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ABSTRACT: Abstract We assessed the prognostic impact of occult bone marrow involvement, determined by flow cytometry and/or polymerase chain reaction, in a population of 117 consecutive patients with newly-diagnosed DLBCL treated with R-CHOP. 24 (20.5%) had morphologically-diagnosed and 16 (13.7%) had occult marrow involvement, and 77 (65.8%) had no marrow involvement. Although the pretreatment characteristics of the negative or occult marrow involvement group were similar, severe hematological toxicity after R-CHOP was more frequent in the occult marrow involvement group. Progression-free survival (PFS; p=0.015) and overall survival (OS; p=0.035) for the occult marrow involvement group were significantly shorter than those for the negative group, and were comparable with those of the morphologic marrow involvement group, independently of the International Prognostic Index score for PFS. Occult bone marrow involvement predicts a severe hematological toxicity and negatively impacts on PFS and OS of R-CHOP therapy.
Leukemia & lymphoma 04/2013; · 2.40 Impact Factor
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ABSTRACT: ABSTRACT Rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) is regarded as the first-line treatment for elderly patients with diffuse large B-cell lymphoma (DLBCL) but it is often necessary to reduce the dose or prolong the intervals between doses. In our center, dose reduction is performed with elderly patients with DLBCL on an individual basis: for patients in their seventies and eighties, the initial CHOP dose is reduced to 70% and 50%, respectively, and the subsequent doses are adjusted so that the patients receive, at 21-day intervals, the highest dose they can tolerate (reduced-dose R-CHOP21). To verify this practice, a retrospective analysis was performed. Between January, 2004 and January, 2011, 109 ≥70-year-old patients with DLBCL received reduced-dose R-CHOP21 with curative intent. The 2-year overall survival rates of the 70-79- and ≥80-year-old patients were 75.2% and 64.6%, respectively. Of 35 deaths, 20 were due to disease progression and five were related treatment toxicity. Multivariate analysis revealed that an age of 75-79 years and an age of 80 years or older were associated with shorter survival. Given that many patients had poor performance status and comorbidities, reduced-dose R-CHOP21 may provide a reasonable balance between efficacy and tolerability for elderly patients with DLBCL.
Leukemia & lymphoma 03/2013; · 2.40 Impact Factor
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Seiji Nagano,
Minako Mori,
Aiko Kato,
Yuichiro Ono,
Kazunari Aoki,
Hiroshi Arima,
Yoko Takiuchi,
Sumie Tabata,
Soshi Yanagita,
Akiko Matsushita,
Takayuki Ishikawa,
Hiroyuki Imai, Takayuki Takahashi
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ABSTRACT: A 74-year-old woman with refractory IgG-κ multiple myeloma developed massive melena caused by hemorrhagic submucosal tumors in the duodenum and middle jejunum. A biopsy revealed the tumor to be marked AL amyloid deposition. Treatment with bortezomib did not improve the melena or the underlying disease. The patient also developed multiple amyloidomas in the bilateral femoral heads, which caused a fracture in the left femoral head. Treatment with lenalidomide, as the final therapeutic option, resolved the intractable melena and improved both the intestinal lesions and myeloma. This case shows that successful treatment of multiple myeloma leads to marked improvement of accompanying AL amyloidosis.
Internal Medicine 01/2013; 52(10):1101-5. · 0.94 Impact Factor
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Sumie Tabata,
Masayuki Kurata,
June Takeda,
Yuuki Funayama,
Nobuhiko Yamauchi,
Kazunari Aoki,
Aiko Kato,
Yuichirou Ono,
Hiroshi Arima,
Yoko Takiuchi,
Seiji Nagano,
Akiko Matsushita,
Yukihiro Imai,
Takayuki Ishikawa, Takayuki Takahashi
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ABSTRACT: Although about 10 to 15% of patients with multiple myeloma (MM) develop AL amyloidosis, liver-restricted fatal amyloidosis is rare. We encountered such an MM patient. A 73-year-old female without a history of carpal tunnel syndrome was diagnosed with IgG-κ MM (Stage I by Durie & Salmon) in January, 2005. Because MM was exacerbated to Stage III in May, 2007, VAD (vincristine, adriamycin, dexamethasone) chemotherapy was performed with minor response, despite 3 courses of this regimen. Three courses of salvage chemotherapy (cyclophosphamide+melphalan; CM) were then performed with near partial response. In March, 2008, just before the 4th cycle of CM chemotherapy, she was slightly icteric with elevated biliary tract enzymes; therefore, treatment was switched to oral cyclophosphamide and prednisolone. At this time, she did not have macroglossia, skin eruption, gastrointestinal dysfunction, or bleeding. Echocardiography was also non-specific. One month later, she developed a marked bleeding tendency and leg edema. Laboratory tests showed a severe deterioration in liver function. In the middle of May, 2008, she progressed to hepatic coma and died of intracranial hemorrhage several days later. Autopsy showed that the liver was almost substituted by AL amyloid substance.
[Rinshō ketsueki] The Japanese journal of clinical hematology 11/2012; 53(11):1906-10.
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Daichi Inoue,
Akiko Matsushita,
Mineyo Kiuchi,
Yoko Takiuchi,
Seiji Nagano,
Hiroshi Arima,
Minako Mori,
Sumie Tabata,
Akiko Yamashiro,
Hayato Maruoka,
Tatsuo Oita,
Yukihiro Imai, Takayuki Takahashi
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ABSTRACT: An 84-year-old Japanese man was admitted because of pancytopenia. The bone marrow was hypoplastic with a predominance of abnormal small lymphocytes and grape cells, which were positive for CD19 and CD20, and partially for the surface ĸ-light chain. Systemic CT scanning showed neither lymph node swelling nor hepatosplenomegaly. Serum immunoelectrophoresis and rocket immunoselection assays showed the presence of monoclonal IgG protein without a corresponding light chain and faint IgMĸ monoclonal protein. Histologic analysis of the clot preparation of the bone marrow aspirate facilitated a diagnosis of lymphoplasmacytic lymphoma (LPL). PCR analysis of the marrow cells demonstrated a clonal rearrangement of the immunoglobulin heavy-chain gene. From these results, we made a final diagnosis of γ-heavy-chain disease (γ-HCD) with underlying LPL localized in the bone marrow. We performed only a single course of immunochemotherapy (rituximab and fludarabine) in view of severely impaired hematopoiesis, which resulted in marked reduction of lymphoma cells and improvement of hematopoiesis. This report suggests the efficacy of rituximab plus fludarabine therapy for LPL-associated γ-HCD.
Acta Haematologica 08/2012; 128(3):139-43. · 1.35 Impact Factor
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Annals of Hematology 05/2012; · 2.62 Impact Factor
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Naoki Kakazu,
Isaku Shinzato,
Yasuhito Arai,
Saori Gotoh,
Akiko Matsushita,
Takayuki Ishikawa,
Kenichi Nagai, Takayuki Takahashi,
Tatsuji Ohno,
Takayuki Tsuchiya,
Misao Ohki,
Tatsuo Abe
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ABSTRACT: We report here a case of acute monocytic leukemia (M5b subtype according to the French-American-British [FAB]classification)
with chromosomal translocation t(11;20)(p15;q11.2). Fluorescence in situ hybridization analysis with a probe for theNUP98 gene, which is located at chromosome band 11p15, showed that the probe hybridized to both derivative chromosomes 11 and 20
as well as to the remaining normal chromosome 11, indicating that theNUP98 gene was split and involved in this translocation. This is the first report of t(11;20)(p15;q11.2) involving theNUP98 gene in overt leukemia.
International Journal of Hematology 04/2012; 74(1):53-57. · 1.27 Impact Factor
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01/2012; , ISBN: 978-953-307-886-1
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Yoko Takiuchi,
Hayato Maruoka,
Kazunari Aoki,
Aiko Kato,
Yuichiro Ono,
Seiji Nagano,
Hiroshi Arima,
Daichi Inoue,
Minako Mori,
Sumie Tabata,
Soshi Yanagita,
Akiko Matsushita,
Mari Nishio,
Yukihiro Imai,
Kiminari Ito,
Haruyuki Fujita,
Norimitsu Kadowaki,
Takayuki Ishikawa, Takayuki Takahashi
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ABSTRACT: Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy with a poor prognosis. We encountered a unique case of BPDCN that was leukemic at presentation without skin lesion and expressed CD33 antigen. A 74-year-old man was admitted because of dyspnea. Physically, hepatosplenomegaly, but not skin lesions and superficial lymph node swelling, was noted. The white blood count was 33.6 × 10(9)/L with 19% giant abnormal cells. These cells were positive for CD4, CD86, CD123 (bright), BDCA-2, and HLA-DR, but negative for CD1a, CD3, CD11b, CD11c, CD13, CD14, CD19, CD64, and CD68. From these findings, a diagnosis of BPDCN was made. In terms of unusual expression, these tumor cells were positive for CD33 but negative for CD56. The karyotype was 47, XY, t(6;8) (p21;q24), + r. We performed combination chemotherapy (Ara-C + VP-16 + MIT), which resulted in a marked reduction of tumor cells and improvement of the dyspnea. On day 16, however, he died of sepsis due to Bacillus cereus. The clinical picture of this patient is unusual and may provide new information on the clinicopathology of BPDCN. [J Clin Exp Hematopathol 52(2) : 107-111, 2012].
Journal of Clinical and Experimental Hematopathology 01/2012; 52(2):107-11.
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Sonoko Shimoji,
Yohko Takiuchi,
Hayato Maruoka,
Daichi Inoue,
Takaharu Kimura,
Minako Mori,
Yuya Nagai,
Katuhiro Togami,
Sumie Tabata,
Masayuki Kurata,
Akiko Matsushita,
Kenichi Nagai, Takayuki Takahashi
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ABSTRACT: A 73-year-old woman with Sjögren's syndrome and autoimmune neutropenia (AIN) associated with large granular lymphocytosis of the polyclonal T cell type, demonstrated autoimmune thrombocytopenia (AIT) at diagnosis of sigmoid colon cancer. Ten months later, both AIN and AIT had exacerbated to agranulocytosis and severe thrombocytopenia below 10×10(9)/L, respectively. There were no dysplastic features of bone marrow hematopoietic cells. Furthermore, an in vitro assay of hematopoietic progenitors showed normal granuloid and erythroid colony formation. Although we serially treated her with prednisolone (oral), filgrastim, intravenous high-dose immunoglobulin infusion, cyclophosphamide (oral), danazol, cyclosporine A (oral), and rituximab, number of neutrophils and platelets elevated only temporarily. During the course of agranulocytosis and severe thrombocytopenia, the patient also developed autoimmune hemolytic anemia (AIHA). She died of pneumonia 5 months after the onset of agranulocytosis. This case is very unique and novel in terms of autoimmune phenomena simultaneously directed to granulocytes, platelets, and red blood cells under the background of Sjögren's syndrome.
[Rinshō ketsueki] The Japanese journal of clinical hematology 07/2011; 52(7):535-9.
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ABSTRACT: Blastic plasmacytoid dendritic cell neoplasm (BPDCN), currently considered to originate from immature plasmacytoid dendritic cells (DC), is a rare and aggressive CD4+CD56+ neoplasm that frequently involves the skin and bone marrow. We present a case of an 80-year-old man with a CD4+CD56+ BPDCN that affected the orbital cavity and bone marrow. Although BPDCN has not been reported to express any lineage-specific markers, the neoplastic cells strongly expressed the CD13 antigen. Therefore, in addition to pathological examination, we attempted to induce in vitro morphological and surface marker changes with IL-3 and CD40 ligand. After treatment with these cytokines, the tumor cells enlarged markedly, acquired many fine dendrites, similar to mature DC, and showed enhanced expression of antigens specific to DC or antigen-presenting cells, such as CD40, CD80, CD83 and CD86. To the best of our knowledge, this is the first report of BPDCN expressing a myeloid antigen, CD13, although CD33 expression has been described in some cases. The present patient received 2 courses of combination chemotherapy consisting of cytarabine and etoposide, which resulted in complete remission. Given that the cellular origin of plasmacytoid DC is still controversial, myeloid antigen expression involving CD13 may not exclude a diagnosis of BPDCN.
Acta Haematologica 06/2011; 126(2):122-8. · 1.35 Impact Factor
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Aiko Kato,
Yoko Takiuchi,
Kazunari Aoki,
Yuichiro Ono,
Hiroshi Arima,
Seiji Nagano,
Sumie Tabata,
Soshi Yanagita,
Akiko Matsushita,
Hayato Maruoka,
Masaya Wada,
Yukihiro Imai,
Takayuki Ishikawa, Takayuki Takahashi
[show abstract]
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ABSTRACT: A 74-year-old man was admitted to hospital because of persistent fever, diarrhea, and abdominal pain. CT scanning showed extensive wall thickening of the colon. He was transferred to our hospital because he further developed ascites and paraaortic lymph node swelling. On presentation, he was extremely emaciated with superficial lymph node swelling, ascitic signs, and leg edema. Histological image of a biopsied mesenteric lymph node demonstrated diffuse infiltration of large abnormal T cells. Surface antigen analysis of abnormal cells in the ascites revealed positivity for CD3, CD8, CD56, and weak positivity for CD103. Polymerase chain reaction analysis showed monoclonal rearrangement of the T cell receptor (TCR) gene. The subtype of TCR was αβ. A diagnosis of enteropathy-associated T cell lymphoma (EATL) type II was made. The lymphoma involved the bone marrow. The patient also had severe hemolytic anemia with a positive Coomb's test result. An additional diagnosis for autoimmune hemolytic anemia (AIHA) was made, which was resistant to methylprednisolone therapy. We first treated him with only vincristine in addition to the steroid to avoid acute tumor lysis syndrome ; however, he died of septic shock that occurred soon after vincristine administration. To the best of our knowledge, this may be the first reported case of EATL complicated by AIHA.
Journal of Clinical and Experimental Hematopathology 01/2011; 51(2):119-23.
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Yuichiro Ono,
Kazunari Aoki,
Aiko Kato,
Hiroshi Arima,
Yohko Takiuchi,
Seiji Nagano,
Sumie Tabata,
Sohshi Yanagita,
Akiko Matsushita,
Hayato Maruoka,
Yukihiro Imai,
Takayuki Ishikawa, Takayuki Takahashi
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ABSTRACT: A 30-year-old man was referred to our hospital with leukocytosis and fecal occult blood. His white blood cell count was 30.2 × 10(9)/L with 79% small- to medium-sized lymphocytes. Surface antigen analysis revealed that these lymphocytes were positive for CD19, CD20, CD10, and CD23, but negative for CD5. The lymphocytes infiltrated the bone marrow. On endoscopic examination of the duodenum and jejunum, many small polypoid lesions were observed. A histologic picture of a biopsied lesion showed diffuse infiltration of small- to medium-sized lymphocytes in the submucosal region. On immunohistochemistry, these lymphocytes were positive for CD20, BCL2, and CD10 (weakly). Polymerase chain reaction analysis of cells from peripheral blood, bone marrow, and intestinal lesion showed a fusion product of BCL2 and immunoglobulin heavy chain (IGH) genes. The fused BCL2/IGH gene was also demonstrated by fluorescence in situ hybridization in the same cell sources. Computed tomography scanning showed marked wall thickening throughout the small intestine and enlarged mesenteric lymph nodes. A diagnosis of follicular lymphoma with massive intestinal involvement in a leukemic state was made. After 6 courses of rituximab-combined CHOP chemotherapy, complete remission was obtained.
Journal of Clinical and Experimental Hematopathology 01/2011; 51(2):135-40.
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Minako Mori,
Akiko Matsushita,
Yohko Takiuchi,
Hiroshi Arima,
Seiji Nagano,
Sonoko Shimoji,
Takaharu Kimura,
Daichi Inoue,
Sumie Tabata,
Sohshi Yanagita,
Kenichi Nagai,
Yukihiro Imai, Takayuki Takahashi
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ABSTRACT: A 70-year-old male was admitted because of back pain due to peri-vertebral tumors. The histologic picture of a needle-biopsied tumor specimen showed pleomorphic large cell infiltration into the collagen fibers. On immunohistochemistry, these abnormal cells were positive for CD68, CD163 and lysozyme but negative for CD1a, 21, 30, and S100. Flow cytometric analysis also demonstrated that these cells were positive for CD13, 14, 38, 45, 56, and HLA-DR. A bone marrow aspirate showed the marked infiltration of abnormal large cells with the same surface antigens as described above. A diagnosis of HS was made. He showed monocytosis in the peripheral blood of more than 1.0 x 10(9)/L from presentation. The karyotype of bone marrow cells was 46,XY,+8. Fluorescent in situ hybridization (FISH) analysis with a probe for chromosome no. 8 showed that all these monocytes carried +8, indicating that he had another disorder of chronic myelomonocytic leukemia (CMML). FISH analysis with a probe for chromosome no. 12 demonstrated that the abnormal large cells in the bone marrow were all tetraploid, while analysis with the chromosome no. 8 probe showed more than 8 signals per cell, indicating that HS cells carried octasomy to decasomy of chromosome no. 8. These findings strongly suggest that HS in the present patient originated from underlying CMML.
International journal of hematology 07/2010; 92(1):168-73. · 1.17 Impact Factor
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Kenichi Nagai,
Hisako Hashimoto,
Kiminari Itoh,
Akiko Matsushita,
Sonoko Shimoji,
Takaharu Kimura,
Daichi Inoue,
Minako Mori,
Yuya Nagai,
Sumie Tabata,
Muneyuki Yanagida, Takayuki Takahashi
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ABSTRACT: A 19-year-old girl with T-lymphoblastic lymphoma (T-LBL) was referred to our hospital because of refractory disease. After complete remission was achieved by the JALSG ALL-97 protocol, she received a bone marrow transplantation (BMT) from an unrelated, HLA-matched donor with myeloablative conditioning. Four months after BMT, T-LBL relapsed and donor lymphocyte infusion was ineffective. After partial remission was achieved with l-asparaginase therapy, she received 2 antigen-mismatched cord blood transplantation with non-myeloablative conditioning; however, sustained engraftment of cord blood stem cells has failed. This was associated with the reappearance of the blood cells from the first donor and the disappearance of leukemic cells from both the peripheral blood and bone marrow. Computed tomography showed no enlarged lymph nodes. The patient and the cord blood donor shared two minor histocompatibility antigens (mHAgs), while these mHAgs were not detected in the blood cells of the first donor. TCR analysis disclosed expanded oligoclonal Vbeta2T cells in the peripheral blood at relapse, and these cells secreted IFN-gamma in response to stimulation by the patient's leukemic cells. Moreover, these cells exhibited cytotoxicity against both leukemic cells and cord blood mononuclear cells. These results strongly suggest that Vbeta2T cells, derived from the first donor, may have been cytotoxic lymphocytes against both leukemic cells and cord blood stem cells.
[Rinshō ketsueki] The Japanese journal of clinical hematology 06/2010; 51(6):413-21.
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Minako Mori,
Daichi Inoue,
Hiroshi Arima,
Yohko Takiuchi,
Seiji Nagano,
Takaharu Kimura,
Sonoko Shimoji,
Yuya Nagai,
Sumie Tabata,
Sohshi Yanagita,
Akiko Matsushita,
Kenichi Nagai,
Yukihiro Imai, Takayuki Takahashi
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ABSTRACT: The prognosis of angioimmunoblastic T cell lymphoma (AITL) is poor because of chemotherapy-resistance and the short duration of remission. In recent years, cyclosporin A (CyA) has been employed as a alternative treatment for AITL in some patients with the rationale that CyA inhibits the activity and proliferation of neoplastic T cells. We herein report 4 chemotherapy-resistant AITL patients who were treated with oral CyA. The dosage of CyA was individually determined in each patient in order to achieve a blood CyA concentration of around 200 ng/ml at the trough level. A patient in whom AITL had relapsed 3 months after high dose chemotherapy with autologous hematopoietic stem cell transplantation (HSCT) achieved a sustained complete remission (CR) with CyA and underwent allogeneic HSCT. In 2 patients who had failed to respond to conventional chemotherapies, the circulating lymphoma cells rapidly disappeared after the initiation of CyA, and one of these patients demonstrated a durable CR. The other patient showed a good response to CyA, but the agent was discontinued because of infection. The remaining one patient with advanced AITL did not respond to CyA and died of disease progression. To our knowledge, the efficacy of CyA for chemotherapy-resistant AITL, even in a leukemic state, has not previously been reported.
[Rinshō ketsueki] The Japanese journal of clinical hematology 05/2010; 51(5):332-8.
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Daichi Inoue,
Yuya Nagai,
Minako Mori,
Seiji Nagano,
Yoko Takiuchi,
Hiroshi Arima,
Takaharu Kimura,
Sonoko Shimoji,
Katsuhiro Togami,
Sumie Tabata,
Soshi Yanagita,
Akiko Matsushita,
Kenichi Nagai,
Yukihiro Imai,
Hiroshi Takegawa, Takayuki Takahashi
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ABSTRACT: Bacillus cereus is a growing concern as a cause of life-threatening infections in patients with hematologic malignancies. However, the risk factors for patients with unfavorable outcomes have not been fully elucidated. At our institution, we observed the growth of B. cereus in blood culture in 68 patients with (23) or without (45) hematologic malignancies treated from September 2002 to November 2009. We defined a case as having sepsis when more than two blood culture sets were positive for B. cereus or only a single set was positive in the absence of other microorganisms in patients who had definite infectious lesions. We determined 12 of 23 patients with hematologic malignancies as having sepsis, as well as 10 of 45 patients without hematologic malignancies (p = 0.012). Of the 12 patients with hematologic malignancies, four patients with acute leukemia died of B. cereus sepsis within a few days. In our cohort, risk factor analysis demonstrated that a neutrophil count of 0/mm(3), central venous (CV) catheter insertion, and the presence of central nervous system (CNS) symptoms were significantly associated with a fatal prognosis (p = 0.010, 0.010, and 0.010, respectively). Analysis of data from our cohort in conjunction with those from 46 previously reported patients with B. cereus sepsis identified similar risk factors, that is, acute leukemia, extremely low neutrophil count, and CNS symptoms (p = 0.044, 0.004, and 0.002, respectively). These results indicate that appropriate prophylaxis and early therapeutic intervention against possible B. cereus sepsis are crucially important in the treatment of hematologic malignancies.
Leukemia & lymphoma 04/2010; 51(5):860-9. · 2.40 Impact Factor
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Yuya Nagai,
Kazuhiro Ikegame,
Minako Mori,
Daichi Inoue,
Takaharu Kimura,
Sonoko Shimoji,
Katsuhiro Togami,
Sumie Tabata,
Masayuki Kurata,
Yukihiro Imai,
Akiko Matsushita,
Kenichi Nagai,
Hiroyasu Ogawa, Takayuki Takahashi
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ABSTRACT: A 32-year-old male with chronic hepatitis B was admitted to a hospital with cellulitis in the right leg in September 2006. Pancytopenia, hepatosplenomegaly, and systemic superficial lymph node swelling were noted, and he was referred to our hospital. He developed fever and liver dysfunction in June 2007 and underwent a splenectomy. His pancytopenia subsequently improved. A pathologic diagnosis of hepatosplenic alphabeta T cell lymphoma was made by examining spleen tissue and biopsy specimens of the liver and mesenteric lymph node. He had stage IVB disease because neoplastic T cells were noted in the bone marrow. The response of the lymphoma to conventional chemotherapy including the CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone) and DeVIC (dexamethasone, etoposide, ifoshamide, carboplatin) regimens was poor and transient. A partial remission was obtained with an ESHAP (etoposide, cisplatin, cytarabine, methylprednisolone) regimen. Therefore, we planned a bone marrow transplantation (BMT) from an HLA-haploidentical sibling donor. He was moved to the Department of Hematology, Hyogo Medical College, to receive this BMT as part of a clinical trial. During the conditioning procedure for the transplantation, however, he died of septicemia. Since hepatosplenic alphabeta T cell lymphoma is very rare with only 23 reported cases to date, herein we report this case and discuss the therapeutic strategy.
International Journal of Clinical Oncology 03/2010; 15(2):215-9. · 1.41 Impact Factor
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Daichi Inoue,
Hiroshi Arima,
Chiharu Kawanami,
Yoko Takiuchi,
Seiji Nagano,
Takaharu Kimura,
Sonoko Shimoji,
Minako Mori,
Sumie Tabata,
Soshi Yanagita,
Akiko Matsushita,
Kenichi Nagai,
Yukihiro Imai, Takayuki Takahashi
[show abstract]
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ABSTRACT: A 64-year-old woman suffering from progressive amyloid A (AA) amyloidosis of the gastrointestinal (GI) tract, associated with active rheumatoid arthritis, was transferred to our hospital due to hypovolemic shock. Although intensive care, including treatment with prednisolone and methotrexate, improved the hypovolemic shock, paralytic ileus became dominant instead of the marked diarrhea, suggesting the terminal stage of AA amyloidosis of the GI tract. Thus, we administered tocilizumab, a humanized anti-interleukin 6 receptor antibody (8 mg/kg, repeated every 4 weeks). Two weeks after the first injection of tocilizumab, serum AA rapidly returned to their normal ranges in accordance with the amelioration of paralytic ileus and systemic joint pain. Surprisingly, after three courses of tocilizumab treatment, colon biopsy revealed no amyloid deposition. Tocilizumab is a promising agent to treat secondary AA amyloidosis by strongly suppressing serum AA levels.
Clinical Rheumatology 03/2010; 29(10):1195-7. · 2.00 Impact Factor
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Daichi Inoue,
Yuya Nagai,
Yoko Takiuchi,
Seiji Nagano,
Hiroshi Arima,
Takaharu Kimura,
Sonoko Shimoji,
Minako Mori,
Katsuhiro Togami,
Sumie Tabata,
Soshi Yanagita,
Akiko Matsushita,
Kenichi Nagai,
Hayato Maruoka,
Yukihiro Imai,
Ritsuro Suzuki, Takayuki Takahashi
Leukemia & lymphoma 03/2010; 51(4):720-3. · 2.40 Impact Factor
