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1.
Rinsho Ketsueki ; 54(4): 365-9, 2013 Apr.
Article in Japanese | MEDLINE | ID: mdl-23666218

ABSTRACT

We retrospectively investigated the status of transfusional iron overload at Kinki University Hospital. One hundred and sixty three patients received more than 10 red blood cell (RBC) units per year in 2009 and 2010. Myelodysplastic syndrome (37.4%) and aplastic anemia (11.0%) accounted for about 50% of the underlying diseases. At the time of receiving a total of 20 RBC units, 90.8% and 66.2% of the 65 patients evaluated had more than 500 and 1,000 ng/ml of serum ferritin, respectively. The frequency of organ dysfunction associated with iron overload was 56.9% of all the patients assessed, 37.8% of patients with serum ferritin levels of 500∼999 ng/ml, and 67.4% of patients with serum ferritin levels >1,000 ng/ml. Although the Japanese guidelines propose 40 units of RBC transfusion and/or a serum ferritin level of 1,000 ng/ml as a good point to start iron chelation therapy, our results suggest that iron overload and consequent organ dysfunction may occur earlier than this. Therefore, it may be necessary to start iron chelation therapy earlier than that suggested by the Japanese guidelines.


Subject(s)
Anemia, Aplastic/therapy , Erythrocyte Transfusion , Ferritins/blood , Iron Overload/etiology , Myelodysplastic Syndromes/therapy , Chelation Therapy/methods , Erythrocyte Transfusion/methods , Female , Humans , Male , Retrospective Studies
2.
Intern Med ; 51(15): 2015-20, 2012.
Article in English | MEDLINE | ID: mdl-22864129

ABSTRACT

Here we report the first case of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), who initially presented with peripheral neuropathy. Nerve conduction, cerebral spinal fluid studies and his clinical course were compatible with sub-acute demyelinating polyradiculoneuropathy. In addition, left cervical lymph node swelling was observed on admission. Diagnosis of PTCL-NOS was made by the histological, immunohistochemical, and Southern blot analyses on the biopsy specimen from the enlarged lymph node. Combination chemotherapy composed of cyclophosphamide, vincristine, doxorubicin and prednisolone (CHOP) was effective for polyneuropathy as well as for lymphoma. Several antibodies relating to paraneoplastic syndrome such as Ma1, Ma2, Amphiphysin, CV2, Ri, Yo and Hu were all negative. Because sural nerve biopsy performed prior to CHOP therapy revealed no infiltration of lymphoma cells, immune dysfunction mediated by some cytokine or unidentified autoantibody related to PTCL-NOS was thought to be involved in the polyradiculoneuropathy.


Subject(s)
Lymphoma, T-Cell, Peripheral/complications , Lymphoma, T-Cell, Peripheral/diagnosis , Polyradiculoneuropathy/etiology , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Humans , Lymph Nodes/immunology , Lymph Nodes/pathology , Lymphoma, T-Cell, Peripheral/drug therapy , Lymphoma, T-Cell, Peripheral/immunology , Male , Middle Aged , Polyradiculoneuropathy/drug therapy , Polyradiculoneuropathy/immunology , Positron-Emission Tomography , Prednisolone/administration & dosage , Sural Nerve/pathology , Vincristine/administration & dosage
3.
Intern Med ; 49(19): 2163-6, 2010.
Article in English | MEDLINE | ID: mdl-20930448

ABSTRACT

We report a case of primary cardiac lymphoma (PCL) occurring in a 76-year-old man during maintenance hemodialysis. Chest computed tomography (CT) revealed a tumor with pericardial effusion in the left ventricular posterior wall. Cytological examination of the pericardial fluid revealed monotonous lymphoid cells positive for B-cell markers, and clonal immunoglobulin heavy chain gene rearrangement was detected, indicating B-cell lymphoma. Rituximab monotherapy was administered biweekly at the therapeutic level on hemodialysis. The follow-up chest CT showed tumor disappearance with pericardial fluid after two courses of therapy. Rituximab monotherapy was effective for an elderly hemodialysis patient with PCL.


Subject(s)
Antibodies, Monoclonal, Murine-Derived/therapeutic use , Heart Neoplasms/therapy , Lymphoma, B-Cell/therapy , Aged , Antibodies, Monoclonal, Murine-Derived/blood , Gene Rearrangement, B-Lymphocyte, Heavy Chain , Heart Neoplasms/diagnosis , Heart Neoplasms/genetics , Heart Neoplasms/immunology , Humans , Lymphoma, B-Cell/diagnosis , Lymphoma, B-Cell/genetics , Lymphoma, B-Cell/immunology , Male , Pericardial Effusion/diagnostic imaging , Pericardial Effusion/pathology , Renal Dialysis , Rituximab , Tomography, X-Ray Computed , Ultrasonography
4.
Hematology ; 11(3): 179-81, 2006 Jun.
Article in English | MEDLINE | ID: mdl-17325958

ABSTRACT

A 53-year-old male with myelodysplastic syndrome developed Sweet's syndrome extensively over his left iliac and inguinal regions that was refractory to standard treatment with corticosteroids and chemotherapy, received a stem cell transplant from an HLA-matched unrelated donor, conditioned by reduced-intensity regimen. The patient achieved complete hematological remission, and the cutaneous lesions improved gradually and then disappeared completely despite the patient receiving granulocyte colony-stimulating factor after transplantation and developing acute graft-versus-host disease.


Subject(s)
Anemia, Refractory, with Excess of Blasts/surgery , Bone Marrow Transplantation , Sweet Syndrome/etiology , Aclarubicin/therapeutic use , Anemia, Refractory, with Excess of Blasts/complications , Anemia, Refractory, with Excess of Blasts/drug therapy , Anti-Inflammatory Agents/therapeutic use , Bone Marrow Transplantation/adverse effects , Busulfan/therapeutic use , Combined Modality Therapy , Cytarabine/therapeutic use , Drug Therapy, Combination , Graft vs Host Disease/etiology , Graft vs Host Disease/prevention & control , Humans , Male , Middle Aged , Prednisolone/therapeutic use , Remission Induction , Sweet Syndrome/drug therapy , Transplantation Conditioning , Transplantation, Homologous/adverse effects , Vidarabine/analogs & derivatives , Vidarabine/therapeutic use
5.
Blood ; 104(12): 3821-8, 2004 Dec 01.
Article in English | MEDLINE | ID: mdl-15280193

ABSTRACT

Based on the hypothesis that long-term fetomaternal microchimerism is associated with acquired immunologic hyporesponsiveness to noninherited maternal antigens (NIMAs) or inherited paternal antigens (IPAs), several groups have recently reported successful cases of non-T-cell-depleted hematopoietic stem cell transplantation (SCT) from HLA-haploidentical family members mismatched for NIMAs. In this study, we examined the outcomes of 35 patients with advanced hematologic malignancies who underwent HLA-2-antigen- or HLA-3-antigen-incompatible SCT from a microchimeric NIMA-mismatched donor. After standard-intensity or reduced-intensity preparative regimens, all patients had sustained hematopoietic recovery with tacrolimus-based graft-versus-host disease (GVHD) prophylaxis. Grade II/IV acute GVHD occurred in 19 (56%) of 34 evaluable patients, while extensive chronic GVHD developed in 13 (57%) of 23 patients who could be evaluated. Multivariate analysis demonstrated that NIMA mismatch in the GVH direction was associated with a lower risk of severe grade III-IV acute GVHD when compared with IPA mismatch (P = .03). Fifteen patients were alive and 14 of them were disease-free with a median follow-up of 20 (range, 8 to 37) months. These results indicate that T cell-replete SCT from an HLA-haploidentical NIMA-mismatched donor can offer durable remission with an acceptable risk of GVHD in selected patients with advanced hematologic malignancies who lack immediate access to a conventional stem cell source.


Subject(s)
Hematopoietic Stem Cell Transplantation/methods , Histocompatibility Testing , Histocompatibility , Isoantigens , Transplantation Chimera , Adolescent , Adult , Cause of Death , Child , Child, Preschool , Feasibility Studies , Female , Graft vs Host Disease/etiology , Haplotypes , Hematologic Neoplasms/complications , Hematologic Neoplasms/mortality , Hematologic Neoplasms/therapy , Hematopoietic Stem Cell Transplantation/adverse effects , Hematopoietic Stem Cell Transplantation/mortality , Humans , Male , Middle Aged , Mothers , Nuclear Family , Registries , Retrospective Studies , Survival Analysis , Tissue Donors
6.
Int J Hematol ; 78(1): 76-8, 2003 Jul.
Article in English | MEDLINE | ID: mdl-12894856

ABSTRACT

Eosinophilic colitis is a rare inflammatory disease characterized by eosinophilic infiltration of the colon and peripheral blood eosinophilia. We report on a case of eosinophilic colitis in a 29-year-old woman with acute myeloid leukemia following allogeneic bone marrow transplantation from her HLA-identical sister. To our knowledge, eosinophilic colitis has rarely been reported in association with allogeneic bone marrow transplantation.


Subject(s)
Bone Marrow Transplantation/adverse effects , Colitis/etiology , Eosinophilia/etiology , Leukemia, Myeloid/complications , Acute Disease , Adult , Bone Marrow Transplantation/immunology , Cell Movement , Colitis/pathology , Colon/pathology , Cytokines/blood , Eosinophilia/pathology , Female , Graft vs Host Disease/pathology , Humans , Leukemia, Myeloid/therapy , Transplantation, Homologous , Transplantation, Isogeneic
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