Miwa Sakai

Publications (14)23.43 Total impact

• Article: Incidence, risk factors and outcomes of bronchiolitis obliterans after allogeneic stem cell transplantation.

  Chiaki Nakaseko, Shinichi Ozawa, Emiko Sakaida, Miwa Sakai, Yoshinobu Kanda, Kumi Oshima, Mineo Kurokawa, Satoshi Takahashi, Jun Ooi, Takayuki Shimizu, Akira Yokota, Fumiaki Yoshiba, Katsumichi Fujimaki, Heiwa Kanamori, Rika Sakai, Takayuki Saitoh, Tohru Sakura, Atsuo Maruta, Hisashi Sakamaki, Shinichiro Okamoto
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  ABSTRACT: Bronchiolitis obliterans (BO) after allogeneic stem cell transplantation (allo-SCT) is a late-onset, life-threatening respiratory complication that significantly reduces a patient's quality of life. We retrospectively analysed the incidence of and risk factors for BO in allo-SCT recipients. In 2087 patients who underwent allo-SCT between January 1994 and June 2005 and survived >90 days after transplantation, 57 patients developed BO with a 5-year cumulative incidence of 2.8%. The median time interval from transplantation to BO diagnosis was 335 days (range 83-907 days). The 5-year cumulative incidence of BO was 1.62% in bone marrow transplantation (BMT) from related donors, 3.83% in peripheral blood stem cell transplantation (PBSCT) from related donors (R-PBSCT), 2.91% in BMT from unrelated donors and 2.65% in unrelated cord blood transplantation. The incidence of BO after R-PBSCT was significantly higher than that after any other type of allo-SCT (p = 0.02). R-PBSCT (p = 0.019) and preceding chronic graft-versus-host disease (GVHD) (p < 0.001) were BO-associated risk factors. Overall 5-year survival of patients with BO from the time of diagnosis was 45.4%, significantly less than those without (77.5% from day 335, p < 0.001). R-PBSCT recipients with existent chronic GVHD have a high risk of developing BO, and need extensive care and repeated pulmonary function tests.
  International journal of hematology 03/2011; 93(3):375-82. · 1.17 Impact Factor
• Article: [Second transplantation for graft failure after allogeneic hematopoietic stem cell transplantation--a retrospective survey by Kanto Study Group for Cell Therapy].

  Maki Hagihara, Heiwa Kanamori, Miwa Sakai, Takehiko Mori, Chiaki Nakaseko, Nobuyuki Aotsuka, Taeko Uehara, Tohru Sakura, Fumio Yoshiba, Nobutaka Kawai, Masatsugu Tanaka, Shin Fujisawa, Chikako Ohwada, Hisashi Wakita, Akira Yokota, Toshihide Kawamura, Atsuo Maruta, Hisashi Sakamaki, Shinichiro Okamoto
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  ABSTRACT: We retrospectively surveyed patients who received a second transplantation for graft failure (GF) after allogeneic hematopoietic stem cell transplantation (SCT) in hospitals participating in the Kanto Study Group for Cell Therapy. A second SCT was performed in 21 of 45 patients with primary GF and in 13 of 15 with secondary GF. The median time between the first and second SCT was 49 days (range, 18-1204 days). The diagnosis included 28 patients with hematologic malignancies and 6 with aplastic anemia. Non-myeloablative or reduced-intensity conditioning was performed in 30 patients. Cord blood was frequently used as the source of stem cells followed by related donor peripheral blood, and unrelated bone marrow. Engraftment was achieved in 23 patients (68%). Conditioning regimen including total body or total lymphoid irradiation, was significantly associated with a higher engraftment rate. Overall survival at 5 years in all patients who underwent second SCT was 34%. Prognostic factors for better survival after second SCT were a time to second SCT longer than 90 days, the performance status at second SCT with 0 or 1, and the administration of tacrolimus for GVHD prophylaxis. The major cause of death after second SCT was infection. Although the outcome of a second SCT for graft failure remains poor, these findings suggest that the selection of patients as well as transplant methods, such as conditioning and GVHD prophylaxis, may contribute to survival.
  [Rinshō ketsueki] The Japanese journal of clinical hematology 06/2010; 51(6):390-7.
• Article: [Hepatitis B virus reactivation in patients with HBs antibodies after allogeneic hematopoietic stem cell transplantation].

  Katsumichi Fujimaki, Chiaki Nakaseko, Kumi Oshima, Miwa Sakai, Ryukou Chou, Yoshinobu Kanda, Miki Nishimura, Heiwa Kanamori, Hisashi Sakamaki
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  ABSTRACT: We retrospectively investigated the clinical characteristics of reactivation of hepatitis B (HB) virus after allogeneic hematopoietic stem cell transplantation (HSCT). Of 2002 patients who received transplantation between January 1994 and December 2004, seven patients who were anti-HB surface antibody (anti-HBs) positive and HB surface antigen (HBs-Ag) negative developed reactivation of the HB virus after allogeneic HSCT. The patients' median age was 49 years, and they consisted of 5 males and 2 females. Six of 7 recipients received hematopoietic stem cells from HLA-identical sibling donors. All donors were negative for HBs-Ag. Six donors were negative for anti-HBs and one donor was not investigated for anti-HBs. HB reactivation occurred 5 to 29 (median 15) months after HSCT. Chronic graft-versus-host-disease (GVHD) was observed in 5 cases. The peak value of GPT during HB reactivation varied from 83 to 1930 (median 318) IU/l. Lamivudine was given to 5 patients. One patient was treated with supportive therapy and other one patient was observed without treatment. Two patients developed fulminant hepatitis and died of hepatic dysfunction. Clinicians should consider the possibility of HB reactivation in anti-HBs-positive patients. The establishment of a preventive method for HB reactivation would be desirable.
  [Rinshō ketsueki] The Japanese journal of clinical hematology 06/2007; 48(5):386-90.
• Article: Effect of blood cyclosporine concentration on the outcome of hematopoietic stem cell transplantation from an HLA-matched sibling donor.

  Yoshinobu Kanda, Rie Hyo, Takuya Yamashita, Katsumichi Fujimaki, Kumi Oshima, Masahiro Onoda, Takehiko Mori, Toru Sakura, Masatsugu Tanaka, Miwa Sakai, Jun Taguchi, Mineo Kurakawa, Atsuo Maruta, Shinichiro Okamoto, Hisashi Sakamaki
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  ABSTRACT: We retrospectively evaluated the effect of the blood cyclosporine (CsA) concentration on the outcome of allogeneic hematopoietic stem cell transplantation from an HLA-matched sibling donor in 171 patients who received a continuous infusion of CsA and short-course methotrexate to prevent graft-versus-host disease (GVHD). CsA was started at 3.0 mg/kg/day and the dose was adjusted to maintain the blood CsA concentration between 250 and 350 ng/ml. The actual dose of CsA averaged 1.9 mg/kg/day at the 3rd week after transplantation. The incidence of grade II-IV acute GVHD was 29.9%. Patient age and sex were identified as independent significant risk factors for acute GVHD. The CsA concentration during the 3rd week after transplantation most strongly affected the incidence of grade II-IV acute GVHD (RR 0.995 for an increase in CsA concentration by 1 ng/ml, P = 0.037) adjusted for other risk factors. The incidence of acute GVHD was significantly lower in patients with a 3rd-week CsA concentration higher than 300 ng/ml than in those with values between 200 and 300 ng/ml (20% vs. 35%, P = 0.036). We concluded that the blood CsA concentration at peri-engraftment period may be important in preventing acute GVHD.
  American Journal of Hematology 12/2006; 81(11):838-44. · 4.67 Impact Factor
• Article: Immune-mediated myelopathy following allogeneic stem cell transplantation.

  Miwa Sakai, Kazuteru Ohashi, Keiko Ohta, Takuya Yamashita, Hideki Akiyama, Shuji Kisida, Noriko Kamata, Hisashi Sakamaki
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  ABSTRACT: We report a case of immune-mediated myelopathy occurring 4 months after unrelated bone marrow transplantation for myelodysplastic syndrome. After the tapering of cyclosporine for graft-versus-host disease prophylaxis, the patient developed several neurological symptoms mimicking the clinical features of multiple sclerosis (MS). Although neurological exacerbation was well stabilized with a bulk dose of corticosteroid, sustained improvement of neurological deficits occurred after the patient developed hematopoietic mixed chimerism (HMC). This experience may provide clinical evidence supporting the current therapeutic concept, in which HMC induction can potentially cure several immune diseases, including MS.
  International Journal of Hematology 11/2006; 84(3):272-5. · 1.27 Impact Factor
• Article: [Successful treatment with voriconazole for disseminated cutaneous and visceral infection by Fusarium solani in a patient with acute myeloid leukemia].

  Takashi Muramatsu, Toshimitsu Ueki, Kazuteru Ohashi, Kumiko Negishi, Tomokazu Suzuki, Minori Shitara, Misao Honma, Tateki Ito, Miwa Sakai, Takuya Yamashita, Hideki Akiyama, Hisashi Sakamaki
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  ABSTRACT: We report the successful treatment of a disseminated Fusarium infection with skin manifestations in a severely neutropenic patient. A 51-year-old man with acute myeloblastic leukemia (M4) underwent two courses of remission induction therapy with cytarabine and daunorubicin. Despite prophylactic treatment with tosufloxacin and micafungin, the patient developed a febrile scrotal ulcer. Eight days later, we noted the appearance of painful and diffuse cutaneous nodules and a plain chest X-ray disclosed multiple nodular lesions. Microbiological examination of the scrotal ulcer revealed infection by Fusarium solani, which was also confirmed by both histological and microbiological examination of the skin nodules. Although the patient was treated with amphotericin B (AMPH-B), the clinical symptoms worsened. After AMPH-B was replaced with voriconazole (VRCZ), the patient's symptoms and chest radiographic findings dramatically improved. Thus, VRCZ might be an alternative therapy for patients with neutropenia who have fusariosis that is refractory or unresponsive to AMPH-B.
  [Rinshō ketsueki] The Japanese journal of clinical hematology 09/2006; 47(8):753-7.
• Article: Meningeal hematopoiesis following radiation myelitis in a hematopoietic stem-cell transplant recipient.

  Miwa Sakai, Kazuteru Ohashi, Takeshi Kobayashi, Takuya Yamashita, Hideki Akiyama, Tetuo Nemoto, Shuji Kishida, Noriko Kamata, Hisashi Sakamaki
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  ABSTRACT: Extramedullary meningeal hematopoiesis (EMH) represents an uncommon finding after stem-cell transplantation. We describe the case of an allogeneic bone marrow transplantation (BMT) recipient who developed EMH 1 month after radiation myelitis had been diagnosed. A 39-year-old man with multiple myeloma underwent matched unrelated BMT following a myeloablative conditioning regimen of cyclophosphamide and total-body irradiation (200 cGyx6). This was followed by delivery of 40 Gy of involved-field radiation to an extramedullary plasmacytoma compressing the spinal cord. Although transplantation went extremely well, the patient developed radiation myelitis 7 months after transplantation, and EMH ensued 1 month later. Because the patient was not in a disease state known to cause EMH, it is tempting to speculate that radiation-related neural injuries might cause donor cells to migrate to the central nervous system.
  American Journal of Hematology 09/2005; 79(4):291-3. · 4.67 Impact Factor
• Article: Granulocyte colony-stimulating factor-primed donor lymphocyte infusion after salvage chemotherapy for treatment of relapsed acute leukemia after allogeneic stem cell transplantation.

  Takeshi Kobayashi, Kazuteru Ohashi, Miwa Sakai, Takuya Yamashita, Yoshiki Okuyama, Kiyoshi Hiruma, Hideki Akiyama, Hisashi Sakamaki
  International Journal of Hematology 08/2005; 82(1):79-81. · 1.27 Impact Factor
• Article: Chest computed tomography of late invasive aspergillosis after allogeneic hematopoietic stem cell transplantation.

  Rie Kojima, Ukihide Tateishi, Masahiro Kami, Naoko Murashige, Yasuhito Nannya, Eiji Kusumi, Miwa Sakai, Yuji Tanaka, Yoshinobu Kanda, Shin-Ichiro Mori, Shigeru Chiba, Masahiko Kusumoto, Shigesaburo Miyakoshi, Hisamaru Hirai, Shuichi Taniguchi, Hisashi Sakamaki, Yoichi Takaue
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  ABSTRACT: Computed tomography (CT) is a powerful diagnostic tool for invasive aspergillosis (IA) after allogeneic stem cell transplantation (allo-SCT); however, little information is available concerning CT findings of late IA after allo-SCT. To characterize CT findings of late IA, we retrospectively examined medical records and high-resolution CT findings of 27 allo-SCT recipients with late IA. Either acute or chronic GVHD was diagnosed in 24 patients. All 27 patients were given corticosteroids at IA diagnosis. High-resolution CT findings included halo (n=12), centrilobular nodules (n=12), ill-defined consolidation (n=13), ground-glass attenuation (n=8), pleural effusion (n=7), pleural-based consolidation (n=4), and cavitation (n=4). CT findings showing centrilobular nodules and either halo or cavitation were classified into bronchopneumonia type and angioinvasive type, respectively. Angioinvasive-type, bronchopneumonia-type, and combination-type IA were diagnosed in 11, 8, and 4 patients, respectively. CT findings were nonspecific in the other 4 patients. One bronchopneumonia-type case and 2 angioinvasive-type IA cases were subsequently diagnosed as combination type. Although there were no significant differences in patient characteristics between the 2 types of IA, bronchopneumonia-type IA had a poorer prognosis than angioinvasive IA ( P=.022). Halo is a useful diagnostic marker in late IA as well as early IA, and late IA frequently manifests as bronchopneumonia.
  Biology of Blood and Marrow Transplantation 08/2005; 11(7):506-11. · 3.87 Impact Factor
• Article: Cytogenetic abnormalities without evidence of relapse after treatment with imatinib and stem cell transplantation in a patient with Ph-positive ALL.

  Miwa Sakai, Kazuteru Ohashi, Takeshi Kobayashi, Takuya Yamashita, Hideki Akiyama, Hisashi Sakamaki
  International Journal of Hematology 03/2005; 81(2):171-3. · 1.27 Impact Factor
• Article: Incidence of invasive aspergillosis after allogeneic hematopoietic stem cell transplantation with a reduced-intensity regimen compared with transplantation with a conventional regimen.

  Rie Kojima, Masahiro Kami, Yasuhito Nannya, Eiji Kusumi, Miwa Sakai, Yuji Tanaka, Yoshinobu Kanda, Shin-Ichiro Mori, Shigeru Chiba, Shigesaburo Miyakoshi, Kinuko Tajima, Hisamaru Hirai, Shuichi Taniguchi, Hisashi Sakamaki, Yoichi Takaue
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  ABSTRACT: To evaluate the clinical characteristics of invasive aspergillosis (IA) after reduced-intensity stem cell transplantation (RIST) compared with those after conventional stem cell transplantation (CST), we examined the medical records of 486 CST and 178 RIST recipients. The overall incidence of IA after allogeneic transplantation was 35 (5.3%) of 664, which gave a 3-year cumulative incidence of 5.6%. The estimated 3-year incidence of IA in CST and RIST was 4.5% and 8.2% (P = .045), respectively, but the mortality rates were similar (76% and 86%). The median onset of IA after RIST (day 127) occurred significantly later than that after CST (day 97). A multivariate analysis revealed that IA was associated with age older than 50 years (relative risk, 2.12; 95% confidence interval, 1.08-4.17; P = .03) and the presence of acute and/or chronic GVHD (relative risk, 6.2; 95% confidence interval, 2.4-16.4; P = .0002). IA remains an important complication after allogeneic transplantation, regardless of the type of conditioning regimen.
  Biology of Blood and Marrow Transplantation 10/2004; 10(9):645-52. · 3.87 Impact Factor
• Article: [A case of Crow-Fukase syndrome showing improvement following excision and irradiation of bone lesions].

  Asako Yoritaka, Miwa Sakai, Keiko Ohta, Shuji Kishida
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  ABSTRACT: A 57-year-old woman suffering from pleural and pericardial effusion, pulmonary hypertention, lymphadenopathy, hepatosplenomegaly, edema, hypertrichosis, small hemangioma and polyneuropathy was diagnosed as Crow-Fukase syndrome. Osteoctomy of the left second rib and irradiation of this rib and the left iliac bone were performed. Serum vascular endothelial growth factor (VEGF) level decreased to less than one-half the level before the operation (from 5,180 to 2,150 pg/ml). Immediately after the operation, pleural and pericardial effusions due to hyperpenetration improved, and polyneuropathy and hypertrichosis due to hypervasularity also gradually improved. The resected lesion was histopathologically found to be of a plasmacytoma of the IgG lambda type. Since the level of VEGF in the tissue specimen was much lower (116 pg/ml) than that in the serum, VEGF could not have been produced by the plasmacytoma.
  Rinsho shinkeigaku = Clinical neurology 07/2004; 44(6):369-71.
• Source

  Available from: Kazuteru Ohashi

  Article: Incapacitating lower limb pain syndrome in cord blood stem cell transplant recipients with calcineurin inhibitor.

  Aiko Kida, Kazuteru Ohashi, Takeshi Kobayashii, Miwa Sakai, Takuya Yamashita, Hideki Akiyama, Shuji Kishida, Hisashi Sakamaki
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  ABSTRACT: Calcineurin-inhibitor induced pain syndrome (CIPS) is a newly described entity with a characteristic feature of sudden onset of severe lower limb pain, and high levels of cyclosporine or tacrolimus may be involved in the pathogenesis. This syndrome is rarely seen in recipients of hematopoietic stem cell transplantation (HSCT) compared with other organ transplant recipients, however, heightened awareness of this complication after HSCT may be needed for hematologists, as misdiagnosis can result in catastrophic consequences. We report herein two cases of lower limb pain syndrome, with some clinical features resembling CIPS, occurring during the early phase of cord blood stem cell transplantation for hematological malignancy.
  Pathology & Oncology Research 02/2004; 10(4):204-6. · 1.37 Impact Factor
• Article: Treatment with granulocyte colony-stimulating factor after allogeneic transplantation increases the risk of hepatic veno-occlusive disease and death: a retrospective analysis of 440 cases at a single centre

  Miwa Sakai, Kazuteru Ohashi, Takeshi Kobayashi, Takuya Yamashita, Hideki Akiyama, Hisashi Sakamaki