Risk assessment for acute kidney injury after allogeneic hematopoietic stem cell transplantation based on Acute Kidney Injury Network criteria.

OBJECTIVE: This is a retrospective study for risk assessment of acute kidney injury after allogeneic hematopoietic stem cell transplantation (allo HSCT) based on the Acute Kidney Injury Network (AKIN) criteria. METHODS: Two hundred and eighty-nine consecutive patients who received allo HSCT were studied retrospectively to identify the risk factors for AKI according to the AKIN criteria. The incidence of AKI based on AKIN staging and overall survival (OS) was evaluated using Cox proportional hazard regression models treating each AKIN stage as a time-dependent covariate. PATIENTS: We identified a total of 180 patients who developed AKI within 100 days after allo HSCT; AKI was classified as stage 1 in 88 patients (30.5%), stage 2 in 46 patients (15.9%) and stage 3 in 46 patients (15.9%). RESULTS: Patients who developed stage 3 AKI had a significantly worse survival compared to those who developed no AKI or lower stage AKI (HR: 7.6, 95%CI: 4.8-12.1; p<0.001). Multivariate analysis for risks for developing AKI revealed an episode of sepsis or sinusoidal obstruction syndrome (SOS) and the use of liposomal amphotericin as a major cause of the severe stage of AKI. CONCLUSION: On the basis of our analysis, sepsis, hemorrhagic cystitis, and acute GVHD were associated with severe AKI, and SOS was associated any stage of AKI.

Poor outcome of myeloablative conditioned allogeneic bone marrow transplantation for myelofibrosis.

OBJECTIVE: This study retrospectively analyzed clinical outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for myelofibrosis (MF) in a single institution. METHODS: During the past 20 years, 6 patients with MF have undergone allo-HSCT in our institution. We investigated the clinical characteristics and follow-up course of these patients. PATIENTS: Median age was 47 years (range, 40-52 years). The median interval between diagnosis and allo-HSCT was 12.5 months (range, 5-97 months). RESULTS: Among these 6 patients, 4 patients were categorized in the high-risk group according to the International Prognostic Scoring System. All 6 patients received myeloablative conditioning regimens, but most of them eventually died of relapse. CONCLUSION: In this small series, allo-HSCT resulted in dismal outcomes. Our experience clearly indicates the need for studies with a larger series of patients to evaluate the efficacy of this modality.

Second allogeneic transplantation for relapsed acute leukemia after initial allogeneic hematopoietic stem cell transplantation.

We retrospectively reviewed the medical records of 45 patients with relapsed acute leukemia after initial allogeneic hematopoietic stem cell transplantation (allo-HSCT). Among 45 patients, a total of 11 patients eventually underwent second allo-HSCT (HSCT-2). Median survival after relapse was 294 days (range, 135-942 days) for HSCT-2. Multivariate analysis showed significantly better survival for recipients of second allo-HSCT than for other patients (hazard ratio, 4.38; 95 % confidence interval, 1.45-13.2; P = 0.009). Although outcomes for patients with relapsed leukemia were generally poor, our results suggest that second HSCT could offer a survival advantage over other conventional salvage strategies.

Clinical impact of pre-transplant pulmonary impairment on survival after allogeneic hematopoietic stem cell transplantation.

We retrospectively analyzed the clinical outcomes of patients with pulmonary impairment before undergoing allogeneic hematopoietic stem cell transplantation (HSCT) for the first time. Among 297 evaluable patients who underwent their first HSCT, 23 had restrictive, obstructive or mixed ventilatory impairment (n = 9, 13 and 1, respectively). Males predominated among the patients with pulmonary impairment (p = 0.037) and received a reduced intensity conditioning (RIC) regimen more frequently, although the difference did not reach statistical significance (p = 0.05). Among 23 patients with pulmonary impairment, 9 underwent post-transplant pulmonary function tests and obstructive ventilatory impairment progressed only in 2 patients, both of whom developed bronchiolitis obliterans. Kaplan-Meier estimates of 3-year overall (OS) among patients with and without pulmonary impairment were 57% and 47%, respectively, and those of relapse-free survival (RFS) were 70%, and 68%, respectively, with no significant differences between the groups (OS, p = 0.235; RFS, p = 0.287). The rates of non-relapse mortality also did not significantly differ (p = 0.835). Our results suggest that allogeneic HSCT is safe for patients with pulmonary impairment. The lower frequency of fatal pulmonary complications after HSCT and the RIC regimen might contribute to favorable survival rates.

Flare hypercalcemia after letrozole in a patient with liver metastasis from breast cancer: a case report.

INTRODUCTION: Tamoxifen may occasionally precipitate serious and potentially life-threatening hypercalcemia. However, to date, this has not been documented with aromatase inhibitors. CASE PRESENTATION: A 65-year-old Japanese woman with liver metastasis from breast cancer was admitted to our hospital with vomiting, anorexia, fatigue, arthralgia, muscle pain and dehydration. She had started a course of letrozole five weeks earlier. Our patient's calcium level was 11.6 mg/dL. She was rehydrated and elcatonin was administered. Our patient's parathyroid hormone and parathyroid hormone-related protein levels were not increased and a bone scintigram revealed no evidence of skeletal metastasis. After our patient's serum calcium level returned to within the normal range, letrozole was restarted at one-half of the previous dose (1.25 mg). There were no episodes of hypercalcemia. However, 84 days after restarting letrozole, our patient again complained of arthralgia and treatment was changed to toremifene. During these periods, repeated ultrasonograms revealed no progression of liver metastasis. CONCLUSION: To the best of our knowledge, this is the first case report of flare hypercalcemia after treatment with letrozole in a patient with metastatic breast cancer.

[Predictors of axillary node metastasis at breast surgery after neoadjuvant chemotherapy in patients with pre- chemotherapy-sentinel node positive breast cancer].

BACKGROUND: We investigated predictors for axillary node metastasis at breast surgery after neoadjuvant chemotherapy (NAC) in patients with pre-chemotherapy-sentinel node positive breast cancer. METHODS: Eighty-two patients were diagnosed as having positive sentinel lymph node (SLN), who had axillary lymph node dissection (ALND) performed after combination anthracycline/taxan based NAC, between 2002 and 2009. RESULTS: Eighteen (22.0%) of the 82 patients had residual axillary metastases after NAC. Multivariate analysis revealed that SLNs status before NAC was an important factor in predicting residual axillary metastases. Predictors of residual nodal disease were the number of macrometastases and the percentage (>50%) of positive SLNs in all SLNs. Among a subgroup of hormone-receptor positive and HER2-negative tumors, the risk of residual nodal metastases were high sensitivity of hormone receptor, with more than 50% of tumor cells staining positive for ER and PgR. CONCLUSION: Patients with two or more positive SLNs before NAC had a high risk of residual nodal metastasis after NAC.

[Role of pharmacists in providing outpatient clinic cancer chemotherapy--a current status of Tokyo Metropolitan Komagome Hospital].

The most important thing in outpatient clinic cancer chemotherapy is to carry out a drug safely and appropriately to patient. In 2003, we started outpatient cancer chemotherapy with the work of preparing injections. Although the number of patients is few, we have extended the work to inpatient cancer chemotherapy at present. It appears that outpatient clinic cancer chemotherapy will continuously be developed with medical environment changes. Therefore, it becomes more important for us to establish and reinforce cooperation with other healthcare professionals in providing outpatient clinic cancer chemotherapy. In the situation like that, the roles of pharmacists include: (1) a prescription check to be enhanced, (2) an execution of proper drug preparation and (3) to lead the patient by doctor or nurse about their medications, etc.