Clinical Features and Treatment Outcomes of 81 Patients with Aggressive Type Adult T-cell Leukemia-lymphoma at a Single Institution over a 7-year Period (2006-2012).

OBJECTIVE: Despite the remarkable advances in chemotherapy and allogeneic hematopoietic stem cell transplantation (HSCT), adult T-cell leukemia-lymphoma (ATL) is still associated with a high mortality rate. It is therefore essential to elucidate the current features of ATL. METHODS: We retrospectively analyzed 81 patients with aggressive type ATL at our institution over a 7-year period based on Shimoyama's diagnostic criteria. RESULTS: Eighty-one patients with a median age of 67.5 years were classified as having acute (n=47), lymphoma (n=32), or chronic type (n=2) ATL. They were initially treated by either palliative therapy (n=25) or systemic chemotherapy [n=56; cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) therapy (n=25)/vincristine, cyclophosphamide, doxorubicin, and prednisone (VCAP)-doxorubicin, ranimustine, and prednisone (AMP)-vindesine, etoposide, carboplatin, and prednisone (VECP) therapy (VCAP-AMP-VECP) or CHOP-VMMV therapy (n=31)], and showed median survival durations of 16 and 277 days, respectively. Subsequent to the initial treatment, HSCT (n=6) was performed for certain patients, thus revealing that two-thirds (n=4) relapsed, and one-third (n=2) survived for 131 days and 203 days, respectively. The relapsed ATL patients were treated with conventional salvage therapy (n=29) or anti-CC chemokine receptor 4 antibody (mogamulizumab) (n=3). The patients treated with mogamulizumab demonstrated complete response (2) and partical response (1) with short duration periods of 82 days, 83 days, and 192 days, respectively. Among the five long-term survivors (>5 years) who received chemotherapy, most showed a low and intermediate risk according to the ATL prognostic index. CONCLUSION: In our study, the overall survival of ATL remains poor due to the advanced age of the patients at diagnosis, a high proportion of patients receiving palliative therapy, and a small proportion of long-term survivors receiving chemotherapy and undergoing HSCT. This study illustrates the current clinical features, treatment strategies, and outcomes in clinical practice.

Clinical features and outcomes of 9 patients with immunodeficiency-associated lymphoproliferative disorders treated at a single institution.

Immunodeficiency-associated lymphoproliferative disorders (LPD) represent a rare life-threatening clinical entity characterized by heterogeneous histological findings that range from polymorphic to monomorphic proliferated abnormal lymphocytes. Currently, there is no standard treatment for LPD. To elucidate the clinical features and treatment outcomes of immunodeficiency-associated LPD patients with rheumatoid arthritis (RA), we retrospectively evaluated 9 cases observed over a 5-year period. The diagnoses of these patients included 5 diffuse large B-cell lymphomas, 3 LPD, and 1 mucosa-associated lymphoid tissue lymphoma. At initial diagnosis, 6 patients had advanced-stage RA, and half of these underwent total knee arthroplasty. All patients with RA received methotrexate (MTX) and low-dose prednisolone. Biologics were administered to 4 of 9 patients. After the development of immunodeficiency-associated LPD, MTX discontinuation resulted in 5 complete remissions (CR), 1 partial remission, and 3 cases of stable disease. Relapse was observed in 3 of 5 CR patients in the MTX-withdrawal remission group. Subsequently, conventional chemotherapy, rituximab, and radiation were administered to 4, 3, and 1 patient, respectively. These treatments induced a second CR. In the chemotherapy group, 1 patient developed acute myocardial infarction and another experienced ileus and pulmonary abscess. In the rituximab group, no severe complications were observed. Consequently, all patients remained disease-free during the median 23-month follow-up period. Our results indicate that, depending on the RA disease stage, performance status, and extent of treatment response, less intensive treatments than those commonly indicated for non-Hodgkin lymphoma, involving MTX discontinuation and subsequent therapy containing rituximab, might be an efficient therapeutic strategy for immunodeficiency-associated LPD.

Successful treatment of bortezomib-refractory multiple myeloma derived from monoclonal gammopathy of undetermined significance with dose-adjusted lenalidomide therapy in a patient with concomitant end-stage renal disease due to diabetic nephropathy requiring haemodialysis.

Malignancy is a fatal complication of end-stage renal disease (ESRD) requiring haemodialysis. However, the successful treatment of haematological malignancies has been rarely reported. We describe the case of a 63-year-old man who presented with IgA-type multiple myeloma (MM; Durie-Salmon stage IIIB) derived from monoclonal gammopathy of undetermined significance concomitant with ESRD due to diabetic nephropathy. First, haemodialysis was initiated before chemotherapy, and bortezomib and dexamethasone were found to be ineffective. Subsequently, 8 courses of dose-adjusted lenalidomide therapy were administered according to the degree of haematological and renal functions. The patient remained in partial remission without disease progression for 21 months. Thus, lenalidomide therapy is effective for bortezomib-refractory MM concomitant with ESRD.

Femoral shaft bowing influences the correction angle for high tibial osteotomy.

BACKGROUND: The optimal femorotibial angle (FTA) after high tibial osteotomy (HTO) is still controversial. Our hypothesis was that FTA itself may not be reliable because FTA cannot represent the accurate alignment of the whole lower extremity. METHODS: Non-weight-bearing radiographs of the lower extremities were taken in 100 Japanese subjects with medial osteoarthritic knees, and seven anatomic parameters were assessed. The correction angle by FTA was calculated so that the postoperative FTA was set at 166 degrees (14 degrees valgus). Another correction angle was calculated so that the mechanical axis passed through the lateral one-fourth of the tibial articular surface after HTO. After the correlation between two correction angles was assessed, influences of anatomic parameters on the discrepancy between two correction angles were assessed. RESULTS: There was a high correlation between two correction angles (R2 = 0.777, P < 0.001). The mechanical axis passed through the lateral one-fourth of the tibial articular surface when the postoperative FTA was set at 166 degrees in 80% of subjects. However, discrepancy between the two correction angles was 3 degrees or larger in 20% of subjects. Femoral shaft bowing and tibial shaft bowing significantly influenced the correction angles. Even though FTA was the same, the femoral head shifted medially in cases with lateral bowing of the femoral shaft, and the correction angle by FTA should be set larger. On the other hand, the correction angle by FTA can be set smaller in knees with medial bowing of the femoral shaft. Tibial shaft bowing also influences the correction angle by FTA. CONCLUSIONS: The correction angle by FTA for HTO should be calculated taking femoral and/or tibial shaft bowing in the frontal plane into account.

An external snapping hip caused by osteochondroma of the proximal femur.

We herein report the findings of a 17-year-old boy who suffered from a right external snapping hip, which was caused by an osteochondroma of the proximal femur. He has been asymptomatic since the excision of the tumor. This case shows a rare etiology in which an external snapping hip occurred between the iliotibal band and the osteochondroma.

Ankle tuberculosis: a report of four cases in a Japanese hospital.

We report four patients suffering from ankle tuberculosis, which is an uncommon disease in Japan. All patients complained of swelling and pain in the affected ankle. Ankle tuberculosis is a disorder that can be easily misdiagnosed. The mean delay in diagnosis was 5.3 months in our series. All patients had already been diagnosed as having ankle tuberculosis by the time they visited our hospital in this series. The patients had been definitively diagnosed to have ankle tuberculosis by means of a needle biopsy in two cases, an open biopsy in one case, and on the basis of the clinical features in one case. All patients received antitubercular therapy and non-weight-bearing protective treatment. Antitubercular therapy was performed for an average of 14.3 months, and non-weight-bearing treatment was maintained for a mean of 4.5 months. The main treatments for such cases include open biopsy for an uncertain diagnosis, débridement for intractable synovitis, and arthrodesis for severely destroyed ankles with pain. All patients received some form of surgical intervention either from previous doctors or from us in this series. We conclude that most patients who suffer from ankle tuberculosis seem to need surgery in addition to adequate chemotherapy and non-weight-bearing protective treatment.

Changes in patellar tracking after total knee arthroplasty: 10-year follow-up of Miller-Galante I knees.

Changes in patellar tilt angle and patellar displacement were evaluated in 18 knees with the Miller-Galante I knee arthroplasty system (Zimmer, Warsaw, Ind). Mean follow-up was 10 years. Patellar tilt angle at final follow-up (5.7 degrees) was significantly larger than at 1 year postoperatively (2.8 degrees). Patellar displacement at final follow-up (5.1 mm) was significantly larger than at 1 year postoperatively (3.4 mm). Preoperatively, patellar tilt angle showed a statistically significant correlation with the change in tilting angle during follow-up. These results suggest patellar tracking can worsen during the long-term postoperative period.