Herpes simplex virus infection in adult patients after unrelated cord blood transplantation: a single-institute experience in Japan.

Herpes simplex virus (HSV) infection in adult patients who underwent cord blood transplantation (CBT) from unrelated donors was studied. None of nine HSV-seronegative patients developed HSV disease after CBT. Of 28 HSV-seropositive patients, seven (25%) developed HSV disease at a median of 92 days after CBT (range, 52-239 days). The cumulative incidence of HSV disease in HSV-seropositive patients was 27% at 12 months after CBT. The manifestations of HSV disease included gingivostomatitis (three patients), herpes labialis (two patients), localized herpes facialis of the nose (one patient), and disseminated eczema herpeticum (one patient). HSV disease recurred in two patients as gingivostomatitis and disseminated eczema herpeticum. All the patients responded to antiviral therapy. The presence of grade II-IV acute graft-versus-host disease (GVHD) was significantly associated with a higher rate of HSV disease after CBT (51 vs 8%, P=0.015). These results suggest that the recovery of HSV-specific immune responses is delayed in patients who develop grade II-IV acute GVHD after CBT.

Remission of acute myeloblastic leukemia after severe pneumonia treated with high-dose methylprednisolone.

We report a case of acute myeloblastic leukemia (AML)-M2 (by French-American-British classification) with t(8;21) (q22:q22) that was complicated with severe pneumonia. The patient tested positive by fluorescence in situ hybridization (FISH) for AML1 splitting and positive by reverse transcriptase polymerase chain reaction (RT-PCR) for chimeric AML1/MTG8 messenger RNA (mRNA), which indicated splitting of the MTG8 gene on chromosome 8 (q22) and the AMLI gene on chromosome 22 (q22). High-dose methylprednisolone was administered, and the leukemic cells disappeared without chemotherapy, although dysplastic hematopoietic cells were observed transiently after the first therapy. After the disappearance of leukemic cells, FISH for AML1 splitting was negative, and real-time PCR results for quantitative chimeric AML1/ MTG8 mRNA were less than the detectable level, however, RT-PCR results for AML1/MTG8 mRNA remained positive. These findings suggest that the patient acquired morphological, cytogenetic. and possibly molecular genetic remission by the synergistic effects of severe infection and high-dose methylprednisolone.

[Simultaneous occurrence of Basedow's disease and autoimmune hemolytic anemia].

A 43-year-old man with a 7-year history of low antinuclear factor titer developed Basedow's disease and autoimmune hemolytic anemia (AIHA) simultaneously. Such simultaneous occurrence of these autoimmune disorders has been reported only rarely. Administration of methimazole for Basedow's disease and prednisolone for AIHA was effective for ameliorating both conditions. The patient had the HLA DR2, DRB1 1501 and DPB1 0501 alleles, suggesting a genetic predisposition for these diseases.

Two cases of non-Hodgkin's lymphoma in first degree relatives.

Two cases of non-Hodgkin's lymphoma (NHL) generated within 6 months in first degree relatives, a father and a son, are presented. The NHL was a diffuse large B-cell type in the father and a small cleaved follicular type in the son. Cytogenetic and molecular studies of the lymphoma cells revealed the rearrangement of the immunoglobulin heavy chain (JH) gene in both patients, the mutation of p53 gene in the father and t(14; 18) (q32; q21) in the son. Both patients had low serum immunoglobulin levels. It is not known whether the occurrence of NHL in this family was incidental or pathogenetically related, since there was no clear common molecular abnormality between the father and the son. The pathogenetic mechanism of this familial occurrence of NHL is discussed.