Negative Impact of Gemtuzumab Ozogamicin on CD33-Positive Early T-Cell Precursor Acute Lymphoblastic Leukemia: A Case Report

Introduction: Early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) is a rare subtype of T-cell leukemia that phenotypically expresses mature T-cell markers and immature myeloid markers such as CD33. Gemtuzumab ozogamicin (GO) is a novel agent for the CD33 molecular targeting antibody conjugated to the cytotoxic agent calicheamicin. GO is anticipated to be effective against ETP-ALL. In vivo studies promise antileukemic effects in cell lines; however, clinical reports to support this research are lacking. We treated a patient who suffered from CD33-positive ETP-ALL using GO. Case Presentation: We treated an 81-year-old man who suffered from ETP-ALL. The patient’s leukemia expressed T cell and myeloid markers including cyCD3, CD5, CD7, CD33, and HLA-DR. Initially, the patient was treated using a standard chemotherapy regimen for acute lymphoblastic leukemia comprising cyclophosphamide, daunorubicin, vincristine, l-asparaginase, and prednisolone. The induction chemotherapy produced the expected complete hematological response; however, bone marrow blasts remained. Following consolidation chemotherapy, the patient maintained a full hematological response. Thereafter, we changed the consolidation regimen to nelarabine, which did not reduce bone marrow blasts effectively. After two courses of nelarabine therapy, we finally used GO at an 8 mg/m2 weekly dose after confirming that CD33 expression was still positive in the patient’s residual leukemic cells. GO was ineffective in treating the patient’s leukemia, and peripheral blasts increased 30 days following treatment. The patient died 81 days after initiating GO therapy. Conclusion: This is the first clinical case of GO having a negative impact on ETP-ALL. Because the GO resistance mechanism for ETP-ALL has not been fully elucidated, treatment modification should be considered to achieve optimal clinical efficacy

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Central Nervous System Peripheral T Cell Lymphoma Manifesting as Lymphomatosis Cerebri That Was Misdiagnosed as Neuro-Behçet’s Disease: A Case Report

Background: Lymphomatosis cerebri (LC) is a unique form of primary central nerves lymphoma (PCNSL), which presents as diffuse infiltration of lymphoma cells characteristically in the white matter rather than tumor formation. However, the involvement of central nervous system (CNS) is unclear because of the lack of contrast enhancement. Case Presentation: We treated a 53-year-old woman with LC and brain lesions resembling neuro-Behcet’s disease. She had a past history of acute uveitis and current symptoms of somnolence and gait disturbances progressing for one month. Cranial magnetic resonance imaging (MRI) revealed high signal lesions in the brain stem. Based on her past history and present clinical findings, she was clinically diagnosed with neuro-Behcet’s disease, which was treated with 1 g of methylprednisolone (mPSL) pulse therapy. Repeated mPSL pulse therapy resulted in a minor response, but the cerebral lesions persisted. After a short remission of several months, signal changes of the brain stem lesion recurred and her consciousness level worsened at 4 months after diagnosis. Upon admission to our hospital, positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography revealed abnormal uptake in the systemic lymph nodes (LNs), including the bilateral inguinal LNs. A diagnosis based on a biopsy of the left inguinal LNs was primary central nervous system lymphoma with inguinal LN lesions, manifesting as LC from malignant peripheral T cell lymphoma, not otherwise specified. Four courses of high-dose methotrexate (3.5 g/m2) therapy lead to temporary recovery of consciousness, but there was no improvement in other neurological findings. All nodal lesions tentatively regressed. Serum soluble interleukin-2 receptor (sIL-2R) (normal range: 121–613 U/mL) was constitutively decreased from 8,520 U/mL before chemotherapy to 740 U/mL after chemotherapy. We observed cerebral micro-bleeds in the center of LC lesions during chemotherapy, but no surgical intervention was required. Two months later, LC recurred in the brain, which was fatal. Conclusions: Neuro-Behçet’s disease is difficult to distinguish from LC when other clinical findings, including human leukocyte antigen disparity, serum sIL-2R, or cerebrospinal IL-6, are lacking. LC should be differentiated from CNS lymphoma before corticosteroid therapy

住民による高齢者サロン運営の課題と対策

一般高齢者の介護予防推進事業である高齢者サロン運営の課題と対策を検討する目的で島根県出雲市C地区の高齢者サロンに参加して実態把握をするとともに、サロンの世話役・福祉委員・参加者等に実施したインタビュー結果をサロン活動の継続の困難さに視点を当て分析した。課題は①独居高齢者等の不参加②参加意欲維持の困難さ③働き盛り男性福祉委員の活動の困難性④世話役の高齢化と人材不足による活動の困難性⑤企画内容の工夫の困難性⑥活動記録等の保存と活用の不徹底⑦社会資源等の情報伝達と周知不足⑧予算確保の困難性・助成金の使途制限による使用の困難性⑨実施場所と回数の不足⑩実施場所の環境整備不足であった。対策として社会福祉協議会、自治協会・保健師などがサロン運営の課題を共有する機会を持ち、サロンを運営する世話役や福祉委員への情報提供や必要な支援することが重要である。また、高齢者が主体的に参加できるよう協力を求めながら実施していく必要がある

Spastic S‐shaped sigmoid colon in hemorrhagic GIST

Abstract We treated a 44‐year‐old man with abdominal pain and melena caused by the gastrointestinal stromal tumor. In this case, computed tomography revealed a spastic S‐shaped sigmoid colon, indicating intestinal spastic paralysis secondary to intestinal bleeding. This finding prompted screening colonoscopy for gastrointestinal bleeding

Aggressive progressive pleuroparenchymal fibroelastosis developed long after allogenic hematopoietic stem cell transplantation

Key Clinical Message The typical pleuroparenchymal fibroelastosis (PPFE) after hematopoietic stem cell transplantation (HSCT) is characterized by late‐onset progressive pulmonary complication within 5 years. PPFE shows a poor prognosis without definitive standard care other than lung transplantation. Our case indicated an over 20 years late‐onset and aggressively exacerbating PPFE