Background. The management of chemotherapy-induced nausea and vomiting (CINV) is of primary concern for both patients with cancer and medical workers. Refractory or breakthrough CINV is especially difficult to deal with and necessitates a different approach. Vitamin B1 deficiency is likely to occur during cancer chemotherapy, with early symptoms of fatigue, anorexia, nausea and vomiting. The efficacy of vitamin B1 for the treatment of delayed or refractory CINV should be confirmed. Methods. Serum vitamin B1 level was prospectively measured in patients experiencing persistent nausea and vomiting after chemotherapy. The response to vitamin B1 therapy was evaluated for three consecutive days after vitamin B1 infusion. Moreover, serum level of vitamin B1 at diagnosis of persistent delayed CINV was compared with the level before chemotherapy. Results. In total, 408 courses of chemotherapy in 86 patients were analyzed. The median age at hospital admission of the enrolled patients was 10.7 years (0.2–25.2). Among these, 44 (10.8%) episodes of persistent delayed CINV were identified in 26 of the enrolled patients. At day 3, the overall response rate was 79.5%; 21 (47.7%) patients achieved a complete response and 14 (31.8%) patients achieved a partial response. The median vitamin B1 level at diagnosis of CINV was significantly lower than the value before chemotherapy (22.8, range 11.9–49.2 vs. 32.7, range 11.2−80.1, respectively, P < 0.001). Conclusion. Patients with a malignant disease who experience persistent nausea and vomiting after chemotherapy often exhibit vitamin B1 deficiency. Vitamin B1 infusion may be beneficial for many of these patients.

Hepatic cirrhosis is a very rare complication of hematopoietic stem cell transplantation (SCT) and of neuroblastoma. We encountered two patients developing cirrhosis after SCT against neuroblastoma. A 6-year-old boy who had received allogeneic bone marrow transplantation developed cirrhosis 10 years after the SCT with the massive upper gastrointestinal hemorrhage. A 27-year-old man receiving allogeneic cord blood transplantation against recurrence of neuroblastoma, died of liver failure due to histological cirrhosis 1 year after the SCT. We could not detect the definite etiologic candidates of cirrhosis; however, careful monitoring appears warranted to avoid overlooking the onset and progression of cirrhosis after SCT.

Most cases of aplastic anemia (AA) complicated by nephrotic syndrome (NS) have been reported to be the effects of chronic graft-versus-host disease after hematopoietic stem cell transplantation (HSCT). We describe a 16-year-old boy with AA with monosomy 7 who developed NS during immunosuppressive treatment for AA alone without HSCT. Recently, there appeared a report of MIRAGE syndrome caused by gain-of-function mutation of SAMD9 gene on chromosome 7 who developed NS. No such mutation was detected in our patient and thus the genetic factors leading to the complication of two diseases remain unknown at this time.

Background. One- or two-day intervals are generally inserted into scheduled conditioning regimens for allogeneic hematopoietic cell transplantation (HCT), primarily due to various social circumstances, such as unexpected natural adversities, abrupt deterioration of patient health, and delays in graft source arrival. We compared the clinical outcomes of patients with interrupted conditioning to those with ordinarily scheduled conditioning. Procedure. We retrospectively analyzed 83 patients (children and adolescents) with oncologic disease who underwent myeloablative conditioning with total body irradiation (TBI). Interruption of conditioning was defined as a regimen in which one or two vacant days (no chemotherapy drug administration or TBI) were added to the initially scheduled regimen. Results. Overall and event-free survival were similar between the scheduled conditioning group and the interrupted conditioning groups (P = 0.955, P = 0.908, respectively). Non-relapse mortality and relapse rates were similar between the groups (P = 0.923, P = 0.946, respectively). The engraftment rate was not affected by interruption (P = 1.000). In contrast, the incidence of grade II–IV acute graft-versus-host disease (GVHD) reached a marginally significant difference between the groups (31% vs. 11%; P = 0.083). Conditioning interruption was identified to be an independent risk factor for chronic GVHD by multivariate analysis (odds ratio: 3.72; 95% CI: 1.04–13.3; P = 0.043). Conclusion. Apart from the incidence of chronic GVHD, clinical outcomes were not affected by one- or two-day intervals during conditioning.

Few studies have investigated the association between severity of lymphopenia and clinical outcome during chemotherapy or hematopoietic stem cell transplantation (HSCT). We investigated this issue by retrospectively analyzing pediatric patients who received allogeneic-HSCT (allo-HSCT) using a newly developed parameter called the LD-index that combines both the duration and the intensity of lymphopenia. A total of 92 patients underwent allo-HSCT in our hospital from April 2007 to August 2019. The median age at HSCT was 10.3 years (range 0.4 – 28.1). The median LD-index was 9,285 (range 2,217 – 36,064). A significantly high association was observed between the LD-index and the incidence of chronic graft-versus-host disease (GvHD) (p = 0.0045). Analysis of predictive factors for chronic GvHD was carried out using univariate analysis. Lower LD-index, donor source and duration (days) of lymphopenia were found to be significant factors associated with chronic GvHD. Multivariate analysis, however, only identified an association between lower LD-index and increased incidence of chronic GvHD (p = 0.004). In conclusion, the duration and the intensity of lymphopenia after allo-HSCT have an effect on the development of chronic GvHD.

Background. Adolescents/young adults (AYAs) with acute lymphoblastic leukemia (ALL) are more likely to have chemotherapy-related complications than children. In addition, several reports have shown that infections account for most of the therapy-related mortality during cancer treatment in AYAs. Thus, we hypothesized that chemotherapy-induced myelosuppression is more severe in AYAs than in children, and the state of neutropenia was compared between children and AYAs using the D-index, a numerical value calculated from the duration and depth of neutropenia. Procedure. This study retrospectively analyzed 95 patients newly diagnosed with ALL at our institution between 2007 and 2019. Of these, 81 were children (< 15 years old) and 14 were AYAs (≥ 15 years old). The D-index and duration of neutropenia during induction chemotherapy for ALL were compared between children and AYAs. Results. The median D-index of children was significantly higher than that of AYAs (8,187 vs. 6,446, respectively, P = 0.017). Moreover, the median duration of neutropenia was also significantly longer in children than in AYAs (24.0 days vs. 11.5 days, respectively, P = 0.007). Conclusion. Contrary to our expectations, myelosuppressive toxicity during induction chemotherapy for ALL was more severe in children than in AYAs.