The outcome and characteristics of patients with relapsed adult T cell leukemia/lymphoma after allogeneic hematopoietic stem cell transplantation

Treatment options for patients with adult T cell leukemia/lymphoma (ATLL) who have relapsed disease after allogeneic hematopoietic stem cell transplantation (allo‐HSCT) are limited. To clarify which patients with ATLL are likely to benefit from these treatment options and to define patient populations for novel treatments, we performed a nationwide retrospective analysis of 252 Japanese patients who had relapsed ATLL after allo‐HSCT. Some long‐term survivors remained after tapering and withdrawal of immunosuppressive agents. Thirty‐six patients who received donor lymphocyte infusion had a better overall survival (OS) in comparison to those who did not [hazard ratio (HR), 0.63; 95% confidence interval (CI), 0.43‐0.93; P = .02], suggesting the efficacy of a graft‐versus‐ATLL (GvATLL) effect even after relapse. Multivariate analysis demonstrated that skin lesions at initial relapse of ATLL were independently associated with higher OS (HR, 0.41; 95% CI, 0.22‐0.74; P = .003), indicating that the skin is a susceptible target organ of GvATLL. This study suggested that enhancement of a GvATLL effect is a potential therapeutic option for relapsed disease after allo‐HSCT. Further investigations of incorporation of immune‐based approaches with new molecular target drugs into the therapeutic options of patients with ATLL before and after transplantation are warranted.     

Clinical features of chronic enteropathy associated with SLCO2A1 gene: a new entity clinically distinct from Crohn’s disease

Journal of Gastroenterology - Chronic enteropathy associated with SLCO2A1 gene (CEAS) is a hereditary disease caused by mutations in the SLCO2A1 gene and characterized by multiple small intestinal...     

Clinical value of 11C-methionine PET/CT in patients with plasma cell malignancy: comparison with 18F-FDG PET/CT

Purpose

PET/CT using FDG has been widely used for the imaging of various malignant tumours, including plasma cell malignancy (PCM), but ¹¹C-methionine (MET), as a radiolabelled amino acid tracer, may also be useful because PCM is able to activate protein synthesis. The purpose of this study was to evaluate the clinical value of PET/CT imaging using MET in PCM, including multiple myeloma, compared with that of FDG PET/CT.

Methods

The study group comprised 20 patients with histologically proven PCM who underwent FDG PET/CT and MET PET/CT scans before (n?=?6) or after (n?=?14) treatment. Semiquantitative analysis was performed on a lesion basis. We also visually evaluated the scans qualitatively using a five-point scale (0, negative; 1, probably negative; 2, equivocal; 3, probably positive; 4, positive) on a lesion and a patient basis. The results were compared between the two scans.

Results

Active PCM was confirmed in 15 patients, including two patients with extramedullary lesions. Uptake of MET tended to be higher (maximum standardized uptake value 10.3 ± 5.6, mean ± SD) than that of FDG (3.4 ± 2.7, p?<?0.001), and more lesions of grade 3 or 4 were depicted by MET (MET 156 lesions vs. FDG 58 lesions). On a patient basis, two patients were accurately diagnosed only by MET. In the remaining 18 patients, consistent results were obtained, but potential upgrade of staging or restaging was necessary in 6 of 11 positive patients because more abnormal lesions were demonstrated by MET. The patient-based sensitivity, specificity and accuracy of MET for restaging were 89 %, 100 % and 93 %, respectively, while those of FDG were 78 %, 100 % and 86 %, respectively.

Conclusion

MET revealed an equal or greater number of lesions in PCM than FDG. MET may be especially useful when negative or inconclusive findings are obtained by FDG despite highly suspicious indications of recurrence.     

Conformability and irritancy of adhesive tapes on the skin

The relationship between the conformability of adhesive tape, the mechanical property of the adhesive tape not to interfere with skin movement, and irritation of the skin was investigated. In order to assess the conformability of adhesive tape to the skin, a uniaxial method employing film strips connected to a strain gauge was used to measure the elastic properly of the skin, with or without application of various elastic tapes. The tension loaded on the strain gauge was measured while the skin was extended by 15% of its original length in a direction across the humeral axis on the flexor side of the upper right arm. The most elastic adhesive tape showed the best conformity to the skin. The same adhesive tapes were applied on the flexor side of both upper arms so that the tape held a piece of sanitary cotton in place for 24 h. Dermal irritation was not so remarkable in the skin under the inner part of the tapes. On the other hand, the skin reaction was much more severe on the skin under the edge portion of the applied tape which showed poor conformability to the skin. These findings seemed to indicate that the skin reaction was caused by localized distortion of the skin under the edge portion of the applied tapes, during movement of the underlying muscle. Actually, the distortion of the skin surface was great in the areas immediately outside the edge of the applied tape. In conclusion, adhesive tape conformable to skin movement reduced localized distortion of the skin during application, resulting in low irritation at the edge of the applied tape.     

A multidisciplinary approach to the treatment of malignant pelvic bone tumors: results with eight consecutive patients

The prognosis for malignant pelvic bone tumors is worse than that for malignant bone tumors of the extremities because definitive surgery in the pelvis is often difficult to accomplish. The results for eight patients who were treated consecutively with a multidisciplinary approach, from 1990, were analyzed. The histologic diagnosis was osteosarcoma in five patients, chondrosarcoma in two, and Ewing's sarcoma in one. Five lesions arose in the ilium and three in the pubis. The extraosseous tumors decreased in size and/or were encapsulated as a result of preoperative chemotherapy in six patients, four of these achieving a wide surgical margin. With respect to tumor location and surgical margin, all five lesions in the ilium involved the sacrum, four of these being resected with an inadequate margin. The three lesions in the pubis were resected with an adequate margin. Local recurrence was observed in two patients who had been treated with an inappropriate margin. During the period between 18 and 57 months after the first operation, five patients were continuously free of disease and one was still alive but had lung metastases. Our results indicate that a patient's chances of definitive surgery may be enhanced by a multidisciplinary approach, although the management of sacroiliac involvement remains challenging. Received: October 4, 1999 / Accepted: March 16, 2000     

Impact of vascular endothelial growth factor receptor 1, 2, and 3 expression on the outcome of patients with gastric cancer

Tumor angiogenesis is a multistep interactive process in which vascular endothelial growth factor (VEGF) and its receptors have a major role. However, the clinical significance of these molecules in gastric cancer (GC) remains unclear. Our study group comprised 86 patients who underwent gastrectomy and subsequently received chemotherapy for recurrent or residual tumor. Using immunohistochemical techniques, we analyzed the expression of VEGF receptors (VEGF-R) 1, 2, and 3. VEGF-R1 expression (defined as >5% staining) was found in the tumor cells of 65 tumors (76%) and in the stromal vessels of 36 tumors (42%). VEGF-R2 expression was found in tumor cells and stromal vessels of 0 and 46 tumors (0 and 53%), respectively, and VEGF-R3 expression was found in tumor cells and stromal vessels of 0 and 75 tumors (0 and 87%), respectively. Univariate analysis revealed that VEGF-R expression correlated with shorter survival (VEGF-R1 in stromal vessels, P  = 0.001; VEGF-R2 in stromal vessels, P  = 0.009; VEGF-R3 in stromal vessels, P  = 0.005) and lower response to S-1 (VEGF-R1 in stromal vessels, P  = 0.039). Multivariate analysis of potential prognostic factors showed that VEGF-R1 and VEGF-R2 in stromal vessels were independent predictors of poor outcome. Our data suggest that VEGF-R expression can be a predictor of unfavorable clinical outcome in GC. VEGF-R are promising candidates as therapeutic targets. ( Cancer Sci 2009; 100: 310–315)     

Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer

Background  

Endoscopic resection (ER) has been accepted as minimally invasive treatment in patients with early gastric cancer (EGC) who have a negligible risk of lymph node metastasis. It has already been determined which lesions in differentiated-type EGC present a negligible risk of lymph node metastasis, and ER is being performed for these lesions. In contrast, no consensus has been reached on which lesions in undifferentiated-type (UD-type) EGC present a negligible risk for lymph node metastasis, nor have indications for ER for UD-type EGC been established.     

Combination of O6-methylguanine-DNA methyltransferase and thymidylate synthase for the prediction of fluoropyrimidine efficacy

We investigated the correlation between the response to fluoropyrimidines as first-line therapy and the expressions of genes in patients with primary colorectal cancer (CRC). The study group comprised 92 patients with metastatic CRC. Total RNA was isolated from laser-captured tumour cells in surgically resected primary lesions, and gene expression was quantitatively evaluated by real-time RT-PCR assay. Low thymidylate synthase (TS), low gamma-glutamyl hydrolase, high reduced folate carrier 1, high O6-methylguanine-DNA methyltransferase (MGMT) and low cyclin E expressions were associated with a good response (P=0.0030, 0.0250, 0.0120, 0.0030 and 0.0020, respectively) on univariate analysis. On multivariate logistic regression analysis, TS and MGMT remained independent predictors of the response. The clinical response rates were 63.2% in the low TS or high MGMT group and 14.3% in high TS and low MGMT group (P<0.0001). The combination of high TS and low MGMT expression is a significant predictor of a poor response to fluoropyrimidine treatment.     

Clinicopathological characteristics of non‐ampullary duodenal tumors and their phenotypic classification

The tumorigenesis of non‐ampullary duodenal epithelial tumors (NADETs) might be different between the oral and anal sides of Vater's papilla. We conducted an immunohistological review to elucidate the clinicopathological features according to the tumor location and phenotypic classification. A review of an institutional database identified 121 patients with 125 superficial NADETs. NADETs were histologically evaluated and classified into the intestinal or gastric type based on immunohistochemical analysis. Clinicopathological factors were compared based on the tumor location and phenotype. Logistic regression analysis was performed to identify independent predictors for gastric‐type NADETs. According to location analysis, the mucin phenotype was significantly different (oral side, intestinal‐type 64.8%, gastric‐type 35.3%; anal side, intestinal‐type 87.3%, gastric‐type 12.7%; P < 0.01). Although the incidence of adenoma was significantly predominant in the intestinal type (75.3%), most gastric‐type NADETs were cancerous (64.3%). Notably, most gastric‐type NADETs were adenocarcinomas even when the tumor size was ≤0 mm. In multivariate analysis, tumor location on the oral side (odds ratio [OR], 4.42), villous structure (OR, 6.44), and low tumor gland density (OR, 9.49) were independent predictors of gastric‐type tumors. Gastric‐type NADETs significantly differ from intestinal‐type NADETs in terms of tumor location, morphology, and biology.