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Biomedical subjects

T Arima

Publications and source records attributed to T Arima.

At least 73 records · Page 4Linked to original sources
PubMed1999

Effects of urinary metabolites of etodolac on diagnostic tests of bilirubin in urine.

Etodolac (CAS 41340-25-4) is a non-steroidal anti-inflammatory drug used clinically. The bilirubin levels in urine samples from patients treated with etodolac were determined with diagnostic tests (diazo and oxidized methods). The urine samples gave a positive reaction with a diazo method, but not with an oxidized method. The serum concentrations of bilirubin in the patients were also in the normal range. These results indicate that the positive reaction of the urine samples from patients treated with etodolac is false and caused by urinary metabolites of etodolac. To identify the false positive substance in the urine samples, the urinary metabolites of etodolac were extracted with ethyl acetate. The extract was injected into a high performance liquid chromatography (HPLC) column and the eluate was mixed with the diazo reagent. Three positive fractions were found. The retention times of the two metabolites in HPLC matched with those of the 6- and 7-hydroxylated metabolites of etodolac. In addition, authentic compounds of the 6- and 7-hydroxylated metabolites gave a positive reaction in the diazo methods. These results indicate that the 6- and 7-hydroxylated metabolites are mainly responsible for the false positive reactions of the urine sample from patients treated with etodolac.

Aged↗
PubMed1999

Complete response to twice-a-day interferon-beta with standard interferon-alpha therapy in acute hepatitis C after a needle-stick.

A 25-year-old male physician with acute hepatitis C after needle-stick injury was treated with combination therapy including twice-a-day interferon-beta (IFN-beta) and standard interferon-alpha (IFN-alpha). The infecting strain was of genotype 1b. Pretreatment hepatitis C virus (HCV) RNA levels were high. Because severe paresthesias occurred with initial daily administration of 5 million units (MU) of lymphoblastoid IFN-alpha, the dose was reduced to 3 to 6 MU of IFN-alpha2b three times a week. However, HCV RNA was not cleared from serum after 20 weeks of standard IFN-alpha2b treatment. A 4-week course with IFN-beta, at the dosage of 3 MU twice daily i.v. drip, was then started and followed by an 18-week course with IFN-alpha2b, 6 MU thrice weekly. After IFN-beta treatment, HCV RNA was cleared from serum without severe adverse effects, including paresthesias. Total amounts of IFN administered were 20 MU of lymphoblastoid IFN-alpha, 648 MU of IFN-alpha2b, and 252 MU of IFN-beta. Complete response and avoidance of chronic HCV infection were achieved. Thus, combination therapy with twice-a-day IFN-beta and standard IFN-alpha was effective in treating an acute hepatitis C patient with a high viral load and sensitivity to adverse effects of high-dose IFN-alpha.

Acute Disease↗
PubMed1999

Helicobacter heilmannii associated erosive gastritis.

The spiral bacteria, Helicobacter heilmannii (H. heilmannii), distinct from Helicobacter pylori (H. pylori), was found in the gastric mucosa of a 71-year-old man without clinical symptoms. The endoscopic examination revealed erosive gastritis. Rapid urease test from the antral specimen was positive, but both culture and immunohistological staining for H. pylori were negative. Touch smear cytology showed tightly spiral bacteria, which were consistent with H. heilmannii. At the second endoscopy after medication regimen for eradication of H. pylori, inflammation was decreased and the rapid urease test was negative. The second cytology showed no evidence of H. heilmannii. Anti-H. pylori therapy may be a useful medication for H. heilmannii.

Abietanes↗
PubMed1999

[Significance of atrial fibrillation, left atrial thrombus and severity of stenosis for risk of systemic embolism in patients with mitral stenosis].

The prognostic significance of atrial fibrillation, left atrial thrombus and the severity of mitral stenosis (MS) for systemic embolism was evaluated in 142 consecutive patients with MS (male 61, female 81; mean age 51 +/- 10 years) who were referred for cardiac catheterization. The relationships between systemic embolization, atrial fibrillation, left atrial thrombus and the size of mitral valve area obtained by the echocardiographic or Doppler method, or cardiac catheterization (Gorlin's formula) were studied. The effects of mitral regurgitation (MR) (Sellers II < or =) on systemic embolism or left atrial thrombus were also evaluated. Atrial fibrillation was observed in 117 patients (87%), 30 (28%) of whom had a history of systemic embolism. Four of 18 patients (22%) with sinus rhythm had a history of systemic embolism. Left atrial thrombus was observed in 63 patients (45%), including 17 (27%) with a history of systemic embolism. Seventeen (22%) of 76 patients without left atrial thrombus had a history of systemic embolism. Left atrial thrombus was detected in 17 of 41 (41%) patients with severe MS [mitral valve area (MVA) < or = 1.0 cm2], 8 of 25 (32%) patients with moderate MS (1.1 < MVA < or = 1.5 cm2), 2 of 14 (14%) patients with mild MS (MVA > or = 1.6 cm2), and embolization was complicated in 11% of cases of severe MS, 32% of cases of moderate MS and 21% of cases of mild MS. There was no significant difference between the 3 groups. Left atrial thrombus was more frequently observed in patients without MR than with MR (44% vs 13%, p < 0.05), but there was no significant difference in the incidence of embolism between the groups (28% vs 22%). Positive therapy intervention should be considered to prevent systemic embolism regardless of the presence or absence of sinus rhythm, MR, left atrial thrombus or severity of stenosis.

Atrial Fibrillation↗
PubMed1999

Low level wild-type and pre-core mutant hepatitis B viruses and HBeAg negative reactivation of chronic hepatitis B.

A qualitative and a quantitative mutation-site specific polymerase chain reaction assay (MSSA) was used to detect low level wild-type and pre-core mutant hepatitis B virus (HBV)-DNA. Serum samples from 11 anti-hepatitis B e (anti-HBe)-positive asymptomatic HBV carriers (Group A) and 10 anti-HBe-positive chronic hepatitis B patients who achieved alanine transaminase (ALT) normalization after antiviral therapy (Group B) were tested. Eleven patients had both wild-type and pre-core mutant HBV-DNA (52%, 4 from Group A and 7 from Group B), whereas 3 patients had only pre-core mutant HBV-DNA (14%, 2 from Group A and 1 from Group B) by qualitative MSSA assay. During a 3-year follow-up period, relapses were observed in 3 patients from Group B and intermittent ALT elevation was observed in 4 patients from Group A and 3 patients from Group B. The wild-type HBV-DNA concentration in the patients with reactivation was 10(2.06+/-2.62) copies/ml, whereas that in all patients without reactivation was below 10(2) copies/ml (P < .05). The pre-core mutant HBV-DNA concentration in the patients with reactivation was also significantly higher than that in the patients without reactivation (10(3.94+/-2.25) vs. 10(0.65+/-1.45) copies/ml, P < .001). All patients with both HBV-DNA concentrations below 10(2) copies/ml did not exhibit reactivation. Our result suggest that a high prevalence of coexistence of low level wild-type and pre-core mutant HBV-DNA has the potential for reactivation in anti-HBe-positive patients. Furthermore, quantification of wild-type and pre-core mutant HBV-DNA was useful to predict the prognosis of anti-HBe-positive infection and evaluate the efficacy of antiviral therapy.

Adult↗
PubMed1999

Experimental grinding in healthy subjects: a model for postexercise jaw muscle soreness?

AIMS: Pain in some bruxers has been suggested to represent a state of postexercise muscle soreness. This study examined the effect of voluntary, controlled grinding movements on the development of pain and soreness in the masticatory system. METHODS: Twelve healthy men (21 to 42 years old) without signs or symptoms of temporomandibular disorders (TMD) participated. Nine trials of 5 minutes of repeated grinding from the intercuspal position to the right canine-canine position (0.5 Hz) were performed on the first day. During the lateral excursions, the electromyographic (EMG) activity of the right masseter muscle was kept above 50% of maximal voluntary occlusal force (MVOF) with the use of visual feedback. The subjects rated pain intensity, unpleasantness, and soreness on 100-mm visual analogue scales (VAS); other pain measures, including the McGill Pain Questionnaire, were also used. Before and after the exercise trials, the MVOF was determined, and pain detection thresholds (PDT) to pressure stimuli were measured at 9 different sites on the masseter muscles. The subjects returned to the laboratory the 3 following days, where VAS, PDT, and MVOF were measured. RESULTS: Immediately following the last grinding trial, there was a significant increase in VAS and MPQ scores of pain intensity, unpleasantness, and soreness, as compared to baseline values (analysis of variance, P < 0.001). There was still a significant effect from grinding on the VAS score of muscle soreness on the following days, with a peak the first day after the exercise (Tukey test, P < 0.023). Pain was frequently (in 7 of 12 subjects) reported in or around the temporomandibular joint. There was a significant effect from grinding on PDT at both masseter muscles (analysis of variance, P < 0.043), with significantly lower PDT the first day after the grinding exercise (Tukey test, P < 0.046). There were no effects from grinding on MVOF. CONCLUSION: These findings suggest that significant but low levels of postexercise muscle soreness can be elicited by standardized grinding movements in the masticatory system of healthy subjects.

Adult↗
PubMed1998

Functional evaluation using motor scores after cervical spinal cord injuries.

Patient evaluation using Zancolli's classification for cervical cord injuries uses easily understood criteria and accurately defines the state of disability in Frankel grade A or B patients. However, this classification cannot be used in Frankel grade C patients even though they also cannot walk. We compared the Zancolli classification with American Spinal Injury Association (ASIA) motor scores in evaluating self-care in Frankel grade C patients. The Zancoli classification was found to correlate closely with the ASIA motor score. The threshold of ability to perform self-care in areas such as urinary toileting and wheelchair mobility occurred approximately between C6A and C6B 1 in the Zancolli classification in Frankel grade A and B patients and at the level of about 30 points in the ASIA motor score in Frankel grade C patients. The ASIA motor score is helpful in defining functional motor status in Frankel grade C patients with cervical spinal cord injuries.

Activities of Daily Living↗
PubMed1998

Transient appearance of CD3+CD8+ T lymphocytes with monoclonal gene rearrangement of T-cell receptor beta locus.

A benign, transient proliferation of atypical lymphocytes and a monoclonal rearrangement of the T-cell receptor beta (TRB) locus was found in a 60-year-old woman who presented with low-grade fever, anorexia and fatigue. A marked and transient atypical lymphocytosis (white blood cell count 90.5 x 10(9)/l) with CD8 surface antigen improved without specific treatment. Although tests for IgM antibodies to hepatitis A, varicella zoster, Epstein-Barr virus (EBV), and cytomegalovirus (CMV) were all negative, a monoclonal gene rearrangement of TRB locus was observed in the DNA of the proliferated atypical lymphocytes by Southern blotting. The clonal rearrangement and the atypical lymphocytes disappeared after 14 d, and the patient has remained well for 7 years. These results suggest that monoclonal proliferation of CD8 lymphocytes can occur based on a non-neoplastic aetiology.

Blotting, Southern↗
PubMed1998

Arsenic trioxide inhibits growth of human T-cell leukaemia virus type I infected T-cell lines more effectively than retinoic acids.

Adult T-cell leukaemia (ATL) is difficult to cure using conventional therapies. Recently the therapeutic possibility of retinoic acids (RA) has been reported. In this study, suppression of in vitro growth of human T-cell leukaemia virus type I (HTLV-I) infected T-cell lines and fresh ATL cells by arsenic trioxide (As2O3) were evaluated by comparison with a series of RA derivatives. Proliferation of four HTLV-I-infected T-cell lines was significantly reduced within 72 h by 1.0 micromol/l As2O3. Growth of two out of four HTLV-I-infected T-cell lines was also inhibited by 1.0 micromol/l RA, but to a lesser extent than by As2O3. The mechanism of this growth inhibition was due to the induction of apoptosis. Apoptosis was also induced in fresh ATL cells from patients by AS2O3, but far less by RA. As described in patients with acute promyelocytic leukaemia, 1.0 micromol/l of As2O3 can be safely achieved in the serum of patients; however, it is difficult to maintain this concentration of RA. In conclusion, As2O3 has therapeutic potential for the treatment of ATL and may be far more clinically beneficial than RA.

Antineoplastic Agents↗
PubMed1998

Mitochondrial encephalomyopathy (Kearns-Sayre syndrome) with complete atrioventricular block: a case report.

A pacemaker was implanted into a 17-year-old man with cardiac failure due to complete atrioventricular block complicated by mitochondrial encephalomyopathy (Kearns-Sayre syndrome). Due to the possible complication of latent myocardial dysfunction, it was decided to implant the dual chamber pacemaker (DDD) and the operation mode was set to DDD 70 ppm 1 year after implantation; this alleviated the cardiac failure. In this case, the necessity of preventive pacemaker implantation in the early stage of cardiac failure was recognized.

Adolescent↗
PubMed1998

Granulocyte colony-stimulating factor in the combination chemotherapy for adult T-cell leukemia (ATL).

We evaluated the effect of granulocyte colony-stimulating factor (G-CSF) on the median survival of 17 patients with Adult T-cell leukemia (ATL). Standard-dose combination chemotherapy using the response-oriented cyclic multidrug (RCM) protocol with G-CSF (lenograstim 2 microg/kg/day or filgrastim 50 microg/m2/day) was administered between October 1990 and December 1994. Complete responses (CR) were achieved in 11 (64.7%) patients, and partial responses (PR) in 4 (23.5%) patients. The median duration of survival was 7.4 months, compared with 6.0 months in ATL patients treated with the RCM protocol alone (historical controls) (n.s.). Infectious complications were the cause of death in 4 (26.7%) of the 15 patients who died. The median duration of neutropenia (absolute neutrophil count < 1.0 x 10(9)/L) was 6 days. G-CSF, in the doses and schedules used here, may have shortened the duration of neutropenia and reduced the incidence of fatal infectious complications. However, concomitant use of G-CSF did not prolong the median duration of survival in patients with ATL treated according to the RCM protocol.

Adjuvants, Immunologic↗
PubMed1998

Involvement of IGF2 and H19 imprinting in choriocarcinoma development.

Complete hydatidiform mole is an abnormal pregnancy characterized by grossly swollen villi in the absence of a fetus (Kajii and Ohama 1997, Wake et al., 1978, Jacobs et al., 1980). It is well known that this abnormal pregnancy product is androgenetic in origin. The entire genome of the molar conceptus is paternally derived. The majority of moles result from fertilization of an empty egg by haploid sperm. The paternally derived haploid set then duplicated without cytokinesis and restores diploidy. Invariably, this class of moles has a 46, XX karyotype and is completely homozygous for genetic markers. Fertilization of an empty egg by two sperms is responsible for the remaining case. These moles show a mixture of homozygous and heterozygous patterns of paternally derived genetic markers. Although complete mole is usually a benign process, 10 to 20 percent of cases leads to either invasive mole or choriocarcinoma. This propensity to malignancy has to associate with the genetic features shown in the mole, that imply the formation of homozygosity and the selective inheritance of paternal genome. It has been described in various human malignancies that both genetic features associate with the inactivation of tumor suppressor genes. Homozygosity would lead to the inactivation of tumor suppressor gene in the mole by a signal event occurred on sperm DNAs. In turn, paternal transmission would result in the silencing of particular tumor suppressor genes. Thus, tumor suppressor genes inactivated either by homozygosity formation or by paternal transmission would be involved in the pathogenesis of choriocarcinoma. Both the maternal and paternal genomes are necessary for normal embryonic development in mammals. Parental-origin-specific functional differences between two alleles, known as genomic imprinting, seem to be exploited for a regulatory mechanism crucial for the proper development of both embryonic and extraembryonic tissues. The list of imprinted genes identified is growing rapidly lately in mouse and man (DeChiara TM et al., 1991, Barlow et al., 1991, Bartolomei MS et al., 1991, Leff SE et al., 1992, Hatada I et al., 1993, Giddings SJ et al., 1994, Hayashizaki Y et al., 1994, Villar AJ et al., 1994, Guillemot F et al., 1995). Among these, IGF2 and H19 tightly linked on human chromosome 11 are of special interest because of their reciprocal imprinting and possible association with certain malignancy and congenital abnormalities. The IGF2 gene expressed from the paternally derived allele (Ohlsson et al., 1993, Giannoukalis et al., 1993), whereas the H19 gene is expressed from the maternally derived allele (Rachmilewitz et al., 1992, Zhang et al 1993, Ferguson-Smith et al., 1993).

Alleles↗
PubMed1997

Evidence for clonal deletion and clonal anergy after intrathymic antigen injection in a transplantation model.

Intrathymic (IT) antigen injection has been shown to induce antigen-specific systemic tolerance in the rodent. To delineate the mechanisms responsible for the induction of tolerance, we used the 2C line of T cell receptor transgenic mice. The majority of T cells in 2C mice express an antigen receptor specific for the major histocompatibility complex class I alloantigen Ld and can be identified with the clonotypic monoclonal antibody 1B2. IT injection of lymphoid cells expressing Ld was found to induce a significant prolongation in BALB/c skin allograft survival. The allograft prolongation was associated with a marked reduction in the number of developing 1B2+ thymocytes (clonal deletion), which occurred primarily at the CD4+ CD8+ stage of thymocyte development, as well as a reduction in the number of mature CD8+ 1B2+ 2C T cells in peripheral lymphoid tissue. In addition, CD8+ 1B2+ 2C T cells that survive deletion have decreased CD8 expression levels and a significantly reduced in vitro proliferative response to specific alloantigen (clonal anergy). Exogenous recombinant interleukin 2 restores the capacity of 2C T cells to respond in vitro to alloantigen. Experiments involving separation of cells by fluorescence-activated cell sorter indicate that there is a precise correlation between the reduction in CD8 expression and anergy induction. Collectively, these data indicate that IT antigen injection can induce antigen-specific systemic tolerance by both clonal deletion and clonal anergy.

Adoptive Transfer↗
PubMed1997

Rejection of spontaneously accepted rat liver allografts with recipientinterleukin-2 treatment or donor irradiation.

While MHC incompatible DA (RTl(a)) to Lewis (RT1(1), LEW) rat liver allografts are acutely rejected, the reciprocal LEW to DA liver grafts are spontaneously accepted. The mechanism of this acceptance remains unclear. We evaluated the effect of donor treatment with total body irradiation (TBI) or gadolinium chloride (GdCl3), and recipient treatment with exogenous IL-2 after transplantation on the survival of the spontaneously accepted liver grafts. Male LEW and DA rats were used as donors and recipients for orthotopic liver allo- or iso-graft transplants. The LEW liver donor was treated by TBI (10 gray) 7 days before transplantation, or LEW donor Kupffer cell phagocytosis was blocked with GdCl3 (7 mg/kg) on days -2 and -1 pretransplant. In an attempt to reverse LEW liver graft acceptance, 180,000 units human IL-2 (hIL-2) were administered daily IP to the DA liver recipients from days 1 to 7 after liver grafting. While untreated LEW recipients rejected DA liver grafts within 13 days, DA recipients accepted LEW livers indefinitely (>302 days). In contrast, irradiation of the LEW liver donor prevented the spontaneous acceptance by DA recipients, and resulted in acute rejection of the liver grafts in 9-20 days. However, spontaneous graft tolerance was restored by parking the irradiated LEW donor liver in naive LEW rats for 48 hr before retransplantation to DA recipients (>50 days). When LEW donors were treated with GdCl3, which is known to block Kupffer cell phagocytosis and antigen processing, the spontaneous acceptance of the LEW liver grafts by DA recipients was unaffected. However, when exogenous rhIL-2 was given daily, LEW liver allografts were rejected by the DA recipients. The resulting liver failure correlated with a progressive increase in serum bilirubin and the development of a predominantly lymphocytic portal tract infiltration, bile duct epithelial damage, and portal vein endothelitis, which is consistent with acute allograft rejection. LEW and DA recipients of liver isografts developed no toxicity and survived indefinitely (>100 days) when treated with the same dose of IL-2. These results indicate that spontaneous rat liver allograft acceptance is associated with the presence of radiosensitive cells in the donor liver that may interact with recipient T cells to inhibit (Th1) production of IL-2.

Animals↗
PubMed1997

Induction of donor specific transplantation tolerance to cardiac allografts following treatment with nondepleting (RIB 5/2) or depleting (OX-38) anti-CD4 mAb plus intrathymic or intravenous donor alloantigen.

The nondepleting monoclonal antirat CD4 antibody, RIB 5/2, has been shown to modulate, but not eliminate, the CD4+ T cells and to prolong survival of rat skin, renal, or cardiac allografts when serially administered after transplantation. In the present study, we compared the efficacy of recipient pretreatment with a single dose of nondepleting RIB 5/2 or depleting OX-38 anti-CD4 monoclonal antibody plus donor alloantigen given intravenously or intrathymically 21 days before transplantation on the survival of completely MHC-mismatched rat cardiac allografts. Intraperitoneal injection of a single dose (20 mg/kg) of RIB 5/2 resulted in a decrease in CD4 surface molecule expression on peripheral CD4+ T cells without cell elimination as shown by FACS analysis. The nonspecific effect of a single dose of RIB 5/2 mAb had resolved by 21 days after treatment as evidenced by the almost complete recovery of normal surface CD4 molecule expression. Cardiac allografts transplanted immediately or 21 days after a single dose of RIB 5/2 alone were uniformly acutely rejected. On the other hand, recipients treated with depleting anti-CD4 OX-38 (20 mg/kg) acutely rejected cardiac allografts transplanted 21 days later, but indefinitely accepted all grafts transplanted on the same day. In contrast, combined treatment with i.v. donor splenocytes (25 x 10(6)) plus nondepleting RIB 5/2, but not with depleting anti-CD4 mAb, OX-38, resulted in survival for more than 100 days in 75% of recipients of donor specific, but not third party, cardiac allografts transplanted 21 days later. Irradiation (3000 rads) of the i.v. donor splenocytes combined with RIB 5/2 abrogated their tolerizing effect. When donor antigen was given intrathymically, both RIB 5/2 and OX-38 resulted in indefinite tolerance to cardiac allografts transplanted 21 days later. The failure of exogenous administration of high dose (180,000 IU/injection) rIL-2 for 10 days to reverse the unresponsiveness of i.v. SC plus RIB 5/2 pretreatment suggests that this tolerant state is not due to a deficiency of IL-2. In vitro studies showed marked inhibition of MLC responsiveness and cytolytic T cell activity in tolerant recipients that cannot be reversed by the addition of IL-2. Thus, pretransplant intravenous donor alloantigen combined with a dose of nondepleting anti-CD4 mAb, RIB 5/2, which alone has no significant effect, induced donor specific cardiac allograft tolerance.

Animals↗
PubMed1997

Graft persistence effectively induces and maintains donor-specific unresponsiveness.

BACKGROUND: In the present study we attempted to evaluate the role of the graft as an alloantigen in induction and maintenance of donor-specific prolongation of allograft survival by short course(s) of FK506 treatment in rat heart transplantation. Materials and methods. In the WKA/Qdj-to-LEW combination group, FK506 (3 mg/kg/day, 7 days, s.c.) was administered from Day 0 after cardiac transplantation. A second WKA/ Qdj cardiac graft was transplanted on Day 14 into the LEW recipient after removal of the first graft on Day 3 or Day 7. In other groups an additional course of FK506 (3 mg/kg/day, 7 days, s.c.) was given from Day 35. A second WKA/Qdj cardiac graft was transplanted on Day 49 into the LEW recipient after removal of the first graft on Day 7 or Day 28. RESULTS: A short course of FK506 treatment allowed for survival prolongation of a cardiac allograft [mean survival time (MST) = 42.8 days]. Removal of the first graft on Day 7 (MST = 16.4 days) but not on Day 3 (MST = 10.2 days) caused donor-specific prolongation of the second allograft survival, which was significantly shorter than that in the recipient without the graftectomy (MST = 32.8 days). When graftectomy was performed on Day 3, there were immunohistochemically detectable levels of donor class II expressing cells in the recipient spleen on Day 7, indicating that the presence of the graft more effectively induced unresponsiveness than microchimerism alone. The additional course of FK506 treatment on Day 35 maintained graft survival (MST > 90.6 days). Removal of the first graft on Day 7 (MST = 13.5 days) or Day 28 (MST = 24.7 days) did not show significant prolongation of the second allograft survival, whereas significant survival prolongation of the second graft was observed in the recipient without the graftectomy (MST = 38.8 days). However, marked survival prolongation of the second donor-specific allograft in half of the recipients that had received the second course of FK506 treatment after graftectomy on Day 28 indicates that residual donor antigen can function as tolerizing antigen with an FK506 supplement. CONCLUSIONS: We concluded that the persistence of a graft more effectively induces and maintains donor-specific unresponsiveness than does the chimeric state of graft-derived cells alone under immunosuppression by FK506 in the rat heart transplantation model.

Animals↗
PubMed1997

Treatment for adult T-cell leukemia.

The purpose of this study was to clarify the clinical efficacy of multidrug chemotherapy for aggressive adult T-cell leukemia (ATL). We report the therapeutic results of treatment of patients with aggressive ATL undertaken between 1986 and 1995. A total of 120 newly diagnosed patients with a performance status of 0-3 and aged < 70 years at diagnosis were entered into the study. Clinical features, including clinical subtypes, serum levels of lactate dehydrogenase and blood urea nitrogen, the response to chemotherapy, and doses of individual chemotherapeutic agents, were evaluated. Of the 120 patients enrolled, 97 had acute-type and 23 lymphoma-type ATL. The complete response rate and median survival of these patients were 25.3% and 9 months, respectively. The 2- and 5-year survival rates were 18.4% and 8%, respectively, and five patients have been alive for > 5 years and are disease-free. These long-term survivors had good prognostic factors at diagnosis. There was no correlation between the doses of the various chemotherapeutic agents and the survival duration. These results indicate that ordinary combined chemotherapy has limited ability to improve the prognosis of aggressive ATL. Our previous study indicated that expression of P-glycoprotein in ATL cells might be involved in resistance to chemotherapeutic agents, particularly doxorubicin, vincristine, and etoposide. Therefore, new therapeutic strategies will be necessary to improve the prognosis of ATL patients.

Adult↗