L-アスパラギナーゼ，ブレオマイシン持続静注法により完全寛解に至った治療不応性の鼻腔原発びまん性大細胞型悪性リンパ腫の1例

抄録

In December 1983, a 44-year-old female was admitted to the Keio University Hospital because of fever and general malaise. The physical examination disclosed several firm bilateral lymphnodes, a left breast mass, hepatosplenomegaly and a nasal mass. The histologic findings of nasal, neck and breast masses were compatible with diffuse large cell type non-Hodgkin's lymphoma. The Ga⁶⁷ scan showed multiple pulmonary involvements (stage IV).
Combination chemotherapies consisting of cyclophosphamide, adriamycin, vincristine and prednisolone (CHOP) and of cyclophosphamide, vincristine, prednisolone and cytarabine (COP-Ara-C) were ineffective, and the disease progressed rapidly in spite of severe pancytopenia due to antineoplastic agents.
A new sequential two-drug regimen consisting of L-asparaginase and bleomycin (ABLE protocol) was begun in April 1984. Five thousand units per day of L-asparaginase were given intravenously for 14 days (days 1∼14), followed by 15mg/m²/d of bleomycin infused intravenously over 24 hrs. for 7 days (days 22∼28). A complete remission was obtained with the first course of the treatment. After an additional course of the identical schedule as the consolidation, she is remaining in unmaintained remission at the time of writing (6+month).
The side effects of the regimen were mild pruritic skin rashes and mild liver dysfunction, neither of which required treatment. The bone marrow suppression and the lung toxicities were not significant. The ABLE protocol is a new encouraging salvage chemotherapy for advanced refractory aggressive non-Hodgkin's lymphomas.