Minoru Takeshima

Brain Natriuretic Peptide Is a Predictor of Anthracycline-Induced Cardiotoxicity

Anthracyclines are effective antineoplastic drugs, but they frequently cause dose-related cardiotoxicity. The cardiotoxicity of conventional anthracycline therapy highlights a need to search for methods that are highly sensitive and capable of predicting cardiac dysfunction. We measured the plasma level of brain natriuretic peptide (BNP) to determine whether BNP might serve as a simple diagnostic indicator of anthracycline-induced cardiotoxicity in patients with acute leukemia treated with a daunorubicin (DNR)-containing regimen. Thirteen patients with acute leukemia were treated with a DNR-containing regimen. Cardiac functions were evaluated with radionuclide angiography before chemotherapies. The plasma levels of atrial natriuretic peptide (ANP) and BNP were measured at the time of radionuclide angiography. Three patients developed congestive heart failure after the completion of chemotherapy. Five patients were diagnosed as having subclinical heart failure after the completion of chemotherapy. The plasma levels of BNP in all the patients with clinical and subclinical heart failure increased above the normal limit (40 pg/ml) before the detection of clinical or subclinical heart failure by radionuclide angiography. On the other hand, BNP did not increase in the patients without heart failure given DNR, even at more than 700 mg/m2. The plasma level of ANP did not always increase in all the patients with clinical and subclinical heart failure. These preliminary results suggest that BNP may be useful as an early and sensitive indicator of anthracycline-induced cardiotoxicity.

Primary T Cell Non-Hodgkin’s Lymphoma of the Central Nervous System

A 42-year-old man developed primary non-Hodgkins lymphoma of the central nervous system (CNS). Immunohistochemical examination suggested that tumor cells were derived from T cells. Primary T cell non-Hodgkins lymphoma of the CNS is a rare tumor, with only 12 well-documented cases in the literature. The clinical features of these 12 cases were similar to those of other CNS lymphomas, and the effect of treatment and prognosis were usually worse than those of extranodal lymphoma. Our patient, who was treated with partial tumor resection and whole-brain irradiation with a boost to the primary site and 5 courses of CHOP therapy (cyclophosphamide, doxorubicin, vincristine, prednisolone), is still alive and in remission 38 months after diagnosis.

CD8-depleted donor leukocyte transfusions for cytomegalovirus antigenemia in patient with acute lymphoblastic leukemia treated with allogeneic CD34(+) cell transplantation.

A 24‐year‐old man with acute lymphoblastic leukemia received an allogeneic CD34+ cell transplant from an HLA‐mismatched sibling because of refractory disease. The CD34+ cells were enriched by the immunomagnetic method. One month after the transplant his situation became complicated due to cytomegalovirus (CMV) antigenemia, which was resistant to treatment with ganciclovir. He was treated with CD8+ cell‐depleted donor lymphocyte transfusions (CD8‐depleted DLT). After CD8‐depleted DLT, the CMV antigenemia disappeared completely. This case report suggested that CD8‐depleted DLT was an effective therapy for CMV antigenemia after allogeneic CD34+ cell transplantation. Am. J. Hematol. 65:278–280, 2000.

Multidrug resistance P-glycoprotein expression on leukemic cells at diagnosis.

糖蛋白の発現による多剤耐性 (MDR) については種々の報告があるが, われわれは44人の未治療の白血病患者の骨髄あるいは末梢血の腫瘍細胞をAPAAP法を使い, C219モノクローナル抗体で染色した.各検体につきそれぞれ1000個の腫瘍細胞を観察し, 強陽性に染まる細胞の割合を求めた.急性非リンパ性白血病 (ANLL) のM4および急性混合性白血病 (AMixL) において発現頻度および平均陽性率が高かった.細胞表面抗原についてはCD7やCD34がMDRと相関があることは報告されてはいるが, 本研究では有意な相関はなかった.また, 細胞形態からも, 幹細胞から単球系にやや分化した段階で陽性となりやすいと推測された.染色体異常については7番染色体異常のある群で50%が, ない群で25%がP糖蛋白陽性であった.しかし, 有意な相関はなかった.MDRと病型および臨床経過に関しては種々の結果が報告されているが, 今回のわれわれのC219モノクローナル抗体を使った免疫染色法でも, これまでの報告と多少異なった結果となった.今後, 統一された方法で症例を蓄積し, 検討していくべきであろう.