Michihiko Masuda

A 78-year-old man and an 81-year-old woman without hemophilia suddenly developed giant ecchymoses and intramuscular hemorrhage. Prolonged activated partial thromboplastin time and low factor VIII activity were observed, and the patients were subsequently diagnosed as having acquired factor VIII inhibitors. The patients were infused with one dose of recombinant factor VIII, 50 to 100 U/kg body weight, followed by cyclophosphamide, 500 mg on day 1 and 200 mg/day on days 2 to 5; vincristine, 2 mg on day 1; and prednisolone, 100 mg/day on days 1 to 5 (recombinant factor VIII-CVP therapy). Both patients responded after one course of therapy. Disappearance of inhibitors was achieved after three to four courses of therapy without subsequent recurrence. Recombinant factor VIII-CVP therapy is safe and effective in the eradication of factor VIII inhibitors.

This study detected clonal T cells in patients with acquired pure red‐cell aplasia (PRCA) by Southern blotting and polymerase chain reaction (PCR). Twenty‐nine adult patients with acquired PRCA were enrolled in this study. Seventeen patients had primary acquired PRCA, while 12 patients had the secondary form. Twenty‐two of 29 (76%) patients demonstrated TCR rearrangement by at least one method. We divided the patients into three groups depending on T‐cell clonality. The CD4/8 ratio of patients who were positive on Southern blotting was significantly lower than that of other groups. Except for the CD4/8 ratio, other laboratory findings did not significantly differ among the three groups. The CD4/8 ratio should be a useful surrogate marker to detect T‐cell clonality. Am. J. Hematol. 79:332–333, 2005.

We observed massive hemolysis after allogeneic peripheral blood stem cell transplantation with minor ABO incompatibility (the donor was group O and the recipient group A). The patient was a 21-year-old man diagnosed as having Philadelphia chromosome-positive chronic myelogenous leukemia. On day 7 post-transplant, there was abrupt onset of massive hemolysis necessitating supportive treatment with transfusions. During the allogeneic peripheral blood stem cell transplantation the patient had received 2 x 10(8) CD3 positive cells/kg and 7.8 x 10(7) CD19 positive cells/kg donor lymphocytes with stem cells. The present case shows that in allogeneic peripheral blood stem cell transplantation with ABO incompatibility, severe hemolysis occurs early after transplantation presumably due to the transfusion of a large number of lymphocytes.

The present multicenter study was performed to evaluate the effect of recombinant human granulocyte-colony stimulating factor (rhG-CSF) on combination therapy using aztreonam (AZT) and clindamycin (CLDM) to treat severe infection in neutropenic patients with hematologic diseases. Forty-three neutropenic patients with infections (rhG-CSF group) were treated with AZT (2 g) and CLDM (600 mg) 2-3 times daily as well as rhG-CSF (Lenograstim or Filgrastim: 2-5μ/kg/day). The clinical efficacy of this regimen was compared to that obtained in 44 febrile neutropenic patients, with hematologic diseases, who received only AZT and CLDM in a previous study (historical control group).The overall efficacy rate was 69.8%(30/43) in the rhG-CSF group and 65.9%(29/44) in the historical control group. Although the neutrophil count was significantly increased and C-reactive protein tended to be lower in the rhG-CSF group, the daily maximum body temperature profiles of the 2 groups were nearly the same.These results suggest that rhG-CSF is of little benefit in the treatment of single infectious episodes in neutropenic patients, and that appropriate antibiotic therapy is more important.

Miconazole (400.1200 mg/day) was administered to patients with deep mycosis and suspected deep mycosis, and the efficacy evaluated. 13-Glucan was determined as the early diagnostic parameter of deep mycosis, and the relationships between the clinical efficacy of miconazole and the titers of β-glucan were also evaluated.Forty-nine cases were evaluated, including 2 cases of deep mycosis and 47 cases of suspected deep mycosis. Most of the patients had hematological malignancies.The rate of efficacy was 100%(2/2) in deep mycosis, 66.0%(31/47) in suspected deep mycosis, and 67.3%(33/49) in total.β-Glucan was determined in 39 cases before the administration of miconazole. The rate of β-glucan positivity was 100%(1/1) in deep mycosis and 44.7%(17/38) in suspected deep mycosis.β-Glucan was also determined before and after the administration of miconazole in 11 cases. The titers of β-glucan became negative in 6 cases, decreased in 2 cases and increased in 3 cases. Thus, the β-glucan titers became negative or decreased in 72.7%(8/11) of the cases. Efficacy of miconazole was 83.3%(5/6) in the cases in which fi-glucan became negative, 50.0%(1/2) in the cases in which the titers of β-glucan decreased, and 33.3%(1/3) in the cases in which the titers of β-glucan increased.Miconazole was effective in the treatment of deep mycosis, and the titers of β-glucan correlated well with the clinical efficacy icacy of miconazole. The determination of pglucan appears to be useful for the diagnosis of deep mycosis.