2022 年 48 巻 3 号 p. 136-142
A 67-year-old man with acute promyelocytic leukemia (APL) with severe renal dysfunction due to diabetes started induction therapy after hemodialysis. Most APL treatments are renal excretion-type drugs, and there are no clear standards for dosage reduction. In addition, there are no case reports on induction therapy of triple-drug combination with daunorubicin (DNR), cytarabine (Ara-C), and all-trans retinoic acid (ATRA) for hemodialysis patients. We started DNR 36 mg/m2 for three days, Ara-C 70 mg/m2 for five days, and ATRA 12 mg/m2 with reference to the APL2000 study and case reports, resulting in hematological remission. The consolidation therapy was designed with reference to the JALSG APL97 study and case reports. The first course of consolidation therapy of mitoxantrone (MIT) 4.2 mg/m2 for three days and Ara-C 100 mg/m2 for five days was started. The second course of consolidation therapy was DNR 30 mg/m2 for two days and Ara-C 100 mg/m2 for five days. In the third course of consolidation therapy, Ara-C 100 mg/m2 was administered for five days, and molecular biological remission was obtained. This patient is still progressing without recurrence (988 days after the start of treatment). This case report presents one of the safe and effective administration methods of APL therapeutic drugs for patients with primary APL with severe renal dysfunction.
