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Department of Hematology

Kunihiro Tsukasaki, Sachiko Seo, Kensuke Narukawa, Rumiko Okamoto, Kota Ohashi

Introduction

The staff physicians and residents of the Department of Hematology carry out clinical and research activities related to multi-disciplinary t reatment of patients with hematological malignancies that consist of more than 100 disease entities in the WHO classification (version 2008). Our Department focuses on early and late phases of clinical trials in collaboration with the Research Center for Innovative Oncology and the Japan Clinical Oncology Group (JCOG), respectively, especially on lymphoid malignancies.

Routine activities

The number of patients with newly diagnosed hematologic malignancies in our Department is increasing, and approximately 298 patients with newly diagnosed hematological malignancies including non-Hodgkin's lymphoma, Hodgkin's lymphoma, multiple myeloma, macroglobulinemia, acute leukemia, myelodysplastic syndrome and chronic leukemia were cared for this year (Table 1). The Department is currently providing routine chemotherapy as an outpatient service to an increasing number of relatively aged patients with hematological malignancies. All patients undergoing intensive chemotherapy and autologous peripheral blood hematopoietic stem cell transplantation (APBSCT) (Table 2) are managed in laminar airflow rooms in the designated ward on the eighth floor. Besides managing patients, the Department also provides consultation on hematological abnormalities detected in Clinical Laboratories. A morning case conference on the inpatient care of our Department is held from Mondays to Friday, and a weekly case conference on new patients visiting our clinic is held on Thursday evenings. On Wednesday evenings, a weekly joint conference on lymphoid malignancies with expert pathologists and an educational cytology conference on bone marrow specimens are held. A joint morning journal club of our Department and the Department of Breast and Medical Oncology is held on Mondays and Fridays.

Research activities

Ancillary studies associated with retrospective case series and clinical trials at this Department have been continuously conducted focusing on several kinds on hematological malignancies and their complications. Recently, a nationwide survey of human T-lymphotropic virus type I (HTLV-1) associated adult T-cell leukemia-lymphoma (ATL) is ongoing by us under a grant for Cancer Research from the Ministry of Health, Labour and Welfare to elucidate the pathophysiology including geographical findings as compared to the surveys in 1980 to 1990.

Clinical trials

Clinical trials on hematological malignancies performed by our Department comprise protocols prepared in-house and participation in the Japan Clinical Oncology Group-Lymphoma Study Group (JCOG-LSG), the Japan Adult Leukemia Study Group (JALSG) and others. The Department participated in pharmaceutical company-sponsored and investigator-initiated new-agent trials including international ones for hematological malignancies. The following JCOG clinical trials are ongoing: a randomized phase III trial of rituximab administered weekly or triweekly with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) in patients with newly diagnosed CD20+ diffuse large B cell lymphoma (DLBCL) (JCOG0601) in which a dose-intense schedule of rituximab is evaluated; a randomized phase II trial comparing biweekly rituximab-CHOP or biweekly rituximab-CHOP/ cyclophosphamide, cytarabine, dexamethasone, etoposide and rituximab (CHASER) followed by high dose melphalan, cyclophosphamide, etoposide and dexamethasone (LEED) with APBSCT in patients with newly diagnosed poor risk CD20+ DLBCL (JCOG0908); a randomized phase II study of two induction treatments of melphalan, prednisolone, plus bortezomib (MPB), JCOG-MPB versus modified PETHEMA-MPB, in elderly patients or non-elderly patients refusing transplants with untreated symptomatic myeloma (JCOG1105); and a single armed phase III study of mLSG15 chemotherapy followed by allo-HSCT, comparing the results with historical control in JCOG9801 of mLSG15 alone to evaluate the promising efficacy of allo-HSCT, possibly associated with a graft-versus-ATL effect, especially in view of a comparison with intensive chemotherapy (JCOG0907). A phase III study evaluating the efficacy of the combination of interferon-alpha (IFN) and zidovudine (AZT) as compared to watchful-waiting for indolent ATL (JCOG1111) is ongoing under a highly advanced medical technology assessment system because IFN and AZT are not covered for ATL by National Health Insurance in Japan. A single armed phase III study of interim-PET response adapted a switch-strategy from ABVD to ABVD/DE-BEACOP for advanced Hodgkin Lymphoma (JCOG1305).


Table 1. Number of new patients Table 2. Type of procedure

List of papers published in 2015

Journal

  1. Katsuya H, Ishitsuka K, Utsunomiya A, Hanada S, Eto T, Moriuchi Y, Saburi Y, Miyahara M, Sueoka E, Uike N, Yoshida S, Yamashita K, Tsukasaki K, Suzushima H, Ohno Y, Matsuoka H, Jo T, Amano M, Hino R, Shimokawa M, Kawai K, Suzumiya J, Tamura K, ATL–Prognostic Index Project. Treatment and survival among 1594 patients with ATL. Blood, 126:2570-2577, 2015
  2. Yoshida N, Tsuzuki S, Karube K, Takahara T, Suguro M, Miyoshi H, Nishikori M, Shimoyama M, Tsukasaki K, Ohshima K, Seto M. STX11 functions as a novel tumor suppressor gene in peripheral T-cell lymphomas. Cancer Sci, 106:1455-1462, 2015
  3. Miura S, Akazawa Y, Kurashige T, Tukasaki K, Kondo H, Yokota K, Mine M, Miyazaki Y, Sekine I, Nakashima M. The Nagasaki Atomic Bomb Survivors' Tumor Tissue Bank. Lancet, 386:1738, 2015
  4. Yoshida N, Imaizumi Y, Utsunomiya A, Miyoshi H, Arakawa F, Tsukasaki K, Ohshima K, Seto M. Mutation Analysis for TP53 in Chronic-Type Adult T-Cell Leukemia/Lymphoma. J Clin Exp Hematop, 55:13-16, 2015
  5. Seo S, Boeckh M, Storer BE, Schubert MM, Rotta M, Sandmaier BM, Mielcarek M. The association between donor and recipient statin use and infections after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant, 50:444-448, 2015
  6. Erard V, Guthrie KA, Seo S, Smith J, Huang M, Chien J, Flowers ME, Corey L, Boeckh M. Reduced Mortality of Cytomegalovirus Pneumonia After Hematopoietic Cell Transplantation Due to Antiviral Therapy and Changes in Transplantation Practices. Clin Infect Dis, 61:31-39, 2015
  7. Seo S, Renaud C, Kuypers JM, Chiu CY, Huang ML, Samayoa E, Xie H, Yu G, Fisher CE, Gooley TA, Miller S, Hackman RC, Myerson D, Sedlak RH, Kim YJ, Fukuda T, Fredricks DN, Madtes DK, Jerome KR, Boeckh M. Idiopathic pneumonia syndrome after hematopoietic cell transplantation: evidence of occult infectious etiologies. Blood, 125:3789-3797, 2015
  8. Uy GL, Costa LJ, Hari PN, Zhang MJ, Huang JX, Anderson KC, Bredeson CN, Callander NS, Cornell RF, Perez MA, Dispenzieri A, Freytes CO, Gale RP, Garfall A, Gertz MA, Gibson J, Hamadani M, Lazarus HM, Kalaycio ME, Kamble RT, Kharfan-Dabaja MA, Krishnan AY, Kumar SK, Kyle RA, Landau HJ, Lee CH, Maiolino A, Marks DI, Mark TM, Munker R, Nishihori T, Olsson RF, Ramanathan M, Rodriguez TE, Saad AA, Savani BN, Schiller GJ, Schouten HC, Schriber JR, Scott E, Seo S, Sharma M, Ganguly S, Stadtmauer EA, Tay J, To LB, Vesole DH, Vogl DT, Wagner JL, Wirk B, Wood WA, D'Souza A. Contribution of chemotherapy mobilization to disease control in multiple myeloma treated with autologous hematopoietic cell transplantation. Bone Marrow Transplant, 50:1513-1518, 2015