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Sung-Won Kim,
Tetsuya E Tanimoto, Noriyuki Hirabayashi,
Seiichi Goto,
Masahiro Kami,
Satoshi Yoshioka,
Toshiki Uchida,
Kenji Kishi,
Yuji Tanaka,
Akio Kohno, [......],
Takayuki Ishikawa,
Tatsuo Ichinohe,
Kengo Takeuchi,
Kinuko Tajima,
Ryuji Tanosaki,
Mine Harada,
Shuichi Taniguchi,
Kensei Tobinai,
Tomomitsu Hotta,
Yoichi Takaue
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ABSTRACT: We retrospectively surveyed the data of 233 patients who underwent myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT) for non-Hodgkin lymphoma (NHL). Donors were HLA-matched relatives in 154 patients (66%) or unrelated volunteers in 60 (26%). Ninety patients (39%) were in complete remission. One hundred ninety-three (83%) received a total body irradiation (TBI)-based regimen, and 40 (17%) received a non-TBI-based regimen. Acute graft-versus-host disease (GVHD) occurred in 155 (67%) of the 233 evaluable patients; grade II to IV in 90 (39%), and grade III to IV in 37 (16%). Treatment-related mortality (TRM) was observed in 98 patients (42%), and 68% of them were related to GVHD. In a multivariate analysis, chemoresistance, prior autograft, and chronic GVHD were identified as adverse prognostic factors for TRM. Relapse or progression of lymphoma was observed in 21%. The 2-year overall survival rates of the patients with indolent (n = 38), aggressive (n = 111), and lymphoblastic lymphoma (n = 84) were 57%, 42%, and 41%, respectively. In a multivariate analysis, chemoresistance, prior autograft, and prior radiotherapy were identified as adverse prognostic factors for overall survival. Although myeloablative allo-HSCT represents an effective therapeutic option for patients with NHL, more work is still needed to decrease TRM and relapse.
Blood 08/2006; 108(1):382-9. · 9.90 Impact Factor
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ABSTRACT: A 55-year-old woman with Ph-negative acute lymphoblastic leukemia in primary induction failure received allogeneic peripheral blood stem cell transplantation from her HLA-compatible sister. Pseudohyponatremia developed due to extreme hypercholesterolemia of 4091 mg/dL accompanied by lipoprotein X and lipoprotein Y. The hypercholesterolemia was caused by cholestasis due to chronic GVHD and ischemic cholangiopathy. In addition, we found that hepatic triglyceride lipase (HTGL) activity was severely decreased, which could be another novel factor causing extreme hypercholesterolemia after allogeneic transplantation. The total cholesterol has been gradually decreasing followed by the improvement of cholestasis with bezafibrate, ursodeoxycholic acid and prednisone treatments, and by a slight increase in HTGL-protein. To our knowledge, this is the first report to describe the association of decreased HTGL with extreme hypercholesterolemia after allogeneic transplantation.
International Journal of Hematology 12/2005; 82(4):362-6. · 1.27 Impact Factor
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Kazuyuki Shimizu,
Osamu Kamiya,
Nobuyuki Hamajima,
Harumitsu Mizuno,
Masahide Kobayashi, Noriyuki Hirabayashi,
Hideo Takeyama,
Ryoichi Kato,
Kohei Kawashima,
Masakazu Nitta,
Tomomitsu Hotta,
Makoto Utsumi,
Eiichi Nagura
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ABSTRACT: A cooperative randomized clinical trial to compare the effectiveness of multi-drug combination chemotherapy (VMCP, vincristine-melphalan-cyclophosphamide-prednisolone) with CP (cyclophosphamide-prednisolone) for the treatment of multiple myeloma was performed. When the whole group of patients was evaluated, the choice of chemotherapy (VMCP or CP) was not a significant prognostic factor associated with response or survival by uni- or multivariate analysis, and the difference between the survival curves of the treatment groups was only marginally significant. However, when the analysis was confined to stage III patients, the choice of chemotherapy became a significant prognostic factor associated with both response rate and survival, and the statistical difference between survival curves was significant. Taking the disease characteristics of multiple myeloma into consideration, the better result obtained with multi-drug combination chemotherapy in the treatment of stage III patients is consistent with other studies supporting the superiority of multi-drug combination chemotherapy for patients with overt systemic disease.
Cancer Science 08/2005; 81(12):1320 - 1327. · 3.33 Impact Factor
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Kazuyuki Shimizu,
Osamu Kamiya, Noriyuki Hirabayashi,
Atsushi Ichikawa,
Kohei Kawashima,
Masahide Kobayashi,
Harumitsu Mizuno,
Eiichi Nagura,
Masakazu Nitta,
Hidehiko Saito,
Hiroshi Sao,
Toshihiko Shibata,
Hideo Takeyama,
Nagoya Myeloma Cooperative Study Group
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ABSTRACT: In the present study 142 patients with myeloma (102 with IgG M-protein and 40 with IgA) treated with either VMCP (65 patients) or MMCP (77 patients) as remission induction therapy were retrospectively analyzed. Response to treatment was evaluated in terms of a more-than-50% fall of pretreatment M-protein and the posttreatment M-protein nadir. Though significantly more patients treated with MMCP achieved partial response (PR) as compared with those treated with VMCP (P=0.019) and though patients achieving PR showed a significantly longer survival than those with less responsiveness (P=0.0091), the difference in survival curves between the two treatment groups was not significant (P=0.1871). The difference in response between the treatment groups evaluated in terms of posttreatment nadir was not significant (P=0.507). Multivariate analysis identified posttreatment M-protein nadir as a significant prognostic factor associated with survival, along with 3 other factors: sex, performance status, and hemoglobin. The lack of difference between the survival curves for patients treated with the 2 regimens despite the significantly different response rates evaluated in terms of percent fall of pretreatment M-protein levels was considered to be due to the lack of a difference in the ability to induce a deep posttreatment nadir between the regimens. Posttreatment M-protein nadir is an important prognostic factor associated with survival and should be included in the evaluation of the efficacy of chemotherapy.
Cancer Science 08/2005; 90(3):355 - 360. · 3.33 Impact Factor
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Naoko Murashige,
Masahiro Kami,
Yukiko Kishi,
Sung-Won Kim,
Masami Takeuchi,
Kosei Matsue,
Yoshinobu Kanda,
Makoto Hirokawa,
Yoshinari Kawabata,
Tomoko Matsumura,
Eiji Kusumi, Noriyuki Hirabayashi,
Koji Nagafuji,
Ritsuro Suzuki,
Kengo Takeuchi,
Kazuo Oshimi
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ABSTRACT: The efficacy of allogeneic haematopoietic stem-cell transplantation (allo-HSCT) for natural killer (NK)-cell neoplasms is unknown. We investigated the results of allo-HSCT for NK-cell neoplasms between 1990 and 2003 through questionnaires. After reclassification by a haematopathologist, of 345 patients who underwent allo-HSCT for malignant lymphoma, 28 had NK-cell neoplasms (World Health Organization classification): extranodal NK/T-cell lymphoma (n=22), blastic NK-cell lymphoma (n=3), and aggressive NK-cell leukaemia (n=3). Twelve were chemosensitive and 16 chemorefractory. Twenty-two had matched-related donors. Stem-cell source was bone marrow in eight and mobilised peripheral blood in 20. Conditioning regimens were myeloablative (n=23) and non-myeloablative (n=5). Grade 2-4 acute graft-versus-host disease (GVHD) and chronic GVHD developed in 12 and 8 respectively. Eight died of disease progression, three of infection, two of acute GVHD, one of veno-occlusive disease, one of interstitial pneumonitis, and one of thrombotic microangiopathy. Two-year progression-free and overall survivals were 34% and 40% respectively (median follow-up, 34 months). All patients who did not relapse/progress within 10 months achieved progression-free survival (PFS) during the follow-up. In multivariate analysis, stem cell source (BM versus peripheral blood; relative risk 3.03), age (>or=40 years vs. <40 years; relative risk 2.85), and diagnoses (extranodal NK/T-cell lymphoma versus others; relative risk 3.94) significantly affected PFS. Allo-HSCT is a promising treatment for NK-cell neoplasms.
British Journal of Haematology 08/2005; 130(4):561-7. · 4.94 Impact Factor
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Hiroyasu Ogawa,
Kazuhiro Ikegame,
Manabu Kawakami,
Satoshi Takahashi,
Hisashi Sakamaki,
Takahiro Karasuno,
Hiroshi Sao,
Yoshihisa Kodera, Noriyuki Hirabayashi,
Shinichiro Okamoto,
Mine Harada,
Koji Iwato,
Atsuo Maruta,
Mitsune Tanimoto,
Keisei Kawa
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ABSTRACT: On the basis of transplantation data from the Japan Society for Hematopoietic Cell Transplantation, we retrospectively analyzed the impact of cytogenetics at diagnosis on the outcome of transplantation in 628 patients with acute myeloid leukemia who underwent autologous (n = 200), allogeneic related (n = 363), or allogenic unrelated (n = 65) stem cell transplantation (SCT) at first complete remission. For autologous SCT, patients at good cytogenetic risk had a significantly lower relapse rate (P = .017) and a significantly higher event-free survival (EFS) (P = .013) compared with those at intermediate risk. For allogeneic SCT, patients at good cytogenetic risk had a significantly lower relapse rate (P = .019) and insignificantly higher EFS (P = .093) than those at poor risk. For unrelated SCT, there was no significant difference in relapse rate or EFS between patients at good risk and those at intermediate risk. Comparison of the 3 transplantation modalities revealed that autologous SCT patients had a significantly higher incidence of relapse compared with related or unrelated SCT patients in the intermediate-risk group but not in the good-risk group. However, there were no significant differences in EFS among the 3 transplant modalities in either of these 2 risk groups. In multivariate analysis, cytogenetics was found to be an independent predictor of relapse as well as of treatment failure.
International Journal of Hematology 07/2004; 79(5):495-500. · 1.27 Impact Factor
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Yoshinobu Kanda,
Shigeru Chiba,
Hisamaru Hirai,
Hisashi Sakamaki,
Tohru Iseki,
Yoshihisa Kodera,
Takahiro Karasuno,
Shinichiro Okamoto, Noriyuki Hirabayashi,
Koji Iwato,
Atsuo Maruta,
Yoshihiro Fujimori,
Tatsuo Furukawa,
Shin Mineishi,
Keitaro Matsuo,
Nobuyuki Hamajima,
Masahiro Imamura
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ABSTRACT: The reported outcome of hematopoietic stem cell transplantation (HSCT) from HLA-mismatched family members has been inconsistent. The object of this study was to evaluate the true impact of HLA-mismatch by using recent data from a homogenous population, excluding HSCT procedures that used graft manipulations, and by considering genotypic matching. Clinical data of 2947 patients who underwent allogeneic HSCT for leukemia or myelodysplastic syndrome were extracted from the database of the Japan Society for Hematopoietic Cell Transplantation. The main outcome measures were survival and the incidence of graft-versus-host disease (GVHD). The presence of serologic HLA-mismatch, higher age, and high-risk disease were identified as independent risk factors for both shorter survival and the development of grade III to IV acute GVHD. The impact of HLA-mismatch on survival was more relevant in standard-risk patients. These findings persisted when we used genotypic HLA matching. Survival after one-locus-mismatched HSCT was equivalent to that after HLA-matched unrelated HSCT. We concluded that when a one-locus-mismatched family donor is available for high-risk patients, immediate HSCT using this donor is warranted. In standard-risk patients, however, survival after one-locus-mismatched HSCT is significantly shorter than that after HLA-matched HSCT, and the indications for HSCT should be considered carefully.
Blood 09/2003; 102(4):1541-7. · 9.90 Impact Factor
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ABSTRACT: A 42-year-old man was diagnosed as having refractory anemia in May, 2001. He developed overt leukemia and received allogeneic bone marrow transplantation (BMT). His younger brother, a 40-year-old man, was diagnosed as having acute leukemia with trilineage myelodysplasia in November, 2001. Although he was treated with conventional chemotherapy, he failed to achieve complete remission. He also received allogeneic BMT. We suggest that environmental factors in addition to a genetic defect in the pluripotent hematopoietic stem cells may be associated with the occurrence of this familial leukemia.
[Rinshō ketsueki] The Japanese journal of clinical hematology 01/2003; 43(12):1061-3.
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Kunio Yano,
Makoto Yazaki,
Kenjiro Kitaori, Noriyuki Hirabayashi,
Saburoh Minami,
Yoshihisa Morishita,
Hironori Yamada,
Tomoki Naoe,
Hiroshi Kojima,
Sei-ichi Goto,
Yoshihisa Kodera,
Yasuo Morishima,
Nagoya Bone Marrow Transplantation Group
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ABSTRACT: BackgroundSince culture, history, personal financial situation, and the health insurance system are strongly associated with quality
of life (QOL) for patients undergoing continuing medical care, any investigation into this subject should be done within individual
areas and countries.
Patients and MethodsWe investigated QOL in adult survivors after bone marrow transplantation (BMT), by administering a mail-back questionnaire
to outpatients seen at 8 hospitals, in association with Nagoya BMT groups.
ResultsThe respondents surveyed were aged 20 years and older at the time of this study, and were not in life-threatening relapse.
The underlying diseases were chronic myelogenous leukemia, acute myelogenous leukemia, acute lymphoblastic leukemia, malignant
lymphoma, severe aplastic anemia, and myelodysplastic syndrome. The average age at the time of study was 37.6 years, and the
median interval between transplantation and the time of study was 38.2 months. Eighty-four patients were treated with allogeneic
BMT, 4 with autologous transplants, and 1 with a syngeneic transplant.
ConclusionOur data showed that QOL gradually continued to improve over time, even 5 years after transplantation. We found that the older
a patient was at the time of BMT or at the time he or she responded to the questionnaire, the poorer his or her QOL was. Total
body irradiation as a part of preconditioning, a diagnosis of acute graft-versus-host disease (GVHD), and underlying disease
were unrelated to QOL. Longer length of time since transplantation positively affects QOL, while diagnosis of chronic GVHD
negatively affects QOL. Being of female sex and being of greater age were factors associated with a greater risk of job loss.
International Journal of Clinical Oncology 05/1998; 3(3):152-158. · 1.41 Impact Factor
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Eiichi Nagura,
Saburo Minami,
Koichiro Nagata,
Yoshihisa Morishita,
Hideo Takeyama,
Hiroshi Sao,
Hisamitsu,
Suzuki,
Tomoki Naoe,
Shozo Yokomaku,
Harumitsu Mizuno,
Takuhei Murase, Noriyuki Hirabayashi,
Takaaki Takeo,
Mitsune Tanimoto,
Kohei Kawashima,
Hidehiko Saito
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ABSTRACT: To obtain background information on elderly acute myeloid leukemia (AML), unselected data covering 159 patients aged 60 years or over with AML from 14 hospitals in Nagoya, Japan was analyzed retrospectively. Among these patients, 119 had de novo acute AML, 32 had AML which evolved from myelodysplastic syndrome (MDS-AML), and 8 had other types of leukemia. The survey showed that MDS-AML tended to be more prevalent in patients aged 70 years and older and that MDS-AML showed a significantly more severe degree of leukopenia and anemia than de novo AML. MDS-AML also showed a significantly lower complete remission (CR) rate than that of de novo AML [6.9% (2/29) vs 58.3% (67/11), P < 0.01] and significantly shorter survival times than those of de novo AML [median: 3.6 months vs 9.6 months, P < 0.01 (generalized Wilcoxon test; GW]. In de novo AML, the proportion of patients treated with conventional therapy (CT group) decreased significantly, and that of those with attenuated therapy (AT group) increased significantly as age elevated (P < 0.01). The CT group showed a significantly higher CR rate (65.4% vs 41.2%, P < 0.05) and a significantly longer survival period than those of the AT group [median: 11.6 months vs 4.8 months, P < 0.05 (GW)]. Overall survival rates of the older age groups became significantly shorter with aging [P < 0.01 (GW)]. Nagoya J. Med. Sci. 62. p. 135-144, 1999
