1988 Volume 29 Issue 2 Pages 237-242
A 46-year-old male was admitted to our hospital and was diagnosed as acute myelomonocytic leukemia (AMMoL) on August 14, 1986. On admission, peripheral white blood cell count was 201×103/μl with 90.5% leukemic cells, monocytoid 5.0%; red blood cell count 1.65×106/μl; hemoglobin 6.1g/dl; hematocrit 17.2%; and platelet count 16×103/μl. With the combination chemotherapy consisted of behenoyl-ara-C, daunomycin, 6-mercaptopurine and prednisolone, he was successfully induced in complete remission, and consolidation therapy was carried out. But suddenly on September 29, serum GOT and GPT levels rose up to 8,580 U and 8,074 U, respectively. On October 1, the clinical diagnosis of fulminant hepatitis (perhaps with non-A, non-B virus) was made. Hematological data showed WBC 16×103/μl with 75% of atypical lymphocytes, RBC 2.18×106/μl and platelets 69×103/μl. The lymphocytosis disappeared on Oct. 4 and he recovered from hepatitis. The Southern blot analysis of this case showed germ line patterns of immunoglobulin and T cell receptor genes from peripheral mononucleated cells digested with restriction endonucleases on admission; on the other hand, digested with BamHI, rearrangement of the gene for the beta chain of the T cell receptor was found when T8 lymphocytosis appeared. Therefore, it is suggested that monoclonal proliferation means not necessarily neoplastic.
