Yutaro Kamiyama

Case of engraftment syndrome appearing as scratch dermatitis

Dear Editor, Scratch dermatitis, or flagellate erythema, is characterized by linear erythematous/hyperpigmented streaks, and can be caused by shiitake mushroom, bleomycin, dermatomyositis and Still’s disease. Engraftment syndrome (ES) presents with pyrexia, maculopapular eruption and edema during neutrophil recovery following hematopoietic stem cell transplantation. Here, we describe a case with scratch dermatitis encountered as a clinical manifestation of ES. A 44-year-old Japanese woman was referred to us with a 2day history of distinct scratch marks due to severe pruritus 18 days after unrelated allogeneic bone marrow transplantation (BMT) from an unrelated donor to treat blast crisis of chronic myeloid leukemia. Human leukocyte antigens between patient and donor were matched at eight of eight loci serologically, and seven of eight loci by DNA typing (mismatch for DRB1). The patient denied having eaten shiitake mushrooms recently. Neither bleomycin nor peplomycin had been administrated. Physical examination showed severe pruritus and erythematous streaks on the trunk on post-BMT day 18 (Fig. 1a). Maculopapular eruptions appeared on the trunk and extremities on day 19 (Fig. 1b). No diarrhea or jaundice was observed. Bodyweight was 56.0 kg, 57.2 kg and 56.2 kg on day 16, 18–21 and 22, respectively. Maximum daily axillary temperature was 37.9°C on day 16, 39.5°C on day 17, 39.1°C on day 18, 39.5°C on day 19 and 38.0°C on day 20. Neutrophil counts were 400/lL on day 16, 1300/lL on day 18 and 3500/lL on day 19. Aspartate transaminase and alanine transaminase concentrations were 173 IU/mL and 340 IU/mL, respectively, on day 18. Histopathological examination of the streaks on the

Epstein-Barr Virus-associated Lymphoproliferative Disorder with Encephalitis Following Anti-thymocyte Globulin for Aplastic Anemia Resolved with Rituximab Therapy: A Case Report and Literature Review

Epstein-Barr virus (EBV)-associated lymphoproliferative disorders (LPDs) sometimes occur following Anti-thymocyte globulin (ATG) administration for allogenic stem cell transplantation but are rare in aplastic anemia (AA) patients. A 55-year-old woman with AA following ATG developed refractory fever and was diagnosed with EBV-LPD. She was successfully treated with weekly rituximab monotherapy; however, she developed EBV encephalitis. She was admitted to the intensive care unit and finally recovered from unconsciousness. EBV-LPD should be considered after ATG for AA when symptoms appear. Because EBV-LPD following ATG for AA can rapidly progress, weekly monitoring of EBV-DNA and early intervention may be necessary.

Incidental detection of malignant lymphoma in subjects in a cancer surveillance programme

Cancer surveillance programmes have recently been introduced in Japan. The usefulness of [F] fluoro-deoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) has been established for the diagnosis/treatment monitoring of various types of cancer. The superiority of PET/CT over conventional scintigraphy for diagnosing malignant lymphoma (ML) has been demonstrated; PET/CT has also been used to evaluate treatment responses in ML (Moog et al, 1997, 1998). However, the diagnostic value of this modality for each histopathological type continues to be debated; in particular, its value for diagnosing low-grade lymphoma is controversial (Karam et al, 2006). We analysed the data for 10 659 individuals who participated in a cancer surveillance programme that included PET/ CT at the Research Centre for Cancer Prevention, National Cancer Centre, Japan, from 2004 to 2011. The subjects were healthy individuals over the age of 40 years with no history of cancer who had elected to participate in this programme. Written informed consent was obtained from all participants. The median age of participants was 59 years and the oldest was 89 years old. For four consecutive years after the screening, all participants were surveyed annually about their health by questionnaires that included questions about development of cancer. The participants could opt for repeated screening. The screening included blood tests, urinalysis, sputum cytology, abdominal ultrasonography, thoracic CT, upper gastrointestinal endoscopy and either colonoscopy or colon X-ray examination. Cervical cytology, mammography, breast ultrasonography and pelvic magnetic resonance imaging (MRI) were also performed on women. PET/CT was performed optionally. Blood tests included a complete blood count, biochemical tests, hepatitis virus screening and serum concentrations of the tumour markers carcinoembryonic antigen, cancer antigen (CA)19-9, prostate-specific antigen in men and CA125 in women. Histopathological subtype, examination(s) that contributed to making the diagnosis, survival and the cause of death were collected for the subjects who had been diagnosed with ML. ML was detected in the initial screening of 18 participants, representing a prevalence of 0 16%, which is higher than the estimated incidence (0 012%) in the general Japanese population (Matsuda et al, 2012). ML was diagnosed in subsequent optional screening in another seven subjects who had not been found to have ML in their initial screening (Fig 1). The questionnaire survey identified that diffuse large B cell lymphoma (DLBCL) had been found in another two cases at other institutions. This cancer screening programme detected 25 cases of ML including 12 marginal zone lymphoma, five follicular lymphoma (FL), four DLBCL, two small lymphocytic

Clinical significance of cancer-related fatigue in multiple myeloma patients

Cancer-related fatigue (CRF) is one of the adverse events in multiple myeloma (MM) patients treated with cytotoxic agents, proteasome inhibitors (PIs), and immunomodulatory drugs (IMiDs) such as bortezomib, lenalidomide, and thalidomide. The aims of our study were to prospectively analyze the clinical significance of CRF, and to evaluate the cumulative incidence of CRF and the survival rates of 16 MM patients who were treated with PIs and IMiDs. Reactivation of salivary human herpes virus (HHV)-6 and HHV-7 was analyzed using real-time quantitative polymerase chain reaction (qPCR). CRF was evaluated using a visual analog scale (VAS). Eleven newly diagnosed multiple myeloma (NDMM) and five relapsed or refractory MM patients were enrolled in this study. The cumulative incidence of CRF was 54.9%. The treatment types were not associated with the CRF incidence. The cumulative incidence of reactivation of HHV-6 and HHV-7 was 73.1% and 45.6%, respectively. However, the reactivation of HHV-6 and HHV-7 was not related to CRF. The overall survival (OS) and progression-free survival (PFS) in NDMM patients with CRF was significantly shorter than in those without CRF. In conclusion, CRF was one of the major symptoms in MM patients, and predicted shorter OS and PFS in NDMM patients.

Clinical significance of granule‐containing myeloma cells in patients with newly diagnosed multiple myeloma

The clinical features and prognostic significance of myeloma cells containing granules remain unclear. The purpose of this retrospective study was to investigate the clinical significance of granule‐containing myeloma cells in patients with newly diagnosed multiple myeloma (NDMM). We retrospectively analyzed the records of 122 patients diagnosed with NDMM between January 2007 and December 2013. Granule‐containing myeloma cells were defined as myeloma cells that exhibited three or more granules in their cytoplasm by May‐Giemsa staining. The patients were classified into two groups, the granule‐containing myeloma (GM) and nongranule‐containing myeloma (non‐GM) groups, depending on the proportion of myeloma cells that contained granules (cut‐off value: 10%). There were 25 (20.5%) patients in the GM group. Patients in the GM group displayed significantly higher CD56 and CD49e expression than those in the non‐GM group (t‐test, P = 0.027 and 0.042). None of the patient characteristics differed significantly between the two groups. There was no significant difference in the chemotherapy profiles of the two groups, and the overall response rates of the two groups were similar. During the median follow‐up period of 33.9 months, the overall survival (OS) in the GM group was similar to that in the non‐GM group; 4‐year OS of the GM and non‐GM groups were 78.5% and 51.9%, respectively (P = 0.126). We concluded that cases of NDMM involving granule‐containing myeloma cells are not infrequent. Moreover, CD56 and CD49e expression was significantly higher in the presence of myeloma cell populations, and the presence of granules did not affect survival.