Use of mycophenolate mofetil and a calcineurin inhibitor in allogeneic hematopoietic stem-cell transplantation from HLA-matched siblings or unrelated volunteer donors: Japanese multicenter phase II trials
PubMed | National Hospital Organization, Tohoku University, National Cancer Center Hospital, Mukogawa Women's University and 7 more.
Type: | Journal: International journal of hematology | Year: 2016
To test the feasibility of mycophenolate mofetil (MMF) for graft-versus-host disease (GVHD) prophylaxis in Japanese patients, we conducted two multicenter prospective phase II trials of allogeneic hematopoietic stem-cell transplantation (HSCT) from HLA-matched related donors (MRD group) with MMF and cyclosporine or HLA 7-8/8 allele-matched unrelated bone-marrow donors (URD group) with MMF and tacrolimus. The cumulative incidences of grade II-IV acute GVHD on day 100, which was the primary endpoint in these trials, were 45.0% (90% CI 25.8-62.5) and 25.8% (90% CI 13.9-39.5) in the MRD (n=20) and URD (n=31) groups, respectively. The rates of 3-year overall survival and non-relapse mortality were 80.0 and 15.0% in the MRD group and 74.2 and 6.5% in the URD group, respectively. GVHD prophylaxis with MMF may lead to a lower incidence of severe mucositis and faster neutrophil engraftment compared to that with methotrexate. A pharmacokinetics study of mycophenolic acid (MPA) showed that a relatively higher plasma concentration of MPA was associated with a lower incidence of acute GVHD. In conclusion, the results of these studies suggest that GVHD prophylaxis with MMF may be useful as an alternative in Japanese patients who may benefit from faster engraftment or less severe mucositis after allogeneic HSCT.
Akiba J.,Kurume University |
Harada H.,Seichokai Fuchu Hospital |
Kawahara A.,Kurume University |
Todoroki K.,Kurume University |
And 2 more authors.
Pathology International | Year: 2013
Metastasizing pleomorphic adenoma (MPA) is the inexplicable metastasis of a histologically benign pleomorphic adenoma (PA). Approximately 50 cases have been reported. A 62-year-old woman noticed pain in the upper molar area. Her medical history included an operation for PA in the hard palate that was performed 20 years previously. On imaging, four relatively well-defined lesions were demonstrated in the maxillary bone. She underwent an operation for these lesions. Each lesion revealed the same histological features. Morphological findings displayed typical features of PA. Immunohistochemical staining showed that tumor cells of both primary and metastasizing lesions were positive for pleomorphic adenoma gene (PLAG) 1, which is a sensitive marker for PA. Gene fusions involving PLAG1 were examined by reverse transcription-polymerase chain reaction. However, no gene rearrangements of PLAG1 were found. We report here on a case of MPA in the maxillary bone, which appeared 20 years after resection of the primary tumor and review the relevant literature. © 2013 Japanese Society of Pathology and Wiley Publishing Asia Pty Ltd.
PubMed | Kurume University and Seichokai Fuchu Hospital
Type: Journal Article | Journal: Pathology international | Year: 2016
Primary thymic adenocarcinoma is extremely rare. Moreover, thymic pure epithelial benign neoplasms are extremely rare. We encountered a cystic tumor almost purely composed of goblet cell-like mucus-producing cells of the thymus. A mass lesion of the mediastinum was detected in a 54-year-old man. The gross specimen presented a unilocular cystic lesion containing abundant mucin, measuring 8 5.5 4.5cm. Microscopic examination revealed a cystic tumor consisting of bland mucus-producing cells resembling goblet cells and forming tiny daughter cysts within the dense fibrous capsule. No destructive growth or infiltration into surrounding thymic tissue was observed. Papillary growth was found in a small focus. Immunohistochemically, tumor cells were positive for cytokeratin 20 and caudal type homobox 2, which are representative markers of enteric differentiation. The patient has been well without any recurrence for approximately ten years after the operation. Thus, the tumor should be regarded as a mucinous cystic tumor in the thymus. Very recently, thymic adenocarcinoma with enteric differentiation was proposed as a novel subtype of thymic carcinoma. This case could be regarded as a benign counterpart of adenocarcinoma of the thymus, enteric type. A further follow-up study is required to confirm the exact biological behavior of this tumor.
A multicenter clinical study evaluating the confirmed complete molecular response rate in imatinib-treated patients with chronic phase chronic myeloid leukemia by using the international scale of real-time quantitative polymerase chain reaction
Shinohara Y.,Akita University |
Takahashi N.,Akita University |
Nishiwaki K.,Jikei University School of Medicine |
Hino M.,Osaka City University |
And 19 more authors.
Haematologica | Year: 2013
Achievement of complete molecular response in patients with chronic phase chronic myeloid leukemia has been recognized as an important milestone in therapy cessation and treatment-free remission; the identification of predictors of complete molecular response in these patients is, therefore, important. This study evaluated complete molecular response rates in imatinib-treated chronic phase chronic myeloid leukemia patients with major molecular response by using the international standardization for quantitative polymerase chain reaction analysis of the breakpoint cluster region-Abelson1 gene. The correlation of complete molecular response with various clinical, pharmacokinetic, and immunological parameters was determined. Complete molecular response was observed in 75/152 patients (49.3%). In the univariate analysis, Sokal score, median time to major molecular response, ABCG2 421C>A, and regulatory T cells were significantly lower in chronic phase chronic myeloid leukemia patients with complete molecular response than in those without complete molecular response. In the multivariate analysis, duration of imatinib treatment (odds ratio: 1.0287, P=0.0003), time to major molecular response from imatinib therapy (odds ratio: 0.9652, P=0.0020), and ABCG2 421C/C genotype (odds ratio: 0.3953, P=0.0284) were independent predictors of complete molecular response. In contrast, number of natural killer cells, BIM deletion polymorphisms, and plasma trough imatinib concentration were not significantly associated with achieving a complete molecular response. Several predictive markers for achieving complete molecular response were identified in this study. According to our findings, some chronic myeloid leukemia patients treated with imatinib may benefit from a switch to second-generation tyrosine kinase inhibitors. © 2013 Ferrata Storti Foundation.
Sogo D.,Seichokai Fuchu Hospital |
Nakazawa T.,Seichokai Fuchu Hospital |
Nishio W.,Seichokai Fuchu Hospital |
Fukukita K.,Seichokai Fuchu Hospital
Japanese Journal of Anesthesiology | Year: 2014
General anesthesia was successfully performed in an 86-year-old woman with severe tracheobronchomalacia. Tracheobronchomalacia in adult is a very rare disease, characterized by weakness of the trachea and bronchi, causing luminal narrowing during expiration. The patient had laparoscopic cholecystectomy. We used propofol remifentanil and rocuronium for induction of anesthesia. For maintenance of anesthesia oxygen, air, propofol fentanyl and remifentanil were used. After the end of operation, we used sugammadex to reverse neuromuscular blockade by rocuronium. The patient showed spontaneous breathing and good awareness, and we extubated. The patient did well and was discharged from the hospital 3 days after the operation. In this case, no special care such as postoperative CPAP was necessary, but normally, general anesthesia for a patient with tracheobronchomalacia requires attention. We gave general anesthesia satisfactorily in a patient with tracheobronchomalacia.
Kumura T.,Seichokai Fuchu Hospital
[Rinshō ketsueki] The Japanese journal of clinical hematology | Year: 2011
Recombinant human soluble thrombomodulin (rTM) is a new drug for the treatment of disseminated intravascular coagulation (DIC), although the effects on obstetric DIC have not yet been fully elucidated. We report herein three patients with obstetric DIC caused by placental abruption, hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, and atonic bleeding, respectively. In all three cases, treatment with rTM proved successful, suggesting that rTM is an efficient method for treating obstetric DIC.
PubMed | Seichokai Fuchu Hospital
Type: Journal Article | Journal: Acta haematologica | Year: 2016
A high expression of Wilms tumor 1 (WT1) mRNA occurs in most cases of acute leukemia and myelodysplastic syndrome (MDS). Although there are many reports suggesting that acute myeloid leukemia patients with high expression levels of WT1 mRNA have a relatively poor long-term survival, there are few reports addressing the relationship between WT1 levels and prognosis in MDS.We retrospectively analyzed 42 elderly patients with MDS whose WT1 levels at diagnosis were available, and we assessed the relationships between WT1 levels in peripheral blood and preexisting prognostic factors such as World Health Organization prognostic scores and Revised International Prognostic Scoring System risk categories, bone marrow blast percentages, and chromosomal abnormalities linked to a poor prognosis. We also evaluated the relationship between WT1 levels and prognosis.WT1 levels were significantly different between high- and low-risk MDS patients (p < 0.05). There was a trend towards a significant difference between those with and those without poor prognostic chromosomal rearrangements (p = 0.051). Moreover, the overall survival and progression-free survival were significantly worse in elderly patients with higher levels of WT1 (p = 0.00039 and p = 0.00077, respectively).The WT1 mRNA expression level at diagnosis may be a significant independent prognostic marker for elderly patients with MDS.
PubMed | Seichokai Fuchu Hospital
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2014
A 7 1-year-old man was admitted to our hospital with leukocytosis and anemia. Chronic myelomonocytic leukemia (CMML)harboring del(20q)was diagnosed by peripheral blood examination and bone marrow aspiration. The patient was subsequently treated with azacitidine, which resulted in rapid disappearance of monocytosis and resolved his dependency on red cell transfusion. With regard to the chromosomal abnormality, although del(20q)is estimated to be encountered in approximately 0.7-1.0% of all CMML cases, its significance in prognosis has not been fully analyzed. Hence, more such cases need to be evaluated to elucidate the therapeutic outcome of CMML involving del(20q). In addition, the Wilms tumor-1(WT 1)level in the patient gradually decreased after the initiation of azacitidine therapy. This phenomenon of WT1 decrease synchronizing with the patients clinical improvement might reflect therapeutic efficacy with regard to the clinical course, as had been observed in acute myeloid leukemia and myelodysplastic syndrome.
PubMed | Seichokai Fuchu Hospital
Type: Case Reports | Journal: [Rinsho ketsueki] The Japanese journal of clinical hematology | Year: 2016
A 59-year-old man diagnosed with the chronic phase of chronic myeloid leukemia (CML) in June 2011 was started on dasatinib (100 mg/day). He had no signs of pleural effusion (PE) or right heart failure before treatment, but symptoms of PE and dyspnea (New York Heart Association class III) appeared in January 2013 and May 2014, respectively. Doppler transthoracic echocardiography and right heart catheterization revealed pulmonary arterial hypertension (PAH) with an estimated pulmonary artery systolic pressure (PASP) of 80 mmHg and estimated mean pulmonary artery pressure of 29 mmHg. Rheumatoid factor, antinuclear antibody, dsDNA antibody, and SCL70 were not elevated, and computed tomography confirmed the absence of a pulmonary embolism. Therefore, dasatinib-related PAH was diagnosed and treatment with this agent was discontinued. The PASP had decreased to 51 and 40 mmHg at one month and one year, respectively, after dasatinib discontinuation. This patient developed PAH while receiving dasatinib administration and only discontinuation of this agent improved his symptoms. The possibility that dasatinib can cause PAH must be considered before administering this agent to patients with CML.
PubMed | Seichokai Fuchu Hospital
Type: | Journal: Case reports in hematology | Year: 2016
The etiologies of secondary idiopathic thrombocytopenic purpura (ITP) include infection, autoimmune disease, and immunodeficiency. We report the cases of three elderly patients who developed ITP after receiving influenza vaccinations. The platelet count of an 81-year-old woman fell to 27,000/L after she received an influenza vaccination. A 75-year-old woman developed thrombocytopenia (5,000 platelets/L) after receiving an influenza vaccination. An 87-year-old woman whose laboratory test values included a platelet count of 2,000/L experienced genital bleeding after receiving an influenza vaccination. After Helicobacter pylori (HP) eradication or corticosteroid treatment, all of the patients platelet counts increased. Influenza vaccination is an underlying etiology of ITP in elderly patients. HP eradication or corticosteroid treatment is effective for these patients. Clinicians should be aware of the association between ITP and influenza vaccinations.