Naoki Shirafuji

A clinical comparison of unrelated cord blood transplantation and unrelated bone marrow transplantation for adult patients with acute leukaemia in complete remission

Summary.u2002 We performed a clinical comparison of unrelated cord blood transplantation (UCBT) and unrelated bone marrow transplantation in adult acute leukaemia patients in complete remission (CR) who received the same conditioning regimen, graft‐versus‐host disease (GvHD) prophylaxis and supportive treatment. The incidence of acute GvHD was almost the same between the two groups, but the haematopoietic recovery was delayed and the incidence of chronic GvHD was higher in the UCBT group. The probability of 2u2003year disease‐free survival was similar between the two groups. These results suggest that adult acute leukaemia patients in CR without a suitable donor should be considered as candidates for UCBT.

Unrelated cord blood transplantation for adult patients with myelodysplastic syndrome-related secondary acute myeloid leukaemia

Seven adult patients with myelodysplastic syndrome (MDS)‐related secondary acute myeloid leukaemia (AML) were treated with total body irradiation (TBI), cytosine arabinoside (Ara‐C) and cyclophosphamide (CY), followed by unrelated human leucocyte antigen (HLA)‐mismatched cord blood transplantation (CBT). Granulocyte colony‐stimulating factor (G‐CSF) was infused continuously from 12u2003h before until the end of Ara‐C therapy to enhance the antileukaemia effect of Ara‐C. Five patients are alive and free of disease at 7–31u2003months after transplantation. These preliminary results suggest that adult MDS‐related secondary AML patients without suitable related or unrelated bone marrow donors should be considered as candidates for CBT.

Expression of granulocyte and granulocyte-macrophage colony-stimulating factors by human non-hematopoietic tumor cells

The expression of granulocyte colony-stimulating factor (G-CSF) mRNA was studied in human non-hematopoietic tumors, including 18 cases of lung cancers 10 cases of stomach cancers, three cases of glioblastomas, and one case each of breast phyllode sarcoma, thyroid cancer, and hepatocellular carcinoma. Northern blot analysis detected G-CSF mRNA in two of the lung cancer cases, in one of the glioblastoma cases, and in both the breast phyllode sarcoma and hepatocellular carcinoma cases. Since G-CSF receptors were not detected on the tumor cells by 125I-G-CSF binding assay, G-CSF autocrine loop are probably not involved in the growth of these G-CSF-producing tumors. Interestingly, granulocyte-macrophage colony-stimulating factor (GM-CSF) mRNA was concomitantly expressed in most of these G-CSF-producing tumors. No major gene deletions or rearrangements of G-CSF and GM-CSF genes were demonstrated by Southern blot analysis in the tumors expressing G-CSF and GM-CSF mRNAs except for one of the glioblastomas (G3) in which one chromosome 17 allele was deleted. Although the mechanism of the concomitant expression of G-CSF and GM-CSF mRNA is unknown, relatively high frequency of this phenomenon suggests the presence of common transcriptional factors acting on regulatory regions of G-CSF and GM-CSF genomes.

Acute disseminated encephalomyelitis (ADEM) after allogeneic bone marrow transplantation for acute myeloid leukemia

Abstract. Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory demyelinating disease of the central nervous system. We describe here a patient who developed ADEM after allogeneic bone marrow transplantation (BMT). A 48-year-old woman with acute myeloid leukemia (M2) underwent allogeneic BMT from her HLA-identical sister. Cyclosporin for prophylaxis of acute graft-versus-host disease (GVHD) was discontinued from day 15 because of its toxicity. She was relatively well after the resolution of cytomegalovirus reactivation and chronic GVHD. Nine months after BMT, she suddenly developed diplopia, dysarthria, and gait disturbance. Computed tomography of the brain at that time revealed no abnormal findings. Leukemia recurrence was not revealed. The neurological symptoms were very mild without further deterioration. Her clinical course was carefully watched without therapy. Two weeks after onset, fluid attenuated inversion recovery magnetic resonance imaging (MRI) revealed multifocal abnormal high-signal intensity mainly in the white matter of the cerebrum as well as in the cerebellum and brainstem. Cerebrospinal fluid examination showed no abnormal findings. No laboratory findings suggested the presence of infectious agents. The typical MRI findings and an acute monophasic clinical course of this patient led to a diagnosis of ADEM. Twelve weeks after onset, the symptoms had almost resolved. Follow-up MRI showed a substantial improvement of the previous lesions without any new lesions. The symptoms had completely resolved 5xa0months after onset. This is a rare case of ADEM developing after allogeneic BMT.

Human herpesvirus 6 variant A infection with fever, skin rash, and liver dysfunction in a patient after unrelated cord blood transplantation

Human herpesvirus 6 variant A infection with fever, skin rash, and liver dysfunction in a patient after unrelated cord blood transplantation

Second Allogeneic Hematopoietic Stem Cell Transplantation for Leukemia Relapse After First Allogeneic Transplantation: Outcome of 16 Patients in a Single Institution

Sixteen patients who underwent a second allogeneic hematopoietic stem cell transplantation (HSCT2) for leukemia relapse after the first allogeneic transplantation (HSCT1) were studied. The patients included 7 patients with acute myelogenous leukemia, 8 with acute lymphoblastic leukemia, and 1 with chronic myelogenous leukemia.The median patient age at HSCT2 was 22 years (range, 12 to 44 years).The median interval between HSCT1 and HSCT2 was 19 months (range, 2 to 46 months). At HSCT2, 7 patients were in complete remission (CR), 7 had relapsed, and 2 had bone marrow aplasia. In 14 patients, donors for HSCT2 were the same as those for HSCT1. Two donors were replaced, 1 for another HLA-matched sibling and 1 for an unrelated cord blood donor. Four patients (25%) died within 100 days after HSCT2 from veno-occlusive disease, sepsis, interstitial pneumonitis, or chronic graft-versus-host disease (GVHD), without leukemia relapse. Seven patients (44%) developed leukemia relapse and died between 4 and 20 months after HSCT2. Five patients (31%) survived beyond 4 years. One patient died from chronic GVHD without leukemia relapse 55 months after HSCT2. The 4 other patients were alive between 79 and 134 months after HSCT2 (median follow-up, 106 months). Factors that favorably influenced survival were age younger than 20 years and CR duration after HSCT1 longer than 12 months. HSCT2 is considered to be beneficial for select patients. Preparative regimens, GVHD prophylaxis, and donor choice for HSCT2 need to be studied to obtain a more successful outcome for HSCT2.

Severe autoimmune thrombocytopenia after allogeneic bone marrow transplantation for aplastic anemia

Autoimmune thrombocytopenia (AITP) after bone marrow transplantation (BMT) was suggested to occur by immune dys-regulation mainly in association with graft-versus-host disease (GVHD). Here we present a patient who developed severe AITP after BMT. A 40-year-old woman with severe aplastic anemia received a BMT from a partially HLA-matched brother. Despite myeloid and erythroid engraftments, platelet recovery was delayed. All bone marrow cells were 46,XY and were derived from the donor. Grade I acute GVHD involving skin developed from day 34 posttransplantation, but promptly responded to prednisolone in addition to a prophylactic dose of tacrolimus. With the tapering of prednisolone, thrombocytopenia progressed without substantial changes in the white blood cell count, hemoglobin concentration, or reticulocyte count. On day 188, the patient developed chronic GVHD involving skin and liver, which promptly responded to the readministration of prednisolone and increased tacrolimus. However, the patient’s platelet count decreased to 9 X 109 cells/L on day 222. The platelet-associated immunoglobulin G (PAIgG) values were elevated. Bone marrow examination showed hypercellularity with plentiful megakaryocytes. The number of colony-forming units-megakaryocyte was within the normal range. The elevated PAIgG values and a correlation between thrombocytopenia and the intensity of the immunosuppressive agents strongly suggested a causative role of the autoimmune mechanisms for thrombocytopenia in this patient.

Production of granulocyte colony-stimulating factor by acute myelomonocytic leukemia cells

Two patients with acute myelomonocytic leukemia (AMMoL) were tested to determine whether or not their cells produced granulocyte colony-stimulating factor (G-CSF). Using the NFS-60 bioassay method, relatively high levels of G-CSF were demonstrated in the serum pre-treated with acid-dialysis and in the media conditioned by leukemia cells. Northern blot analysis for G-CSF using cDNA as a probe revealed that G-CSF production was increased at the mRNA level in the cells. No rearrangement at the DNA level, however, was observed by genomic Southern analysis. Our data indicate that the leukemic cells in AMMoL probably have the capacity to synthesize and secrete G-CSF.

The effect of granulocyte colony-stimulating factor administration in healthy donors before bone marrow harvesting

To investigate whether granulocyte colony‐stimulating factor (G‐CSF) administration to donors before harvest may lighten the burden imposed on them and accelerate the bone marrow (BM) recovery, we administered 2u2003μg/kg/d of G‐CSF for five consecutive days before the marrow harvest. All of the donors tolerated the G‐CSF administration well without severe adverse events. After 5u2003d of G‐CSF treatment, CD34+ cells and granulocyte–macrophage colony‐forming units (GM‐CFU) in the donors BM exceeded baseline values by 4.2‐fold (range 0.71–316) and 1.6‐fold (0.28–118) respectively. The concentration of total nucleated cells (×u2003107/ml) in the graft increased from 1.61 (0.95–3.23) to 2.44 (1.27–4.01). Although we collected 1020u2003ml of BM and obtained 1.50u2003×u20031010 nucleated cells from unprimed donors, 940u2003ml of BM were sufficient to obtain 2.14u2003×u20031010 nucleated cells from primed donors. However, G‐CSF‐primed BM did not shorten the time to tri‐lineage engraftment and the duration of hospitalization compared with unprimed BM, although primed BM contained more CD34+ cells than baseline values. We consider that the advantages of BM priming are not the acceleration of BM recovery but rather the reduction of blood loss during BM harvesting.

Using related donors other than genotypically HLA-matched siblings in allogeneic hematopoietic stem cell transplantation for hematologic disease: a single institution experience in Japan.

Thirty patients with hematologic diseases received allogeneic hematopoietic stem cell transplants (HSCT) from related donors other than genotypically HLA-matched siblings. Their outcomes were compared with those of 102 patients who had received HSCT from genotypically HLA-matched siblings. All donors in the study group were HLA-haploidentical relatives.The degree of HLA mismatches in unshared haplotype was 0-locus (n = 6), 1-locus (n = 20), and 2-locus (n = 4). All patients in the study group achieved successful engraftment at a median of 17 days (range, 10-35 days). Grade II-IV and III-IV acute graft-versus-host disease (GVHD) occurred in 16 (53%) and 9 (30%) patients, respectively, in the study group, rates that were significantly higher than those of the control group, which were 33 (33%) and 12 (12%) patients, respectively (P = .034 and .022, respectively). The frequency of chronic GVHD was 85% (22 out of 26 evaluable patients) in the study group, a rate that was also significantly higher than that of the control group with 57% (52 of 91 patients) (P = .0078). The estimated probability of disease-free survival (DFS) for the study group was 56% at 5 years. When the 2 groups were compared according to the risk of disease, the probabilities of DFS at 5 years for patients with low risk in the study and for control groups were 100% and 84%, respectively, and those for patients with high risk were 43% and 42%, respectively.These results showed that the DFS for patients with both low and high risks in the study group was comparable to that of the control group. In conclusion, despite higher probabilities of acute and chronic GVHD, unmanipulated allogeneic HSCT from related donors other than genotypically HLA-matched siblings was considered to be a reasonable alternative for patients without genotypically HLA-matched sibling donors.Int J Hematol. 2002;76:354-359.