Patients who have undergone hematopoietic stem cell transplantation (HSCT) for hematological disease experience high mortality when infected by coronavirus disease 2019 (COVID-19). However, the safety and efficacy of the COVID-19 vaccine in HSCT patients remain to be investigated. We prospectively evaluated the safety and immunogenicity of the BNT162b2 mRNA COVID-19 vaccine (Pfizer BioNTech) in 25 Japanese allogeneic HSCT patients in comparison with 19 healthy volunteers. While anti-S1 antibody titers in almost all healthy volunteers after the second dose were higher than the cut-off value reported previously, levels in HSCT patients after the second dose were diverse. Nineteen patients (76%) had seroconversion of anti-S1 IgG. The median optical density of antibody levels in HSCT patients with low IgG levels (<600 mg/dL), steroid treatment, or low lymphocytes (<1000/μL) was significantly lower than that in the other HSCT patients. There were no serious adverse events (>Grade 3) and no new development or exacerbation of graft-versus-host disease after vaccination. We concluded that the BNT162b2 mRNA vaccine is safe and effective in Japanese allogeneic HSCT patients.

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We investigated the efficacy of BNT162b2 mRNA COVID-19 vaccine in patients with B-cell malignancies treated with anti-CD20 antibody. Although T-cell-mediated immune responses were detected even in patients receiving R-CHOP treatment, the S1 antibody titer following BNT162b2 vaccination remained only marginally increased for more than 3 years after the final dose of anti-CD20 antibody. We found no relationship between the percent of B-cells and S1 antibody titer. The duration of this suppression was much longer than we anticipated. Further protection and treatment strategies against COVID-19 for these patients are warranted.

Among B-cell non-Hodgkin's lymphomas, neural cell adhesion molecule/CD56 expression is exceptional. In this study, seven cases of CD56-positive diffuse large B-cell lymphoma (DLBCL) are described. The frequency of CD56-positive DLBCL was 7% in our hospital. Four of seven (57.1%) cases expressed both CD10 and bcl-6 suggestive of a germinal center B-cell phenotype. Six of seven (85.7%) cases expressed bcl-6. Two cases expressed aberrant T cell-associated antigens, one each of CD7 and CD8. However, none of these seven cases showed CD5 expression. No significant difference was observed between CD56-positive and CD56-negative DLBCL in terms of the five international prognostic index risk factors. However, all seven cases had at least one extranodal involvement and showed a good response to initial treatment. The predominance of extranodal involvement in our series may be associated with the adhesion-related function of CD56. A high frequency of bcl-6 expression may be associated with a more favorable clinical course and prognosis.

Dear Editor, Chromosomal translocations involving ETV6 at 12p13 and ABL1 at 9q34 are very rare, but are very rare but recurrent aberrations in hematological malignancies including BCR/ ABL1-negative chronic myeloid leukemia (CML), myeloproliferative neoplasm (MPN), and acute leukemia [1,2]. The resultant ETV6/ABL1 fusion protein is thought to play a crucial role in leukemic transformation by the constitutive activation of tyrosine kinase [1]. Similar to BCR/ABL1-positive CML, it has been reported that several cases of ETV6/ABL1-positive CML/MPN presented with blast crisis (BC) in lymph nodes as well as bone marrow [3][4][5][6][7]. Here, we describe the first case of extramedullary T-lymphoid BC of ETV6/ABL1-positive MPN.A 31-year-old man was admitted because of generalized lymphadenopathy and leukocytosis. Peripheral blood values were hemoglobin 113 g/L, platelets 438×10 9 /L, and leukocytes 50.7×10 9 /L with 20 % myelocytes, 17 % metamyelocytes, 10 % band forms, 32 % segmented neutrophils, and 11 % eosinophils. Bone marrow was hypercellular with myeloid hyperplasia and prominent eosinophilia, and compatible with MPN ( Fig. 1a-c). Pathological examination of inguinal lymph nodes was consistent with T-lymphoblastic lymphoma (T-LBL) (Fig. 1d). Immunohistochemistry showed that lymphoma cells were positive for CD3, CD1a, and TdT (Fig. 1e). The patient was treated by dasatinib with hyper-CVAD protocol followed by myeloablative allogeneic stem cell transplantation (SCT). However, he died of idiopathic pneumonia syndrome, 11 months after initial diagnosis.G banding and spectral karyotyping of bone marrow cells on admission showed 46,XY,der(9)t(9;12)(q34;p13), del(12)(p13)[1]/46,sl,t(7;14)(p13;q11.2)[18]/47,sdl1,+19[1] (Fig. 2a). The karyotype of lymph node cells was similar as follows: 46,XY,t(7;14)(p13;q11.2),der(9)t(9;12) (q34;p13),del(12)(p13) [4]. Fluorescence in situ hybridization (FISH) on metaphase spreads of bone marrow cells detected the ETV6/ABL1 fusion signal on the der(9)t(9;12)(q34;p13) ( Fig. 2b). FISH on interphase nuclei of lymph node cells also confirmed the ETV6 /ABL1 fusion signals (Fig. 2c). Reverse transcription-polymerase chain reaction (RT-PCR) demonstrated two types of ETV6 /ABL1 fusion transcripts (types B and A) only in bone marrow cells of the patient (Fig. 2d) [2]. Southern blot analyses of lymph node cells showed rearrangement of TRD@ Jδ1, but germline configuration of IGH@ JH, TRB@ Cβ1, and TRG@ Jγ (data not shown).We have detected a rare translocation der(9)t(9;12) (q34;p13) resulting in an ETV6 /ABL1 fusion gene. We confirmed an expression of the fusion transcripts in

Scopulariopsis alboflavescens is a soil saprophyte that is widely distributed in nature. Recently, there have been increasing number of reports of invasive infections with Scopulariopsis species in immunocompromised patients. In this report, we described an adult woman with acute myeloid leukemia and who developed S. alboflavescens pneumonia. Liposomal amphotericin B and voriconazole combination therapy was unsuccessful and the patient died because of pneumonia. Scopulariopsis is highly resistant to available antifungal agents and almost invariably fatal. This case report should alert clinicians to the importance of listing Scopulariopsis as a pathogenic fungus in immunocompromised patients.

Immune reconstitution affects clinical outcomes after allogeneic hematopoietic stem cell transplantation (HSCT), and it has been suggested that lymphocyte recovery affects survival after HSCT. However, few studies have examined lymphocyte recovery in Asian patients who received mycophenolate mofetil (MMF) prophylaxis for graft-versus-host disease. We retrospectively evaluated early lymphocyte recovery after HSCT among Japanese adults who received MMF prophylaxis. Patients were divided into two groups according to their median absolute lymphocyte count (ALC) on day 28 after HSCT as follows: the "low ALC group" (≤ 0.22 × 10 cells/L) and the "high ALC group" (> 0.22 × 10 cells/L). With a median follow-up of 317 days, the high ALC group showed significantly better overall survival than the low ALC group (at 1 year: 62 vs. 46%, P = 0.02). The high ALC group also tended to have better non-relapse mortality than the low ALC group (at 1 year: 13 vs. 23%, P = 0.08). There was no significant difference in relapse rate between the high and low ALC groups (at 1 year: 29 vs. 35%, P = 0.2). We conclude that among Japanese patients who received MMF prophylaxis, ALC on day 28 after HSCT was effective in predicting overall survival and non-relapse mortality.