基本情報
- 所属
- 自治医科大学 分子病態治療研究センター 領域融合治療研究部 / さいたま医療センター血液科 教授
- J-GLOBAL ID
- 201501000612691971
- researchmap会員ID
- B000247677
研究分野
1経歴
3-
2023年11月 - 現在
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2015年4月 - 現在
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2023年4月 - 2023年10月
論文
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Bone marrow transplantation 59(3) 325-333 2024年3月Various complications can influence hematopoietic cell transplantation (HCT) outcomes. Renal complications can occur during the early to late phases of HCT along with various factors. However, studies focusing on fatal renal complications (FRCs) are scarce. Herein, we analyzed 36,596 first allogeneic HCT recipients retrospectively. Overall, 782 patients died of FRCs at a median of 108 (range, 0-3,440) days after HCT. The cumulative incidence of FRCs was 1.7% and 2.2% at one and five years, respectively. FRCs were associated with older age, male sex, non-complete remission (non-CR), lower performance status (PS), and HCT comorbidity index (HCT-CI) associated with renal comorbidity in multivariate analysis. The risk factors within 100 days included older age, multiple myeloma, PS, and HCT-CI comorbidities (psychiatric disturbance, hepatic disease, obesity, and renal disease). Older age and male sex were risk factors between 100 days and one year. After one year, HCT-CI was associated with the presence of diabetes and prior solid tumor; total body irradiation was identified as a risk factor. Non-CR was a common risk factor in all three phases. Furthermore, acute and chronic graft-versus-host disease, reactivation of cytomegalovirus, and relapse of underlying disease also affected FRCs. Systematic follow-up may be necessary based on the patients' risk factors and post-HCT events.
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Transplantation proceedings 2024年2月8日BACKGROUND: As the Japanese population may have less genetic diversity than other ethnic groups, treatment outcomes may be affected when allogeneic hematopoietic cell transplantation is performed in other races. However, evidence explaining the effect of racial differences is limited. METHODS: We used the Japanese National Database to examine the outcomes of first allogeneic bone marrow transplantations (BMTs) performed between Japanese and non-Japanese patients from 1996 to 2021. We performed propensity score matching using sex, age group, underlying disease group, HLA mismatch, conditioning regimen intensity, and BMT implementation age to select Japanese-to-Japanese BMT patients as the controls. RESULTS: The numbers of non-Japanese-to-Japanese and Japanese-to-non-Japanese BMT cases included in the analysis were 48 and 75, respectively, and the following outcomes were compared: overall survival, non-relapse mortality, acute graft-vs-host disease (GVHD) ≥ grade II, chronic GVHD, and engraftment of neutrophils and platelets. Most parameters did not differ when comparing BMTs according to ethnicity; only platelet engraftment was delayed in Japanese-to-non-Japanese BMT but not in non-Japanese-to-Japanese BMT. CONCLUSIONS: The results of this study suggested that BMT performed in Japanese and non-Japanese patients has little effect on treatment outcomes. The results of this study may be useful for donor selection in Japan, where internationalization has progressed in recent years.
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American journal of hematology 99(2) 263-273 2024年2月We retrospectively evaluated the effect of 17 individual comorbidities, defined by the hematopoietic cell transplantation (HCT)-specific comorbidity index, on non-relapse mortality (NRM) and overall survival (OS) in 9531 patients aged between 16 and 70 years who underwent their first allogeneic HCT from 8/8 and 7/8 allele-matched unrelated donors (8/8 and 7/8 MUDs) or single-unit unrelated cord blood (UCB) between 2011 and 2020 using data from a Japanese registry database. In the multivariate analysis, infection (adjusted hazard ratio [HR], 1.62, 95% confidence interval [CI], 1.33-1.99 for 8/8 and 7/8 MUDs; adjusted HR, 1.33, 95%CI, 1.12-1.58 for UCB) and moderate/severe hepatic comorbidity (adjusted HR, 1.57, 95%CI, 1.04-2.38 for 8/8 and 7/8 MUDs; adjusted HR, 1.53, 95%CI, 1.09-2.15 for UCB) had a significant impact on NRM in both donor groups. Cardiac comorbidity (adjusted HR, 1.40, 95%CI, 1.08-1.80), mild hepatic comorbidity (adjusted HR, 1.22, 95%CI, 1.01-1.48), rheumatologic comorbidity (adjusted HR, 1.67, 95%CI, 1.11-2.51), renal comorbidity (adjusted HR, 2.44, 95%CI, 1.46-4.09), and severe pulmonary comorbidity (adjusted HR, 1.40, 95%CI, 1.11-1.77) were significantly associated with an increased risk of NRM but only in UCB recipients. Renal comorbidity had the strongest impact on poor OS in both donor groups (adjusted HR, 1.73, 95%CI, 1.10-2.72 for 8/8 and 7/8 MUDs; adjusted HR, 2.24, 95%CI, 1.54-3.24 for UCB). Therefore, unrelated donor selection should be taken into consideration along with the presence of specific comorbidities, such as cardiac, rheumatologic, renal, mild hepatic, and severe pulmonary comorbidities.
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Blood advances 2024年1月1日Higher rate of non-relapse mortality (NRM) remains yet to be resolved in umbilical cord blood transplantation (UCBT). Considering that UCBT has some unique features compared with allogeneic hematopoietic cell transplantation from other graft sources, a UCBT-specific NRM risk assessment system is required. Thus, in this study, we sought to develop a UCBT-specific NRM Risk Assessment (CoBRA) score. Using a nationwide registry database, we retrospectively analyzed 4437 recipients who had received their first single-unit UCBT. Using the backward elimination method, we constructed the CoBRA score in a training cohort (n = 2687), which consisted of recipients age ≥ 55 (score 2), hematopoietic cell transplantation-specific comorbidity index (HCT-CI) ≥ 3 (score 2), male recipient, graft-versus-host disease (GVHD) prophylaxis other than tacrolimus in combination with methotrexate, performance status (PS) 2-4, HLA allele mismatch ≥ 2, refined disease risk index (DRI) high-risk, myeloablative conditioning (MAC), and CD34+ cell doses < 0.82 x 105/kg (score 1 in each). The recipients were categorized into three groups: Low (0-4 points), Intermediate (5-7 points), and High (8-11 points) groups according to the CoBRA score. In the validation cohort (n = 1750), the cumulative incidence of NRM at 2 years was 14.9%, 25.5%, and 47.1% (P < 0.001), and 2-year overall survival (OS) was 74.2%, 52.7%, and 26.3% (P < 0.001) in the Low, Intermediate, and High groups, respectively. In summary, the CoBRA score could predict the NRM risk as well as OS after UCBT. Further external validation will be needed to confirm the significance of the CoBRA score.
MISC
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臨床血液 64(4) 250-254 2023年4月34歳男性。KMT2A-MLLT1陽性急性骨髄性白血病の第1寛解期で,busulfan/高用量cyclophosphamideを前処置としてHLA適合の妹より同種末梢血幹細胞移植を施行した。Day14に生着し以降は寛解を維持した。重篤な移植片対宿主病も認めなかったが,経口cyclosporin(CsA)10mg/dayまで減量した移植後6ヶ月の時点で間質性肺炎を発症した。間質性肺炎に対して投与したprednisolone(PSL)の効果は一時的で,間質性肺炎は急速に増悪した。追加精査にて抗MDA5抗体陽性が判明したためcyclophosphamide+PSL+CsAによる3剤併用療法を開始して奏効が得られた。しかし,後遺症の呼吸不全で人工呼吸器管理を要したため,弟と妹より生体肺移植を施行した。3剤併用療法と生体肺移植により呼吸状態の改善を得た抗MDA5抗体陽性急速進行性間質性肺疾患の症例を経験したため,ここに報告する。(著者抄録)
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日本血液学会学術集会 83回 OS1-5 2021年9月
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日本血液学会学術集会 83回 OS3-4 2021年9月
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Association between CMV reactivation and late-onset invasive aspergillosis after allogeneic HCT(和訳中)日本血液学会学術集会 83回 OS3-4 2021年9月
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日本血液学会学術集会 83回 OS3-1 2021年9月
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日本血液学会学術集会 83回 OS3-3 2021年9月
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日本血液学会学術集会 83回 OS3-2 2021年9月
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日本血液学会学術集会 83回 OS3-3 2021年9月
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日本血液学会学術集会 83回 OS3-4 2021年9月
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臨床血液 61(4) 379-386 2020年4月バイオマーカーとは生体内(血液,体液,尿,組織)にある細胞,生理活性物質,遺伝子などの中で,疾患の進行や治療介入の反応などによく相関する客観的な指標である。移植後合併症として重要なものに急性および慢性移植片対宿主病があげられるが,移植患者内の環境を経時的に評価することができれば,移植片対宿主病の発症予測,重症度判定,そして治療方針決定に有用なツールとなりうる。本稿では,バイオマーカーの定義,急性および慢性移植片対宿主病のバイオマーカーとして確立しつつあるものや興味深いバイオマーカー等を紹介する。バイオマーカーには免疫再構築異常に関連するもの,標的臓器に関わるもの,創傷治癒(炎症や線維化)に関わるものなどがあげられ,様々なバイオマーカーの視点から移植片対宿主病の複雑な病態生理ネットワークの理解につながれば幸いである。今後もバイオマーカー研究は,診断,治療,創薬において重要なものになるだろう。(著者抄録)
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内科 124(4) 2113-2117 2019年10月<文献概要>▼幹細胞,代替ドナー,サポーティブケアの発展により,現在では年間3,000件以上の同種造血幹細胞移植が実施されている.▼同種免疫による抗腫瘍効果が魅力の治療であるが,一方で,急性もしくは慢性移植片対宿主病という新たな病態をつくり出してしまう可能性がある.▼免疫不全のなかで種々の感染症のリスクがあり,晩期においては生活の質(QOL)を非常に落としかねない合併症にも気をつけていかねばならない.▼総合的な多職種にわたるアプローチと管理が必要となる治療でもある.
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日本造血細胞移植学会総会プログラム・抄録集 39th 232 2017年2月15日
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日本造血細胞移植学会総会プログラム・抄録集 39th 218 2017年2月15日
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BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION 22(3) S204-S205 2016年3月
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BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION 22(3) S412-S412 2016年3月
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