Yumiko Ohbayashi

Adjunct teriparatide therapy with monitoring of bone turnover markers and bone scintigraphy for bisphosphonate-related osteonecrosis of the jaw

The management of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is still difficult in many cases that do not respond to conservative treatments. We report a case of BRONJ treated by adjunctive teriparatide therapy for 6 months with monitoring of bone turnover markers (at baseline, at 1, 3, and 6 months of treatment, and after 9 months off therapy) and bone scintigraphy (at baseline, 3 and 6 months, and after 9 months off therapy). The patient was a 78-year-old woman with osteoporosis and BRONJ. She had not responded to previous conventional treatment. Teriparatide was added for resolution of BRONJ. The pain disappeared after 1 month, and remarkable bone regeneration was obtained after 6 months, with significantly increasing bone formation and resorption markers. Bone scintigraphy showed regression of the uptake area. This case suggests the usefulness of monitoring bone turnover markers and using bone scintigraphy to increase the effectiveness of teriparatide therapy.

Multivariate analysis of factors influencing oral mucositis in allogeneic hematopoietic stem cell transplantation

Little information is available regarding the effect of oral intervention on the outcome of hematopoietic stem cell transplantation (HSCT). We retrospectively analyzed the incidence of oral mucositis after allogeneic HSCT with or without oral intervention among 96 consecutive patients in our hospital between January 1988 and March 2006. We combined two oral intervention strategies: cryotherapy and oral health care. The former was applied beginning in 2003 for patients being treated with melphalan, and the latter, which was the study’s main strategy, was applied to all HSCT recipients beginning in 2004. Oral mucositis was evaluated according to NCI CTCAE v3.0. The incidence of oral mucositis was 30.9% (17/55) in reduced-intensity stem cell transplantation (RIST), which was significantly lower than the 90.2% (37/41) in conventional stem cell transplantation (CST; P < 0.001). Among these 96 patients, severe oral mucositis was observed in 19 (46.3%) CST cases and in 6 (10.9%) RIST cases (P < 0.001). The occurrence of oral mucositis apparently decreased after oral health care instructions were given. Multiple logistic analysis revealed that the conditioning regimen and oral health care were independent risk factors for the incidence of oral mucositis. The cryotherapy did not exert enough potency to prevent oral mucositis in patients who had undergone CST or RIST. We concluded that oral health care improved tissue damage due to an overall upgrade in oral hygiene during chemotherapy.

A long-term study of implanted artificial hydroxyapatite particles surrounding the carotid artery in adult dogs

In this long-term study, we implanted HAP into adult dogs using a silicone chamber attached to the carotid artery to clarify tissue reaction to HAP implantation over a long period. We designed chambers and both hemispheres of the chambers were filled with HAP particles, and were placed around both carotid arteries of seven adult dogs. The implants were removed after 150, 300, 380 days, and histological and ultrastructual examination was undertaken. We observed bone-like tissue which was formed where HAP particles were implanted. Immunohistochemical findings showed that osteocalcin and osteonectin were as positive in the bone-like tissue as in normal bone. This study suggests that biological factors from the arterial wall might play an important role in new bone-like tissue forming, and that HAP has a strong osteoconductive ability even at heterogeneous sites.

Fludarabine and melphalan conditioning with tacrolimus as GVHD prophylaxis for allogeneic stem cell transplant recipients is an effective reduced-intensity combination regimen compared to the conventional regimen

BackgroundAs a reduced-intensity stem-cell transplantation (RIST) regimen, the combination of fludarabine and melphalan (FM) with an appropriate immunosuppressant reduces nonrelapse mortality (NRM).MethodsWe retrospectively compared the efficacy of a RIST regimen with FM with that of a conventional stem cell transplantation (CST) regimen. Eighty-two consecutive hematological patients who underwent allogeneic stem-cell transplantation (SCT) at our hospital were enrolled. Preparation for RIST consisted of 25 mg/m2 fludarabine and melphalan 70 mg/m2. The conventional regimen employed high-dose cyclophosphamide and total-body irradiation (12 Gy) or busulfan and high-dose cyclophosphamide. Graft-versus-host disease (GVHD) prophylaxis for RIST consisted of tacrolimus alone or in conjunction with short-term methotrexate for unrelated donors.ResultsOf the 82 patients, 42 received the conventional CST regimen (median age, 35 years) and 40 received the RIST regimen (median age, 51 years). The probability of NRM was 17% (7/42) in the CST group and 8% (3/40) in the RIST group. Grade II to IV GVHD occurred in significantly more CST patients (38%) than RIST patients (28%). However, the overall survival was the same in the two groups (43%).ConclusionThe RIST regimen with FM incorporating tacrolimus and methotrexate demonstrated low TRM incidence and moderate control of GVHD and had efficacy comparable to that of the CST regimen, despite the advanced age of the RIST patient group.

Chill Burn after Cryotherapy in a Thrombocytopenic Recipient: TheAdverse Effect of Thrombocytopenia on Dermal Wounding

Oral cryotherapy is an evidence-proven standard care for cancer patients. The efficacy of oral cryotherapy during chemotherapy is established especially for the treatment using melphalan. However, the patients’ neutrophil and platelet are usually decreased when undergoing cytotoxic chemotherapy, and the influence of which has not been fully evaluated clinically. We experienced the case complicated with chill burn like skin wound by direct damage of cryotherapy and discussed the function of neutrophils and platelets in the process of wound healing.

Monitoring of bone turnover markers and bone scintigraphy for teriparatide therapy in bisphosphonate related osteonecrosis of the jaw

Treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ) remains an intractable problem in many cases. Recent literatures have shown that the new treatment modality using teriparatide may be beneficial to BRONJ. However, the teriparatide therapy was not effective in all cases. It would be necessary to assess the therapeutic effectiveness of teriparatide with predictable procedures to treat BRONJ. We report here two cases of BRONJ treated by adjunctive teriparatide therapy for 6 months while simultaneously performing the monitoring of changes of bone turnover markers and the quantitative assessment of bone scintigraphy. Six months after the combination of teriparatide and conservative treatment, CT showed evidence of bone regeneration and the intraoral wound was completely healed. Biochemical bone formation markers were monitored at the time points of 0, 1, 3 and 6 months. Almost of all the markers related to the bone formation and resorption revealed an increase during the teriparatide treatment. The uptake area and quantitative value of technetium-99m-methylene diphosphonate showed a reduction after the administration of teriparatide. It was strongly suggested that teriparatide therapy is one of the useful treatments for BRONJ based on monitoring bone turnover results and employing bone scintigraphy.

Rhabdomyosarcoma of the Mandible

Abstract This report is of an embryonal rhabdomyosarcoma presenting in the mandible of a 12-year-old boy. The tumour exhibited rapid growth and resistance to chemotherapy. The clinical findings, diagnostic course, and treatment are described in detail.