This study examined changes in practice patterns and outcomes of allogeneic hematopoietic cell transplantation (HCT) over the past 20 years. Data were analyzed from a Japanese nationwide registry of consecutive adult patients with acute myeloid leukemia who underwent allogeneic HCT between 2001 and 2020. The study population included 17,553 patients, of whom 6653 underwent allogeneic HCT in 2001–2010 and 10,900 in 2011–2020. Patients in the later period were older, were more likely to be in first complete remission, and more frequently received umbilical cord blood transplantation. After adjusting for major covariates, the 2011–2020 cohort had lower risks of overall mortality (hazard ratio [HR], 0.84; 95
Owing to the lack of a standardized surgical approach, surgical treatment of patients with chronic postoperative inguinal pain remains challenging. The aim of the present study was to evaluate the safety and long-term efficacy of surgical intervention in patients with chronic postoperative inguinal pain based on the patient-reported outcome measures. Fifty-four patients who underwent surgery for chronic postoperative inguinal pain at two institutions between March 2013 and July 2024 were retrospectively evaluated. The surgical procedure was selected according to the type of pain and primary hernia repair procedure. Safety was assessed by early postoperative morbidity, and long-term efficacy was evaluated by a questionnaire survey regarding postsurgical satisfaction (excellent/good/moderate/poor), hernia recurrence, and change in the pain scale score. At a median follow-up of 35.3 months, 92
Second-line FOLFIRI plus ramucirumab (RAM) is one of standard treatments for metastatic colorectal cancer (mCRC) following progression on anti-EGFR therapy in RAS wild-type tumors. However, biomarkers for RAM efficacy remain unclear. We conducted a translational analysis to evaluate the association of plasma biomarkers, including angiogenesis-related factors (AFs) and RAS mutations in circulating tumor DNA (ctDNA), with clinical outcomes. This biomarker study was embedded within the JACCRO CC-16 trial, which enrolled patients with mCRC with RAS wild-type tumors receiving FOLFIRI plus RAM after anti-EGFR therapy. Plasma samples were collected at baseline, day 15, and post-treatment. RAS status in ctDNA was analyzed using BEAMing digital PCR; AFs were assessed using Luminex multiplex assay. Associations with progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) were analyzed. Among 41 evaluable patients with RAS wild-type tumors, RAS mutations were detected in ctDNA at pretreatment in 44
Background Postoperative regional nodal irradiation (RNI) is a standard treatment for breast cancer at high risk of regional recurrence; however, the necessity of including the internal mammary node (IMN) region in the radiation field remains unclear. This study aimed to evaluate treatment outcomes in a large cohort of patients who received postoperative radiotherapy with RNI excluding the IMN region. Methods This study included patients with breast cancer who underwent surgery followed by RNI without IMN irradiation between 2007 and 2018. The primary endpoint was disease-free survival (DFS), and the secondary endpoints were overall survival (OS), breast cancer-specific mortality (BCM), distant metastasis-free survival (DMFS), recurrence patterns, and treatment-related adverse events. Results In total, 799 patients were included. The 5-year DFS, OS, BCM, and DMFS rates were 75.9, 88.3, 9.7, and 77.1%, respectively. Worse outcomes were associated with a higher number of positive lymph nodes and estrogen receptor (ER)-negative disease. Medial/central tumor location and younger age were each significantly associated with poorer outcomes, being associated with worse DFS and DMFS. Bone was the most common recurrence site. ER-negative disease, a higher number of positive lymph nodes, medial/central location, and younger age were significant risk factors for recurrence, particularly distant metastasis. IMN recurrence was rare. Conclusions In this cohort, medial/central tumor location, ER-negative disease, and extensive nodal involvement were associated with poorer outcomes, suggesting that these factors may identify patients who can benefit from IMN irradiation. These findings may serve as important reference data when determining the indication for IMN irradiation on an individual patient basis.
Graft intolerance syndrome (GIS) is a well-recognized complication after kidney allograft failure, characterized by fever, graft pain, and systemic inflammation. Management options include continued immunosuppression, graft nephrectomy, and renal artery embolization, each associated with specific risks. We report a case of GIS successfully treated with percutaneous renal allograft artery embolization using carbon dioxide angiography in a patient with iodinated contrast allergy. A 66-year-old woman with autosomal dominant polycystic kidney disease underwent living-donor kidney transplantation and later developed chronic allograft dysfunction, eventually resuming hemodialysis. Following immunosuppression tapering, she presented with recurrent fever and pain over the renal allograft. Despite broad-spectrum antibiotic therapy, her symptoms persisted and imaging showed no abscess formation. Repeated blood cultures were negative. Allograft biopsy revealed extensive tissue necrosis with interstitial inflammation and vascular thrombosis. Multiple donor-specific anti-human leukocyte antigen antibodies with high mean fluorescence intensity were detected, suggesting ongoing alloimmune sensitization. Based on the clinical course and investigations, GIS was diagnosed. Given the high surgical risk and contrast allergy, percutaneous embolization of the renal allograft artery was performed using a combination of carbon dioxide angiography and CT guidance. Clinical symptoms improved promptly after the procedure, allowing discontinuation of calcineurin inhibitor therapy and steroid tapering, with no recurrence during follow-up. This case highlights carbon dioxide contrast angiography- and computed tomography-guided renal artery embolization as a safe and effective minimally invasive treatment option for GIS, particularly in patients unsuitable for iodinated contrast media or surgical nephrectomy.
