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A 65-year-old male patient was admitted to the Jikei Daisan Hospital due to leukocytosis, anemia and thrombocy-topenia. He was diagnosed as having Philadelphia-positive acute myeloid leukemia. He was negative for hepatitis B surface antigen (HBsAg), HBs antibody, and HB core antibody before transfusion. On day 3 of hospitalization, he was transfused with platelets. The transfusion product was confirmed negative on the quadrivalent nucleic acid amplification test (NAT), conducted as pre-transfusion screening. The donor was positive for NAT two weeks later at the time of re-donation, but retrospective survey was not done due to a negative result for additional hepatitis B virus (HBV) DNA. However, the donor was found positive for HBVDNA one month after re-donation. Case review revealed that the patient had received the product which had been collected during the window period. Monitoring for both HBsAg and HBVDNA every three to six weeks was required. Although HBVDNA was negative on day 44,84, and 129 after hospitalization, he became positive for HBsAg and HBVDNA six months after transfusion, on day 149. HBVDNA sequence between the patient and donor were matched, confirming post-transfusion HBV infection. Preemptive therapy with entecavir prevented the development of acute hepatitis, and his HBVDNA status became negative. [ABSTRACT FROM AUTHOR]

The central nervous system toxicity of high-dose cytosine arabinoside is well recognized, but the toxicity of cytosine arabinoside in the peripheral nervous system has been infrequently reported. A 49-year-old Japanese man was diagnosed with acute myeloid leukemia. After he achieved complete remission, he received high-dose cytosine arabinoside treatment (2 g/m2 twice a day for 5 days; total, 20 g/m2) as consolidation therapy. The first course of high-dose cytosine arabinoside resulted in no unusual symptoms, but on day 21 of the second course of treatment, the patient complained of numbness in his right foot. Electromyogram and nerve-conduction studies showed peripheral neuropathy in both peroneal nerves. This neuropathy was gradually resolving; however, after the patient received allogeneic bone marrow transplantation, the symptoms worsened, with the development of graft-versus-host disease, and the symptoms subsequently responded to methylprednisolone. Although the mechanisms of peripheral neuropathy are still unclear, high-dose cytosine arabinoside is a therapy that is potentially toxic to the peripheral nervous system, and auto/alloimmunity may play an important role in these mechanisms. [ABSTRACT FROM AUTHOR]

We report a 19-year-old male with acute myeloid leukemia who developed an early cytomegalovirus gastrointestinal disease with a high level of cytomegalovirus antigenemia after bone marrow transplantation. He underwent bone marrow transplantation from HLA-matched related donor. He developed acute graft-versus-host disease on day 15, and he immediately went on prednisolone. The graft-versus-host disease disappeared immediately, but he developed a severe epigastralgia on day 23. Although absolute neutrophil count was 0.5 × 109/l, the pp65 cytomegalovirus antigenemia increased up to 1120 cells/slide. The endoscope examination was performed on day 29 and it showed erosive gastritis, and microscopical examination revealed nuclear inclusion bodies and positive cells of cytomegalovirus antigen. Ganciclovir treatment was started, and it continued until negative cytomegalovirus antigenemia was confirmed. He consequently discharged to outpatient without late phase CMV diseases or recurrence of AML. We assessed that the patient had two risk factors. First, he was the cytomegalovirus seropositive patient and received bone marrow from seronegative donor. Second, he was treated with prednisolone for acute graft-versus-host disease. The ganciclovir treatment turned out to be successful, but the cytomegalovirus disease developed too early to start the antigenemia guided preemptive treatment. The high-risk patients could develop the early cytomegalovirus disease even though under the status of myelosuppression after bone marrow transplantation. [ABSTRACT FROM AUTHOR]

Abstract  To investigate the role of matrix metalloproteinases (MMPs) in the mobilization of peripheral blood stem cells stimulated by granulocyte colony-stimulating factor (G-CSF), we analyzed MMP serum levels in 11 healthy donors and 9 patients who had hematological malignancies or germ cell tumors. A dose of 5–10 µg/kg per day of G-CSF (lenograstim) was administered for 4–8 days to each subject. The serum levels of MMP-2, and MMP-9; interleukin-3, -6, -8, and -10; stem cell factor; interferon-γ; and tumor necrosis factor-α were measured both before and during G-CSF administration. MMP-9 was found to be increased in both the cancer patients and the healthy donor group. In contrast, the levels of each of the other factors tested were unchanged. No significant positive correlation was observed between the MMP-9 levels and the number of CD34+ cells. Hence, we found no significant role for MMPs during the mobilization of peripheral blood stem cells stimulated by G-CSF. [ABSTRACT FROM AUTHOR]