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Methotrexate (MTX) in combination with a calcineurin inhibitor has been commonly used for prophylaxis of graft-versus-host disease (GVHD) following umbilical cord blood transplantation (UCBT) in Japan. However, the appropriate prophylactic MTX dosage in UCBT has not been established to date. To determine the preferential GVHD prophylaxis in UCBT, this study retrospectively investigated the administration of short-term MTX for 2 days versus 3 days. Of 103 adult patients submitted to UCBT enrolled in the study, 73 received tacrolimus (TAC) with 2 days of MTX given at 10 mg/m 2 on day 1 and 7 mg/m 2 on day 3 (very short-term [vs] MTX), whereas 30 patients received TAC with 3 days of MTX given at 10 mg/m 2 on day 1, 7 mg/m 2 on day 3, and 7 mg/m 2 on day 6 (short-term [s] MTX). In univariate analysis, neutrophil engraftment was shown to be significantly better (P = .039) in the vsMTX/TAC group. Among high-risk patients, the vsMTX/TAC group also exhibited earlier neutrophil engraftment (P = .042); however, the incidence of acute GVHD was higher in the vsMTX/TAC group (P = .035) on univariate analysis. In multivariate analysis, compared with sMTX/TAC, vsMTX/TAC was associated with lower risk of relapse (hazard ratio, .27; 95% confidence interval, .11 to .64; P = .003) . These results suggest that vsMTX/ TAC can be appropriate GVHD prophylaxis after UCBT, especially in higher-risk patients.

Immunodeficiency-associated lymphoproliferative disorders (LPD) are characterized by excessive lymphoid proliferation developing in the context of immunosuppression. 1,2 According to the 2017 World Health Organization (WHO) classification, there are 4 categories of immunodeficiencyassociated LPD: LPD associated with primary immune disorders, lymphomas associated with human immunodeficiency virus infection, post-transplant LPD (PTLD), and other iatrogenic immunodeficiency-associated LPD (OIIA-LPD). 1,2 PTLD and OIIA-LPD are iatrogenic, developing in association with immunosuppressive treatment in the setting of organ transplantation and autoimmune disease, respectively. PTLD is one of the important complications after solid organ transplantation (SOT) and hematopoietic stem-cell transplantation (HSCT). 1 The frequency varies depending on the organ type (10%-15% in SOT recipients and 0.5%-2.5% in

Four male patients admitted to the same ward in the rst half of September 201Y were identi ed to have respiratory syncytial virus RSV infection. Their ages ranged from 49 to 85 years median 72.5. One patient was infected with human immunodeficiency virus and three patients had hematological malignancies. Following immuno-chromatological testing with a nasal cavity swab, RSV infection was diagnosed. Although blood and sputum cultures were performed in three patients, no signi cant bacteria were detected. Two cases responded to supportive therapy. However, one patient died secondary to multiple myeloma, and another patient developed pneumonia and died with an exacerbation of leukemia. RSV infections in immunocompromised hosts are associated with a poor prognosis. Early diagnosis will facilitate isolation of infected individuals to prevent hospital outbreaks.

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