ECD) is a very rare form of the non-Langerhans histiocytic multisystem disorder. The cardiac involvement is often challenging and is associated with poor prognosis. Transthoracic echocardiography was used to detect right atrium tumors in a 62-year-old man with heart failure who was admitted to our hospital. The circumferential soft tissue sheathing of the aorta (coated aorta) and fat infiltration around the kidneys (hairy kidneys) was seen on a contrast-enhanced computed tomography strongly suspecting ECD imaging. The patient was diagnosed with ECD based on histopathology reports of the surgical resection tumor. The characteristic imaging findings of ECD may contribute to an early and accurate diagnosis.
The novel coronavirus (COVID-19) pandemic has affected all aspects of human life worldwide. Under this situation, the American Society of Hematology and European Hematology Association have provided resources and recommendations for the management of hematologic diseases during the COVID-19 pandemic. This review aims to summarize these recommendations and provide helpful, accurate, and up-to-date information for Japanese hematologists.
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread worldwide and was classified as a pandemic by the World Health Organization in March 2020. However, its clinical manifestations and optimal management in immunosuppressed patients, including recipients of hematopoietic stem cell transplantation (HSCT), are unknown. There have been some international guidelines for the management of COVID-19 in HSCT recipients. In this issue, we describe the Japanese real-world clinical condition and careful points, explaining those international guidelines.
PCR assay cannot always detect the SARS-CoV2 virus, which might be due to differences in the sensitivities of each sampling site. Under these circumstances, immunochromatography may serve as an alternative method to detect anti-SARS-CoV-2 IgG antibodies that can demonstrate a history of infection. In patients with severe COVID-19 infection, 14 of 19 serum samples were shown to be positive, whereas 6 of 10 samples from patients with asymptomatic or mild cases were negative for IgG antibodies. Two patients with immune thrombocytopenia, who were treated with prednisolone, experienced aggressive behavior of COVID-19-related respiratory failure and eventually died. Patients who were before an achievement of remission and those who received steroid-based chemotherapy possessed a higher risk of death, and more deaths were observed in patients with lymphoid malignancies including lymphoma and myeloma compared with those with myeloid malignancies. As for daily medical care in hematological department, a stricter cohorting strategy using repeat PCR tests or isolation to a private room should be adopted in order to prevent viral spread to the environment.
Preventing COVID-19 infection in pediatric patients with hematological disease and cancer is important. Thus, patients and those around them should avoid crowds, wear masks, and perform hand hygiene. It is necessary to try to prevent nosocomial infections during hospitalization. Moreover, determining COVID-19 complications and the condition of patients with hematological disease and cancer, and determining a personalized treatment strategy that prioritizes the treatment of high-risk conditions is necessary when suffering from COVID-19. However, another problem is when the patient refrains from visiting a medical institution due to the fear of contracting COVID-19 infection and becomes seriously ill. Furthermore, the lack of medical resources has affected the treatment of pediatric patients with hematological disease and cancer (e.g., delays and changes in treatment). Thus, appropriate information needs to be provided to children and their parents so that preventive measures can be taken.