Publications by authors named "Hidenori Wada"
Article Synopsis
- Clinical research on how physical function before transplantation affects outcomes in older adults is limited, prompting a study of 150 patients over 55 who underwent their first hematopoietic cell transplantation (HCT) from 2010 to 2021.
- The study found no differences in overall survival, non-relapse mortality, or disease relapse among different age groups, but higher pretransplantation physical function (measured by hand grip strength, knee extension strength, and a 6-minute walk test) suggested better overall survival and significantly lower non-relapse mortality.
- The results indicated that men and women require different thresholds for physical function assessments, and, while the overall incidence of disease relapse didn't vary significantly between groups, those with higher
The optimal bridge strategy at the decision for allogeneic hematopoietic stem cell transplantation (HSCT) in patients with myelodysplastic syndrome (MDS) is unclear. We performed a prospective observational study in which 110 patients with MDS who were decided to undergo HSCT were enrolled. Among these 110 patients, 77 patients were enrolled in this study within 1 month from the decision for HSCT.
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- The study examines the replacement of calcineurin inhibitors (CIs) with corticosteroids in patients facing adverse effects like renal impairment after allogeneic hematopoietic cell transplantation (HCT).* -
- Among 42 patients evaluated, the main reasons for switching were renal issues, fluid overload, and thrombotic microangiopathy, with notable improvements in creatinine and body weight within four weeks.* -
- Despite a high 100-day non-relapse mortality rate of 57.1% and 24.4% of patients developing acute graft-versus-host disease (GVHD) post-switch, the switch provided benefits for certain patients' renal and fluid conditions.*
Aggressive natural killer cell leukemia (ANKL) is a rare lymphoid neoplasm frequently associated with Epstein-Barr virus, with a disastrously poor prognosis. Owing to the lack of samples from patients with ANKL and relevant murine models, comprehensive investigation of its pathogenesis including the tumor microenvironment (TME) has been hindered. Here we established 3 xenograft mice derived from patients with ANKL (PDXs), which enabled extensive analysis of tumor cells and their TME.
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- - A 34-year-old man with a type of leukemia underwent a stem cell transplant after going into remission, but developed interstitial pneumonia six months later after reducing his cyclosporine A dosage.
- - Initially treated with prednisolone for his lung condition, he improved temporarily but worsened when the medication was lowered; further tests revealed he had anti-MDA5 antibodies.
- - A combination therapy of intravenous cyclophosphamide, prednisolone, and cyclosporine A was started, effectively treating his pneumonia, and he ultimately received successful living-donor lung transplants from his siblings.
Article Synopsis
- Autologous hematopoietic cell transplantation (HCT) leads to more severe myelosuppression and mucosal damage than conventional chemotherapy, but neutropenia lasts for a shorter duration due to stem cell rescue.
- A study of 208 patients who underwent autologous HCT revealed that the median neutropenic period was shorter compared to those undergoing intensive chemotherapy for acute myeloid leukemia (AML), but the incidence of febrile neutropenia (FN) was similarly high across both treatments.
- Despite the high rate of FN in autologous HCT patients, the incidence of bloodstream infections (BSI) was notably lower compared to AML consolidation chemotherapy, suggesting differences in infection profiles between the two treatments.
Article Synopsis
- - Chronic active Epstein-Barr virus infection (CAEBV) can lead to pulmonary artery hypertension (PAH) as a serious cardiovascular complication, but the exact mechanisms and treatment effects are not fully understood.
- - A study involving four adult CAEBV patients with PAH showed that treatment with a vasodilator improved heart pressure, and further enhancements were noted when CAEBV was treated, either through chemotherapy or allogeneic hematopoietic cell transplantation.
- - Autopsy results revealed EBV-infected cells contributing to vasculitis and PAH, indicating that the condition can improve with appropriate PAH medication and CAEBV treatment.
Article Synopsis
- The initial treatment for chronic graft-versus-host disease (cGVHD) is commonly high doses of prednisolone, but patients without high-risk factors may be treated with lower doses or other immunosuppressants.
- A study evaluated 54 cGVHD patients treated with low-intensity immunosuppressive therapy, finding a failure-free survival (FFS) rate of 50% at 24 months, with certain risk factors affecting outcomes.
- By 36 months, the current failure-free survival (cFFS) rate improved to 67%, indicating that low-intensity treatment was beneficial for patients without significant risk features despite variations based on the severity of the condition.
Article Synopsis
- A study compared high-dose cytarabine (HD-AraC) and anthracycline-containing chemotherapy as post-remission therapies for acute myeloid leukemia (AML) patients before undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT).
- Out of 132 patients, those receiving HD-AraC had a lower cumulative dose of anthracyclines and slightly better selection for core-binding factor AML, with similar overall cardiac event rates between the two groups (9.1% for HD-AraC vs 11.0% for anthracycline).
- The event-free survival (EFS) rates three years post-transplant were comparable, with 40.9% for HD
Article Synopsis
- A 26-year-old male with acute myelogenous leukemia underwent two ABO-incompatible hematopoietic stem cell transplants but retained his original blood type.
- Despite showing complete donor-type chimerism, it was found that the recipient's original blood type antigens continued to be produced in non-hematopoietic organs.
- This case highlights the need for thorough examinations to establish the accurate blood type following ABO-incompatible transplants.
Article Synopsis
- The study analyzed cytomegalovirus (CMV) reactivation in patients who underwent stem cell transplants, focusing on the area under the curve (AUC) of CMV antigenemia (CMV-AG) to measure both viral load and duration of infection.
- Among 195 patients with CMV reactivation, factors like older age and corticosteroid use were linked to higher CMV-AUC, which correlated with worse overall survival (OS) and increased non-relapse mortality (NRM).
- The findings suggest that monitoring CMV-AUC can provide insights into the severity of CMV reactivation and identify patients at higher risk for complications post-transplant.
Chronic graft-versus-host disease (cGVHD) of the liver is often observed in allogeneic hematopoietic stem cell transplantation (allo-HSCT) during tapering or after stopping calcineurin inhibitors (CI). We conducted a retrospective analysis of 242 allo-HSCT recipients whose CI dose was reduced to less than 40 mg of cyclosporin A or 0.4 mg of tacrolimus to clarify the clinical characteristics of liver GVHD in patients on low-dose CI.
View Article and Find Full Text PDFLarge outbreaks of measles or rubella occasionally occur around the world, and measles infection can be severe and even fatal in transplant patients. However, limited data are available on immunity to measles, mumps, and rubella (MMR) in adult patients after allogeneic stem cell transplantation (allo-HCT). The aim of this study was to evaluate the immune status against MMR and the effects of vaccination against MMR in adult patients after allo-HCT.
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- The study analyzed how two measures, L_AOC (area over the lymphocyte curve) and L_AUC (area under the lymphocyte curve), affect the reactivation of cytomegalovirus (CMV) in patients after receiving stem cell transplants.
- Out of 394 patients, 301 were included, and the researchers found that both L_AOC and L_AUC were independent predictors of CMV reactivation, along with factors like age and CMV serostatus.
- While the area-based measures were not better than measuring lymphocyte counts alone for predicting CMV reactivation, they may better indicate which patients will need longer antiviral treatment.
Article Synopsis
- This study analyzed how the D-index, a measure of neutropenia's depth and duration, relates to the occurrence of invasive fungal disease (IFD) shortly after allogeneic hematopoietic stem cell transplantation (HSCT) in 394 patients.
- Out of 19 cases of early IFD, most occurred despite patients receiving antifungal treatments, highlighting that both the cumulative D-index and lower performance status are significant risk factors for IFD.
- The research concluded that the c-D-index can effectively predict IFD risks, with a determined cutoff value of 10,644, although its predictive advantage over cumulative days of neutropenia was minimal.
Background: We evaluated the clinical impact of cytomegalovirus (CMV) reactivation calculated in terms of the area under the curve of CMV antigenemia (CMV-AUC) on the development of invasive mold infection (IMI) in the post-engraftment phase after allogeneic hematopoietic stem cell transplantation (HSCT).
Methods: Among 394 consecutive patients who underwent their first allogeneic HSCT at our center between 2007 and 2018, 335 were included after excluding patients with a past history of invasive fungal disease (IFD), the development of IFD before engraftment, engraftment failure, or early death within 30 days. CMV antigenemia (CMV-AG) was monitored weekly after engraftment and 3 or more cells/2 slides were regarded as positive.
Autologous hematopoietic recovery after allogeneic hematopoietic cell transplantation (allo-HCT) is rare in patients who receive myeloablative conditioning (MAC). Autologous hematopoietic recovery suggests graft rejection, leading to concerns about subsequent disease relapse. We herein report a rare case of a patient with acute leukemia who experienced autologous hematopoietic recovery after cord blood transplantation (CBT) with total body irradiation-based MAC.
View Article and Find Full Text PDFWhile the dose of ganciclovir (GCV) is decided base on patients' body weight (BW), that of valganciclovir (VGCV) is fixed as 900 or 1800 mg/d regardless of the patient's BW in preemptive therapy for cytomegalovirus (CMV) reactivation in hematopoietic stem cell transplantation. We analyzed the impact of the patient's BW on the effectiveness and adverse events (AEs) of VGCV. From March 2004 to February 2017, 27 patients received VGCV as a first-line treatment for CMV reactivation.
View Article and Find Full Text PDFWe prospectively validated the previously reported L-index, which reflects both the intensity and duration of lymphopenia, and further evaluated it using a lymphocyte subset analysis after allogeneic hematopoietic stem cell transplantation (HSCT) (n = 30). The L-index was defined as the area over the lymphocyte curve during lymphopenia (<700/μl), and calculated from the start of conditioning to day30 (L-index(30)) and day100 (L-index(100)). The lymphocyte subset including CD3, CD4, CD8, CD19 and CD56 was analyzed before and at 14, 21, 28, 42, 56, 70, and 84 days after HSCT.
View Article and Find Full Text PDFObjective: Although invasive fungal disease (IFD) is an important complication in allogeneic hematopoietic stem cell transplantation (HSCT), the clinical significance of surgery, including the role of surgical resection for persistent pulmonary fungal disease prior to allogeneic HSCT in the current era with a variety of available antifungal agents, is controversial. We investigated the role of surgical resection.
Methods: We retrospectively investigated six patients who underwent surgical resection of suspected pulmonary fungal disease prior to allogeneic HSCT between April 2007 and June 2016 at our medical center.
Myeloablative conditioning regimens are associated with severe gonadal toxicity. To preserve ovarian function, we have been investigating ovarian shielding during total body irradiation (TBI) with a myeloablative dose. In this report, we update the clinical outcomes.
View Article and Find Full Text PDFObjectives: To establish the optimal strategy for haploidentical hematopoietic stem cell transplantation (HSCT).
Methods: We performed a prospective study on haploidentical HSCT using low-dose alemtuzumab. Alemtuzumab was added at 0.
Article Synopsis
- The study examines how the quality of life of patients who undergo allogeneic hematopoietic stem cell transplantation (HSCT) worsens initially but improves over time, focusing particularly on chronic graft-versus-host disease (GVHD) and glucocorticoid therapy.
- A total of 162 patients were evaluated before and at multiple intervals after HSCT, revealing that physical recovery metrics, such as knee strength and walking distance, generally improved by 12 months post-transplant.
- The findings indicate that chronic GVHD and high glucocorticoid dosage hinder recovery of various physical functions (like BMI and muscle strength), suggesting the need for potential adjustments in glucocorticoid treatment and continued physical support for affected patients
Infection and inflammation can induce acute graft-vs.-host disease (aGVHD). We hypothesized that febrile neutropenia early after allogeneic hematopoietic cell transplantation (HCT) would increase the risk of aGVHD and non-relapse mortality (NRM).
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