Persistently High Platelet Factor 4 Levels in an Adolescent with Recurrent Late Thrombotic Complications after SARS-CoV-2 mRNA Vaccination.

Thrombosis after severe acute respiratory syndrome coronavirus 2 vaccination is a serious complication in patients with a thrombophilic predisposition. Herein, we present a 17-year-old female who had underlying antiphospholipid syndrome (APS) and developed deep vein thrombosis (DVT) 6 months after her second BNT162b2 vaccine dose. Although she had no family history of thrombosis, she had previously developed DVT at 6 years of age, with thrombus formation in the right common iliac vein and the inferior vena cava, along with concomitant left pulmonary infarction. The patient had received anticoagulant therapy for 6 years after DVT onset, with subsequent treatment cessation for 5 years without recurrence. She received the BNT162b2 vaccine at 17 years of age, 1 week before a routine outpatient visit. Platelet factor 4 elevation was detected 14 days after the first vaccination, persisting for 5 months without thrombotic symptoms. Six months after the second vaccine dose, the DVT recurred and was treated with a direct oral anticoagulant. The vaccine was hypothesized to exacerbate the patient's APS by activating coagulation. Platelet factor 4 levels may indicate coagulation status. When patients predisposed to thrombosis are vaccinated, coagulation status and platelet activation markers should be monitored to prevent DVT development.

English version of Japanese Clinical Practice Guidelines 2022 for gastrointestinal stromal tumor (GIST) issued by the Japan Society of Clinical Oncology.

The Japan Society of Clinical Oncology Clinical Practice Guidelines 2022 for gastrointestinal stromal tumor (GIST) have been published in accordance with the Minds Manual for Guideline Development 2014 and 2017. A specialized team independent of the working group for the revision performed a systematic review. Since GIST is a rare type of tumor, clinical evidence is not sufficient to answer several clinical and background questions. Thus, in these guidelines, we considered that consensus among the experts who manage GIST, the balance between benefits and harms, patients' wishes, medical economic perspective, etc. are important considerations in addition to the evidence. Although guidelines for the treatment of GIST have also been published by the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO), there are some differences between the treatments proposed in those guidelines and the treatments in the present guidelines because of the differences in health insurance systems among countries.

[Comparative evaluation of 2 antiemesis tools for the prevention of chemotherapy-induced nausea and vomiting].

Although recent advances in chemotherapy have led to improved quality of life(QOL)and prolonged survival in patients with advanced cancer, treatment is often discontinued because of adverse events associated with chemotherapy, regardless of its efficacy.Nevertheless, chemotherapy has been validated in the United States and United Kingdom and is used worldwide. In Japan, few reports have been published regarding the use of assessment tools including the Multinational Association of Supportive Care in Cancer(MASCC)Antiemesis Tool(MAT)for the evaluation of chemotherapy-induced nausea and vomiting(CINV).We prospectively investigated the utility of the MAT and digestive symptom diary(DSD).In total, 68 patients who underwent highly and moderately emetogenic chemotherapy were included in the efficacy analyses.The improvement in the control of CINV during the delayed phase was significantly different between the DSD and MAT groups(p= 0.0148).The results obtained using the MAT warrant further validation.Meanwhile, the DSD may be used as an information tool by medical staff and patients.