In spite of the clinical usefulness of cisplatin (CDDP), there are many occasions in which it is difficult to continue the administration of CDDP due to its nephrotoxicity and neurotoxicity. We examined the incorporation of CDDP into polymeric micelles to see if this allowed the resolution of these disadvantages. Cisplatin was incorporated into polymeric micelles through the polymer -metal complex formation between polyethylene glycol poly(glutamic acid) block copolymers and CDDP (NC-6004). The pharmacokinetics, pharmacodynamics, and toxicity studies of CDDP and NC-6004 were conducted in rats or mice. The particle size of NC-6004 was approximately 30 nm, with a narrow size distribution. In rats, the area under the curve and total body clearance values for NC-6004 were 65-fold and one-nineteenth the values for CDDP (Po0.001 and 0.01, respectively). In MKN-45-implanted mice, NC-6004 tended to show antitumour activity, which was comparable to or greater than that of CDDP. Histopathological and biochemical studies revealed that NC-6004 significantly inhibited the nephrotoxicity of CDDP. On the other hand, blood biochemistry revealed transient hepatotoxicity on day 7 after the administration of NC-6004. Furthermore, rats given CDDP showed a significant delay (Po0.05) in sensory nerve conduction velocity in their hind paws as compared with rats given NC-6004. Electron microscopy in rats given CDDP indicated the degeneration of the sciatic nerve, but these findings were not seen in rats given NC-6004. These results were presumably attributable to the significantly reduced accumulation of platinum in nerve tissue when NC-6004 was administered (Po0.05). NC-6004 preserved the antitumour activity of CDDP and reduced its nephrotoxicity and neurotoxicity, which would therefore seem to suggest that NC-6004 could allow the long-term administration of CDDP where caution against hepatic dysfunction must be exercised.

IntroductionProgrammed death-1 (PD-1), a member of the CD28 costimulatory receptor superfamily, inhibits T-cell activity by providing a second signal to T cells in conjunction with signaling through the T-cell receptor. 1 To date, B7-H1 and B7-DC have been identified as ligands for PD-1 (PD-Ls). During chronic viral infection, PD-1 is selectively up-regulated by the exhausted T cells, and blockade of this pathway restores CD8 ϩ T-cell function and reduces viral load. 2 This signaling system has been recently highlighted in the research of human immunodeficiency virus (HIV) infection. [3][4][5][6] In addition, PD-1 is indicated to be involved in the evasion of tumor immunity. [7][8][9][10] Hodgkin lymphoma (HL) is characterized by massive reactive infiltrates surrounding Hodgkin/Reed-Sternberg (H/RS) cells. HL patients are well recognized as having defective cellular immunity; they are susceptible to bacterial, fungal, and viral infections, and in vitro studies show depressed T-cell proliferation and reduced synthesis of Th1 cytokines. 11 We report here that PD-1-PD-L signaling system is operative in patients with HL, and tumor-infiltrating T cells around H/RS cells seem to be kept in balance by this inhibitory signaling. Our findings illuminate the mechanism for deficient cellular immunity observed in HL patients, and propose a potentially effective immunologic strategy for the treatment of HL. Methods Cell lines and clinical sample preparationThe following cell lines were described previously 12,13 : HL cell lines KM-H2, L428, and HDLM-2; anaplastic large cell lymphoma (ALCL) cell line DEL; follicular lymphoma cell line FL-218; diffuse large B-cell lymphoma (DLBCL) cell line KIS-1; Burkitt lymphoma cell lines Daudi, Raji, Middle 91, Tree 92, and Ramos; adult T-cell leukemia/lymphoma cell line HUT 102; and acute T-cell leukemia cell line Jurkat. LCL-OHN is an Epstein-Barr virus (EBV)-transformed lymphoblastoid B-cell line (LCL). Peripheral blood samples were collected from 19 HL patients, 12 B-NHL patients, and 11 healthy volunteers after informed consent was obtained in accordance with the Declaration of Helsinki. This study is approved by the institutional review board of Kyoto University. After removing red blood cells using ACK lysis buffer, leukocytes were subjected to flow cytometry. For immunohistochemistry, tissue specimens were snap-frozen in OCT compound (TissueTek, Tokyo, Japan) and stored at Ϫ80°C. Reverse transcription-polymerase chain reaction, flow cytometry, and immunohistochemistryTotal RNA was isolated from cells with Trizol (Invitrogen, Carlsbad, CA), and cDNA was synthesized using MultiScribe Reverse Transcriptase (Applied Biosystems, Foster City, CA). PCR assays were performed by the conventional method using Taq polymerase (TaKaRa Biotechnology, Shiga, Japan). For flow cytometry, cells were analyzed on a FACScan (Becton Dickinson, Mansfield, MS). The following antibodies were used: PEconjugated B7-H1 and B7-DC (eBioscience, San Diego, CA), FITC-PD-1 (BD Pharmingen, San Diego, CA), PC5-CD4 a...

BackgroundLymphoid neoplasm with 18q21.3/BCL2 and 8q24/MYC translocation to immunoglobulin (IG) genes as dual-hit lymphoma/leukemia is very rare and known to have a poor clinical outcome. Design and MethodsTo clarify the clinicopathological characteristics of this malignancy, we analyzed 27 cases of cytogenetically proven dual-hit lymphoma/leukemia. ResultsDual-hit lymphoma/leukemia was diagnosed at presentation in 22 cases and at relapse or disease progression in 5 cases. At the time of diagnosis of dual-hit lymphoma/leukemia, extranodal involvement was found in 25 cases (93%) and central nervous system involvement occurred in 15 cases (56%). The median survival and 1-year survival rate of the 27 cases were only 6 months and 22%, respectively, after diagnosis of the dual-hit lymphoma/leukemia. Seven cases of triple-hit lymphoma/leukemia (dual-hit lymphoma/leukemia with 3q27/BCL6 translocation) were included; the median survival of these patients was only 4 months from the diagnosis of the dual-hit lymphoma/leukemia. The duration of survival of the patients with a triple-hit malignancy was shorter than that of the other 20 cases of dual-hit lymphoma/leukemia (p=0.02). The translocation partner of MYC subdivided the dual-hit cases into two groups; 14 cases of IGH and 13 cases of IGK/L. The MIB-1 index was investigated in 14 cases with aggressive B-cell lymphoma, and was higher in the group with MYC-IGH translocation (n=7) than in the MYC-IGK/L group (n=7) (p=0.02). Overall survival was not different between the MYC-IGH translocation group (n=14) and the MYC-IGK or MYC-IGL translocation group (n=13). ConclusionsDual-hit lymphoma/leukemia is a rare but distinct mature B-cell neoplasm with an extremely poor prognosis characterized by frequent extranodal involvement and central nervous system progression with either of the translocation partners of MYC.

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Purpose: The purpose of this research was to evaluate the feasibility of reduced-intensity unrelated cord-blood transplantation (RI-UCBT) in adult patients with advanced hematological diseases.Experimental Design: Thirty patients (median age, 58.5 years; range, 20 -70 years) with advanced hematological diseases underwent RI-UCBT at Toranomon Hospital between September 2002 and August 2003. Preparative regimen composed of fludarabine 25 mg/m 2 on days ؊7 to ؊3, melphalan 80 mg/m 2 on day ؊2, and 4 Gy total body irradiation on day ؊1. Graft-versus-host disease prophylaxis was composed of cyclosporin alone.Results: Twenty-six patients achieved primary neutrophil engraftment after a median of 17.5 days. Median infused total cell dose was 3.1 ؋ 10 7 /kg (range, 2.0 -4.3 ؋ 10 7 /kg). Two transplant-related mortalities occurred within 28 days of transplant, and another 2 patients displayed primary graft failure. Cumulative incidence of complete donor chimerism at day 60 was 93%. Grade II-IV acute graft-versus-host disease occurred in 27% of patients, with median onset 36 days. Primary disease recurred in 3 patients, and transplant-related mortality within 100 days was 27%. Estimated 1-year overall survival was 32.7%. Excluding 7 patients with documented infection, 19 patients displayed noninfectious fever before engraftment (median onset, day 9). Manifestations included high-grade fever, eruption, and diarrhea. The symptoms responded well to corticosteroid treatments in 7 of 13 treated patients.Conclusion: This study demonstrated the feasibility of RI-UCBT in adults.

Immune reactions after RI-CBT can be categorized into three distinct subtypes.

Anthracyclines have long been considered to be among the most active agents clinically available for the treatment of breast cancer despite their toxicity. To improve their pharmacological profiles, a new macromolecular prodrug, denoted NC-6300, was synthesized. NC-6300 comprises epirubicin covalently bound to polyethyleneglycol polyaspartate block copolymer through an acid-labile hydrazone bond. The conjugate forms a micellar structure spontaneously in aqueous media with a diameter of 60-70 nm. The block copolymers are partially substituted with hydrophobic benzyl groups to stabilize the micellar structure. The present study was designed to confirm that polymeric micelles incorporating epirubicin through an acid-labile linker improve the therapeutic index and achieve a broad range of therapeutic doses. Pharmacokinetic studies in rats showed highly enhanced plasma retention of NC-6300 compared with native epirubicin. The maximal tolerated doses in mice of NC-6300 and native epirubicin were 25 and 9 mg/kg, respectively, when administered three times with a 4-day interval between each dose. NC-6300 at 15 and 20 mg/kg with the same administration schedule regressed a Hep3B human hepatic tumor with slight and transient bodyweight loss. Remarkably, NC-6300 also inhibited growth of an MDA-MB-231 human breast tumor at the same dosage. In contrast, native epirubicin at 7 mg/kg administered three times with a 4-day interval was only able to slow tumor growth. Tissue distribution studies of NC-6300 showed efficient free epirubicin released in the tumor at 74% by area under the concentration-time curve (AUC) evaluation, supporting the effectiveness of NC-6300. In conclusion, NC-6300 improved the potency of epirubicin, demonstrating the advantage of NC-6300 attributable to the efficient drug release in the tumor. (Cancer Sci 2011; 102: 192-199) A nthracyclines were first introduced for the treatment of metastatic breast cancer in the 1970s and are still among the most active single agents for the treatment of this disease despite their cardiotoxicity.(1) The aim of increasing their efficacy was first addressed using liposomes.(2) Efforts to design liposomes that are pH-sensitive, temperature-sensitive or antibody-targeted have all been pursued with various degrees of success.(3) However, current clinically approved liposomal formulations have still resulted in only modest increased efficacy for the treatment of cancer.(4) Its actual advantage is reduced toxicity rather than increased therapeutic effect. To increase the efficacy, polymer-based anthracyclines have also been studied extensively. (8,9) Recent strategies have been developed and successfully applied to attain desirable tumor localization through polymeric micelles composed of polyethylene glycol (PEG)-poly (amino acid) block copolymers.(10) These types of strategies involve drug release inside endosomes and lysosomes after cellular internalization, where the slightly acidic pH leads to cleavage of the acid-sensitive linkage.

Epirubicin is widely used to treat various human tumors. However, it is difficult to achieve a sufficient antitumor effect because of dosage limitation to prevent cardiotoxicity. We hypothesized that epirubicin-incorporating micelle would reduce cardiotoxicity and improve the antitumor effect. NC-6300 comprises epirubicin covalently bound to PEG polyaspartate block copolymer through an acid-labile hydrazone bond. The conjugate forms a micellar structure of 40-80 nm in diameter in an aqueous milieu. NC-6300 (10, 15 mg ⁄ kg) and epirubicin (10 mg ⁄ kg) were given i.v. three times to mice bearing s.c. or liver xenograft of human hepatocellular carcinoma Hep3B cells. Cardiotoxicity was evaluated by echocardiography in C57BL ⁄ 6 mice that were given NC-6300 (10 mg ⁄ kg) or epirubicin (10 mg ⁄ kg) in nine doses over 12 weeks. NC-6300 showed a significantly potent antitumor effect against Hep3B s.c. tumors compared with epirubicin. Moreover, NC-6300 also produced a significantly longer survival rate than epirubicin against the liver orthotopic tumor of Hep3B. With respect to cardiotoxicity, epirubicin-treated mice showed significant deteriorations in fractional shortening and ejection fraction. In contrast, cardiac functions of NC-6300 treated mice were no less well maintained than in control mice. This study warrants a clinical evaluation of NC-6300 in patients with hepatocellular carcinoma or other cancers. (Cancer Sci 2013; 104: 920-925) H epatocellular carcinoma (HCC) is the fifth most common cancer and the third largest cause of cancer mortality worldwide.(1,2) The range of available oncological treatment for HCC is sometimes limited due to poor liver function caused by concomitant chronic liver disease, especially liver cirrhosis, which is mainly the result of hepatitis virus infection. Surgical resection is widely considered the mainstay for curative treatment and yields a certain survival rate. However, <20% of patients with HCC can undergo surgical resection. (3,4) With the exception of patients at an early stage and with adequate liver function, recurrence rates after surgical resection are unfortunately high. High recurrence rates are also seen in patients treated by other local treatment options, such as ablation, percutaneous ethanol injection, and trans-arterial chemoembolization.(5) For advanced HCC, the only available option is sorafenib, a tyrosine kinase inhibitor, which was recently approved; however, the survival rate associated with its use is far from satisfactory.