Eri Yamamoto

Peripheral blood absolute lymphocyte/monocyte ratio as a useful prognostic factor in diffuse large B-cell lymphoma in the rituximab era

The tumor microenvironment, including tumor‐infiltrating lymphocytes and myeloid‐derived cells, is an important factor in the pathogenesis and clinical behavior of malignant lymphoma. However, the prognostic significance of peripheral lymphocytes and monocytes in lymphoma remains unclear.

European Treatment and Outcome Study score does not predict imatinib treatment response and outcome in chronic myeloid leukemia patients

The Sokal and Hasford scores were developed in the chemotherapy and interferon era and are widely used as prognostic indicators in patients with chronic myeloid leukemia (CML). Recently, a new European Treatment and Outcome Study (EUTOS) scoring system was developed. We performed a multicenter retrospective study to validate the effectiveness of each of the three scoring systems. The study cohort included 145 patients diagnosed with CML in chronic phase who were treated with imatinib. In the EUTOS low‐ and high‐risk groups, the cumulative incidence of complete cytogenetic response (CCyR) at 18 months was 86.9% and 87.5% (P = 0.797) and the 5‐year overall survival rate was 92.6% and 93.3% (P = 0.871), respectively. The cumulative incidence of CCyR at 12 months, 5‐year event‐free survival and 5‐year progression‐free survival were not predicted using the EUTOS scoring system. However, there were significant differences in both the Sokal score and Hasford score risk groups. In our retrospective validation study, the EUTOS score did not predict the prognosis of patients with CML in chronic phase treated with imatinib.

MIB-1 labeling index as a prognostic factor for patients with follicular lymphoma treated with rituximab plus CHOP therapy.

The MIB‐1 labeling index, which is based on Ki67 immunostaining, is widely used to evaluate the proliferation of tumor cells in lymphoma. However, its clinical significance has not been fully assessed. We retrospectively evaluated the prognostic impact of the MIB‐1 labeling index at the time of diagnosis, in 98 patients with follicular lymphoma (FL) grade 1–3b who were treated uniformly with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R‐CHOP) therapy. The 5‐year progression‐free survival (PFS) for an MIB‐1 labeling index of ≥10% (n = 60) and <10% (n = 38) was 35% and 61%, respectively (P = 0.015). The 5‐year overall survival (OS) for an MIB‐1 labeling index of ≥10% and <10% was 77% and 92%, respectively (P = 0.025). Pathological grading was not correlated with PFS or OS. In multivariate analysis, an MIB‐1 labeling index of ≥10% was independently associated with poor PFS and OS. In conclusion, an MIB‐1 labeling index of 10% is a useful cut‐off level for predicting the prognosis of patients with FL.

Septicemia from Lactobacillus rhamnosus GG, from a Probiotic Enriched Yogurt, in a Patient with Autologous Stem Cell Transplantation

Probiotic-rich foods are consumed without much restriction. We report here, a case of septic shock caused by yogurt derived Lactobacillus species in a 54-year-old male patient with acute promyelocytic leukemia, in second complete remission, and who was an autologous stem cell transplantation recipient. He received high dose chemotherapy and autologous peripheral blood stem cell transplantation. He ingested commercially available probiotic-enriched yogurt because of severe diarrhea. One week later, he developed septic shock, and the pathogen was determined by strain-specific PCR analysis as Lactobacillus rhamnosus GG (ATCC 53103), which was found to be identical with the strain in the yogurt he consumed. Thus, because even low virulent Lactobacilli in the probiotic products can be pathogenic in the compromised hosts, ingestion of such products should be considered with caution in neutropenic patients with severe diarrhea, such as stem cell transplantation recipients.

Dissemination pattern of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue

1Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan, 2Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan, 3Department of Hematology, Shizuoka Red Cross Hospital, Shizuoka, Japan, 4Department of Hematology, Yokosuka City Hospital, Yokosuka, Japan, 5Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan, and 6Department of Hematology/ Immunology, Fujisawa City Hospital, Fujisawa, Japan, 7Department of Hematology/Oncology, Yamato Municipal Hospital, Yamato, Japan, 8Department of Internal Medicine, Yokohama Ekisaikai Hospital, Yokohama, Japan and 9Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan

Primary diffuse large B-cell lymphoma of the testis relapsing in the right atrium.

A 62-year-old man with a previous history of stage IA diffuse large B-cell lymphoma (DLBCL) of the testis was referred with facial oedema and neck tenderness. He had completed six courses of R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) two years previously, coupled with intrathecal chemotherapy as central nervous system (CNS) prophylaxis and had achieved complete remission. Thereafter, he had undergone follow-up blood tests every 2 months and positron emission tomography computerized tomography (PET-CT) scanning every 6 months. On this occasion, PET-CT showed a mass on the right atrium with a maximum standardized uptake value of 22 5 (left), and blood tests showed elevated lactate dehydrogenase and soluble interleukin-2 receptor levels. Contrastenhanced CT (right panel) and echo analysis demonstrated the mass to have invaded the superior vena cava causing internal jugular vein thrombosis, and the patient was immediately admitted for further evaluation and treatment. In the following 24-h period, a decrease in his blood pressure and decline in blood oxygenation were observed, indicative of superior vena cava syndrome resulting from the growing mass in the atrium. Emergency surgery was performed, with partial resection of the tumour and the implantation of a permanent pacemaker. Pathological examination revealed the tumour to be DLBCL. The patient received salvage chemotherapy without any complications. He achieved a second complete remission, following which autologous transplantation was carried out. Primary testicular DLBCL sometimes relapses in the contralateral testis or in the CNS, but relapse in the heart is very rare.