Impact of graft-versus-host disease on outcomes after allogeneic hematopoietic cell transplantation for adult T-cell leukemia: a retrospective cohort study.

Allogeneic hematopoietic cell transplantation (HCT) is an effective treatment for adult T-cell leukemia (ATL), raising the question about the role of graft-versus-leukemia effect against ATL. In this study, we retrospectively analyzed the effects of acute and chronic graft-versus-host disease (GVHD) on overall survival, disease-associated mortality, and treatment-related mortality among 294 ATL patients who received allogeneic HCT and survived at least 30 days posttransplant with sustained engraftment. Multivariate analyses treating the occurrence of GVHD as a time-varying covariate demonstrated that the development of grade 1-2 acute GVHD was significantly associated with higher overall survival (hazard ratio [HR] for death, 0.65; P = .018) compared with the absence of acute GVHD. Occurrence of either grade 1-2 or grade 3-4 acute GVHD was associated with lower disease-associated mortality compared with the absence of acute GVHD, whereas grade 3-4 acute GVHD was associated with a higher risk for treatment-related mortality (HR, 3.50; P < .001). The development of extensive chronic GVHD was associated with higher treatment-related mortality (HR, 2.75; P = .006) compared with the absence of chronic GVHD. Collectively, these results indicate that the development of mild-to-moderate acute GVHD confers a lower risk of disease progression and a beneficial influence on survival of allografted patients with ATL.

[Awareness about medical expenses and certifications of eligibility for limited health insurance payments for chemotherapy among clinicians at the Ehime Cancer Care Network Priority Hospitals (Ehime Cancer Kyoten Hospitals)].

The "Cancer Chemotherapy and its Management" subcommittee at the Ehime Cancer Care Network Priority Hospitals (Ehime Cancer Kyoten Hospitals)with a focus on medical expenses associated with chemotherapy, surveyed awareness among 98 clinicians regarding certifications of eligibility for Limited Health Insurance Payments during cancer treatment. This committee also lists social and clinical problems encountered at the Ehime Cancer Care Network Priority Hospitals. In our survey, 78% of clinicians were consulted about medical expenses associated with chemotherapy and were actively involved in resolving medical expense problems and resulting correspondences. However, only 38% of clinicians could explain the details of the Japanese guideline on the catastrophic cap and the certifications of eligibility for Limited Health Insurance Payments. This knowledge deficit was more pronounced in younger residents. From our analyses of the awareness about medical expenses among clinicians, we recommend the establishment of the following systems for the management of cancer patients. First, establish a reporting system and early consultation on the catastrophic cap and the certifications of eligibility before initiating cancer treatment. Second, education regarding medical expenses should be mandatory for clinicians, especially for young residents. Third, patients with cancer suffering in the interval of the medical expense and the social system should be relieved with new systems.

Maximum standard uptake value of 18F-fluorodeoxyglucose positron emission tomography is a prognostic factor for progression-free survival of newly diagnosed patients with diffuse large B cell lymphoma.

The treatment of patients with diffuse large B cell lymphoma (DLBCL) would be greatly facilitated with a rapid method for determining prognosis that can be performed more easily and earlier than cytological or specific pathological examinations. It has been suggested that newly diagnosed patients with DLBCL who have low maximum standard uptake value (SUV(max)) on (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) are more likely to be successfully treated and remain in remission compared with patients with high SUV(max), but this concept has been poorly studied. We retrospectively analyzed 50 patients with de novo DLBCL to evaluate the relationship between the SUV(max) and disease progression. For patients with low SUV(max) (n = 10) and high SUV(max) (n = 40) (P = 0.255), respectively, the 3-year overall survival rates were 90 and 72 %, and the progression-free survival (PFS) rates were 90 and 39 % (P = 0.012). By multivariate analysis, the revised International Prognostics Index (R-IPI) and SUV(max) at diagnosis were shown to predict longer PFS. The 3-year PFS for patients with low SUV(max) classified into the good prognosis group by R-IPI was 100 vs. 62 % for those with high SUV(max) (P = 0.161), and patients with low SUV(max) classified into the poor prognosis group by R-IPI was 80 vs. 18 % for those with high SUV(max) (P = 0.050). We conclude that the SUV(max) on FDG-PET for newly diagnosed patients with DLBCL is an important predictor of disease progression, especially for patients with poor prognosis by R-IPI.

Transplantation of allogeneic hematopoietic stem cells for adult T-cell leukemia: a nationwide retrospective study.

Allogeneic hematopoietic stem cell transplantation (HSCT) is increasingly used as a curative option for adult T-cell leukemia (ATL), an intractable mature T-cell neoplasm causally linked with human T-cell leukemia virus type I (HTLV-I). We compared outcomes of 386 patients with ATL who underwent allogeneic HSCT using different graft sources: 154 received human leukocyte antigen (HLA)-matched related marrow or peripheral blood; 43 received HLA-mismatched related marrow or peripheral blood; 99 received unrelated marrow; 90 received single unit unrelated cord blood. After a median follow-up of 41 months (range, 1.5-102), 3-year overall survival for entire cohort was 33% (95% confidence interval, 28%-38%). Multivariable analysis revealed 4 recipient factors significantly associated with lower survival rates: older age (> 50 years), male sex, status other than complete remission, and use of unrelated cord blood compared with use of HLA-matched related grafts. Treatment-related mortality rate was higher among patients given cord blood transplants; disease-associated mortality was higher among male recipients or those given transplants not in remission. Among patients who received related transplants, donor HTLV-I seropositivity adversely affected disease-associated mortality. In conclusion, allogeneic HSCT using currently available graft source is an effective treatment in selected patients with ATL, although greater effort is warranted to reduce treatment-related mortality.

[Follicular lymphoma showing long-term false positive results by FDG-PET after rituximab-containing chemotherapy].

We report a patient with follicular lymphoma who had false positive results on 18-fluorodeoxyglucose positron emission tomography (FDG-PET) tests for more than six months due to inflammatory reactions continuing over a long period of time after chemotherapy with rituximab. Although FDG-PET has advantages over other imaging methods when used for the evaluation of the response to chemotherapy and detection of recurrence, attention should be paid to the possibility of false positive results due to such inflammatory conditions, especially when rituximab is administered. Biopsy of the FDG-uptake lesions is strongly recommended if recurrence is suspected.

The utility of positron emission tomography/computed tomography in the staging of extranodal natural killer/T-cell lymphoma.

Natural killer (NK)/T-cell lymphoma cases are rarely discovered using positron emission tomography/computed tomography (PET/CT). We compared the utility of PET/CT and that of conventional methods (CMs; CT with IV contrast, biopsies from primary sites, and bone marrow examinations) in the staging of extranodal NK/T-cell lymphoma. Nineteen untreated patients with extranodal NK/T-cell lymphoma at three institutions were analyzed. PET/CT and CMs were applied for initial workups following diagnosis. PET/CT and CMs were compared and evaluated for their ability to detect tumor lesions and their influence on the staging and treatment strategies. In total, 116 lesions were detected by CM and PET/CT. Using PET/CT, 108 lesions (93%) were discovered. The number of nodal lesions was 28: all were positive by PET/CT and 26 (93%) by CMs. The number of extranodal lesions was 89: 84 (94%) and 54 (61%) lesions were positive by PET/CT and CMs, respectively. PET/CT was superior to CMs in detecting cutaneous lesions [31/31 lesions (100%) vs. 20/31 lesions (65%), respectively; P=0.042]. Bone marrow involvement was confirmed pathologically in only seven patients; four cases (57%) were positive by PET/CT. Using CMs, ten patients (53%) were stages I-II and nine (47%) were stages III-IV. Using PET/CT, eight patients (42%) were in stages I-II and 11 (58%) were in stages III-IV. PET/CT findings altered the stage and treatment strategy in two cases (11%). Our study demonstrated that PET/CT is a useful tool for detecting extranodal lesions in NK/T-cell lymphoma, particularly cutaneous lesions. PET/CT may therefore influence future staging and treatment strategies.

[Current problems for outpatients undergoing cancer chemotherapy in Ehime Priority Hospitals of Cancer Care Network (Ehime Cancer Kyoten Hospitals)].

Ehime Priority Hospitals of Cancer Care Network(Ehime Cancer Kyoten Hospitals)regularly have meetings to discus the current problems in cancer care in Ehime Prefecture. We established three subcommittees:"Registration of Cancer Incident," "Critical Paths for the Management of Patients with Cancer,"and"Palliative Care for Patients with Advanced Cancer"to exchange our opinions. We recently set up a new subcommittee related to the physical and spiritual care of patients undergoing chemotherapy treatment,"A Subcommittee dealing with Cancer Chemotherapy and its Management"."This subcommittee has tried to identify current problems with chemotherapy for outpatients in each institution through questionnaire and analysis. As a result of this survey, it was found that Ehime Priority Hospitals have total of seventy-three beds for outpatients undergoing chemotherapy, and that they performed chemotherapy 19, 671 times in 2008. A total of eight oncology physicians and sixteen oncology nurses were engaged in performing chemotherapy in this system. The questions patients most frequently asked during chemotherapy concerned the management of therapy-related complications, dealing with problems at night and during holidays after chemotherapy, and financial problems related to the costs of treatment. In this study we found three issues that need to be managed in Ehime Priority Hospitals. First, for the nursing of outpatients undergoing chemotherapy, more staff engaged in different types of care is required. Second, a new system to deal with emergencies at night and during holidays after chemotherapy is necessary, because Ehime Priority Hospitals use the same system to deal with chemotherapy patients as for other patients. Third, cooperation between pharmacies and out-clinics is important for patient compliance during chemotherapy, especially for the administration of oral anti-tumor agents. Ehime Priority Hospitals of Cancer Care Network is trying to improve each institution while dealing with these problems.

Pregnancy-induced thrombocytopenia and TTP, and the risk of fetal death, in Upshaw-Schulman syndrome: a series of 15 pregnancies in 9 genotyped patients.

Upshaw-Schulman syndrome (USS) is a congenital thrombotic thrombocytopenic purpura (TTP) due to mutations in the gene that encodes for ADAMTS13 (ADAMTS13), but its clinical signs may be mild or absent during childhood. We have identified 37 patients with USS (24 females, 13 males) belonging to 32 families. The nine women from six families who were diagnosed during their first pregnancy are the focus of this report. Six of the nine women had episodes of thrombocytopenia during childhood misdiagnosed as idiopathic thrombocytopenic purpura. Thrombocytopenia occurred during the second-third trimesters in each of their 15 pregnancies, with 16 babies (one twin pregnancy), often followed by TTP. Of 15 pregnancies, eight babies were stillborn or died soon after birth, and the remaining seven were all premature except one, who was born naturally following plasma infusions to the mother that had started at 8 weeks' gestation. All nine USS women had severely deficient ADAMTS13 activity. ADAMTS13 analyses demonstrated that eight women were compound heterozygotes of Y304C/G525D (2 siblings), R125VfsX6/Q1302X (2 siblings), R193W/R349C (2 siblings), I178T/Q929X, and R193W/A606P; one woman was homozygous for R193W. Only the R193W mutation has been previously reported. These observations emphasize the importance of measuring ADAMTS13 activity in the evaluation of thrombocytopenia during childhood and pregnancy.

[Peculiar "chestnuts in burrs" formation in MGIT cultures of pulmonary Mycobacterium xenopi cases].

We report 3 patients whose sputum and bronchoalveolar lavage fluid (BALF) cultures for acid fast bacteria in MGIT liquid media grew colonies of Mycobacterium xenopi (M. xenopi) with a characteristic chestnut burr like appearance. Patients I, II, and III were a 74-year-old man, 47-year-old woman, and 62-year-old woman, respectively. Chest X ray showed a pulmonary cavity in each case. Patient I had a history of pulmonary and renal tuberculosis. The past medical history of patient II was unremarkable. Patient III had a history of lung cancer. Eight sputum samples and 4 BALF samples from patient I, 3 sputum samples and 1 BALF sample from patient II, and 4 sputum samples from patient III were positive for acid fast bacteria, and the organism was identified as M. xenopi in 9 samples. Smears of these MGIT-positive cultures were stained by the Ziehl Neelsen method, and examined under a microscope. Large and small, spherical shaped, 15-100 microm clusters of thin, elongated bacteria, with a chestnut burr-like or spherical moss like and partly budding appearance, were scattered throughout the smear preparation. Although only 34 cases of M. xenopi infection were reported in Japan between 1984 and 2005, the number of reported cases has been on the increase in recent years. Since no report from Japan, Europe, or the United States have noted the characteristic appearance of M. xenopi in cultures, we consider that the feature described in this communication is useful to presumptively identify M. xenopi.

Single-dose daily infusion of cyclosporine for prevention of Graft-versus-host disease after allogeneic bone marrow transplantation from HLA allele-matched, unrelated donors.

Peak blood concentration of cyclosporine (CsA) in renal transplantation patients was recently reported to be associated with clinical efficacy. We therefore evaluated the toxicity and efficacy of a regimen of once-daily infusion of CsA plus a short course of methotrexate as prophylaxis of graft-versus-host disease (GVHD) after allogeneic bone marrow transplantation from an HLA allele-matched, unrelated donor. Nineteen patients with hematologic malignancies received CsA, 3 mg/kg per day, as a 4-hour intravenous (IV) infusion from day -1. After engraftment, patients received CsA orally at twice the IV dose. The CsA dose was adjusted to maintain the blood trough level between 150 and 200 ng/mL. Methotrexate was administered IV at doses of 10 mg/m(2) on day 1 and 7 mg/m(2) on days 3, 6, and 11. Bone marrow engraftment occurred in all patients. Grade 1 and grade 2 GVHD occurred in 6 (31.6%) and 7 (36.8%) of the 19 patients, respectively. No patient had grade 3 or 4 GVHD. Acute nephrotoxicity developed in 1 (5.3%) of the 19 patients, and hypertension developed in 3 (15.8%) of the 19 patients. We evaluated the pharmacokinetics of 4-hour CsA infusion in 10 patients. The mean trough concentration, mean peak concentration, mean time to peak concentration, and area under the curve (24 hours) were 161 +/- 43 ng/mL, 1498 +/- 387 ng/mL, 3.2 +/- 1.0 hours, and 10,848 +/- 1,991 ng +/- h/mL, respectively. This regimen was well tolerated and did not enhance the risk of severe GVHD in patients undergoing allogeneic bone marrow transplantation from an HLA allele-matched, unrelated donor.

["Cord formation" in smear specimen prepared from sputum for a more rapid method of presumptive identification of Mycobacterium tuberculosis].

Cord formation of Mycobacterium tuberculosis complex is very uncommon in smear specimen prepared directly from sputum, although such a finding is well known in solid or liquid media and has recently been evaluated as a rapid method for presumptive identification in special liquid media (BACTEC or MGIT). We examined 308 (Mycobacterium tuberculosis 271 and Nontuberculous mycobacteria 37) positive smear specimens prepared directly from sputum in our hospital. These specimens all showed a "modified Gaffky scale" as +2 or more and this cord formation was found in four cases (five specimens). Each of these specimens was from a patient with severe lung tuberculosis showing cavity formation and each patient was complicated severe diabetes mellitus. The morphology of cord formation on smear specimens prepared directly from sputum was similar to that in liquid or solid media, and consequently the relevant bacilli were identified as Mycobacterium tuberculosis complex by PCR examination. In this study, we assessed "cord formation" in smear specimen prepared directly from sputum as a more rapid presumptive identification of Mycobacterium tuberculosis complex based on microscopic morphology, as well as cord formation in liquid or solid media.

Expression of SOCS3 mRNA in bone marrow cells from CML patients associated with cytogenetic response to IFN-alpha.

Previously, we have demonstrated that constitutive expression of suppressor of cytokine signaling-3 (SOCS3) affects the sensitivity of chronic myelogenous leukemia (CML) cell lines to interferon-alpha (IFN-alpha). In the present study, we analyzed the expression of SOCS3 mRNA in bone marrow cells from patients with CML at diagnosis, with the aid of real-time polymerase chain reaction. SOCS3 mRNA expression in bone marrow cells from CML patients who responded well to IFN-alpha therapy was significantly lower than that in cells from healthy volunteers and patients who were resistant to IFN-alpha therapy. Methylation of SOCS3 promoter was absent in bone marrow cells from all CML patients examined. These results indicate that the expression of SOCS3 mRNA is inversely associated with the sensitivity to IFN-alpha both in vitro and in vivo and that differences in SOCS3 mRNA expression are not due to the methylation status of SOCS3 promoters.

Megakaryoblastic leukemia cell line MOLM-16 derived from minimally differentiated acute leukemia with myeloid/NK precursor phenotype.

The megakaryoblastic leukemia cell line MOLM-16 was established at relapse from the peripheral blood of a 77-year-old Japanese woman with minimally differentiated acute myeloid leukemia (AML-M0). Immunophenotyping of the fresh leukemic cells revealed a myeloid/NK precursor phenotype being positive for CD7, CD13, CD33, CD34, and CD56. In addition, megakaryocyte-associated antigens CD41 and CD61 were found to be positive. The established cell line designated MOLM-16 was proliferatively responsive to the treatment with various cytokines including EPO, GM-CSF, IL-3, PIXY-321, and TPO. MOLM-16 revealed characteristics of the megakaryocytic lineage in terms of immunophenotyping being positive for CD9, CD31, CD36, CD41, CD61, CD62P, CD63, CD110, CD151, thrombospondin, von Willebrand factor (vWf), and fibrinogen. Electron microscopic analysis showed positivity for ultrastructural platelet peroxidase in the nuclear envelope. The karyotype analysis of MOLM-16 revealed various numerical and structural abnormalities including t(6;8)(q21;q24.3), t(9;18)(q13;q21) and marker chromosomes. The extensive immunological, cytogenetic and functional characterization of MOLM-16 suggests that this cell line may represent a scientifically significant in vitro model which could facilitate the evaluation of megakaryocytic differentiation.

Radiofrequency ablation in a pig liver model: effect of transcatheter arterial embolization on coagulation diameter and histologic characteristics.

To determine whether transcatheter arterial embolization (TAE) can alter radiofrequency (RF)-induced coagulation necrosis, we evaluated the morphology and histologic characteristics of RF ablation lesions combined with TAE in normal pig liver. Using a RF ablation system, consisting of a RF generator and 2-cm expandable LeVeen needle electrodes, nine lesions were generated by RF ablation combined with TAE and 11 lesions by RF ablation alone in five animals. On completion of treatment, the lesions were excised for gross and histologic examination. Gross examination demonstrated a core of ablated tissue surrounded by a narrow rim of hemorrhagic necrosis. The final shape of the lesion in the RF ablation group was frequently altered by patent intrahepatic vessels at the periphery of the lesion, whereas the lesions in the RF ablation and TAE group were spherical (P<0.05, chi(2)-test). The coagulation diameter was significantly larger in the RF ablation and TAE group than in the RF ablation group (28.7+/-4.2 vs. 24.1+/-3.2 mm, P<0.05). Histochemical (lactate-dehydrogenase, maleate-dehydrogenase and NADPH-diaphorase) stainings showed what appeared to be 100% cellular destruction in the ablated lesion and its hemorrhagic rim in both groups. We conclude that RF ablation combined with TAE induces greater and more spherical areas of coagulation necrosis in normal pig liver tissue than RF ablation alone.

Infantile spongiform leukoencephalopathy: clinical and neuropathologic findings.

A 10-month-old male with spongy leukoencephalopathy is presented. Neurologic manifestations included feeding difficulties, horizontal nystagmus, and spasticity at 5 months of age. His head circumference was within the normal range. Radiologic examination demonstrated a diffuse white matter disorder. There was no detectable biochemical abnormality. He followed a neurologically progressive course. Neuropathologic findings revealed characteristic vacuolar changes in the white matter located immediately under the cortex with spongy alterations of the entire subcortical white matter, including intense astrocytic gliosis and marked vascular hyperplasia. Tissue of the matrix was destroyed in the deep white matter to form cystic areas of degeneration. White matter myelin development was severely disturbed compared with that of a normal infant of the same age. Cortical neuronal cells were preserved and did not reveal any specific abnormalities. Electron microscopic examination revealed that each vacuole in the white matter was covered by several layers of myelin structures, and intralamellar splits of white matter myelin were observed. These neuropathologic findings are also observed in some known inherent metabolic disorders. The present patient, however, did not demonstrate any metabolic abnormalities. These findings suggested a new genetic disorder of myelin metabolism.

Novel B-cell acute lymphoblastic leukemia sister cell lines BALM 19-23 and BALM-26 with interclonal proliferative and phenotypic heterogeneity from a patient with hypercalcemia.

A series of human acute lymphoblastic leukemia (ALL) cell lines, BALM-19, -20, -21, -22, -23 (BALM 19-23) and BALM-26 were established from a patient with B-cell characteristics of ALL L2 type. All cell lines were derived from bone marrow specimens, BALM 19-23 from a sample taken at diagnosisand BALM-26 from one at relapse. Like the original leukemia cells, the established lines present various B-cell characteristics, being positive for cell surface immunoglobulin (Ig) chains but also for nuclear terminal deoxynucleotidyl transferase; hence the cell lines should be assigned to B-cell category B-IV. As a unique feature, the cell lines expressed the CD33 myeloid antigen in addition to the common B-cell markers. Heterogeneous antigen expression among the different cell lines was found regarding CD35, CD39, CD45RA, CD78 and CD95. The malignant nature of the cell lines was documented by negativity for the Epstein-Barr virus and by the occurrence of clonal non-random structural chromosome abnormalities. The patient's serum showed hypercalcemia, prompting further investigation of the established cell lines which expressed parathyroid hormone related peptide (PTHrP) mRNA as examined by reverse transcriptase polymerase chain reaction. The established B-cell ALL sister cell lines, BALM 19-23 and BALM-26, could provide useful material for clarifying the pathogenesis of this type of B-cell malignancy. The scientific significance of this panel of cell lines lies in the availability of a series of clonally derived but phenotypically different sister cell lines established at different phases of the disease.

Clinicohistological features of liver failure after excessive hepatectomy.

BACKGROUND/AIMS: Patients at high risk of liver failure sometimes suffer such failure with hyperbilirubinemia after hepatectomy. This report clarifies the clinicohistological findings in liver failure cases after excessive hepatectomy, and discusses the mechanisms of liver failure. METHODOLOGY: Of 16 patients who suffered liver failure after hepatectomy between May 1992 and December 1999, 7 patients who underwent liver biopsy or autopsy were studied. The biopsy findings showed that, in each case, the percentages of hepatocytes that were apoptotic or binucleated were calculated. The number of bile plugs per 1000 micron 2 was counted and the thickness of collagen fibers in Disse's space was measured at 10 sites. The total bilirubin level was monitored over time, and the triggers, other than excessive hepatectomy, of increases in the bilirubin level were investigated. RESULTS: From the histological findings, liver failure cases were classified into cholestatic and nonregenerative types. Regeneration of hepatocytes and fibrosis in Disse's space were characteristic of the cholestatic type, while apoptosis of hepatocytes was characteristic of the nonregenerative type. Other than excessive hepatectomy, postoperative infection was the only trigger of liver failure in the cholestatic type, and ischemic changes of the liver resulted in liver failure in the nonregenerative type. The total bilirubin level changed more slowly in the cholestatic type than in the nonregenerative type after postoperative complications occurred. CONCLUSIONS: Liver failure after excessive hepatectomy is of two types: cholestatic, mainly induced by postoperative infection, and nonregenerative, mainly induced by severe ischemia reperfusion injury.

Respiratory epithelial adenomatoid hamartoma in the nasal cavity.

We report a 65-year-old male with a hamartoma in the left nasal cavity. A mass was found in the left nasal cavity and was diagnosed as a benign tumor on the basis of preoperative findings. Left lateral rhinotomy was performed to completely remove it and the lesion was found to have arisen from the inferior turbinate. The pathological diagnosis was respiratory epithelial adenomatoid hamartoma. We discuss the pathological features of this disease.

[Improvement for identification of Mycobacterium tuberculosis complex by immunochromatographic assay anti-MPB 64 monoclonal antibodies with "H2O2" addition trial on blood culture samples].

An improvement trial for identification of the Mycobacterium tuberculosis complex by immunochromatographic assay using anti-MPB 64 monoclonal antibodies (MPB 64-ICA) is documented. The new MPB 64-ICA is very useful for simple and rapid identification of the Mycobacterium tuberculosis complex with specificity, but it is a little difficult to prove the Mycobacterium tuberculosis complex on the blood culture samples taken from the immunosuppressive or the AIDS patients, because the reactive bands are red or reddish-purple in both the control and positive zones of immunochromatographic assay, which are often indistinguishable from the background mixed with hemoglobin caused from the blood samples. We tried to remove the hemoglobin interference in the samples and was able to make clear the background with addition of hydrogen peroxide (H2O2). The results are followings; the optimum time and density of H2O2 are from 5 to 15 minutes and 35%, respectively. Accordingly, the improvement trial for identification of the Mycobacterium tuberculosis complex by immunochromatographic assay using MPB64-ICA with H2O2 is useful to identify the positive reactive band from the interference by hemoglobin.