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Background: The extrahepatic manifestations of HCV infection are usually refractory to IFN-alpha and ribavirin. Given that the pathophysiology is autoimmune disorders, rather than the direct cytotoxicity of HCV, various immunosuppressants have been attempted, including rituximab with favorable results. However, questions on the possible opportunistic infections and hepatitis exacerbation by rituximab remain unsolved.Methods: We hereby report 8 HCV-positive cases treated with rituximab. Indication for the treatment were severe extrahepatic conditions associated with HCV infection in 2 cases and malignant lymphoma in 6. Sequential measurements of serum transaminases, viral load, and routine clinical examination were performed for a median follow-up of 13 months.Results: None of the 8 patients showed clinical or liver deterioration, or opportunistic infections, although 3 of them had a significant increase in HCV-load. Rituximab was well tolerated in all cases.Conclusions: Our results further support the safety of rituximab in HCV-positive patients, providing a promising treatment modality, when needed, for HCV-associated extrahepatic disorders. [ABSTRACT FROM AUTHOR]

Summary:To evaluate the feasibility of reduced intensity stem cell transplantation (RIST) with bone marrow from a matched unrelated donor (MUD), we retrospectively investigated 20 patients with hematological disorders who received RIST in the Tokyo SCT consortium from January 2000 to October 2002. The preparative regimens were fludarabine-based (150-180?mg/m2, n=18) or cladribine-based (0.77?mg/kg, n=2). To enhance engraftment, antithymocyte globulin (ATG) and 4 or 8?Gy total body irradiation (TBI) were added to these regimens in nine and 11 patients, respectively. GVHD prophylaxis was cyclosporine with or without methotrexate. In all, 19 achieved primary engraftment. Three developed graft failure (one primary, two secondary), and five died of treatment-related mortality within 100 days of transplant. Seven of the 19 patients who achieved initial engraftment developed grade II-IV acute GVHD, and seven of 13 patients who survived >100 days developed chronic GVHD. At a median follow-up of 5.5 months, estimated 1-year overall survival was 35%. Compared with a TBI-containing regimen, an ATG-containing regimen was associated with a high risk of graft failure (30 vs 0%, P=0.0737). This study supports the feasibility of RIST from MUD; however, procedure-related toxicities remain significant in its application to patients.Bone Marrow Transplantation (2004) 33, 697-702. doi:10.1038/sj.bmt.1704425 Published online 2 February 2004 [ABSTRACT FROM AUTHOR]

Presents the letter to the editor about an article on graft-versus-host disease, published in a previous issue of the journal.

We have carried out the transient nonlinear transport measurements on the layered cobalt oxide Ca3Co4O9, in which a spin density wave (SDW) transition is proposed at TSDW≃30 K. We find that, below TSDW, the electrical conductivity systematically varies with both the applied current and the time, indicating a close relationship between the observed nonlinear conduction and the SDW order in this material. The time dependence of the conductivity is well analyzed by considering the dynamics of SDW which involves a low-field deformation and a sliding motion above a threshold field. We also measure the transport properties of the isovalent Sr-substituted systems to examine an impurity effect on the nonlinear response, and discuss the obtained threshold fields in terms of thermal fluctuations of the SDW order parameter. [ABSTRACT FROM AUTHOR]

Abstract Background The financial burden of medical expenses has been increasing for cancer patients. We investigated the relationship between household income and financial burden among patients with chronic myelogenous leukaemia (CML) who have been treated with imatinib. Methods A questionnaire was distributed to 1200 patients between May and August 2009. We retrospectively surveyed their household incomes, out-of-pocket medical expenses, final co-payments after refunds, and the perceived financial burden of their medical expenses in 2000, 2005 and 2008. Results A total of 577 patients completed the questionnaire. Their median age was 61 years (range, 15–94). A financial burden was felt by 41.2 % (28 of 68) of the patients treated with imatinib in 2000, 70.8 % (201 of 284) in 2005, and 75.8 % (400 of 528) in 2008. Overall, 182 patients (31.7 %) considered its discontinuation because of the financial burden and 15 (2.6 %) temporarily stopped their imatinib prescription. In 2000, 2005 and 2008, the patients’ median annual household incomes were 49,615 US Dollars (USD), 38,510 USD and 36,731 USD, respectively, with an average currency exchange rate of 104 Yen/USD in 2008. Their median annual out-of-pocket expenses were 11,548, 12,067 and 11,538 USD and their median final annual co-payments were 4,375, 4,327 and 3,558 USD, respectively. Older patients (OR = 0.96, 95 % CI: 0.95–0.98, p ≪ 0.0001 for 1-year increments), and patients with higher household incomes (OR = 0.92, 95 % CI: 0.85–0.99, p = 0.03 for 10,000 USD-increments) were less likely to have considered discontinuing their imatinib treatment. Conversely, patients with higher annual final co-payments (OR = 2.21, 95 % CI: 1.28–4.28, p = 0.004 for 10,000 USD-increments) were more likely to have considered discontinuing their imatinib treatment. Conclusions The proportion of CML patients who sensed a financial burden increased between 2000 and 2008. During this period, their annual incomes fell by 13,000 USD, although their medical expenses did not change. Financial support for patients being treated with expensive drugs remains a major problem in Japan.