The present study sought to elucidate the prognosis of adult T‐cell leukemia–lymphoma (ATL) patients receiving mogamulizumab, a defucosylated anti‐CCR4 monoclonal antibody. Progression‐free survival (PFS) and overall survival (OS) of ATL patients enrolled in two studies are herein updated, namely NCT00355472 (phase I study of mogamulizumab in relapsed patients with ATL and peripheral T‐cell lymphoma) and NCT00920790 (phase II study for relapsed ATL). Of 13 patients with relapsed aggressive ATL in the phase I study, four (31%) survived >3 years. For 26 relapsed patients with aggressive ATL in the phase II study, median PFS was 5.2 months and 1‐year PFS was 26%, whereas median OS was 14.4 months, and 3‐year OS was 23%. For patients without a rash or who developed a grade 1 rash only, median PFS was 0.8 months, and 1‐year PFS was zero, with a median OS of 6.0 months, and 3‐year OS of 8%. In contrast, for patients who developed a rash ≥grade 2, median PFS was 11.7 months, and 1‐year PFS was 50%, with a median OS of 25.6 months, and 3‐year OS of 36%. Thus, we conclude that mogamulizumab monotherapy may improve PFS and OS in some patients with relapsed aggressive ATL, especially those who develop a skin rash as a moderate immune‐related adverse event. Therefore, further investigation is warranted to validate the present observations and to clarify the mechanisms involved in the activity of mogamulizumab.
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.
The localization of atrial-natriuretic factor (ANF)-like immunoreactivity was investigated in the brain and heart of the treefrog Hyla japonica by the indirect immunofluorescence technique. Concurrently, the effect of weightlessness on the distribution of ANF-containing neurons and cardiocytes was studied in frogs that were sent into space for 9 days on the space station "MIR." In control animals, the amygdala contained the most prominent group of ANF-immunoreactive cells and fibers. ANF-positive neurons and nerve processes were also detected in other areas of the telencephalon such as the nucleus olfactorius, the pallium mediale, and the striatum. In "space frogs," the intensity of labeling of the amygdala and nucleus olfactorius was similar to that seen in control animals. In contrast, the pallium and the striatum of "space frogs" were totally devoid of positive cell bodies. In the diencephalon, of all animals, numerous ANF-immunoreactive perikarya and fibers were seen in the hypothalamus, the anterior thalamus, the infundibulum, and the median eminence. ANF-positive cell bodies were also noted in the lateral forebrain bundle of control frogs but were absent in "space frogs." The major difference between control and "space frogs" was observed in the posterior nuclei of the thalamus. In "space frogs," the nucleus posterocentralis thalami and the nucleus posterolateralis thalami exhibited large ANF-immunoreactive perikarya, while, in control frogs, these nuclei only contained scarce positive nerve fibers. In the mesencephalon, ANF-positive cell bodies and nerve processes were seen in the nucleus tegmenti mesencephali, the interpeduncular nucleus, and the nucleus cerebelli of all animals. However, stained perikarya were only observed in the nucleus reticularis isthmi of control frogs. In the heart, atrial cardiocytes exhibited intense ANF-like immunoreactivity. ANF-positive myocytes were also detected in the subpericardial region of the ventricle. The density and distribution of the staining were identical in the heart of control and "space frogs." These data support the concept that prolonged exposure to microgravity affects biosynthesis and/or release of ANF-related peptides in discrete regions of the amphibian brain.
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