研究等業績 - その他 - 髙橋 直人
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Abe F.
Modern Rheumatology Case Reports ( Modern Rheumatology Case Reports ) 6 ( 2 ) 278 - 281 2022年06月
IgG4-related disease (IgG4-RD) involves multiple organs, including the lungs and central nervous system. Lung lesions are frequently reported as mass lesions or non-specific interstitial pneumonia, whereas organizing pneumonia (OP) due to IgG4-RD is rare. Furthermore, limited information is currently available on hypertrophic pachymeningitis (HP). We herein report a case of IgG4-RD complicated with OP and HP. The diagnosis was confirmed based on the serum concentration of IgG4 and the results of salivary gland and transbronchial lung biopsies. HP did not respond to steroid monotherapy and was also resistant to rituximab and intravenous cyclophosphamide; however, the combination therapy of methotrexate and dexamethasone was effective.
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脾臓浸潤による非外傷性脾破裂をきたし剖検で確定診断した血管内大細胞型B細胞リンパ腫
黒木 航, 小林 敬宏, 馬越 通信, 北舘 明宏, 今泉 ちひろ, 齋藤 雅也, 小林 五十鈴, 藤島 眞澄, 藤島 直仁, 吉岡 智子, 後藤 明輝, 高橋 直人
臨床血液 ( (一社)日本血液学会-東京事務局 ) 63 ( 6 ) 523 - 529 2022年06月
非外傷性脾破裂(ASR)は悪性リンパ腫の致死的合併症である。血管内大細胞型B細胞リンパ腫(IVLBCL)に伴うASR(IVLBCL-ASR)の報告は過去に1例のみで,その機序は不明な点が多い。今回我々は,剖検所見からIVLBCL-ASRと診断した1例を報告する。症例は78歳男性。IVLBCLの精査中に出血性ショックのため突然死し,剖検所見で大量の血性腹水と脾破裂を認めた。全身の小血管内にCD20陽性大型異型リンパ球の浸潤を認めIVLBCLと診断し,腫瘍細胞浸潤は裂創部位を含めた脾被膜部ではわずかで脾臓中心部で著明で,脾中心部での腫瘍増殖による脾内圧亢進がASRの原因と考えられIVLBCL-ASRと確定診断した。患者は入院3ヵ月前に舌がんの精査目的で施行された18F-FDGPET/CT検査で右副腎に異常集積を認めており,病理所見では同部位に一致して腫瘍浸潤を認めた。IVLBCLの早期診断における18F-FDG PET/CT検査の有用性を再認識し,IVLBCLの進行に伴いASRの発症リスクが上昇することが示唆され,早期の全身化学療法の実施が重要であると考えられた。(著者抄録)
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Fukuda N.
Cancer Chemotherapy and Pharmacology ( Cancer Chemotherapy and Pharmacology ) 89 ( 5 ) 609 - 616 2022年05月
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ネフローゼ症候群に対するリツキシマブ維持療法の有効性と安全性の検討
加賀 一, 橋本 眞子, 阿部 史人, 齋藤 綾乃, 齋藤 雅也, 奈良 瑞穂, 涌井 秀樹, 高橋 直人
日本腎臓学会誌 ( (一社)日本腎臓学会 ) 64 ( 3 ) 266 - 266 2022年05月
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同種造血幹細胞移植後に粘膜類天疱瘡による難治性食道狭窄症を来した1例
藤田 菜々子, 山下 鷹也, 阿部 史人, 斎藤 綾乃, 北舘 明宏, 奈良 美保, 吉岡 智子, 高橋 直人
臨床血液 ( (一社)日本血液学会-東京事務局 ) 63 ( 5 ) 490 - 490 2022年05月
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薬物モニタリングにより胃瘻からのベネトクラクス粉砕投与が安全に施行できた再発急性骨髄性白血病
佐藤 保奈実, 小林 敬宏, 藤田 菜々子, 吉岡 智子, 奈良 美保, 三浦 昌朋, 高橋 直人
臨床血液 ( (一社)日本血液学会-東京事務局 ) 63 ( 5 ) 489 - 489 2022年05月
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Kaga H.
International Journal of Hematology ( International Journal of Hematology ) 115 ( 1 ) 129 - 134 2022年01月
Human herpesvirus-8 (HHV8)-positive, human immunodeficiency virus (HIV)-negative multicentric Castleman disease (MCD) is a rare and age-related lymphoproliferative disorder caused by cytokine storm. Rituximab treatment is currently recommended because B-cell depletion eliminates the primary reservoir for HHV8. We report the first case of effective rituximab treatment of a Japanese patient (an 87-year-old woman) with this disorder. Her inflammatory symptoms and lymphadenopathy improved after medium-dose steroid therapy, but these symptoms recurred during steroid tapering. After one course of rituximab therapy, she achieved sustained remission. HHV8-associated MCD should be considered as a possible diagnosis in HIV-negative patients with inflammatory symptoms and lymphadenopathy.
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Matsuda Y.
Cancer Science ( Cancer Science ) 2022年
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Takahashi N.
International Journal of Hematology ( International Journal of Hematology ) 2022年
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Wataru Kuroki, Takahiro Kobayashi, Michinobu Umakoshi, Akihiro Kitadate, Chihiro Imaizumi, Masaya Saito, Isuzu Kobayashi, Masumi Fujishima, Naohito Fujishima, Tomoko Yoshioka, Akiteru Goto, Naoto Takahashi
[Rinsho ketsueki] The Japanese journal of clinical hematology ( 一般社団法人 日本血液学会 ) 63 ( 6 ) 523 - 529 2022年
Atraumatic splenic rupture (ASR) is a rare but fatal complication of malignant lymphoma. However, only one case of intravascular large B-cell lymphoma (IVLBCL)-related ASR (IVLBCL-ASR) has previously been reported, and the mechanism of IVLBCL-ASR is unknown. We present the case of a 78-year-old man who died unexpectedly and was diagnosed with IVLBCL-ASR pathologically by autopsy. A massive intraperitoneal hemorrhage and four lacerations on the splenic surface were discovered during the autopsy. CD20-positive lymphoma cells that infiltrated into small vessels were highly concentrated in the center of the spleen and were only slightly distributed in the lacerations on the splenic surface. Therefore, increased intrasplenic pressure due to lymphoma cell proliferation was identified as the cause of ASR. The patient had undergone 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for tongue cancer evaluation 3 months earlier, and positive uptake was found in the right adrenal gland, where lymphoma cell infiltration was confirmed by the autopsy. Our findings suggest that clinicians should be aware that the advanced stage of IVLBCL can cause fatal ASR via increased intrasplenic pressure. Therefore, early diagnosis and early treatment intervention are desirable to prevent the onset of IVLBCL-ASR, and 18F-FDG PET/CT is useful for the early diagnosis of IVLBCL.
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Adult-onset Still's Disease during Pregnancy Treated with Tocilizumab
Imaizumi C.
Internal Medicine ( Internal Medicine ) 61 ( 20 ) 3137 - 3140 2022年
A 28-year-old woman exhibited a spiking fever, arthritis, and liver disfunction when she was 22 weeks pregnant. She was diagnosed with adult-onset Still's disease (AOSD). As her condition was resistant to corticosteroid therapy, tocilizumab (TCZ) was selected. The TCZ treatment was effective, and she delivered a healthy child while receiving TCZ treatment. Cases in which AOSD first arises during pregnancy are rare, and there have been no reports of TCZ treatment for AOSD being initiated during pregnancy. Although the safety of TCZ treatment during pregnancy has not been established, it may be effective against severe AOSD that develops during pregnancy.
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Yuda J.
Cancer Medicine ( Cancer Medicine ) 12 ( 3 ) 2990 - 2998 2022年
Asciminib, a first-in-class, allosteric inhibitor of BCR-ABL1 that acts by STAMP (Specifically Targeting the ABL Myristoyl Pocket), is a novel therapeutic option for patients with chronic myeloid leukemia (CML). In the global, phase 3, open-label ASCEMBL study in patients with CML in chronic phase (CML-CP) pretreated with ≥2 tyrosine kinase inhibitors (TKIs) (NCT03106779), asciminib (40 mg twice-daily) demonstrated significant superiority over the ATP-competitive TKI bosutinib (500 mg once daily) for the primary endpoint of major molecular response (MMR; BCR::ABL1 transcript levels on the international scale [BCR::ABL1IS ] ≤0.1%) at week 24. Here, we report results from a descriptive subgroup analysis of Japanese patients enrolled in ASCEMBL study (data cut-off: May 25, 2020). Overall, 16 Japanese patients were randomized (asciminib, n = 13; bosutinib, n = 3). At week 24, the MMR rate with asciminib was 30.8% (4/13; 95% confidence interval [CI], 9.09-61.43). BCR::ABL1IS ≤1% and complete cytogenic response (CCyR) at week 24 were 61.5% (8/13 patients) and 50.0% (4/8 patients), respectively. In the bosutinib group, no patient achieved MMR, CCyR, or BCR::ABL1IS ≤1%, but results were limited by the low number of patients. The safety profile of asciminib was comparable to that previously observed in the overall study population. Findings from this Japanese subgroup analysis of the ASCEMBL study support the use of asciminib for the treatment of Japanese patients with CML-CP previously treated with ≥2 TKIs. ClinicalTrials.gov Identifier: NCT03106779.
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Bortezomib-EPOCH併用療法により長期寛解が得られたHIV陰性精巣原発形質芽球性リンパ腫
藤島 崇嗣, 川端 良成, 道下 吉広, 北林 淳, 高橋 直人
臨床血液 ( 一般社団法人 日本血液学会 ) 63 ( 10 ) 1386 - 1391 2022年
<p>形質芽球性リンパ腫（PBL）は，HIV感染や免疫不全を背景に発症する稀なB細胞性リンパ腫である。今回，我々はHIV陰性精巣原発PBLに対し，bortezomib併用-EPOCH療法が著効し長期寛解が得られた症例を経験したので報告する。症例は86歳男性。免疫不全を伴う基礎疾患なし。急速に増大する右精巣腫瘍を認め，右高位精巣摘除術を施行した。摘除標本で形質細胞様異型リンパ球のびまん性増殖を認め，免疫組織化学染色で，CD38，CD138，CD56，λ，MUM1，EBER，MYC陽性であるが，CD20陰性，MIB1 index 90％であった。PET/CTで全身リンパ節腫脹を認めたが，骨髄および髄液浸潤はなく，PBL，臨床病期IIIE-A，IPI高中間リスクと診断した。髄注併用V-EPOCH療法を6コース施行し完全寛解が得られた。左精巣に予防的照射（計30 Gy）施行後，診断から2年半以上経過したが完全寛解を維持している。PBLは急速進行性で予後不良な疾患であるが，その稀少性から標準的治療は未確立である。精巣原発PBLに対し，髄注および局所照射を併用したV-EPOCH療法は，高齢者にも寛解と長期予後を期待できる有効な初期治療法の一つと考えられた。</p>
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Takahashi N.
Cancer Medicine ( Cancer Medicine ) 2022年
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Sato M.
Journal of X-Ray Science and Technology ( Journal of X-Ray Science and Technology ) 30 ( 4 ) 777 - 788 2022年
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Early Pulmonary Rehabilitation with Neuromuscular Electrical Stimulation in a Patient with Acute Exacerbation of Rheumatoid Arthritis-associated Interstitial Lung Disease: A Case Report
OKURA Kazuki, TAKAHASHI Yusuke, HASEGAWA Kakeru, HATAKEYAMA Kazutoshi, SAITO Kimio, IMAIZUMI Chihiro, KAGA Hajime, TAKAHASHI Naoto
Physical Therapy Research ( 一般社団法人日本理学療法学会連合 ) advpub ( 0 ) 2022年
<p>Introduction: Early implementation of neuromuscular electrical stimulation (NMES) has been reported to prevent muscle atrophy and physical functional decline in patients requiring mechanical ventilation. However, its effect in patients with acute exacerbation of interstitial lung disease (ILD) remains unclear. We herein report our experience using the NMES combined with mobilization in a patient with an acute exacerbation of rheumatoid arthritis-associated ILD (RA-ILD) requiring mechanical ventilation. Case presentation: A 74-year-old man was admitted to the intensive care unit (ICU) and put on mechanical ventilation due to severe acute exacerbation of RA-ILD. Early mobilization and the NMES using a belt electrode skeletal muscle electrical stimulation system were started on day 7 of hospitalization (day 2 of ICU admission). The NMES duration was 20 min, performed once daily. The patient could perform mobility exercises on day 8 and could walk on day 16. We assessed his rectus femoris and quadriceps muscle thicknesses using ultrasound imaging, and found decreases of 4.5% and 8.4%, respectively, by day 14. On day 27, he could independently visit the lavatory, and the NMES was discontinued. He was instructed to start long-term oxygen therapy on day 49 and was discharged on day 63. His 6-minute walk distance was 308 m and his muscle thickness recovered to levels comparable to those at the initial evaluation at the time of discharge. Conclusion: Combining the NMES and mobilization started in the early phase and continued after ICU discharge was safe and effective in a patient with a severe acute exacerbation of RA-ILD.</p>
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Takashiki R.
Japan Journal of Nursing Science ( Japan Journal of Nursing Science ) 2022年
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Ovarian Follicular Lymphoma Diagnosed due to Hydronephrosis
Noguchi Shinsuke, Kimura Yuiko, Shibano Sumire, Ariake Chika, Iwasawa Takuya, Oyama Noriaki, Sato Hirokazu, Enomoto Katsuhiko, Takahashi Naoto
Japanese Journal of Medicine ( 一般社団法人 日本内科学会 ) advpub ( 0 ) 293 - 298 2022年
<p>A 74-year-old woman presented with left lateral abdominal pain. Abdominal echography revealed left hydronephrosis and a pelvic mass. The patient underwent left adnexal resection of a suspected left ovarian tumor and was diagnosed with follicular lymphoma (FL) of clinical stage IIIA, grade 2. The patient was treated with rituximab-combined chemotherapy and achieved complete remission. The most common histological types of ovarian lymphoma are diffuse large B-cell lymphoma and Burkitt lymphoma, with FL being an extremely rare variant. We herein report a case of ovarian FL diagnosed as hydronephrosis. </p>
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Ono T.
Cancer Science ( Cancer Science ) 114 ( 3 ) 995 - 1006 2022年
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Fukushi Y.
British Journal of Clinical Pharmacology ( British Journal of Clinical Pharmacology ) 89 ( 5 ) 1695 - 1700 2022年
The effects of polymorphisms of ABCB1 and ABCG2 on the dose-adjusted plasma trough concentrations and cerebrospinal fluid (CSF)-to-plasma ratios of ponatinib were evaluated. Blood (C4 ) and CSF (CSF4 ) concentrations at 4 h after administration were determined. The median (95% confidence interval) CSF4 -to-C4 ratio of ponatinib in subjects homozygous for ABCB1 variants 1236T/T, 2677T/T + T/A or 3435T/T were significantly higher than that in a group of subjects with other genotypes (P = .026, .012 and .015, respectively). The median (95% confidence interval) CSF4 -to-C4 ratio of ponatinib in 4 patients with the combination of ABCB1 variants 1236T/T-2677T/T + T/A-3435T/T was 2.62% (1.42-3.42%); this ratio was significantly higher than that in subjects with other genotypes (1.08% [0.89-1.47%]; P = .006). The brain distribution of ponatinib was affected by ABCB1 polymorphisms and therefore seems to be modulated by P-glycoprotein at the blood-brain and blood-CSF barriers.