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Stuver R, Geller S. Advances in the treatment of mycoses fungoides and Sézary syndrome: a narrative update in skin-directed therapies and immune-based treatments. Front Immunol 2023; 14:1284045. [PMID: 37868986 PMCID: PMC10585160 DOI: 10.3389/fimmu.2023.1284045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
Mycoses fungoides (MF) and Sézary syndrome (SS) are cutaneous T-cell lymphomas that are often challenging to manage given the absence of reliably curative therapies, at times high symptom burden with significant detriment to quality of life, and need for ongoing treatment for disease and symptom control. Recent developments in skin-directed treatments include optimizing the use of existing topical therapies, the introduction of known dermatological agents and treatment modalities for the specific treatment of MF/SS (such as mechlorethamine gel, calcineurin inhibitor creams, and photodynamic therapy), and novel local and topical agents. For advanced disease, dedicated clinical trials have translated to exciting progress, leading to the approval of brentuximab vedotin (2017) and mogamulizumab (2018) for relapsed MF/SS. Additional studies of other active systemic agents, including various cellular therapies, represent further attempts to add to the therapeutic armamentarium in treating MF/SS. In this review, we highlight these recent advancements, ranging from optimization of skin-directed therapies to the introduction of novel systemic agents. We focus on therapies approved in the preceding five years or under investigation in advanced-phase clinical trials.
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Affiliation(s)
- Robert Stuver
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Shamir Geller
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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2
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Stuver R, Horwitz SM, Epstein-Peterson ZD. Treatment of Adult T-Cell Leukemia/Lymphoma: Established Paradigms and Emerging Directions. Curr Treat Options Oncol 2023; 24:948-964. [PMID: 37300656 PMCID: PMC11010735 DOI: 10.1007/s11864-023-01111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 06/12/2023]
Abstract
OPINION STATEMENT Adult T-cell leukemia/lymphoma (ATL) is a rare, aggressive subtype of peripheral T-cell lymphoma developing after many years of chronic, asymptomatic infection with the retrovirus human T-cell lymphotropic virus type 1 (HTLV-1). HTLV-1 is endemic to certain geographic areas of the world, and primary infection generally occurs in infancy through mother-to-child transmission via breastfeeding. In less than 5% of infected individuals, a decades-long pathogenic process culminates in the development of ATL. Aggressive subtypes of ATL are life-threatening and challenging to treat, with median overall survival typically less than 1 year in the absence of allogeneic hematopoietic cell transplantation (alloHCT). Owing to the rarity of this illness, prospective large-scale clinical trials have been challenging to perform, and treatment recommendations are largely founded upon limited evidence. Herein, we review the current therapeutic options for ATL, providing a broad literature overview of the foremost clinical trials and reports of this disease. We emphasize our own treatment paradigm, which is broadly based upon disease subtype, patient fitness, and intent to perform alloHCT. Finally, we highlight recent advances in understanding ATL disease biology and important ongoing clinical trials that we foresee as informative and potentially practice-changing.
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Affiliation(s)
- Robert Stuver
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 E. 74th St, New York, NY, 10021, USA.
| | - Steven M Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 E. 74th St, New York, NY, 10021, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Zachary D Epstein-Peterson
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 E. 74th St, New York, NY, 10021, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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Tsukamoto Y, Kiyasu J, Choi I, Kozuru M, Uike N, Utsunomiya H, Hirata A, Fujioka E, Ohno H, Nakashima E, Nakashima Y, Miyashita K, Tachikawa Y, Narazaki T, Tsuda M, Haji S, Takamatsu A, Tanaka E, Goto T, Takatsuki H, Oyama M, Muta H, Yagi Y, Ikeda M, Matsushima T, Yufu Y, Suehiro Y. Efficacy and Safety of the Modified EPOCH Regimen (Etoposide, Vincristine, Doxorubicin, Carboplatin, and Prednisolone) for Adult T-cell Leukemia/Lymphoma: A Multicenter Retrospective Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e445-e453. [PMID: 32312633 DOI: 10.1016/j.clml.2020.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND We retrospectively analyzed patients with untreated aggressive adult T-cell leukemia/lymphoma who received the modified EPOCH (mEPOCH) regimen. PATIENTS AND METHODS Patients received up to 6 mEPOCH cycles. Etoposide (50 mg/m2/day), doxorubicin (10 mg/m2/day), and vincristine (0.4 mg/m2/day) were each given as a continuous 96-hour infusion on days 1 to 4. Prednisolone (40 mg/m2/day) was given intravenously or orally on days 1 to 4 and then tapered and stopped on day 7, and carboplatin (dose calculated for each patient individually using Calvert's formula according to a target under the curve of 3 mg/mL/min) was given as a 2-hour intravenous infusion on day 6. RESULTS In 103 patients, overall response rate and complete response rate were 58% and 25%, respectively. With a median follow-up of 8.9 months, the median survival time was 9.8 months (95% confidence interval, 7.2-13.9 months). The median progression-free survival (PFS) was 4.2 months (95% confidence interval, 3.4-5.7 months). Patients who completed ≥ 4 cycles experienced significantly better overall survival and PFS compared with those who completed < 4 cycles. Twenty-eight patients underwent allogeneic hematopoietic stem cell transplantation after mEPOCH and demonstrated significantly prolonged overall survival and PFS compared with those who did not undergo transplantation. CONCLUSION The mEPOCH regimen is effective with tolerable adverse effects and may be an alternative treatment option for adult T-cell leukemia/lymphoma.
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Affiliation(s)
- Yasuhiro Tsukamoto
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan; Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | - Junichi Kiyasu
- Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan; Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan; Department of Pathology, Kurume University, Kurume-city, Fukuoka, Japan.
| | - Ilseung Choi
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Mitsuo Kozuru
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Naokuni Uike
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Hayato Utsunomiya
- Cell Therapy, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Akie Hirata
- Clinical Laboratory Medicine, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Eriko Fujioka
- Cell Therapy, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Hirofumi Ohno
- Cell Therapy, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Eriko Nakashima
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Yasuhiro Nakashima
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Kaname Miyashita
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Yoshimichi Tachikawa
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Taisuke Narazaki
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Mariko Tsuda
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Shojiro Haji
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Akiko Takamatsu
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Emi Tanaka
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Tatsuro Goto
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Hiroshi Takatsuki
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
| | - Makoto Oyama
- Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | - Hiroki Muta
- Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | - Yu Yagi
- Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | - Motohiko Ikeda
- Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | | | - Yuji Yufu
- Department of Hematology, Iizuka Hospital, Iizuka-city, Fukuoka, Japan
| | - Youko Suehiro
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan; Cell Therapy, National Hospital Organization Kyushu Cancer Center, Fukuoka-city, Fukuoka, Japan
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Reduced-intensity haploidentical peripheral blood stem cell transplantation using low-dose thymoglobulin for aggressive adult T cell leukemia/lymphoma patients in non-complete remission. Ann Hematol 2020; 99:599-607. [PMID: 32006150 PMCID: PMC7060159 DOI: 10.1007/s00277-020-03934-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 01/24/2020] [Indexed: 11/28/2022]
Abstract
Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) has been accepted as a treatment option for aggressive (acute or lymphoma type) adult T cell leukemia/lymphoma (ATLL) patients with a poor prognosis, when a suitable HLA-matched donor is not available. However, haplo-HSCT carries a potential risk of treatment-related mortality including severe graft-versus-host disease (GVHD). Therefore, we conducted a prospective pilot study in order to evaluate the efficacy and safety of reduced-intensity haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) with low-dose thymoglobulin (2.5 mg/kg only on day −2), fludarabine, melphalan, and total body irradiation 4 Gy for aggressive ATLL. Three consecutive acute type ATLL patients, who were ineligible for conventional myeloablative conditioning due to advanced age or comorbidities, were enrolled. One patient received pretransplant mogamulizumab therapy. All the patients were not in complete remission (CR) at the time of transplantation. Our transplantation protocol was safely carried out. CR was achieved in all the patients after transplantation. HTLV-I viral loads became undetectable after transplantation. No severe adverse events such as grade III-IV GVHD or viral/fungal diseases were observed. At a follow-up of 2 years, they were still in CR. However, T cell receptor repertoire diversities were low 1 year after transplantation in next-generation sequencing. Our results show encouraging therapeutic benefits of this pilot approach using reduced-intensity haplo-PBSCT with low-dose thymoglobulin for aggressive ATLL patients.
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Kato K, Uike N, Wake A, Yoshimitsu M, Tobai T, Sawayama Y, Takatsuka Y, Fukuda T, Uchida N, Eto T, Nakashima Y, Kondo T, Taguchi J, Miyamoto T, Nakamae H, Ichinohe T, Kato K, Suzuki R, Utsunomiya A. The outcome and characteristics of patients with relapsed adult T cell leukemia/lymphoma after allogeneic hematopoietic stem cell transplantation. Hematol Oncol 2018; 37:54-61. [DOI: 10.1002/hon.2558] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/06/2018] [Accepted: 07/06/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Koji Kato
- Department of Medicine and Biosystemic ScienceKyushu University Graduate School of Medical Sciences Fukuoka Japan
| | - Naokuni Uike
- Department of HematologyNational Kyushu Cancer Center Fukuoka Japan
| | - Atsushi Wake
- Department of HematologyToranomon Hospital Tokyo Japan
| | - Makoto Yoshimitsu
- Department of Hematology and ImmunologyKagoshima University Hospital Kagoshima Japan
| | - Tomomi Tobai
- University of Michigan, Comprehensive Cancer Center Ann Arbor MI USA
| | - Yasushi Sawayama
- Department of HematologySasebo City General Hospital Sasebo Japan
| | | | - Takahiro Fukuda
- Department of Stem Cell TransplantationNational Cancer Center Hospital Tokyo Japan
| | | | - Tetsuya Eto
- Department of HematologyHamanomachi Hospital Fukuoka Japan
| | | | - Tadakazu Kondo
- Department of Hematology and OncologyKyoto University Hospital Kyoto Japan
| | - Jun Taguchi
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine UnitNagasaki University Hospital Nagasaki Japan
| | - Toshihiro Miyamoto
- Department of Medicine and Biosystemic ScienceKyushu University Graduate School of Medical Sciences Fukuoka Japan
| | - Hirohisa Nakamae
- Department of HematologyOsaka City University Graduate School of Medicine Osaka Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and MedicineHiroshima University Hiroshima Japan
| | - Koji Kato
- Children's Medical CenterJapanese Red Cross Nagoya First Hospital Nagoya Japan
| | - Ritsuro Suzuki
- Department of HSCT Data Management/BiostatisticsNagoya University Graduate School of Medicine Nagoya Japan
| | - Atae Utsunomiya
- Department of HematologyImamura General Hospital Kagoshima Japan
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Fuji S, Kato K, Nakano N, Ishida T, Ishitsuka K, Choi I, Matsuoka KI, Utsunomiya A. Pre- and posttransplant use of mogamulizumab in patients with aggressive adult T-cell leukemia-lymphoma: A statement from key opinion leaders in Japan. ACTA ACUST UNITED AC 2018. [DOI: 10.1002/acg2.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Shigeo Fuji
- Department of Hematology; Osaka International Cancer Institute; Osaka Japan
| | - Koji Kato
- Department of Medicine and Biosystemic Science; Kyushu University Graduate School of Medical Science; Fukuoka Japan
| | - Nobuaki Nakano
- Department of Hematology; Imamura General Hospital; Kagoshima Japan
| | - Takashi Ishida
- Department of Hematology and Oncology; School of Medical Sciences; Nagoya City University Graduate; Nagoya Japan
- Division of Hematology and Oncology; Department of Internal Medicine; School of Medicine; Iwate Medical University; Iwate Japan
| | - Kenji Ishitsuka
- Department of Hematology and Immunology; Kagoshima University Hospital; Kagoshima Japan
| | - Ilseung Choi
- Department of Hematology; National Hospital Kyushu Cancer Center; Fukuoka Japan
| | - Ken-ichi Matsuoka
- Department of Hematology and Oncology; Okayama University; Okayama Japan
| | - Atae Utsunomiya
- Department of Hematology; Imamura General Hospital; Kagoshima Japan
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7
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Opportunities for therapeutic antibodies directed at G-protein-coupled receptors. Nat Rev Drug Discov 2017; 16:787-810. [PMID: 28706220 DOI: 10.1038/nrd.2017.91] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
G-protein-coupled receptors (GPCRs) are activated by a diverse range of ligands, from large proteins and proteases to small peptides, metabolites, neurotransmitters and ions. They are expressed on all cells in the body and have key roles in physiology and homeostasis. As such, GPCRs are one of the most important target classes for therapeutic drug discovery. The development of drugs targeting GPCRs has therapeutic value across a wide range of diseases, including cancer, immune and inflammatory disorders as well as neurological and metabolic diseases. The progress made by targeting GPCRs with antibody-based therapeutics, as well as technical hurdles to overcome, are presented and discussed in this Review. Antibody therapeutics targeting C-C chemokine receptor type 4 (CCR4), CCR5 and calcitonin gene-related peptide (CGRP) are used as illustrative clinical case studies.
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Ishitsuka K, Yurimoto S, Kawamura K, Tsuji Y, Iwabuchi M, Takahashi T, Tobinai K. Safety and efficacy of mogamulizumab in patients with adult T-cell leukemia-lymphoma in Japan: interim results of postmarketing all-case surveillance. Int J Hematol 2017; 106:522-532. [PMID: 28597329 DOI: 10.1007/s12185-017-2270-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 02/07/2023]
Abstract
We present the interim results of a postmarketing all-case surveillance study in patients with C-C chemokine receptor 4 (CCR4)-positive, relapsed or refractory adult T-cell leukemia-lymphoma (ATL) treated with the anti-CCR4 monoclonal antibody mogamulizumab since its 2012 launch in Japan. The safety and efficacy analysis populations comprised 484 and 442 patients, respectively. The ATL subtype was acute in 58.9% and lymphoma in 34.2% of patients. All patients were scheduled to receive intravenous infusions of mogamulizumab (1.0 mg/kg) once weekly for eight weeks, alone or in combination with other modalities. Adverse drug reactions (ADRs) were reported in 74.0% of patients, of which 35.7% were serious and 6.2% were fatal. The priority survey items of infusion-related reaction, skin disorder, infection, immune disorder, and tumor lysis syndrome were reported in 29.3, 34.3, 22.1, 3.5, and 2.5% of patients, respectively. Graft-versus-host disease was reported in 25/42 patients who received mogamulizumab before allogeneic hematopoietic stem cell transplantation. The best overall response rate was 57.7% overall, 57.5% in patients treated with mogamulizumab alone, and 58.2% in patients treated with combination therapy. This surveillance indicates that mogamulizumab shows acceptable tolerability in practice; however, because of the risk of serious/fatal ADRs, patients administered mogamulizumab should be carefully monitored.
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Affiliation(s)
- Kenji Ishitsuka
- Division of Hematology and Immunology, Center for Chronic Viral Diseases, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | | | | | - Yukie Tsuji
- Pharmacovigilance and Quality Assurance Division, Kyowa Hakko Kirin Co., Ltd., Tokyo, Japan
| | - Manabu Iwabuchi
- Pharmacovigilance and Quality Assurance Division, Kyowa Hakko Kirin Co., Ltd., Tokyo, Japan
| | | | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
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9
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Kawano N, Kuriyama T, Yoshida S, Kawano S, Yamano Y, Marutsuka K, Minato S, Yamashita K, Ochiai H, Shimoda K, Ishikawa F, Kikuchi I. The Impact of a Humanized CCR4 Antibody (Mogamulizumab) on Patients with Aggressive-Type Adult T-Cell Leukemia-Lymphoma Treated with Allogeneic Hematopoietic Stem Cell Transplantation. J Clin Exp Hematop 2017; 56:135-144. [PMID: 28331127 PMCID: PMC6144179 DOI: 10.3960/jslrt.56.135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 11/28/2016] [Accepted: 01/19/2017] [Indexed: 11/01/2022] Open
Abstract
Although a humanized CCR4 antibody (mogamulizumab) was reported to be effective for refractory adult T-cell leukemia-lymphoma (ATL), several reports regarding the use of mogamulizumab before allo-hematopoietic stem cell transplantation (HSCT) strongly indicated a high incidence of severe acute graft-versus-host-disease (GVHD) and treatment-related mortality (TRM). We retrospectively analyzed nine aggressive-type ATL patients who underwent allo-HSCT at a single institution in Miyazaki from 2006.1.1 to 2015.7.31. Among nine ATL patients, three had used mogamulizumab before treatment with allo-HSCT because of the poor control of refractory ATL. All three patients were treated with four to eight cycles of mogamulizumab. The interval from last administration of mogamulizumab to allo-HSCT was two to five months. All three patients with prior mogamulizumab treatment developed mild-moderate acute GVHD (grade 2) 28, 34, or 40 days after allo-HSCT. Acute GVHD was controlled by prednisolone treatment. Two patients in complete remission before allo-HSCT exhibited relatively prolonged survival (survival rate, 66%). Moreover, one patient developed human T-cell leukemia virus type 1-associated myelopathy-mimicking myelitis at five months after allo-HSCT. In contrast, two of six ATL patients without a history of mogamulizumab use survived (survival rate 33%). Thus, in cases of mogamulizumab use before treatment with allo-HSCT for refractory ATL, an appropriately long interval from the last administration of mogamulizumab to allo-HSCT may be one of factors to reduce TRM by acute GVHD, and to subsequently enhance graft-versus-tumor effects in ATL cases. Furthermore, caution is needed when administering mogamulizumab before allo-HSCT for severe GVHD and TRM.
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Affiliation(s)
- Noriaki Kawano
- Department of Internal Medicine, Miyazaki
Prefectural Miyazaki Hospital, Miyazaki,
Japan
| | - Takuro Kuriyama
- Department of Internal Medicine, Miyazaki
Prefectural Miyazaki Hospital, Miyazaki,
Japan
| | - Shuro Yoshida
- Department of Internal Medicine, Miyazaki
Prefectural Miyazaki Hospital, Miyazaki,
Japan
| | - Sayaka Kawano
- Department of Internal Medicine, Miyazaki
Prefectural Miyazaki Hospital, Miyazaki,
Japan
| | - Yoshihisa Yamano
- Department of Rare Diseases Research, Institute of Medical
Science, St. Marianna University Graduate School of Medicine,
Kanagawa, Japan
| | - Kousuke Marutsuka
- Department of Pathology, Miyazaki Prefectural
Miyazaki Hospital, Miyazaki,
Japan
| | - Seiichirou Minato
- Department of Neurology, Miyazaki Prefectural
Miyazaki Hospital, Miyazaki,
Japan
| | - Kiyoshi Yamashita
- Department of Internal Medicine, Miyazaki
Prefectural Miyazaki Hospital, Miyazaki,
Japan
| | - Hidenobu Ochiai
- Trauma and Critical Care Center, Faculty of Medicine,
University of Miyazaki Hospital,
Miyazaki, Japan
| | - Kazuya Shimoda
- Division of Gastroenterology and Hematology, Department of
Internal Medicine, Faculty of Medicine, University of Miyazaki,
Miyazaki, Japan
| | - Fumihiko Ishikawa
- Research Unit for Human Disease Models, RIKEN
Research Center for Allergy and Immunology,
Yokohama, Japan
| | - Ikuo Kikuchi
- Department of Internal Medicine, Miyazaki
Prefectural Miyazaki Hospital, Miyazaki,
Japan
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10
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Iyama S, Sato T, Ohnishi H, Kanisawa Y, Ohta S, Kondo T, Mori A, Tsutsumi Y, Kuroda H, Kakinoki Y, Yamamoto S, Takahashi T, Shindo M, Torimoto Y, Sato K, Iwasaki H, Haseyama Y, Kohda K, Nagamachi Y, Hirayama Y, Sakai H, Hirata Y, Fukuhara T, Ikeda H, Kobune M, Kato J, Kurosawa M. A Multicenter Retrospective Study of Mogamulizumab Efficacy in Adult T-Cell Leukemia/Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:23-30.e2. [DOI: 10.1016/j.clml.2016.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/02/2016] [Accepted: 09/08/2016] [Indexed: 01/28/2023]
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Fuji S, Shindo T. Friend or foe? Mogamulizumab in allogeneic hematopoietic stem cell transplantation for adult T-cell leukemia/lymphoma. Stem Cell Investig 2016; 3:70. [PMID: 27868052 DOI: 10.21037/sci.2016.09.13] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 12/28/2022]
Abstract
Adult T-cell leukemia/lymphoma (ATL/ATLL) is a peripheral T-cell neoplasm associated with human T-lymphotropic virus type-1 (HTLV-1). Even the currently most intensive chemotherapy regimen modified LSG15 (mLSG15, VCAP-AMP-VECP) results in a dismal clinical outcome, with a median overall survival of only around 1 year. Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) may lead to long-term remission in a proportion of patients with aggressive ATL, the clinical outcome in patients with refractory or relapsed ATL is unsatisfactory. The anti-CCR4 antibody mogamulizumab (moga) has been recently approved for ATL in Japan, and it is effective in a significant proportion of patients with refractory or relapsed ATL. However, there are major concerns about the harmful influences of pretransplant moga on the immune reconstitution after allo-HSCT. Specifically, moga depletes regulatory T cells (Tregs) for at least a few months, which may increase the risk of graft-versus-host disease (GVHD) after allo-HSCT. A recent retrospective study from Japan clearly showed that pretransplant moga increased the risk of severe and steroid-refractory GVHD, which led to increases in non-relapse mortality and overall mortality. To improve the overall clinical outcome in patients with relapsed or refractory ATL, more studies are needed to incorporate moga without increasing adverse effects on the clinical outcome after allo-HSCT. In this review, we aim to provide an updated summary of the research related to moga and allo-HSCT.
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Affiliation(s)
- Shigeo Fuji
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Takero Shindo
- Department of Hematology, Respiratory Medicine and Oncology, Saga University School of Medicine, Saga, Japan
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12
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Hirosawa M, Higashi T, Iwashige A, Yamaguchi T, Tsukada J. HLA-haploidentical hematopoietic stem cell transplantation with low-dose thymoglobulin GVHD prophylaxis for an adult T cell leukemia/lymphoma patient treated with pretransplant mogamulizumab. Ann Hematol 2016; 96:327-328. [PMID: 27766392 PMCID: PMC5226989 DOI: 10.1007/s00277-016-2856-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/04/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Makoto Hirosawa
- Hematology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8556, Japan
| | - Takehiro Higashi
- Hematology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8556, Japan
| | - Atsushi Iwashige
- Hematology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8556, Japan
| | - Takahiro Yamaguchi
- Hematology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8556, Japan
| | - Junichi Tsukada
- Hematology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8556, Japan.
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Striving to cure adult T-cell leukaemia/lymphoma: a role for allogeneic stem cell transplant? Bone Marrow Transplant 2016; 51:1549-1555. [PMID: 27618683 DOI: 10.1038/bmt.2016.154] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/18/2016] [Accepted: 04/22/2016] [Indexed: 11/09/2022]
Abstract
Adult T-cell leukaemia/lymphoma (ATL) is an aggressive HTLV-1-related malignancy, rare outside of regions where the retrovirus is endemic. Although the use of antiviral therapy has improved outcomes, particularly for indolent forms of ATL, response to combination chemotherapy is poor and outcomes for aggressive subtypes remains dismal. Consolidation with allogeneic stem cell transplant (alloSCT) has an increasing role in the management of ATL in eligible patients, offering favourable long-term remission rates. However, relatively high-transplant-related mortality and issues with donor recruitment for certain ethnicities remain problematic. In this review, we discuss the rationale for and issues surrounding alloSCT in ATL in the context of conventional and emerging therapies.
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Tsubokura Y, Satake A, Hotta M, Yoshimura H, Fujita S, Azuma Y, Nakanishi T, Nakaya A, Ito T, Ishii K, Nomura S. Successful treatment with mogamulizumab followed by allogeneic hematopoietic stem-cell transplantation in adult T-cell leukemia/lymphoma: a report of two cases. Int J Hematol 2016; 104:744-748. [PMID: 27573760 DOI: 10.1007/s12185-016-2087-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 01/25/2023]
Abstract
A humanized anti-CC chemokine receptor 4 (CCR4) monoclonal antibody, mogamulizumab (MOG), has been shown to be safe and effective in the treatment of relapsed/refractory adult T-cell leukemia/lymphoma (ATLL). MOG depletes ATLL cells as well as regulatory T cells (Tregs), as CCR4 is expressed on these cells as well. In this context, pretransplant treatment with MOG may induce severe graft-versus-host disease (GVHD) in allogeneic hematopoietic stem-cell transplantation (HSCT). However, the influence of MOG on allogeneic HSCT, including its induction of GVHD, is unclear. In this report, we describe two patients treated with MOG who subsequently underwent allogeneic HSCT. They did not develop severe GVHD or treatment-related complications. In addition, we examined the kinetics of Tregs in the second case. Finally, we suggest that the detrimental effects of MOG can be avoided, which should be prospectively evaluated in future studies.
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Affiliation(s)
- Yukie Tsubokura
- First Department of Internal Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
| | - Atsushi Satake
- First Department of Internal Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan.
| | - Masaaki Hotta
- First Department of Internal Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
| | - Hideaki Yoshimura
- First Department of Internal Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
| | - Shinya Fujita
- First Department of Internal Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
| | - Yoshiko Azuma
- First Department of Internal Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
| | - Takahisa Nakanishi
- First Department of Internal Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
| | - Aya Nakaya
- First Department of Internal Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
| | - Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
| | - Kazuyoshi Ishii
- First Department of Internal Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
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15
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Fuji S, Inoue Y, Utsunomiya A, Moriuchi Y, Uchimaru K, Choi I, Otsuka E, Henzan H, Kato K, Tomoyose T, Yamamoto H, Kurosawa S, Matsuoka KI, Yamaguchi T, Fukuda T. Pretransplantation Anti-CCR4 Antibody Mogamulizumab Against Adult T-Cell Leukemia/Lymphoma Is Associated With Significantly Increased Risks of Severe and Corticosteroid-Refractory Graft-Versus-Host Disease, Nonrelapse Mortality, and Overall Mortality. J Clin Oncol 2016; 34:3426-33. [PMID: 27507878 DOI: 10.1200/jco.2016.67.8250] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Allogeneic hematopoietic stem-cell transplantation (allo-HSCT) is one important treatment option for patients with aggressive adult T-cell leukemia/lymphoma (ATLL). Mogamulizumab (anti-CCR4 monoclonal antibody; Mog) was recently approved as a treatment for ATLL in Japan. Major concerns exist about the possible adverse effects of pretransplantation Mog because Mog depletes regulatory T cells for several months. We assessed the impact of pretransplantation Mog on clinical outcomes after allo-HSCT. PATIENTS AND METHODS We included 996 allo-HSCT recipients age 70 years or younger with aggressive ATLL who were given the diagnosis between 2000 and 2013 and who received intensive chemotherapy by multiple chemotherapeutic drugs as first-line therapy. Before allo-HSCT, 82 patients received Mog with a median interval of 45 days from the last Mog to allo-HSCT. RESULTS Pretransplantation Mog was associated with an increased risk of grade 3 to 4 acute graft-versus-host disease (GVHD; relative risk, 1.80; P < .01) and refractoriness to systemic corticosteroid for acute GVHD (relative risk, 2.09; P < .01). One-year cumulative incidence of nonrelapse mortality was significantly higher in patients with pretransplantation Mog compared with those without (43.7% v 25.1%; P < .01). The probability of 1-year overall survival was also significantly inferior in patients with pretransplantation Mog compared with those without (32.3% v 49.4%; P < .01). In particular, use of Mog with intervals < 50 days to allo-HSCT was associated with a dismal clinical outcome. CONCLUSION Pretransplantation Mog was significantly associated with an increased risk of GVHD-related mortality, which supports the relevance of CCR4-expressing Tregs after allo-HSCT in humans. In clinical practice, Mog should be cautiously used for patients with ATLL who are eligible for allo-HSCT.
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Affiliation(s)
- Shigeo Fuji
- Shigeo Fuji, Yoshitaka Inoue, Saiko Kurosawa, and Takahiro Fukuda, National Cancer Center Hospital; Kaoru Uchimaru, The University of Tokyo; Hisashi Yamamoto, Toranomon Hospital, Tokyo; Yoshitaka Inoue, Kumamoto University Hospital, Kumamoto; Atae Utsunomiya, Imamura Bun-in Hospital, Kagoshima; Yukiyoshi Moriuchi, Sasebo City General Hospital, Sasebo; Ilseung Choi, National Hospital Organization Kyushu Cancer Center; Hideho Henzan, Hamanomachi Hospital; Koji Kato, Kyushu University Graduate School of Medical Sciences, Fukuoka; Eiichi Otsuka, Oita Prefectural Hospital, Oita; Takeaki Tomoyose, University of the Ryukyus, Okinawa; Ken-ichi Matsuoka, Okayama University, Okayama; and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Yoshitaka Inoue
- Shigeo Fuji, Yoshitaka Inoue, Saiko Kurosawa, and Takahiro Fukuda, National Cancer Center Hospital; Kaoru Uchimaru, The University of Tokyo; Hisashi Yamamoto, Toranomon Hospital, Tokyo; Yoshitaka Inoue, Kumamoto University Hospital, Kumamoto; Atae Utsunomiya, Imamura Bun-in Hospital, Kagoshima; Yukiyoshi Moriuchi, Sasebo City General Hospital, Sasebo; Ilseung Choi, National Hospital Organization Kyushu Cancer Center; Hideho Henzan, Hamanomachi Hospital; Koji Kato, Kyushu University Graduate School of Medical Sciences, Fukuoka; Eiichi Otsuka, Oita Prefectural Hospital, Oita; Takeaki Tomoyose, University of the Ryukyus, Okinawa; Ken-ichi Matsuoka, Okayama University, Okayama; and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atae Utsunomiya
- Shigeo Fuji, Yoshitaka Inoue, Saiko Kurosawa, and Takahiro Fukuda, National Cancer Center Hospital; Kaoru Uchimaru, The University of Tokyo; Hisashi Yamamoto, Toranomon Hospital, Tokyo; Yoshitaka Inoue, Kumamoto University Hospital, Kumamoto; Atae Utsunomiya, Imamura Bun-in Hospital, Kagoshima; Yukiyoshi Moriuchi, Sasebo City General Hospital, Sasebo; Ilseung Choi, National Hospital Organization Kyushu Cancer Center; Hideho Henzan, Hamanomachi Hospital; Koji Kato, Kyushu University Graduate School of Medical Sciences, Fukuoka; Eiichi Otsuka, Oita Prefectural Hospital, Oita; Takeaki Tomoyose, University of the Ryukyus, Okinawa; Ken-ichi Matsuoka, Okayama University, Okayama; and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yukiyoshi Moriuchi
- Shigeo Fuji, Yoshitaka Inoue, Saiko Kurosawa, and Takahiro Fukuda, National Cancer Center Hospital; Kaoru Uchimaru, The University of Tokyo; Hisashi Yamamoto, Toranomon Hospital, Tokyo; Yoshitaka Inoue, Kumamoto University Hospital, Kumamoto; Atae Utsunomiya, Imamura Bun-in Hospital, Kagoshima; Yukiyoshi Moriuchi, Sasebo City General Hospital, Sasebo; Ilseung Choi, National Hospital Organization Kyushu Cancer Center; Hideho Henzan, Hamanomachi Hospital; Koji Kato, Kyushu University Graduate School of Medical Sciences, Fukuoka; Eiichi Otsuka, Oita Prefectural Hospital, Oita; Takeaki Tomoyose, University of the Ryukyus, Okinawa; Ken-ichi Matsuoka, Okayama University, Okayama; and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kaoru Uchimaru
- Shigeo Fuji, Yoshitaka Inoue, Saiko Kurosawa, and Takahiro Fukuda, National Cancer Center Hospital; Kaoru Uchimaru, The University of Tokyo; Hisashi Yamamoto, Toranomon Hospital, Tokyo; Yoshitaka Inoue, Kumamoto University Hospital, Kumamoto; Atae Utsunomiya, Imamura Bun-in Hospital, Kagoshima; Yukiyoshi Moriuchi, Sasebo City General Hospital, Sasebo; Ilseung Choi, National Hospital Organization Kyushu Cancer Center; Hideho Henzan, Hamanomachi Hospital; Koji Kato, Kyushu University Graduate School of Medical Sciences, Fukuoka; Eiichi Otsuka, Oita Prefectural Hospital, Oita; Takeaki Tomoyose, University of the Ryukyus, Okinawa; Ken-ichi Matsuoka, Okayama University, Okayama; and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ilseung Choi
- Shigeo Fuji, Yoshitaka Inoue, Saiko Kurosawa, and Takahiro Fukuda, National Cancer Center Hospital; Kaoru Uchimaru, The University of Tokyo; Hisashi Yamamoto, Toranomon Hospital, Tokyo; Yoshitaka Inoue, Kumamoto University Hospital, Kumamoto; Atae Utsunomiya, Imamura Bun-in Hospital, Kagoshima; Yukiyoshi Moriuchi, Sasebo City General Hospital, Sasebo; Ilseung Choi, National Hospital Organization Kyushu Cancer Center; Hideho Henzan, Hamanomachi Hospital; Koji Kato, Kyushu University Graduate School of Medical Sciences, Fukuoka; Eiichi Otsuka, Oita Prefectural Hospital, Oita; Takeaki Tomoyose, University of the Ryukyus, Okinawa; Ken-ichi Matsuoka, Okayama University, Okayama; and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Eiichi Otsuka
- Shigeo Fuji, Yoshitaka Inoue, Saiko Kurosawa, and Takahiro Fukuda, National Cancer Center Hospital; Kaoru Uchimaru, The University of Tokyo; Hisashi Yamamoto, Toranomon Hospital, Tokyo; Yoshitaka Inoue, Kumamoto University Hospital, Kumamoto; Atae Utsunomiya, Imamura Bun-in Hospital, Kagoshima; Yukiyoshi Moriuchi, Sasebo City General Hospital, Sasebo; Ilseung Choi, National Hospital Organization Kyushu Cancer Center; Hideho Henzan, Hamanomachi Hospital; Koji Kato, Kyushu University Graduate School of Medical Sciences, Fukuoka; Eiichi Otsuka, Oita Prefectural Hospital, Oita; Takeaki Tomoyose, University of the Ryukyus, Okinawa; Ken-ichi Matsuoka, Okayama University, Okayama; and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideho Henzan
- Shigeo Fuji, Yoshitaka Inoue, Saiko Kurosawa, and Takahiro Fukuda, National Cancer Center Hospital; Kaoru Uchimaru, The University of Tokyo; Hisashi Yamamoto, Toranomon Hospital, Tokyo; Yoshitaka Inoue, Kumamoto University Hospital, Kumamoto; Atae Utsunomiya, Imamura Bun-in Hospital, Kagoshima; Yukiyoshi Moriuchi, Sasebo City General Hospital, Sasebo; Ilseung Choi, National Hospital Organization Kyushu Cancer Center; Hideho Henzan, Hamanomachi Hospital; Koji Kato, Kyushu University Graduate School of Medical Sciences, Fukuoka; Eiichi Otsuka, Oita Prefectural Hospital, Oita; Takeaki Tomoyose, University of the Ryukyus, Okinawa; Ken-ichi Matsuoka, Okayama University, Okayama; and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koji Kato
- Shigeo Fuji, Yoshitaka Inoue, Saiko Kurosawa, and Takahiro Fukuda, National Cancer Center Hospital; Kaoru Uchimaru, The University of Tokyo; Hisashi Yamamoto, Toranomon Hospital, Tokyo; Yoshitaka Inoue, Kumamoto University Hospital, Kumamoto; Atae Utsunomiya, Imamura Bun-in Hospital, Kagoshima; Yukiyoshi Moriuchi, Sasebo City General Hospital, Sasebo; Ilseung Choi, National Hospital Organization Kyushu Cancer Center; Hideho Henzan, Hamanomachi Hospital; Koji Kato, Kyushu University Graduate School of Medical Sciences, Fukuoka; Eiichi Otsuka, Oita Prefectural Hospital, Oita; Takeaki Tomoyose, University of the Ryukyus, Okinawa; Ken-ichi Matsuoka, Okayama University, Okayama; and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takeaki Tomoyose
- Shigeo Fuji, Yoshitaka Inoue, Saiko Kurosawa, and Takahiro Fukuda, National Cancer Center Hospital; Kaoru Uchimaru, The University of Tokyo; Hisashi Yamamoto, Toranomon Hospital, Tokyo; Yoshitaka Inoue, Kumamoto University Hospital, Kumamoto; Atae Utsunomiya, Imamura Bun-in Hospital, Kagoshima; Yukiyoshi Moriuchi, Sasebo City General Hospital, Sasebo; Ilseung Choi, National Hospital Organization Kyushu Cancer Center; Hideho Henzan, Hamanomachi Hospital; Koji Kato, Kyushu University Graduate School of Medical Sciences, Fukuoka; Eiichi Otsuka, Oita Prefectural Hospital, Oita; Takeaki Tomoyose, University of the Ryukyus, Okinawa; Ken-ichi Matsuoka, Okayama University, Okayama; and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hisashi Yamamoto
- Shigeo Fuji, Yoshitaka Inoue, Saiko Kurosawa, and Takahiro Fukuda, National Cancer Center Hospital; Kaoru Uchimaru, The University of Tokyo; Hisashi Yamamoto, Toranomon Hospital, Tokyo; Yoshitaka Inoue, Kumamoto University Hospital, Kumamoto; Atae Utsunomiya, Imamura Bun-in Hospital, Kagoshima; Yukiyoshi Moriuchi, Sasebo City General Hospital, Sasebo; Ilseung Choi, National Hospital Organization Kyushu Cancer Center; Hideho Henzan, Hamanomachi Hospital; Koji Kato, Kyushu University Graduate School of Medical Sciences, Fukuoka; Eiichi Otsuka, Oita Prefectural Hospital, Oita; Takeaki Tomoyose, University of the Ryukyus, Okinawa; Ken-ichi Matsuoka, Okayama University, Okayama; and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Saiko Kurosawa
- Shigeo Fuji, Yoshitaka Inoue, Saiko Kurosawa, and Takahiro Fukuda, National Cancer Center Hospital; Kaoru Uchimaru, The University of Tokyo; Hisashi Yamamoto, Toranomon Hospital, Tokyo; Yoshitaka Inoue, Kumamoto University Hospital, Kumamoto; Atae Utsunomiya, Imamura Bun-in Hospital, Kagoshima; Yukiyoshi Moriuchi, Sasebo City General Hospital, Sasebo; Ilseung Choi, National Hospital Organization Kyushu Cancer Center; Hideho Henzan, Hamanomachi Hospital; Koji Kato, Kyushu University Graduate School of Medical Sciences, Fukuoka; Eiichi Otsuka, Oita Prefectural Hospital, Oita; Takeaki Tomoyose, University of the Ryukyus, Okinawa; Ken-ichi Matsuoka, Okayama University, Okayama; and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ken-Ichi Matsuoka
- Shigeo Fuji, Yoshitaka Inoue, Saiko Kurosawa, and Takahiro Fukuda, National Cancer Center Hospital; Kaoru Uchimaru, The University of Tokyo; Hisashi Yamamoto, Toranomon Hospital, Tokyo; Yoshitaka Inoue, Kumamoto University Hospital, Kumamoto; Atae Utsunomiya, Imamura Bun-in Hospital, Kagoshima; Yukiyoshi Moriuchi, Sasebo City General Hospital, Sasebo; Ilseung Choi, National Hospital Organization Kyushu Cancer Center; Hideho Henzan, Hamanomachi Hospital; Koji Kato, Kyushu University Graduate School of Medical Sciences, Fukuoka; Eiichi Otsuka, Oita Prefectural Hospital, Oita; Takeaki Tomoyose, University of the Ryukyus, Okinawa; Ken-ichi Matsuoka, Okayama University, Okayama; and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuhiro Yamaguchi
- Shigeo Fuji, Yoshitaka Inoue, Saiko Kurosawa, and Takahiro Fukuda, National Cancer Center Hospital; Kaoru Uchimaru, The University of Tokyo; Hisashi Yamamoto, Toranomon Hospital, Tokyo; Yoshitaka Inoue, Kumamoto University Hospital, Kumamoto; Atae Utsunomiya, Imamura Bun-in Hospital, Kagoshima; Yukiyoshi Moriuchi, Sasebo City General Hospital, Sasebo; Ilseung Choi, National Hospital Organization Kyushu Cancer Center; Hideho Henzan, Hamanomachi Hospital; Koji Kato, Kyushu University Graduate School of Medical Sciences, Fukuoka; Eiichi Otsuka, Oita Prefectural Hospital, Oita; Takeaki Tomoyose, University of the Ryukyus, Okinawa; Ken-ichi Matsuoka, Okayama University, Okayama; and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takahiro Fukuda
- Shigeo Fuji, Yoshitaka Inoue, Saiko Kurosawa, and Takahiro Fukuda, National Cancer Center Hospital; Kaoru Uchimaru, The University of Tokyo; Hisashi Yamamoto, Toranomon Hospital, Tokyo; Yoshitaka Inoue, Kumamoto University Hospital, Kumamoto; Atae Utsunomiya, Imamura Bun-in Hospital, Kagoshima; Yukiyoshi Moriuchi, Sasebo City General Hospital, Sasebo; Ilseung Choi, National Hospital Organization Kyushu Cancer Center; Hideho Henzan, Hamanomachi Hospital; Koji Kato, Kyushu University Graduate School of Medical Sciences, Fukuoka; Eiichi Otsuka, Oita Prefectural Hospital, Oita; Takeaki Tomoyose, University of the Ryukyus, Okinawa; Ken-ichi Matsuoka, Okayama University, Okayama; and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Sendai, Japan
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