巻号一覧
25 巻, 3 号
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第25回総会
特別講演
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森 和博1984 年 25 巻 3 号 p. 279-287
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありPDF形式でダウンロード (725K)
教育講演
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—急性転化を中心として—宇塚 善郎1984 年 25 巻 3 号 p. 288-298
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありA unifying concept of the development of the terminal transformation in chronic myelogenous leukemia is presented. The attention was limited to the four areas in which new information has been accumulated rescently; Clinical features, cytogenetics, in vitro colony assay for hemopoietic stem cell, and new approaches to treatment of patients in transformation.
Currently available evidence suggests that the Ph1 positive clone may originate in a single pluripotential stem cell and transition to a more aggressive terminal phase of the disease is usually accompanied by evidence of cytogenetic evolution. The disease provides us with a opportunity for investigating genotypic and phenotypic changes paralleling the development and progression of a malignant hemopoietic stem cell clone.
The nature of stem cell defect and associated humoral regulatory imbalance which confer on the Ph1 positive clone a proliferative advantage over normal stem cells was demonstrated. Many aspects of the treatment of patients in transformation are reviewed.
Preliminary results of syngeneic and allogeneic marrow transplantation for patients still in chronic pahse suggest one possible avenue to successes in curative treatment of CML.
Although attempts to obtain clinical benefit with chemotherapy have been in general disappointing, our combination program with vindesine, cytosine arabinoside, and prednisolone resulted in high complete remission rate in patients with CML in lymphoid and myeloid crisis as well.抄録全体を表示PDF形式でダウンロード (808K) -
—その多様性と生物学的活性—矢原 一郎1984 年 25 巻 3 号 p. 299-304
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありRecent Pregress of lymphokine research is noted based on our own investigations as examples. Subjects dealt with in this review are: (a) Molecular structure of IL2 and IL3. (b) Emergence and disappearance of IL2 receptors. (c) Lymphocyte stimulation and lymphokines. (d) Lymphokines produced by T cell clones.抄録全体を表示PDF形式でダウンロード (403K)
臨床研究
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—病型分類の試み—河野 文夫, 山口 一成, 西村 弘道, 津田 弘之, 真田 功, 石井 正夫, 麻生 範雄, 中川 幹子, 高月 清1984 年 25 巻 3 号 p. 305-312
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありThirty-two patients of adult T-cell leukemia (ATL) were studied. The birth places of the patients were all located in Kyushu districts with one exception, and 22 of them were in Kumamoto prefecture. As for anti-ATLA (ATL-associated antigen), twenty-nine patients were examined to be all positive. Considering clinical feature and course of 32 cases they were classified in four types. They were smoldering, chronic, crisis and acute type including both therapy resistant and therapy sensitive groups. These types were found to be utterly different from each other in clinical feature, in complication, and in prognosis, which might suggest that therapies should be different by types. For smoldering and chronic types, therapy was not recomendable. Then, for crisis and acute types, intensive chemotherapy was necessary. Yet, cases of acute type ended in poor prognosis in spite of the intensive chemotherapy. More effective therapy are required for them.抄録全体を表示PDF形式でダウンロード (1051K) -
白幡 聡, 中村 外士雄, 朝倉 昭雄, 田中 正章, 椎木 みどり1984 年 25 巻 3 号 p. 313-321
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありMean platelet volume (MPV) and platelet distribution width (PDW) were examined by Coulter Counter model S plus in 49 children with thrombocytopenia (platelet count, 50,000-100,000/μl) consisting of 15 cases with acute idiopathic thrombocytopenic purpura (ITP), 8 with chronic ITP, 14 with acute leukemia, 2 with neuroblastoma and 10 with miscellaneous diseases.
MPV was significantly increased in the patients with ITP, infections and mixed connective tissue disease (MCTD), whereas MPV in those with the malignancies, liver cirrhosis, Kasabach-Merritt syndrome and hemolytic uremic syndrome was normal. MPV in the patients with ITP, infections and MCTD was decreased as the platelet count increased, and it was normalized when the patients' platelet counts reached the normal range.
Significant increase of PDW was noted in all patients with platelet counts between 50,000 and 100,000/μl. PDW was decreased as the platelet count increased, reaching the normal level simultaneously with normalization of the platelet count, except in malignancies where PDW was still increased when platelet counts were normalized. Transient increases of MPV and PDW were observed at the recovery stage in patients with Kasabach-Merritt syndrome and hemolytic uremic syndrome.抄録全体を表示PDF形式でダウンロード (656K) -
檀 和夫1984 年 25 巻 3 号 p. 322-328
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありPatterns of the CFU-C colony growth were studied on bone marrow aspirates in 35 patients with acute non-lymphocytic leukemia (ANLL) by the monolayer semi-solid agar method using a human leukocytes conditioned medium as a source of colony stimulating activity. Each patient was classified into one of the follwing three groups according to the growth pattern at diagnosis: group I, no growth; group II, numerous clusters with no colony formation; group III, colonies and numerous clusters with an abnormal cluster to colony ratio. The patients received antileukemic combination chemotherapies including daunorubicin and/or cytosine arabinoside. Complete remissions were attatined in 10 of 19 (53%) in group I, in 9 of 10 (90%) in group II, and in 1 of 6 (17%) in group III, the differences in remission rates between groups I and II, and II and III being statistically significant. Neither the age, initial counts of leukocytes, blasts and platelets nor hemoglobin concentration was correlated with therapeutic responses in this series of patients. A normal pattern of CFU-C colony growth was recovered in a sustained remission while the colony count remained subnormal in the remission showing an early relapse. It is concluded that the CFU-C assay in ANLL patients is useful for assessment of the quality of remission as well as for prediction of the response to induction chemotherapy.抄録全体を表示PDF形式でダウンロード (443K) -
II. 抗体産生におけるHelper機能障害舩渡 忠男, 小出 朝男, 平沢 康, 大谷 英樹, 斎藤 正行1984 年 25 巻 3 号 p. 329-336
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありEffect of peripheral blood monocytes from patients with multiple myeloma on immunoglobulin production by normal lymphocytes was investigated. The monocytes from twelve of nineteen patients suppressed the capacity of B-lymphocytes to mature into immunoglobulin-secretory cells.
In the other these patients the helper function of monocytes for immunoglobulin synthesis by lymphocytes was impaired. In addition, the monocytes after treatment with neuraminidase were restored to accelerate the immunoglobulin synthesis. It was suggested from these findings that the activity of these monocytes from certain cases with multiple myeloma might be influenced by sialic acid on their surface.抄録全体を表示PDF形式でダウンロード (560K) -
—一般化学療法との比較を中心に—吉田 喬, 原田 実根, 舟田 久, 森 孝夫, 末永 孝生, 塩原 信太郎, 石野 千津子, 大竹 茂樹, 尾高 和亮, 手島 博文, 近 ...1984 年 25 巻 3 号 p. 337-345
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありEight patients with acute lymphoblastic leukemia (4 patients in remission and 4 patients in relapse) were treated with cyclophosphamide (60mg/kg×2 days) and total body irradiation (10 Gy) followed by allogeneic bone marrow transplantation from their HLA-identical siblings. Nineteen patients were treated with convetional chemotherapy as the first remission induction therapy. Four (50%) of transplantation group are alive for 7 to 61 months in unmaintained remission; four (21%) of the chemotherapy group are alive for 3 to 11 months in maintained remission. Relapse and sepsis were the major causes of failure in both groups, interstitial pneumonia and hepatic venoocclusive disease were the other major causes of morbidity and mortality in transplantation group. In summary, allogeneic bone marrow transplantation to young adults with ALL in the first or second complete remission may offer the best chance of long term remission or cure.抄録全体を表示PDF形式でダウンロード (695K)
症例
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冨本 秀和, 工藤 寛之, 山村 隆, 安田 譲, 稲田 雅美, 中村 重信, 亀山 正邦, 北 堅吉, 高 大成1984 年 25 巻 3 号 p. 346-351
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありAn autopsy case of chronic myelogenous leukemia (CML) associated with erythroblastic crisis is reported. The 31-year-old male had been proved CML for forty months. The patient was admitted to our department because of bilateral leg pain in February 1981. Physical examination revealed anemic conjunctiva, marked splenomegaly and generalized lymphadenopathy. Anemia and leukocytosis with shift to the left were recognized on laboratory examination. In addition there existed PAS stain positive erythroblastoid cells with low N/C ratio and round granular nucleus. Erythroblastoid cells were counted to 194 per 200 leukocytes. He was placed on vincristin, predonisolone, 6MP (VPM). The total WBC and immature cells were reduced in number. Two months later the patient developed fever, marked lymphadenopathy and died of gastrointestinal bleeding in spite of intensive treatment with blood transfusion.抄録全体を表示PDF形式でダウンロード (793K) -
赤星 雅, 滝川 倫, 萩原 誠久, 押味 和夫, 溝口 秀昭, 岡田 美智子, 榎本 康弘, 渡辺 陽之輔, 今井 三喜1984 年 25 巻 3 号 p. 352-358
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありA case of primary myelofibrosis terminating in acute megakaryoblastic leukemia is reported. A 60-year-old female was admitted because of fever and progressive anemia. Erythroblasts, poikilocytosis and high platelet count were already observed in the peripheral blood 4 years prior to admission when she received mastectomy for breast cancer. On admission, she was diagnosed as having primary mylofibrosis because of splenomegaly, bone marrow fibrosis, and peripheral blood leukoerythroblastosis and poikilocytosis. When the previous findings were taken together, she seemed to have been suffering from primary myelofibrosis for more than 4 years. Two months after admission, blasts appeared in the peripheral blood and gradually increased in number. The blasts were identified as megakaryoblasts because platelet peroxidase was positive. Chromosomal analysis of the peripheral blood showed direct dup (1 q) and t(3; 21). She developed cerebral infarction and died 3 months after admission. An autopsy revealed that blasts with similar morphology massively infiltrated into the pleura, skin, spleen, liver and bone marrow, accompanied with remarkable fibrosis.
As far as we know, this is the first report of acute megakaryoblastic leukemia following primary myelofibrosis, in which the leukemic blasts were identified as megakaryoblasts by the presence of platelet peroxidase. It is interesting to note chromosomal abnormality in No. 3, because the relationship between chromosome No. 3 and the abnormality in megakaryopoiesis had been reported.抄録全体を表示PDF形式でダウンロード (1417K) -
名取 英世, 田中 健, 江上 康一郎, 中村 栄治, 加地 正郎, 本告 匡1984 年 25 巻 3 号 p. 359-364
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありA 47-year-old female was admitted to our hospital because of cervical lymphadenopathy in April 1982.
She was diagnosed as immunoblastic lymphadenopathy by cervical lymph node biopsy and treated with Predonine, showing some responses.
In June when generalized lymphadenopathy was found she was treated with VEPA (Vincristine, Endoxan, Predonine, Adriamycin) and responded gradually.
Although she was discharged from the hospital thereafter, she was readmitted because of fever, general fatigue and generalized lymphadenopathy in October. Her temperature on readmission was 38.6°C. Generalized lymphadenopathy and hepatosplenomegaly were realized and severe pancytopenia (Hb-9.8g/dl; white cell count-1,400/cmm; platelet count-56,000/cmm) was also proved. The bone marrow was hypocellular with 5.2% histiocytes with phagocytes. Total bililubin, lactic dehydrogenase and serum iron were increased, and haptoglobin decreased. Direct coombs test was positive.
She was treated with Predonine, Vincristine, Endoxan and several antibiotics again, but she died two months after readmission.
Autopsy findings revealed no malignant histiocytes with phagocytes in the bone marrow, lymph nodes and spleen.抄録全体を表示PDF形式でダウンロード (1101K) -
山根 行雄, 枝川 潤一, 西田 一弘, 津田 昌一郎, 前川 平, 谷脇 雅史, 薗田 精昭, 三沢 信一, 阿部 達生, 瀧野 辰郎1984 年 25 巻 3 号 p. 365-371
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありA 62-year old female with plasma cell leukemia (Ig-G, κ) is reported. There was intermediate period of multiple myeloma, treated with cyclophosphamide and melphalan for 2 years. Cytogenetic study was revealed complicated chromosomal abnormalities. The modal number was 39, 41 and 78, and 13 (31.6%) out of 41 cells examined are pseudodiploid chromosome constitation. Two consistent structual rearrangements, t(1; 6) (q44; q16), der (22) dup t(22; 12) (q12; q11 q24) were found and double minute chromosome (DM) was also observed. It was believed that DM contained the amplified DHFR gene copies, and was presumed the relationship between DM and resistance to chemotherapy. Our case was resistant to combination chemotherapy. The significance of 14q+ marker and DM was discussed.抄録全体を表示PDF形式でダウンロード (1514K) -
佐野 元春, 浅野 洋治, 杉本 裕之, 児玉 秀文, 井上 梅樹, 友安 茂, 鶴岡 延熹1984 年 25 巻 3 号 p. 372-376
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありA 14-year-old male was admitted on June 3, 1982 because of pyrexia and nosebleed. Physical examination revealed neither lymphadenopathy nor hepatosplenomegaly.
Laboratory examination showed RBC 137×104/cmm, hemoglobin 4.9 g/dl, Ht 13.5%, platelets 1.1×104/cmm, and WBC 6,600/cmm with 38.5% myeloblasts and 3% promyelocytes. Auer's bodies were observed in immature leukemic cells and in mature neutrophils with pseudo-Pelger-Huët's anomaly. Neutrophil alkaline phosphatase (NAP) activity was low. A sternal marrow aspiration disclosed hypercellular marrow (nucleated cell count, 272,000/cmm) with 64.9% myeloblasts and 1.9% promyelocytes. A diagnosis of acute myeloblastic leukemia (M2 in FAB classification) was made. A complete remission was obtained by combination chemotherapy with daunomycin, Ara-C, BH-AC and prednisolone. Auer's bodies in both blast cells and mature neutrophils disappeared and NAP activity rose to normal level after complete remission. In this case, neutrophils with Auer's bodies might orignate from immature leukemic cells. It is suggested that leukemic cells differentiate to mature neutrophils in some case of acute myeloid leukemia.抄録全体を表示PDF形式でダウンロード (737K) -
中村 喜行, 斉藤 博, 宜保 行雄, 鈴木 陽一, 今井 俊輔, 鍛治 良一, 北野 喜良, 門野 聡, 飯島 康美, 川上 裕隆, 古田 ...1984 年 25 巻 3 号 p. 377-382
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありA case of adult T-cell leukemia (ATL) and the studies on ATL virus infection in the family member are reported.
The patient, 74 years old man, visited our hospital because of skin eruption and upper-abdominal fullness. He was born and had been in Okinawa Prefecture until his 16 years of age when he moved to and has been living in Matsumoto city where ATL is nonendemic. His peripheral white blood cell count was 38,000, with 59% of abnormal lymphocyte with lobulated, gyruslike appearing nuclei. Bone marrow aspiration showed also 61% of such abnormal lymphocyte. The surface marker analysis of these lymphocytes revealed a character of inducer T-cell. Antibody to ATL-cell associated antigen was positive in his serum and also in the serum of his daughter. ATL virus genom was found to be integrated into DNA of the patient's leukocyte and also of the leukocytes of his wife and a son, both of whom were born and raised in Matsumoto city and had never visited the ATL endemic area.
These results indicated that the vertical and/or horizontal infection could be a mode of the ATL virus transmission in this family.抄録全体を表示PDF形式でダウンロード (861K) -
吉田 弥太郎, 山岸 司久, 福原 資郎, 沢田 博義, 大熊 稔, 内野 治人, 中村 徹1984 年 25 巻 3 号 p. 383-392
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありThree cases of atypical myeloproliferative disorders were presented. These patients had had symptoms of fatigue for months before being seen. The blood picture was characterized by pancytopenia and morphological abnormalities of the three hemopoietic cell lineages including the presence in the blood of nucleated red cells, megakaryocytes and immature blast cells. The bone marrow aspiration always yielded a dry tap. The marrow biopsy revealed varying degrees of myelofibrosis and increasing numbers of megakaryocytes. The clinical course after diagnosis ranged from 11.5 to 63 months. In all 3 cases there was no evidence for extramedullary hemopoiesis throughout the course nor myeloid metaplasia in any organ at autopsy.抄録全体を表示PDF形式でダウンロード (1421K) -
松下 修三, 松崎 博充, 河野 文夫, 満屋 裕明, 山口 一成, 桜井 健一, 竹宮 聖隆, 高月 清1984 年 25 巻 3 号 p. 393-398
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありA case of non-secretory multiple myeloma accompanied with gastric carcinoma is reported. A 56 year old man was admitted to our hospital because of semicoma due to hypercalcemia. The E.S.R. was 65 mm/hr. Bence Jones protein in urine was negative. Plasma cell like abnormal cells were found in bone marrow (B.M.) and peripheral blood. But no M-protein was detected in the serum or concentrated urine by immunoelectrophoresis. Further study of immunoperoxidase staining of B. M. cells revealed the monoclonal proliferation of kappa light chain containing cells. And plaque forming cell assay (P.F.C. assay) of peripheral blood mononuclear cells showed monoclonal proliferation of kappa light chain secreting cells. Biopsy of gastric mucosa disclosed moderately differentiated adenocarcinoma. In this case, the existence of kappa light chain synthesis and secretion have been proved, although M-protein in serum and urine was not found. These observations suggest that secreted protein disappeared by enhanced catabolism or rapid deposition. This type of non-secretory myeloma have been speculated but there have been no evidence. We demonstrated it with P.F.C. assay for the first time. The patient was complicated with early stage gastric cancer, which makes him more impressive.抄録全体を表示PDF形式でダウンロード (750K) -
上塚 芳郎, 井上 康夫, 馬渕 友良1984 年 25 巻 3 号 p. 399-404
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありA case of methyldopa induced autoimmune hemolytic anemia accompanied by multiple cerebral infarction was reported.
A 65 year old woman was admitted because of consciousness loss and left hemiplegia. Laboratory findings on admission showed marked anemia with RBC count of 880,000/mm3 and hemoglobin value of 4.1 g/dl. Indirect bilirubin was increased up to 5.3 g/dl.
The diagnosis of methyldopa induced hemolytic anemia with cerebrovascular accident was made. CT scan of the brain showed multiple low density areas. Cerebral angiography revealed the occlusion of both right anterior cerebral artery and left posterior cerebral artery. These findings suggested that cerebral infarction occurred simultaneously at the different site of the brain.
Authors speculate that severe hemolysis induced by methyldopa causes ADP liberation from the destroyed RBC, and activates platelet aggregation resulting in the occurrence of multiple cerebral infarction.抄録全体を表示PDF形式でダウンロード (1323K) -
中山 志郎, 永井 謙一, 吉田 輝夫, 矢部 榑樹, 井谷 舜郎, 高橋 隆幸, 星野 孝1984 年 25 巻 3 号 p. 405-412
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありA 47-year-old male patient was hospitalized with a complaint of high fever which persisted for 2 months in spite of various antibiotics therapy. On admission his spleen was palpable 8cm below the costal margin. The peripheral blood showed RBC 470×104/mm3, Hb 13.0g/dl, WBC 3,300/mm3, and platelet 27.3×104/mm3. WBC differential count demonstrated 1.0% myelocytes, 4.5% metamyelocytes, 12.5% band forms, 4.0% segmented neutrophils, 18.0% eosinophils, 20.0% basophils, 8.5% monocytes and 44.5% lymphocytes. NAP score was 137. A bone marrow aspirate revealed a normal M/E ratio and a slight maturation disturbance in granulocytic series with 5.2% of blastic cells. Cytogenetic analysis of the bone marrow cells revealed a karyotype of 46, XY, t(8q-; 22q+), t(9q+; 22q-) in almost all metaphases examined. Because of persistent high fever and gradual progress of neutropenia, he was placed on prednisolone 30mg daily which made him afebrile on the next day, and thereafter WBC counts began to rise gradually. About 9 months after the onset of therapy, WBC counts estimate over 3×104/mm3 with a typical pattern of CML, and a bone marrow aspirate showed intense granulocytic hyperplasia. Bone marrow cytogenetic studies at this time revealed the presence of Ph1 chromosomes alone with a disappearance of t(8q-; 22q+). Since then, he was put on dibromomanitol therapy, and has been in complete remission for about 3 years.
It could be concluded that our case are CML preceded by so-called clinical blastic crisis, because there was no evidence suggestive blastic transformation hematologically, and t(8q-; 22q+) was an additional chromosomal abnormality frequently seen in blastic phase of CML. Some discussions were made in concern with published reports describing few cases who developed typical CML shortly after VP therapy from ALL.抄録全体を表示PDF形式でダウンロード (774K)
例会
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1984 年 25 巻 3 号 p. 413-437
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありPDF形式でダウンロード (2408K)
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