Unrelated bone marrow transplantation or immediate umbilical cord blood transplantation for patients with acute myeloid leukemia in first complete remission.

BACKGROUND: While unrelated bone marrow transplantation (UBMT) has been widely used as alternative donor transplantation, the use of umbilical cord blood transplantation (UCBT) is increasing recently. METHODS: We conducted a decision analysis to address which transplantation procedure should be prioritized for younger patients with acute myeloid leukemia (AML) harboring high- or intermediate-risk cytogenetics in first complete remission (CR1), when they lack a matched related donor but have immediate access to a suitable umbilical cord blood unit. Main sources for our analysis comprised the data from three phase III trials for a chemotherapy cohort (n = 907) and the registry data for a transplantation cohort (n = 752). RESULTS: The baseline analysis showed that when the 8/8 match was considered for UBMT, the expected 5-year survival rate was higher for UBMT than for UCBT (58.1% vs. 51.8%). This ranking did not change even when the 7/8 match was considered for UBMT. Sensitivity analysis showed consistent superiority of UBMT over UCBT when the time elapsed between CR1 and UBMT was varied within a plausible range of 3-9 months. CONCLUSIONS: These results suggest that 8/8 or 7/8 UBMT is a better transplantation option than UCBT even after allowing time required for donor coordination.

[The Tokyo Metropolitan Government plan to promote the cancer control program].

Within the framework of the National Cancer Act, the Tokyo Metropolitan Government has executed a plan to promote the cancer control programs since 2008. The effort has resulted in substantial outcomes in the last 5 years. Or reviewing the past plan and in compliance with the National Basic Plan to Promote Cancer Control Program, which was initiated in 2012, the new Tokyo Plan will be launched this fiscal year. This plan focuses on cancer prevention, early detection, the provision of high-level and comprehensive cancer medical services, the identification of anxiety in patients cancer and their families, and the advancement of cancer registration and research activities.

[Salt-wasting nephropathy induced by foscarnet treatment for HHV-6 encephalitis in a hematopoietic stem cell transplant].

A 51-year-old woman with myelodysplastic syndrome developed HHV-6 encephalitis on day 34 after unrelated bone marrow transplantation. Although prompt treatment with foscarnet stabilized encephalitis and there were no serious neurological sequelae, the patient developed both hyponatremia and natriuresis 11 days after intravenous administration of foscarnet. Subsequent investigation demonstrated hyponatremia due to salt-wasting nephropathy induced by foscarnet. Discontinuation of foscarnet and fluid replacement therapy with adequate sodium chloride (NaCl) resulted in a gradual resolution of hyponatremia and natriuresis. Currently, 8 months after these clinical events, the patient is under outpatient treatment for persistent nephropathy that requires small amounts of oral NaCl supplement, but she is otherwise in good clinical condition.

Human herpesvirus 6 meningoencephalitis in allogeneic hematopoietic stem cell transplant recipients.

We retrospectively investigated the clinical characteristics of human herpesvirus 6 (HHV-6) meningoencephalitis within 100 days after allogeneic hematopoietic stem cell transplantation (HSCT). Of 1148 patients who received transplants between January 1999 and December 2003, 11 patients (0.96%) with HHV-6 meningoencephalitis were identified. Ten of 11 recipients received hematopoietic stem cells from donors other than HLA-identical siblings. Confusion was the most frequent central nervous system (CNS) symptom, and a skin rash with high-grade fever preceded the CNS symptoms in 9 patients. Magnetic resonance imaging of the brain showed an abnormal increased T2 signal in the hypothalamus of 5 patients. Eight patients were treated with ganciclovir, and an improvement of CNS symptoms was obtained in 3 patients; 3 patients treated with acyclovir showed no improvement. Improvement in the meningoencephalitis seemed less frequent in patients with abnormal findings in the hypothalamus than in those without such findings. Because the symptoms of HHV-6 meningoencephalitis mimicked those of cyclosporine- or tacrolimus-induced encephalopathy, the drugs were withdrawn at the onset of CNS symptoms in 10 patients, resulting in the development of grade IV graft-versus-host disease (GVHD) in 5 patients. Three patients died of HHV-6 meningoencephalitis, and 6 died of other causes, including GVHD. In conclusion, HHV-6 meningoencephalitis is a rare but potentially life-threatening complication in patients who undergo allogeneic HSCT. Careful assessment of the clinical findings and the brain may allow early and precise diagnosis of HHV-6 meningoencephalitis and contribute to improving its prognosis.