BACKGROUND:Secondary acute myeloid leukemia (sAML) and AML with myelodysplasia-related changes (AML-MRC) are associated with poor prognosis, but the impact relative to de novo AML remains controversial. We investigated clinical and genetic features in a multicenter Japanese cohort before CPX-351 approval. METHODS:We retrospectively analyzed 294 patients with newly diagnosed AML registered in the Hokkaido Leukemia Net between 2022 and 2023. Propensity score matching was used to adjust baseline variables. Genetic profiles were assessed in 160 matched patients. RESULTS:In the matched cohort, sAML/AML-MRC did not show inferior overall survival compared with non-sAML/non-AML-MRC (P = 0.90). Adverse karyotypes were the predominant determinant among sAML/AML-MRC. Among sAML/AML-MRC patients, adverse karyotypes were associated with poorer survival than those without adverse karyotypes (P = 0.0075). In contrast, non-sAML/non-AML-MRC groups did not affect survival regardless of adverse karyotypes (P = 0.51). Among 65 patients with ELN 2017 adverse-risk, those with TP53 mutations had markedly shorter survival than those with TP53 wild-type (P = 0.018). CONCLUSIONS:sAML/AML-MRC with an adverse karyotype had a dismal outcome. These findings provide a benchmark for risk stratification in the pre- CPX-351 era.
The oncologic outcomes of pedunculated-type T1 colorectal cancer (CRC) remain unknown. We determined the risk factors for lymph node metastasis (LNM) and recurrence and evaluated the survival according to the treatment method. In this multicenter retrospective study involving 4673 patients with T1 CRC, we analyzed 444 patients with pedunculated-type T1 CRC treated between 2009 and 2016. Treatment included local resection (LR) alone (n = 169), surgery with lymph node (LN) dissection alone (n = 83), and LR followed by additional surgery with LN dissection (n = 192). Factors associated with LNM and recurrence, relapse-free survival (RFS) and overall survival (OS) by treatment were analyzed. The median follow-up period was 64 months. LNM and recurrence were observed in 25 (5.6
INTRODUCTION:Vedolizumab binds to α4β7 integrin, thereby inhibiting lymphocyte migration into the gastrointestinal tract. It is used to treat moderate to severe ulcerative colitis (UC) and Crohn's disease. This study evaluated vedolizumab concentrations, α4β7 integrin saturation, and T lymphocyte immunophenotype proportions in blood, serum and inflamed colorectal tissue according to treatment efficacy in patients with moderate to severe UC. METHODS:This was a phase 4, multicenter, open-label, single-arm study. Patients were observed for a total of 54 weeks. Clinical remission was defined as complete Mayo score ≤ 2 or partial Mayo score ≤ 1. RESULTS:The study included 11 patients with UC, 10 of whom were tumor necrosis factor alpha antagonist therapy-naïve. Seven and six patients were in remission at weeks 14 and 54, respectively. Vedolizumab concentrations and lymphocyte α4β7 integrin saturation in serum and inflamed colorectal tissue at weeks 14 and 54 did not differ significantly between remitters and non-remitters. The proportion of T cell subsets differed in remitters and non-remitters for CD4+ T cells in blood at week 14 (62.7% vs 47.4%, p = 0.0061) and CD161+ memory CD4+ T cells (65.7% vs 53.1%, p = 0.0357) in inflamed colorectal tissue at week 54. Week 54 remitters had higher proportions of CD161+ memory CD4+ T cells in inflamed colorectal tissue at baseline (before vedolizumab treatment) than did week 54 non-remitters (48.5% vs 31.3%, p = 0.0303). CONCLUSION:T cell immunophenotype may be a promising predictive biomarker of vedolizumab treatment efficacy.
Recently, endovascular catheter-based interventions have become an established therapeutic option for severe valvular heart disease. Although cholesterol crystal embolism is a well-recognized complication of endovascular treatment, the hydrophilic polymer coating of catheter devices may also induce embolic events. Herein, we reported a rare case of hydrophilic polymer embolism (HPE) after transcatheter aortic valve replacement for severe aortic stenosis. At present, there are no specific treatment options for HPE, but early diagnosis and corticosteroid therapy may be effective. This report highlighted the characteristics and successful management of HPE based on a patient we treated and previous literature.
Background Primary small intestinal lymphoma (PSIL) is a rare disease, and its clinical characteristics and prognostic factors remain insufficiently defined because of limited large-scale data. Methods We conducted a nationwide multicenter retrospective study of 686 patients diagnosed with PSIL between January 2008 and December 2017 at 44 institutions in Japan. Clinical characteristics, histological subtypes, and overall survival were analyzed. Results B-cell lymphoma was the predominant immunophenotype (n = 623, 91%), whereas T-cell lymphoma was uncommon (n = 50, 7%). Diffuse large B-cell lymphoma (DLBCL) was the most frequent histological subtype (n = 330, 48%), followed by follicular lymphoma (FL) (n = 224, 33%). Compared with other B-cell lymphomas, FL was more common in women and more frequently involved the jejunum (P < 0.001). The 5-year overall survival rate was significantly higher in patients with B-cell lymphoma than in those with T-cell lymphoma (81% vs. 23%, P < 0.001). Multivariate Cox regression analysis identified age > 60 years and T-cell lymphoma as independent adverse prognostic factors, whereas FL was an independent predictor of favorable overall survival. Conclusions This nationwide multicenter analysis delineates the clinicopathological features and survival outcomes of PSIL in Japan. FL represents the second most common subtype after DLBCL and is associated with a favorable prognosis among PSIL subtypes.
