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1.
Rinsho Ketsueki ; 64(2): 119-124, 2023.
Article in Japanese | MEDLINE | ID: mdl-36990731

ABSTRACT

The patient, a 56-year-old lady, also exhibited numerous lymphadenopathy, hepatosplenomegaly, hyperleukocytosis (167,200/µl, aberrant lymphocytes 91.5%), and fever. A lymph node biopsy revealed follicular lymphoma (FL), grade 1. Peripheral blood tumor cells did not express CD10, which was a distinctive characteristic of the lymph node specimen. To prevent tumor lysis syndrome (TLI), CHOP was delivered without an anti-CD20 antibody, but afterward, residual lymphoma cells were found in peripheral blood (>80%). As a result, obinutuzumab (Obi) was given on day 8 following the second round of CHOP, and the tumor cells in the peripheral blood vanished without any major side effects like TLI. She underwent six chemotherapy sessions before receiving maintenance therapy with Obi and achieving a full metabolic response. According to reports, leukemic FL exhibits negative CD10 expression in peripheral blood lymphoma cells, while leukemic mantle cell lymphoma also shows this trait. Therefore, it is important not to confuse the two types in diagnosis. Leukemic FL with significant leukocytosis is reportedly uncommon and has a bad prognosis. Our case indicates that CHOP with Obi would be a good alternative for cases like yours, however, there have been a few cases recorded. Further case accumulation or investigation is warranted.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Lymphoma, Follicular , Female , Humans , Middle Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclophosphamide/therapeutic use , Doxorubicin/therapeutic use , Lymphoma, Follicular/drug therapy , Prednisolone/therapeutic use , Prednisone/therapeutic use , Rituximab/therapeutic use , Vincristine/therapeutic use
2.
Acta Haematol ; 145(2): 193-200, 2022.
Article in English | MEDLINE | ID: mdl-34818223

ABSTRACT

To evaluate the long-term efficacy of high-dose dexamethasone (HD-DXM) treatment for immune thrombocytopenia (ITP), we retrospectively analysed 36 newly diagnosed ITP patients treated with HD-DXM as a first-line treatment. An initial response was obtained in 23 (63.9%) patients, including 11 with a complete response (CR) and 12 with a partial response (PR). Six months after HD-DXM treatment, 26 of 33 (78.8%) evaluable patients achieved objective responses, including 18 CR and 8 PR. Among 13 patients without initial response, very early increased platelet count within a week (VEIP) was observed in 7 patients, 5 (71.4%) of whom achieved a response at 6 months. In 29 patients who had available platelet count within a week, patients showing VEIP revealed longer survival than those who did not (p = 0.026). HD-DXM was an effective treatment for newly diagnosed ITP patients. VEIP after HD-DXM treatment initiation was associated with a long-term objective response in newly diagnosed ITP patients.


Subject(s)
Purpura, Thrombocytopenic, Idiopathic , Dexamethasone/therapeutic use , Humans , Platelet Count , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Retrospective Studies , Treatment Outcome
3.
Intern Med ; 60(17): 2859-2862, 2021 Sep 01.
Article in English | MEDLINE | ID: mdl-33775998

ABSTRACT

We herein report two cases of thrombotic thrombocytopenic purpura (TTP) complicated by other autoimmune disorders, autoimmune hepatitis and immune thrombocytopenia, respectively. In both cases, corticosteroids were continuously administered for the treatment of preceding autoimmune disorders. However, a sufficient objective response for TTP was not obtained by plasma exchange and corticosteroid treatment. Once a week rituximab (375 mg/m2) treatment for 4 times was initiated within 2 weeks from the diagnosis. Both patients achieved a sufficient response, and have never had any recurrence as of the last follow-up dates. The early introduction of rituximab could be an effective treatment option in TTP patients complicated with other autoimmune disorders.


Subject(s)
Purpura, Thrombocytopenic, Idiopathic , Purpura, Thrombotic Thrombocytopenic , Humans , Plasma Exchange , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/drug therapy , Purpura, Thrombotic Thrombocytopenic/complications , Purpura, Thrombotic Thrombocytopenic/diagnosis , Purpura, Thrombotic Thrombocytopenic/drug therapy , Recurrence , Rituximab/therapeutic use
7.
Rinsho Ketsueki ; 53(12): 1991-6, 2012 Dec.
Article in Japanese | MEDLINE | ID: mdl-23318964

ABSTRACT

Intracranial involvement of relapsed Hodgkin lymphoma (HL) is quite rare and its prognosis is very poor. We report a patient with relapsed HL with central nervous system (CNS) involvement after autologous stem cell transplantation successfully treated with allogeneic bone marrow transplantation with reduced intensity conditioning regimen. A standard therapy for relapsed CNS HL has not yet established. To the best of our knowledge, this is the first case report describing allogeneic stem cell transplantation for relapsed CNS HL in an elderly patient. Our results in this case suggest that allogeneic stem cell transplantation could be a useful therapeutic option in relapsed CNS HL patients, if their CNS lesions are controlled before stem cell transplantation.


Subject(s)
Central Nervous System/pathology , Hodgkin Disease/pathology , Secondary Prevention , Bone Marrow Transplantation/methods , Female , Hodgkin Disease/therapy , Humans , Middle Aged , Neoplasm Invasiveness , Time Factors , Transplantation, Homologous/methods , Treatment Outcome
8.
Rinsho Ketsueki ; 52(7): 563-9, 2011 Jul.
Article in Japanese | MEDLINE | ID: mdl-21821991

ABSTRACT

A 70-year-old man was admitted to our hospital with fever, generalized lymphadenopathy and hypoxia in October 2009. Blood examination demonstrated leukocytosis, anemia, thrombocytopenia and hyper γ-globulinemia. Peripheral blood and bone marrow smear showed marked plasma cell proliferation mimicking plasma cell leukemia. However, flow cytometric analysis showed that plasma cells were of polyclonal origin and M-protein was not detected by immunofixation of serum protein. Elevations of soluble interleukin 2 receptor and serum IL-6 were observed. A heavy Epstein-Barr viral load was detected in serum by real-time PCR. Biopsy was obtained from the right inguinal lymph node. The pathological diagnosis was angioimmunoblastic T-cell lymphoma (AITL) and rearrangement of the T-cell receptor Cß1 gene was detected. The patient was treated with CHOP therapy, and all clinical manifestations, including fever, lymphadenopathy, anemia, thrombocytopenia, hyper γ-globulinemia, plasmacytosis and hypoxia, were improved. Only a few reported cases have demonstrated AITL with marked polyclonal plasmacytosis. Although pathological mechanisms of plasmacytosis in AITL patients have not been fully elucidated, it is suggested that IL-6 and IL-10 were involved in its pathogenesis in the present case.


Subject(s)
Bone Marrow/pathology , Immunoblastic Lymphadenopathy/blood , Immunoblastic Lymphadenopathy/pathology , Lymphoma, T-Cell/blood , Lymphoma, T-Cell/pathology , Plasma Cells/pathology , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Humans , Immunoblastic Lymphadenopathy/drug therapy , Immunoblastic Lymphadenopathy/etiology , Interleukin-10 , Interleukin-6 , Leukemia, Plasma Cell , Lymphoma, T-Cell/drug therapy , Lymphoma, T-Cell/etiology , Male , Prednisolone/administration & dosage , Treatment Outcome , Vincristine/administration & dosage
9.
Rinsho Ketsueki ; 51(3): 189-95, 2010 Mar.
Article in Japanese | MEDLINE | ID: mdl-20379113

ABSTRACT

Factors that affect the response of multiple myeloma patients to thalidomide were evaluated in 40 patients who were not eligible for chemotherapy (untreated: 14, relapse/refractory: 26). The complete response (CR) rate was 2.5%; partial response (PR) 50.0%; minimal response (MR) 25.0%; no change (NC) 12.5%; and progressive disease 10.0%. The response to thalidomide could be evaluated after four weeks of treatment. Significantly higher responses were associated with untreated patients, patients with combined use of thalidomide plus dexamethasone, and patients with kappa light chain. Patients who responded well to thalidomide showed a significantly higher progression-free survival (PFS) rate. In patients with kappa light chain, PFS and overall survival rates were significantly higher than those with lambda light chain. Frequent adverse reactions were numbness (47.5%), constipation (32.5%), and eruption (30.0%). In patients previously treated with vincristine, numbness occurred in a significantly higher percentage of patients.


Subject(s)
Multiple Myeloma/drug therapy , Thalidomide/administration & dosage , Adult , Aged , Aged, 80 and over , Constipation/chemically induced , Dexamethasone/administration & dosage , Disease-Free Survival , Drug Eruptions/etiology , Drug Therapy, Combination , Female , Humans , Hypesthesia/chemically induced , Immunoglobulin kappa-Chains , Immunoglobulin lambda-Chains , Male , Middle Aged , Multiple Myeloma/mortality , Thalidomide/adverse effects , Treatment Outcome
10.
Int J Hematol ; 83(2): 147-51, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16513533

ABSTRACT

Eradication of Helicobacter pylori leads to platelet recovery in some patients with idiopathic thrombocytopenic purpura (ITP). Therefore, the pathogenesis of a subgroup of ITP is probably associated with H pylori infection (H pylori-related ITP). If H pylori-related ITP is a definite subgroup of ITP, specific oligoclonal T-cells might accumulate in the peripheral blood (PB). To address this issue, we performed single-strand conformation polymorphism analysis of complementarity-determining region 3 (CDR3) of the T-cell receptor beta-chain genes of PB T-cells. Fourteen ITP patients with H pylori infection and 12 ageadjusted healthy volunteers were studied. Of the 14 patients, 8 patients (responders) exhibited a platelet response after successful H pylori eradication therapy, but 6 patients (nonresponders) did not. Vbeta5.2, Vbeta15, and Vbeta19 gene usage by clonally expanded T-cells in PB obtained before H pylori eradication therapy was significantly higher in responders than in nonresponders or healthy volunteers (Vbeta5.2, P = .023; Vbeta15, P = .004; Vbeta19, P = .036). Furthermore, an abrogation of clonally expanded T-cells was observed after therapy in some responders. These findings suggest that specific T-cell clones accumulate in H pylori-related ITP and that such clones may be associated with immune-mediated destruction of platelets.


Subject(s)
Helicobacter Infections/complications , Helicobacter pylori , Purpura, Thrombocytopenic, Idiopathic/immunology , Purpura, Thrombocytopenic, Idiopathic/microbiology , T-Lymphocytes/pathology , Adult , Aged , Blood Platelets/microbiology , Blood Platelets/pathology , Case-Control Studies , Clone Cells/immunology , Clone Cells/pathology , Complementarity Determining Regions/genetics , Female , Humans , Male , Middle Aged , Polymorphism, Single-Stranded Conformational
11.
Rinsho Ketsueki ; 43(6): 477-81, 2002 Jun.
Article in Japanese | MEDLINE | ID: mdl-12134705

ABSTRACT

We observed massive hemolysis after allogeneic peripheral blood stem cell transplantation with minor ABO incompatibility (the donor was group O and the recipient group A). The patient was a 21-year-old man diagnosed as having Philadelphia chromosome-positive chronic myelogenous leukemia. On day 7 post-transplant, there was abrupt onset of massive hemolysis necessitating supportive treatment with transfusions. During the allogeneic peripheral blood stem cell transplantation the patient had received 2 x 10(8) CD3 positive cells/kg and 7.8 x 10(7) CD19 positive cells/kg donor lymphocytes with stem cells. The present case shows that in allogeneic peripheral blood stem cell transplantation with ABO incompatibility, severe hemolysis occurs early after transplantation presumably due to the transfusion of a large number of lymphocytes.


Subject(s)
ABO Blood-Group System , Blood Group Incompatibility/complications , Hematopoietic Stem Cell Transplantation/adverse effects , Hemolysis , Adult , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Male
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