Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chromosome Deletion , Chromosomes, Human, Pair 17/ultrastructure , Gene Deletion , Genes, p53 , Liver/pathology , Multiple Myeloma/pathology , Aneuploidy , Angiogenesis Inhibitors/administration & dosage , Angiogenesis Inhibitors/adverse effects , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Boronic Acids/administration & dosage , Boronic Acids/adverse effects , Bortezomib , Chromosome Aberrations , Clone Cells/chemistry , Clone Cells/ultrastructure , Dexamethasone/administration & dosage , Fatal Outcome , Female , Humans , Incidental Findings , Lenalidomide , Middle Aged , Multiple Myeloma/chemistry , Multiple Myeloma/complications , Multiple Myeloma/drug therapy , Multiple Myeloma/genetics , Neoplasm Proteins/analysis , Neoplasms, Multiple Primary , Osteolysis/diagnosis , Osteolysis/etiology , Proteasome Inhibitors/administration & dosage , Proteasome Inhibitors/adverse effects , Pyrazines/administration & dosage , Pyrazines/adverse effects , Recurrence , Thalidomide/administration & dosage , Thalidomide/adverse effects , Thalidomide/analogs & derivatives , Tumor Suppressor Protein p53/analysis , Uterine Neoplasms/surgerySubject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Cerebrospinal Fluid/cytology , Meningeal Neoplasms/chemically induced , Meningeal Neoplasms/pathology , Multiple Myeloma/chemically induced , Multiple Myeloma/pathology , Plasma Cells/pathology , Aged , Boronic Acids/administration & dosage , Boronic Acids/adverse effects , Bortezomib , Dexamethasone/administration & dosage , Dexamethasone/adverse effects , Fatal Outcome , Female , Humans , Magnetic Resonance Imaging , Meningeal Neoplasms/cerebrospinal fluid , Meningeal Neoplasms/diagnosis , Multiple Myeloma/cerebrospinal fluid , Multiple Myeloma/diagnosis , Pyrazines/administration & dosage , Pyrazines/adverse effects , Thalidomide/administration & dosage , Thalidomide/adverse effectsABSTRACT
Severe ventilator-associated pneumonia (VAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) developed in a patient with acute respiratory distress syndrome. After tracheostomy, the patient was treated with antibiotic therapy guided by serial surveillance cultures of endotracheal aspirates. According to the result of the culture, the suitable antibiotic targeting the pathogen (e.g., MRSA, Pseudomonas aeruginosa, Klebsiella oxytoca) that had grown most predominantly in the culture was used until clinical resolution of VAP, leading to avoidance of overusing broad-spectrum antibiotics and ultimately a favorable outcome. During vancomycin (VCM) therapy for MRSA VAP, MRSA bacteremia occurred even though the trough value of VCM was sufficiently high. After the change from VCM to linezolid (LZD), the VAP improved promptly, indicating that LZD is superior to VCM in the treatment of MRSA pneumonia.
Subject(s)
Methicillin-Resistant Staphylococcus aureus/drug effects , Pneumonia, Ventilator-Associated/drug therapy , Pneumonia, Ventilator-Associated/microbiology , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Acetamides/therapeutic use , Aged , Anti-Bacterial Agents/therapeutic use , Bronchoalveolar Lavage , Humans , Linezolid , Male , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Microbial Sensitivity Tests , Oxazolidinones/therapeutic use , Respiratory Distress Syndrome/microbiology , Respiratory Distress Syndrome/therapy , Vancomycin/therapeutic useABSTRACT
Chronic myeloid leukemia (CML) is generally diagnosed in the chronic phase. We have recently encountered two CML-blastic phase (BP) cases, a 71-year-old woman and a 74-year-old man, who resembled de novo acute leukemia. The complete blood count was normal at least 11 and 13 months before the presentation, respectively. The leukemic cells showed predominant lymphoid phenotype. The blasts and granulocytes were positive for BCR-ABL, indicative of CML-BP. Both patients were successfully treated with prednisone and vincristine, followed by Imatinib. Our cases indicate rare presentations of CML-BP with an extremely short chronic phase. Ph-positive de novo acute leukemia should be carefully distinguished from CML-BP.
Subject(s)
Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology , Lymphocytes/pathology , Phenotype , Aged , Diagnosis, Differential , Female , Fusion Proteins, bcr-abl/metabolism , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma/metabolism , Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology , Time FactorsABSTRACT
Chemoradiotherapy has improved the outcome of patients with esophageal cancer. Although a sufficiently long-time survival has resulted in the increase of several treatment-related late toxicities, little is still known about the incidence of secondary malignancies. In our hospital, 348 patients with esophageal cancer received chemotherapy consisting of nedaplatin and 5-fluorouracil and concurrent irradiation. Median and average follow-up durations were 8 and 21 months (1-92), respectively. Four patients developed leukemia after 19-48 months of follow-up. Two patients were diagnosed with overt leukemia from myelodysplastic syndrome presenting a complex karyotype, including the deletion of chromosome 5 or 7. Notably, one patient showed an additional chromosomal abnormality with t(9;22)(q34;q11). Other patients developed acute myeloid leukemia with t(9;22)(q34;q11) and Burkitt leukemia with t(8;14)(q24;q32). All patients eventually succumbed to leukemia. Platinum and fluorouracil have shown relatively lower risks for secondary malignancies in comparison with alkylating agents and topoisomerase II inhibitors. Especially, nedaplatin has never been described to introduce secondary neoplasms. Our report supports the idea that the concurrent administration of radiotherapy with these agents affects the risk of leukemia. Interestingly, rare balanced chromosomal abnormalities were observed in the present cases, thus providing new insights into the leukemogenesis of therapy-related leukemia.
Subject(s)
Esophageal Neoplasms/drug therapy , Esophageal Neoplasms/radiotherapy , Leukemia, Myeloid, Acute , Myelodysplastic Syndromes , Neoplasms, Second Primary , Aged , Antineoplastic Agents/adverse effects , Chromosome Aberrations/chemically induced , Chromosomes, Human, Pair 5 , Combined Modality Therapy/adverse effects , Esophageal Neoplasms/pathology , Female , Fluorouracil/administration & dosage , Humans , Karyotyping , Leukemia, Myeloid, Acute/diagnosis , Leukemia, Myeloid, Acute/pathology , Male , Middle Aged , Myelodysplastic Syndromes/diagnosis , Myelodysplastic Syndromes/pathology , Organoplatinum Compounds/administration & dosage , Radiotherapy/adverse effectsABSTRACT
A 68-year-old woman was referred to Oami Hospital for severe leukocytopenia. Laboratory data revealed severe leukocytopenia (0.8x10(9)/l), severe neutropenia (0.22x10(9)/l) and IgM-kappa monoclonal gammopathy. Granular lymphocytes accounted for more than 90% of leukocytes. Surface marker analysis revealed that these lymphocytes were CD3+, CD4-, CD8+ and CD16+, and monoclonal rearrangement of T-cell receptor genes was seen on Southern blot hybridization analysis. She was diagnosed with T-cell lineage granular lymphocyte proliferative disorder (T-GLPD). During 13-year follow-up without granulocyte-colony stimulating factor (G-CSF) administration, except for one hospitalization because of bacterial pneumonia, she has not experienced severe infection, despite severe neutropenia. T-GLPD should be kept in mind as a cause of leukocytopenia with or without monoclonal gammopathy, and surface marker or Southern blot hybridization analysis should be considered for determining the diagnosis. There are many reports about Caucasian patients with T-GLPD suffering from recurrent infections and dying of severe infection, but in Japanese T-GLPD patients, severe infection is very rare, as shown in the present case report.
Subject(s)
Leukemia, Large Granular Lymphocytic/diagnosis , Leukemia, Large Granular Lymphocytic/therapy , Neutropenia/complications , Aged , Communicable Diseases , Female , Fluoroimmunoassay , Follow-Up Studies , Humans , Immunoglobulin M , Leukemia, Large Granular Lymphocytic/complications , Leukemia, Large Granular Lymphocytic/genetics , Paraproteinemias , Pneumonia, Bacterial , Severity of Illness IndexABSTRACT
Reactivation of hepatitis B virus (HBV) has been recognized as one of the most serious complications in patients receiving chemotherapy with rituximab. From October 2007 to December 2008, rituximab was administered to 123 B-cell lymphoma patients in our institute. Four patients with positive hepatitis B surface antigen (HBsAg) received preemptive entecavir, and none of them developed HBV reactivation. For 26 patients whose hepatitis B surface antibody (HBsAb) and/or hepatitis B core antibody (HBcAb) were positive, HBV-DNA was monitored for one year after completion of chemotherapy. During this period, HBV reactivation was observed in two patients. Hepatitis was prevented in one patient by the administration of entecavir at the time HBV-DNA turns positive. Another developed de novo hepatitis B due to failure of monitoring. Preemptive entecavir for HBsAg positive patients and HBV-DNA monitoring for HBsAb and/or HBcAb positive patients seem to be effective.
Subject(s)
Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/adverse effects , Antineoplastic Agents/administration & dosage , Antiviral Agents/administration & dosage , Guanine/analogs & derivatives , Hepatitis B virus/physiology , Hepatitis B/etiology , Hepatitis B/prevention & control , Lymphoma, B-Cell/drug therapy , Lymphoma, B-Cell/virology , Virus Activation , Aged , Antibodies, Monoclonal, Murine-Derived , Biomarkers/blood , Carrier State/virology , DNA, Viral/analysis , Guanine/administration & dosage , Hepatitis B/diagnosis , Hepatitis B Surface Antigens/blood , Hepatitis B virus/genetics , Humans , Male , Monitoring, Physiologic , RituximabABSTRACT
A 66-year-old man, on thrice-weekly hemodialysis for 7 years, was referred to Chiba Cancer Center Hospital in August 2006 because of a left axillary tumor. Computed tomography revealed several enlarged lymph nodes assembling at the left axilla. The serum soluble IL-2 receptor was 47,500 U/mL, and HTLV-1 antibody was positive. His parents came from Kyushu. The pathological diagnosis was peripheral T-cell lymphoma, CD4(+). He was clinically diagnosed as having an adult T-cell leukemia/lymphoma, lymphoma type, and clinical stage II. Two courses of CHOP therapy were given to the patient, without any response. Because the patient had to undergo hemodialysis consistently, we preferred mild salvage therapy to more intensive treatment. Then, sobuzoxane (SBZ), 1,600 mg/day in two divided doses, was administered orally for 5 days. Soon thereafter, unexpectedly, the axillary tumor rapidly became small, resulting in disappearance four months later. SBZ therapy, 800 mg/day x 3 days, was continued at intervals of 7 to 8 weeks until October 2008. At the time of reporting, May 2009, the patient was well without recurrence of ATLL, and the remission has lasted 26 months or more. The reason why CHOP-resistant ATLL responded dramatically to SBZ alone is not clear, but the plasma concentration of the metabolite of SBZ was possibly very high because of renal failure. Another possibility is that hemodialysis removed the growth factor(s) or anti-apoptotic factor(s) derived from ATLL cells.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Drug Resistance, Neoplasm , Leukemia-Lymphoma, Adult T-Cell/complications , Leukemia-Lymphoma, Adult T-Cell/drug therapy , Piperazines/therapeutic use , Renal Dialysis , Renal Insufficiency/complications , Aged , Cyclophosphamide/therapeutic use , Doxorubicin/therapeutic use , Humans , Leukemia-Lymphoma, Adult T-Cell/diagnostic imaging , Male , Prednisone/therapeutic use , Remission Induction , Renal Insufficiency/therapy , Tomography, X-Ray Computed , Vincristine/therapeutic useSubject(s)
Antibiotic Prophylaxis/adverse effects , Clostridioides difficile , Enterocolitis, Pseudomembranous/etiology , Aged , Aged, 80 and over , Diarrhea/etiology , Female , Humans , Male , Middle Aged , Neoplasms/surgery , Perioperative Care/adverse effects , Postoperative Complications/prevention & controlABSTRACT
A 40-year-old man undergoing allo-hematopoietic stem cell transplantation for chronic myelogenous leukemia and developing diarrhea was administered prophylactic antibiotics including levofloxacin, fluconazole, cotrimoxazole, and vancomycin. Stool specimens were positive for toxin A in enzyme immunoassay but negative for toxin B in cell culture assay with a neutralization test, indicating that toxin A detection was false-positive. Stool culture yielded enterotoxin producing Clostridium perfringens, not Clostridium difficile. Polymerase chain reaction (PCR) detected the gene encoding C. perfringens enterotoxin in DNA extracted from stool specimens, but not the toxin B gene. Laboratory tests for enterotoxic C. perfingens may therefore be necessary for diagnosing antibiotic-associated diarrhea when culture for C. difficile is negative.
Subject(s)
Anti-Bacterial Agents/adverse effects , Clostridium Infections/etiology , Clostridium perfringens , Diarrhea/etiology , Adult , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , MaleABSTRACT
We report a rare case of multiple myeloma that developed extramedullary plasmacytoma at the hilus of the liver causing obstructive jaundice. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy was quite useful in the diagnosis. A 71-year-old man was diagnosed with stage IIIA multiple myeloma in June 2007 based on osteolytic lesions, increased atypical plasma cells in the bone marrow, and monoclonal (M) protein of IgA-lambda, IgG-lambda, BJP-lambda type. M-protein was decreased by MP therapy following radiotherapy for the cervical lesion. However, in February 2008, M-protein started to increase again. The patient presented with obstructive jaundice in the middle of March. Abdominal ultrasound and MRI demonstrated a 12-mm mass at the hilus of the liver and the upper biliary tract dilatation, and a stent was placed across the bile duct stricture. EUS-FNA biopsy from the hepatic hilar mass showed multiple sheets of atypical plasma cells consistent with extramedullary plasmacytoma. The abdominal and intracranial mass did not respond to bortezomib therapy and gradually developed. Radiotherapy and high dose dexamethazone therapy were performed with little effect. The patient died in June 2008. To our knowledge, this is the first reported case of extramedullary plasmacytoma diagnosed by EUS-FNA.
Subject(s)
Biopsy, Fine-Needle , Endosonography , Liver Neoplasms/diagnosis , Liver Neoplasms/pathology , Multiple Myeloma , Neoplasms, Second Primary , Plasmacytoma/diagnosis , Plasmacytoma/pathology , Aged , Fatal Outcome , Humans , Jaundice, Obstructive/etiology , Liver Neoplasms/diagnostic imaging , Male , Neoplasm Recurrence, Local , Plasmacytoma/diagnostic imagingABSTRACT
A 62-year-old man presented with lymphocytosis, anemia, thrombocytopenia, abdominal lymphadenopathies, and gross splenomegaly. He had a high serum immunoglobulin M (IgM) of 1,150 mg/dl and IgM-kappa type monoclonal protein was detected. Bone marrow examination demonstrated massive infiltration of CD19+CD20+CD5-CD10-CD23-lymphoplasmacytic cells, and the diagnosis of Waldenstrom's macroglobulinemia (WM) was made. The serum levels of soluble interleukin-2 receptor and beta2-microglobulin were also elevated to 14,300 U/ml and 6.2 mg/l, respectively. The high tumor burden and aggressive clinical features prompted the initiation of CHOP therapy. After three courses of CHOP, the patient recovered from anemia and the serum IgM level decreased to 615 mg/dl. Then we administered rituximab in combination with CHOP (R-CHOP therapy). After an additional five courses of R-CHOP, bone marrow tumor cells, splenomegaly and lymphadenopathies entirely disappeared and IgM-type monoclonal protein also became negative on immunofixation studies. Thus, a complete response (CR) was achieved and the patient has remained in CR for 12 months. Although new therapeutic options for WM including combination chemotherapy have recently been explored, complete response rates defined by immunofixation remain low. Our case indicates that R-CHOP therapy is fully effective and tolerable for aggressive type WM.
Subject(s)
Antibodies, Monoclonal/administration & dosage , Antineoplastic Agents/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Waldenstrom Macroglobulinemia/drug therapy , Antibodies, Monoclonal, Murine-Derived , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cyclophosphamide/administration & dosage , Disease Progression , Doxorubicin/administration & dosage , Drug Administration Schedule , Humans , Male , Middle Aged , Prednisolone/administration & dosage , Rituximab , Splenomegaly/drug therapy , Splenomegaly/etiology , Treatment Outcome , Vincristine/administration & dosage , Waldenstrom Macroglobulinemia/complicationsABSTRACT
Here we report three cases of hepatitis B virus (HBV) reactivation after cessation of preemptive lamivudine therapy in B-cell lymphoma patients treated with rituximab plus CHOP (R-CHOP). Two patients received eight cycles of R-CHOP, and one received two cycles of R-CHOP followed by two courses of rituximab. As all the patients were HBV surface antigen (HBsAg) positive, lamivudine was administered simultaneously with R-CHOP to prevent virus reactivation. All the patients developed hepatitis due to HBV reactivation 6, 8 and 13 months after completion of chemotherapy, and 4, 2 and 2 months after cessation of lamivudine, respectively. They were treated with either lamivudine or entecavir and all achieved full recovery. When HBV carriers undergo immunosuppressive anticancer treatment, prophylactic antiviral therapy is well recognized as effective. However, the optimal method of prophylaxis has not yet been established. Since the introduction of rituximab, new problems such as delayed HBV reactivation from HBsAg positive patients and de novo hepatitis B from HBsAg negative patients have emerged. Guidelines for prophylactic antiviral therapy in the era of rituximab need to be established.
Subject(s)
Anti-HIV Agents/administration & dosage , Antibodies, Monoclonal/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carrier State/prevention & control , Carrier State/virology , Hepatitis B virus/physiology , Hepatitis B/prevention & control , Hepatitis B/virology , Lamivudine/administration & dosage , Lymphoma, B-Cell/drug therapy , Lymphoma, B-Cell/virology , Virus Activation , Adult , Aged , Antibodies, Monoclonal, Murine-Derived , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Female , Humans , Immunocompromised Host , Male , Middle Aged , Prednisolone/administration & dosage , Rituximab , Vincristine/administration & dosageABSTRACT
Extranodal natural killer (NK)/T cell lymphoma, nasal type, is a recently recognized distinct entity and the most common type of non-B cell extranodal lymphoma in Asia. This retrospective analysis studied the potential survival benefits of hematopoeitic stem cell transplantation (HSCT) compared with a historical control group. A total of 47 patients from 3 previously published series of HSCT were matched according to NK/T cell lymphoma International Prognostic Index (NKIPI) risk groups and disease status at transplantation with 107 patients from a historical control group for analysis. After a median follow-up of 116.5 months, the median survival time was not determined for the HSCT group, but it was 43.5 months for the control group (95% confidence interval [CI] = 6.7 to 80.3 months; P = .127, log-rank test). In patients who were in complete remission (CR) at the time of HSCT or at surveillance after remission, disease-specific survival rates were significantly higher in the HSCT group compared with the control group (disease-specific 5-year survival rate, 87.3% for HSCT vs 67.8% for non-HSCT; P = .027). In contrast, in subgroup analysis on non-CR patients at the time of HSCT or non-HSCT treatment, disease-specific survival rates were not significantly prolonged in the HSCT group compared with the control group (1-year survival rate, 66.7% for HSCT vs 28.6% for non-HSCT; P = .141). The impact of HSCT on the survival of all patients was significantly retained at the multivariate level with a 2.1-fold (95% CI =1.2- to 3.7-fold) reduced risk of death (P = .006). HSCT seems to confer a survival benefit in patients who attained CR on postremission consolidation therapy. These findings suggest that, in particular, patients in CR with high NKIPI risk scores at diagnosis should receive full consideration for HSCT.
Subject(s)
Hematopoietic Stem Cell Transplantation , Lymphoma, Extranodal NK-T-Cell/mortality , Lymphoma, Extranodal NK-T-Cell/therapy , Adolescent , Aged , Case-Control Studies , Disease-Free Survival , Asia, Eastern , Female , Follow-Up Studies , Humans , Lymphoma, Extranodal NK-T-Cell/diagnosis , Male , Middle Aged , Risk Factors , Survival Rate , Transplantation, AutologousABSTRACT
Although Clostridium difficile colitis is a common problem during chemotherapy, fulminant expression is rarely observed. Here, we describe a 68-year-old woman who developed fatal colitis due to Clostridium difficile infection. The patient was treated with CHOP therapy for relapsed lymphoma. In the nadir phase, she developed severe bloody diarrhea with a high fever and died within 12 hours after the beginning of symptoms. Clostridium difficile was identified in her stool and an autopsy showed hemorrhagic necrosis on the whole colon and rectum. This case demonstrates the substantial incidence of an unexpected feature with Clostridium difficile infection even with popular chemotherapy.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Clostridioides difficile/isolation & purification , Enterocolitis, Pseudomembranous/microbiology , Immunocompromised Host , Lymphoma, B-Cell/drug therapy , Aged , Autopsy , Cyclophosphamide/adverse effects , Disease Progression , Doxorubicin/adverse effects , Enterocolitis, Pseudomembranous/physiopathology , Fatal Outcome , Female , Humans , Lymphoma, B-Cell/diagnosis , Lymphoma, B-Cell/immunology , Prednisolone/adverse effects , Risk Assessment , Severity of Illness Index , Vincristine/adverse effectsABSTRACT
The fibroblast growth factors (FGFs) are involved in hematopoiesis and tumorigenesis. However, little is known about the contribution of the FGFs identified within the past 10 years to leukemogenesis. To elucidate whether these FGFs (FGF-8, -9, -10, -11, -12, -13, -14, -16, -17, -18, -19, -20, and -21) are expressed in leukemic cells, we performed RT-PCR analyses using 28 cell lines. The members of a fetal-oncogenic subfamily, FGF-8/-17/-18, were often expressed (53.5%, 25.0%, and 32.1%) with the co-expression of their receptors. Realtime quantitative-PCR analysis showed that FGF-8/-17 were aberrantly expressed in patients with acute leukemia. Moreover, cell proliferation assays revealed the proliferation activity of FGF-17 on leukemic cells expressing its receptors. These results demonstrated that certain recently identified FGFs play an important role in the growth of leukemic cells, possibly with an autocrine mode of action, and that these FGFs will become novel biomarkers for hematopoietic tumors.
Subject(s)
Fibroblast Growth Factors/metabolism , Hematologic Neoplasms/metabolism , Base Sequence , Biomarkers, Tumor/genetics , Biomarkers, Tumor/metabolism , Cell Line, Tumor , DNA Primers , Fibroblast Growth Factors/genetics , Hematologic Neoplasms/genetics , Hematologic Neoplasms/pathology , Humans , Reverse Transcriptase Polymerase Chain ReactionABSTRACT
Therapy-related acute myeloid leukemia (t-AML) with t(8;21) and therapy-related myelodysplastic syndrome (t-MDS) with trisomy 1q due to der(1;7) developed in the same patient with T-cell lymphoma at intervals of six years. After the development of t-MDS with trisomy 1q, during complete remission of t-AML, the number of megakaryoblasts increased to maximally 74% of leukocytes in the blood. This is a very rare case of two separate therapy-related myeloid malignancies (early t-AML and late t-MDS) and is also a notable case of t-MDS with trisomy 1q due to der(1;7) accompanied by megakaryoblastic proliferation.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Chromosomes, Human, Pair 1 , Leukemia, Myeloid, Acute/chemically induced , Lymphoma, T-Cell/drug therapy , Myelodysplastic Syndromes/chemically induced , Trisomy/genetics , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biopsy, Needle , Chromosome Aberrations , Disease Progression , Disease Susceptibility , Fatal Outcome , Female , Humans , Immunohistochemistry , Leukemia, Myeloid, Acute/complications , Leukemia, Myeloid, Acute/pathology , Lymphoma, T-Cell/complications , Lymphoma, T-Cell/diagnosis , Myelodysplastic Syndromes/complications , Myelodysplastic Syndromes/pathology , Risk Assessment , Trisomy/diagnosisABSTRACT
Between February and July 2001, 15 patients were diagnosed as Clostridium difficile-associated diarrhea in a ward of hematological neoplasm and lung cancer in a cancer center hospital. Of these 15 patients, 10 had malignant lymphoma, and 12 and 11 had exposure to antimicrobial agents and cancer chemotherapy, respectively, before the onset of diarrhea. Toxin A-positive, toxin B-positive (A+ B+) C. difficile was recovered from five patients and the remaining 10 patients suffered from diarrhea caused by toxin A-negative, toxin B-positive (A- B+) strains. All of the 10A- B+ isolates represented an identical banding pattern by PCR ribotyping and classified into one type (two subtypes) by pulsed field gel electrophoresis typing, indicating that a nosocomial outbreak of diarrhea caused by A- B+ C. difficile occurred among the patients hospitalized on this ward. Detection of toxin A in stool specimens by a toxin A detection kit was performed on 14 patients. Although two patients who carried A+ B+ strains were positive for toxin A assay, toxin A detection test was negative in 12 patients including 10 patients with A- B+ C. difficile infection. Diagnosis of C. difficile-associated diarrhea by combination of toxin A assay in feces and culture of C. difficile could successfully lead to recognition of an outbreak caused by A- B+ C. difficile in a cancer center hospital.