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1.
Gan To Kagaku Ryoho ; 48(6): 815-819, 2021 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-34139730

RESUMO

In elderly patients aged≥80 with newly diagnosed multiple myeloma(NDMM), the optimal initial doses of bortezomib (Bor)and lenalidomide(Len)remain unclear. We performed a retrospective analysis that included 20 patients with NDMM aged≥80 years who underwent treatment with Bor or Len at our hospital from July 2010 to December 2019. Among the patients treated with Bor, the median time to next treatment(TTNT)was 4.2 months, and the median dose was 1.0 mg/m2 per injection. While patients with International Staging System(ISS)Ⅲ or an estimated glomerular filtration rate of < 40 mL/ min/1.73 m2 required dose reductions, dose intensity did not significantly affect TTNT. Among the patients treated with Len, the median TTNT was 14.6 months, and the median dose of Len was 10.0 mg/day. All patients who started with6le;10 mg Len continued the initial dose; the others required a dose reduction. Treatment was discontinued in 2 patients because of disease progression and in other 15 patients because of adverse events(AEs). In conclusion, initial doses of Bor at 1.0 mg/ m2 per injection and Len at 10 mg per day may provide potent disease control and permit continuing treatment with few AEs in elderly patients with MM.


Assuntos
Mieloma Múltiplo , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bortezomib/efeitos adversos , Dexametasona/uso terapêutico , Humanos , Lenalidomida/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Estudos Retrospectivos
2.
Acta Haematol ; 143(5): 478-480, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31522179

RESUMO

Acquired factor V inhibitor (AFVI) is a rare coagulopathy. It may be triggered by specific antigens such as antibiotics. We herein report the first case of AFVI after treatment with prasugrel hydrochloride (prasugrel) in an 80-year-old male who underwent percutaneous coronary intervention because of angina pectoris 6 years ago and was initiated on aspirin and ticlopidine hydrochloride. He was switched from ticlopidine hydrochloride to prasugrel before undergoing percutaneous coronary intervention for myocardial infarction. Fifteen days later, he developed sudden nasal hemorrhage, hematuria, and systemic purpura. Coagulation tests revealed prolonged prothrombin time-international normalized ratio (11.35) and activated partial thromboplastin time (170 s). The coagulation factor profile revealed a decreased FV activity (1%). The Bethesda assay for FV inhibitor was positive. AFVI was diagnosed; prasugrel was immediately discontinued, and administration of recombinant activated factor VII and prednisolone were initiated. Hemorrhagic symptoms immediately disappeared; FV activity improved, and the FV inhibitor titer was normalized.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico , Inibidores dos Fatores de Coagulação Sanguínea/sangue , Fator V/antagonistas & inibidores , Hemorragia/etiologia , Cloridrato de Prasugrel/efeitos adversos , Idoso de 80 Anos ou mais , Fator V/metabolismo , Fator VIIa/uso terapêutico , Hemoglobinas/análise , Hemorragia/diagnóstico , Humanos , Coeficiente Internacional Normatizado , Masculino , Tempo de Tromboplastina Parcial , Cloridrato de Prasugrel/uso terapêutico , Proteínas Recombinantes/uso terapêutico
3.
Gan To Kagaku Ryoho ; 47(7): 1097-1099, 2020 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-32668860

RESUMO

A 75-year-old woman presented to our hospital with a history of fever, cervical lymphadenopathy, and fatigue. Computed tomography(CT)revealed systemic lymphadenopathy with prominent splenomegaly. Axillary lymph node biopsy results revealed diffuse proliferation of atypical lymphoid cells with arborizing high endothelial venules. Immunohistochemical staining was positive for CD3, CD5, and CD10, but negative for CD20 and CD79a. Given these findings, a diagnosis of angioimmunoblastic T-cell lymphoma(AITL)was made. Due to the extremely high tumor burden, pre-therapy with corticosteroids was initiated. However, the patient suddenly went into hemorrhagic shock. Contrast-enhanced CT revealed abdominal bleeding due to splenic rupture. Bleeding was rapidly controlled using transcatheter arterial embolization(TAE). Five days after TAE, mini-CHOP therapy was initiated. Splenomegaly is common in hematologic disease. Owing to the lethality of the condition, in cases of progressive anemia with splenomegaly in patients with hematologic disease, the possibility of splenic rupture should be considered. Since TAE carries no risk of post-splenectomy infection and allows timely resumption of chemotherapy, it could be considered as one of the preferred treatment choices for splenic rupture in hemodynamically unstable patients.


Assuntos
Embolização Terapêutica , Linfoma de Células T , Neoplasias Esplênicas/complicações , Ruptura Esplênica , Idoso , Feminino , Hemorragia , Humanos , Linfoma de Células T/complicações , Ruptura Espontânea , Esplenectomia , Ruptura Esplênica/etiologia
4.
Gan To Kagaku Ryoho ; 46(6): 1043-1047, 2019 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-31273172

RESUMO

Ixazomib, an oral proteasome inhibitor, has been demonstrated to significantly improve progression-free survival(PFS)in patients with relapsed and refractory multiple myeloma(RRMM). Ixazomib has recently been approved in Japan, but its effectiveness and safety have not been fully investigated in a clinical setting. We retrospectively analyzed the records of 28 patients with RRMM who were treated with ixazomib in combination with lenalidomide and dexamethasone(IRd)in our institution between June 2017 and June 2018. The median patient age was 75 years at the start of IRd therapy. In total, 46.4% of the patients had previously received more than 3 treatment lines, prior to this study. The overall response rate was 37.0%, and the median PFS was 286 days. Over a median of 5 cycles of IRd, Grade 3 to 4 leukocytopenia, thrombocytopenia, and anemia occurred in 17.9%, 14.3%, and 32.1% of the patients, respectively; these incidences were higher than in previous reports. The severity of diarrhea or rash, however, was comparable with that in other studies. Patients with an estimated glomerular filtration rate of less than 50mL/min/1.73m2 received a lower cumulative dose of ixazomib and lenalidomide than those with other rates. PFS did not significantly differ between the 2 groups. Although it is necessary to carefully observe IRdtreated patients for hematological toxicity, IRd therapy is effective in heavily pretreated RRMM patients. It might be reasonable to reduce the dose of ixazomib in patients with renal impairment.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Mieloma Múltiplo , Compostos de Boro , Dexametasona , Glicina/análogos & derivados , Humanos , Japão , Lenalidomida , Mieloma Múltiplo/tratamento farmacológico , Estudos Retrospectivos
5.
Rinsho Ketsueki ; 58(7): 772-775, 2017.
Artigo em Japonês | MEDLINE | ID: mdl-28781273

RESUMO

A 91-year-old male with fever of unknown origin was referred to our department. 18F-FDG PET/CT scan revealed a high FDG uptake in abdominal lymph nodes and multiple bones. The bone marrow biopsy showed fibrosis and atypical megakaryocytes, which were consistent with myelofibrosis. The patient died 28 days after admission and an autopsy was performed. The lymph nodes and bone marrow specimens revealed scattered Reed-Sternberg cells and a dearth of lymphoid cells with fibrosis. A final diagnosis of lymphocyte-depleted classical Hodgkin lymphoma (LDCHL) with bone marrow involvement was made. It is necessary to identify LDCHL during differential diagnosis for bone marrow fibrosis accompanied by lymphadenopathy.


Assuntos
Doença de Hodgkin/diagnóstico , Doença de Hodgkin/patologia , Mielofibrose Primária/diagnóstico , Mielofibrose Primária/patologia , Idoso de 80 Anos ou mais , Autopsia , Evolução Fatal , Doença de Hodgkin/complicações , Humanos , Masculino , Invasividade Neoplásica , Mielofibrose Primária/etiologia
6.
Int J Hematol ; 119(1): 88-92, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38010569

RESUMO

Myeloid/natural killer (NK) cell precursor acute leukemia (MNKPL) is a rare leukemia subtype that possibly originates from precursor NK cells. The disease has a poor prognosis, and information on its treatment is lacking. We herein report the first case of a 46-year-old woman with MNKPL who was refractory to two lines of acute myeloid leukemia (AML)-type intensive chemotherapy but was successfully treated with venetoclax and azacytidine (VEN/AZA). She was diagnosed with MNKPL based on the conformations of immature lymphoblastoid morphology without myeloperoxidase reactivity that showed a CD7/CD33/CD34/CD56/HLA-DR positive phenotype and extramedullary regions. The disease was refractory to induction therapy with daunorubicin and cytarabine (DNR/Ara-C) and to reinduction therapy with mitoxantrone, etoposide, and cytarabine (MEC). After two lines of induction chemotherapy, massive pericardial and pleural effusion was found, and was suspected to be extramedullary lesions. The patient developed cardiac tamponade and required pericardiocentesis. Thus, VEN/AZA was administered as third-line therapy. After two cycles of VEN/AZA, the pericardial and pleural effusion disappeared, and complete remission was achieved. The patient received post-transplant cyclophosphamide-based haploidentical transplantation and has stayed relapse-free as of her last follow-up examination 2 years after diagnosis.


Assuntos
Leucemia Mieloide Aguda , Derrame Pleural , Humanos , Feminino , Pessoa de Meia-Idade , Células Matadoras Naturais/patologia , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/patologia , Citarabina , Doença Aguda , Derrame Pleural/patologia , Azacitidina/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
7.
Clin Case Rep ; 9(5): e04126, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34026165

RESUMO

Low-dose imatinib with monitoring of drug concentrations in blood may successfully control Philadelphia chromosome-positive mixed phenotype acute leukemia (Ph+MPAL), particularly in elderly patients with comorbidities.

8.
Ann Clin Lab Sci ; 50(3): 333-341, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32581022

RESUMO

The morphological classification of multiple myeloma (MM) has long been known to have an impact on its clinical course. We retrospectively analyzed 30 cases of newly diagnosed MM initially treated with bortezomib or lenalidomide between November 2014 and November 2018. The morphological bone marrow types were assessed on the basis of the Greipp classification. The patients' median age was 74.5 years (range, 49-88), and the male-to-female ratio was 0.67. The International Staging System stages were as follows: stages I, II, and III accounted for 3.3%, 46.7%, and 50.0% of patients, respectively. The M-proteins were IgG (n=21) and non-IgG (n=9). The median progression free survival (PFS) was not reached. The proportion of plasma, immature, and plasmablastic cells in the bone marrow was significantly affected by PFS. When scored with 1 point each, PFS could be stratified into three groups. All patients who had ≥5% of immature cells had a complex karyotype. This study shows that the visual morphological classification of plasma cells is an important prognostic factor even when bortezomib or lenalidomide is used as induction therapy. Further research is expected to reveal the optimal treatment strategy for immature and plasmablastic MM.


Assuntos
Células da Medula Óssea/patologia , Mieloma Múltiplo/metabolismo , Mieloma Múltiplo/patologia , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Medula Óssea , Bortezomib/administração & dosagem , Bortezomib/uso terapêutico , Intervalo Livre de Doença , Feminino , Humanos , Lenalidomida/administração & dosagem , Lenalidomida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/tratamento farmacológico , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
9.
Gan To Kagaku Ryoho ; 36(11): 1931-4, 2009 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-19920404

RESUMO

A 54-year-old female patient visited our hospital as an outpatient in August 2008 for her growing mass thigh, without pain, redness or fever. She had suffered discomfort from that swelling since she had been diagnosed with erysipelas by a dermatologist she had visited 6 months before and received some medication. Suspicious of a subcutaneous soft tissue tumor, we performed a biopsy, and histological examination of the lesion indicated malignant lymphoma (follicular lymphoma grade 2). PET-CT (as of September, 2008) showed abnormal migration at the right inguinocrural and right external iliac lymph nodes. In view of her age and the that rapid exacerbation, we considered chemotherapy (rituximab, cyclophosphamide, adriamycin, vincristine and prednisolone: R-CHOP) and involved field radiotherapy (IFRT) better to perform than 'watchful wait'. PET-CT (as of November, 2008) after 3 courses of R-CHOP therapy showed abnormal migration had been significantly improved (complete remission on PET-CT) and completely disappeared in the right external iliac lymph nodes. For long-term prognosis and prophylaxis of recurrence, we then added 2 courses of chemotherapy (rituximab alone) and IFRT (30 Gy/20 Fr) as radical therapy. She is now doing well and visits our hospital once a month for follow-up after achieving CR with RECIST guideline.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma Folicular/terapia , Antibióticos Antineoplásicos/administração & dosagem , Antineoplásicos Alquilantes/administração & dosagem , Antineoplásicos Hormonais/administração & dosagem , Antineoplásicos Fitogênicos/administração & dosagem , Terapia Combinada , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Prednisolona/administração & dosagem , Indução de Remissão , Vincristina/administração & dosagem
10.
Case Rep Hematol ; 2019: 1816287, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31183224

RESUMO

Carfilzomib (CFZ) improves progression-free survival for patients with relapsed or refractory multiple myeloma (MM) but has shown higher frequency of cardiovascular adverse events (CVAEs) than other proteasome inhibitors. We report the first autopsy case of acute death from cardiac failure shortly after administration of carfilzomib. A 74-year-old female was diagnosed with IgA MM after a 2-year period of smoldering MM. She was refractory to both bortezomib plus dexamethasone and lenalidomide plus dexamethasone therapies, so she subsequently received CFZ in combination with lenalidomide and dexamethasone. The day after the start of the therapy, she complained of severe dyspnea with a significant decline in left ventricular ejection fraction. Her acute cardiac failure rapidly progressed, and she died on day 7 of the start of CFZ. The autopsy showed invasion of inflammatory cells between the myocardial cells and very little myocardial necrosis. There was no obvious thrombus in the coronary artery of the heart, and no infarction or amyloid deposition was observed in the myocardium. Pathological findings of hypersensitivity myocarditis, a drug-induced cardiomyopathy, appeared to agree with this case except for absence of an eosinophilic infiltration of the myocardium. A CFZ-induced CVAE is generally considered reversible. However, rapidly progressing fatal heart failure like in our case is rare. To characterize CFZ-associated CVAE, further case collection is needed.

11.
Clin Lymphoma Myeloma Leuk ; 19(12): 799-805, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31648956

RESUMO

BACKGROUND: We investigated the prognostic effects of frailty and its association with comorbidity in patients with myelodysplastic syndrome (MDS). PATIENTS AND METHODS: This retrospective analysis included 118 consecutive patients diagnosed with MDS. Frailty was evaluated using the clinical frailty scale (CFS). Comorbidity was classified using the Charlson comorbidity index (CCI) and MDS comorbidity index (MDS-CI). RESULTS: On multivariate analysis, CFS (≥ 5 vs. < 5; hazard ratio [HR], 3.37; P = .002), CCI (≥ 2 vs. < 2; HR, 2.59; P = .002), and Revised International Prognostic Scoring System (IPSS-R) category (HR, 2.1; P = .009) were independently predictive of overall survival (OS). One-year OS of patients with CFS ≥ 5 or CCI ≥ 2 were significantly worse compared with those with CFS < 5 or CCI < 2 (55% vs. 91%; P < .001; 46% vs. 91%; P < .001, respectively). OS was clearly stratified into 3 groups according to CFS (≥ 5 vs. < 5) and CCI (≥ 2 vs. < 2; P < .001). When comparing these 3 groups, the incidence of infection-related mortality progressively increased with CFS ≥ 5 and/or CCI ≥ 2 (P < .001). This effect was more obvious in patients with lower IPSS-R. CONCLUSION: The present study suggests frailty and comorbidity may be patient-related, independent predictive factors of poor prognosis. This could probably be attributed to increasing infection-related mortality with frailty and comorbidity. Combining the evaluation of frailty and comorbidity with IPSS-R might aid in more precise prediction of OS, especially in patients with low risk of MDS.


Assuntos
Fragilidade/epidemiologia , Infecções/epidemiologia , Síndromes Mielodisplásicas/epidemiologia , Idoso , Comorbidade , Feminino , Humanos , Infecções/etiologia , Infecções/mortalidade , Japão/epidemiologia , Masculino , Mortalidade , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/mortalidade , Síndromes Mielodisplásicas/terapia , Prognóstico , Fatores de Risco , Análise de Sobrevida
12.
Clin Lymphoma Myeloma Leuk ; 16(8): 434-41, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27263047

RESUMO

BACKGROUND: Increasing evidence suggests that decreased skeletal muscle mass (sarcopenia) or adipose tissue assessed using computed tomography (CT) predicts negative outcomes in patients with solid tumors. However, the prognostic value of such an assessment in multiple myeloma (MM) remains unknown. PATIENTS AND METHODS: Consecutive patients with newly diagnosed symptomatic MM were retrospectively analyzed. The cross-sectional area of skeletal muscles and subcutaneous or visceral adipose tissue was measured using CT. Body composition indexes (skeletal muscle index, subcutaneous adipose tissue index [SAI], and visceral adipose tissue index) were calculated. The association between these indexes and overall survival (OS) was examined. RESULTS: Of 56 evaluable patients, 37 (66%) had sarcopenia. The 2-year OS in patients with SAI < median was 58% compared with 91% in those with SAI ≥ median (P = .006). In multivariate analyses, SAI < median was significantly associated with poor OS (hazard ratio, 4.05; P = .02). Sarcopenia was not associated with OS. The maximum value of the standardized uptake value was significantly higher in patients with SAI < median (P = .02). CONCLUSION: The findings of this study suggest that low subcutaneous adipose tissue at baseline predicts poor survival outcome in patients with MM.


Assuntos
Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/patologia , Gordura Subcutânea/patologia , Idoso , Composição Corporal , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/diagnóstico por imagem , Mieloma Múltiplo/terapia , Músculo Esquelético/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Prognóstico , Sarcopenia/diagnóstico por imagem , Sarcopenia/patologia , Gordura Subcutânea/diagnóstico por imagem , Análise de Sobrevida , Tomografia Computadorizada por Raios X
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