巻号一覧
25 巻, 9 号
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綜説
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高橋 隆一1984 年 25 巻 9 号 p. 1371-1379
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありRecently it is accepted that immunodeficiency such as congenital immunodeficiency, autoimmune diseases and organ transplant recipients are associated with a high risk of malignancy, especially malignant lymphoma. Therefore, relationship between immunodefiency and the development of malignant lymphoma has been attracted attention. But in Japan reviews concerned with this problem have been seldom reported probably because of poor attention.
Author experienced eight cases of malignant lymphoma occurred subsequent to autoimmune diseases and feel that such cases are not rare, so the development of malignant lymphoma associated with immunodeficiency is reviewed from literatures to attract attention.
Ninety cases of malignant lymphoma occurred during course of autoimmune dieases were summed up from literatures and questionaire and analysed. Results were as follows: 1) Collagen diseases (especially Sjögren's syndrome and SLE) were most frequent as basic autoimmune diseases. 2) Cases treated with immunosuppressive agents were unexpectedly few. 3) When malignant lymphoma occurred, in about half basic autoimmune diseases got better.抄録全体を表示PDF形式でダウンロード (695K)
臨床研究
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岩田 吉史, 仮谷 嘉晃, 田中 公, 小林 透, 大野 敏之, 影山 慎一, 片山 直之, 片岡 吉貴, 神尾 典彦, 太田 千鶴子, 康 ...1984 年 25 巻 9 号 p. 1380-1387
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありTwenty patients with multiple myeloma were treated with a combination chemotherapy, consisting of melphalane, cyclophosphamide, ACNU, vincristine, and prednisolone (modified M-2 protocol). Twelve of 20 patients had no prior treatment, while 8 of 20 had been resistant to melphalane or cyclophosphamide.
A good response was obtained in 11 of 20 cases (55%), and a limited response in 5 of 20 cases (25%). The response rate was 80% in total cases. The response rate in the patients with high tumor mass (Stage III) was higher than that with low tumor mass (Stage I, II).
Modified M-2 protocol appered to be effective not only as induction therapy for high tumor mass patients, but also for such patients as resistant to melphalane-prednisolone.抄録全体を表示PDF形式でダウンロード (520K) -
—VincristineおよびPrednisolone (VP) 先行療法の意義について—斉藤 憲治, 梶谷 博, 奥山 明彦, 大里 守彦, 原 正彦, 渡辺 完爾, 土橋 雄介, 山崎 竜弥, 浜口 裕之, 坂巻 寿, 榎原 ...1984 年 25 巻 9 号 p. 1388-1393
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありFourteen adults with previously untreated acute lymphocytic leukemia (ALL) were treated initially with vincristine and prednisolone (VP) alone, and other agents including an anthracycline if the initial response was poor after about two weeks. Seven cases attained a complete remission (CR) with VP alone, and three of the other seven patients achieved CR after adding other agents, giving an overall CR rate of 71.4%. It seems possible to roughly estimate the possibility of inducing CR with VP alone from the degree of a decrease in the number of blasts in blood and bone marrow about two weeks after the start of VP therapy. At this time an increase in the counts of neutrophils and platelets was seen in some of the unresponders as well as the responders to the treatment with VP alone.
From our results and a review of the literature, we conclude that initial treatment with VP alone or plus L-asparaginase followed by an anthracycline is one of the excellent induction therapies for adult ALL, because this strategy can reduce the risk for life-threatening infection and bleeding during the intensive induction therapy.抄録全体を表示PDF形式でダウンロード (406K) -
上田 正博, 吉川 敏一, 小野寺 秀記, 出口 雅子, 村上 正志, 古川 泰正, 竹村 周平, 加藤 治樹, 杉野 成, 近藤 元治1984 年 25 巻 9 号 p. 1394-1401
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありThe effect of methylprednisolone on disseminated intravascular coagulation (DIC) was investigated in 3 DIC cases developed from abdominal aortic aneurysm (case 1), peritonitis carcinomatosa due to gastric cancer (case 2) and miliary tuberculosis (case 3). The diagnosis of DIC and severity were graded based on the “DIC team” scoring system.
After the administration of methylprednisolone, each case recovered from DIC as judged by the scores: from 8 to 5 (case 1), from 7 to 5 (case 2) and from 7 to 0 (case 3), respectively. In the case 3 with miliary tuberculosis, therapeutic effect of methyl-prednisolone was enhanced by the simultaneous use of FOY.
The present investigation suggested that administration of methylprednisolone is useful in the treatment of DIC by itself, or by the combination of anticoagulant therapy.抄録全体を表示PDF形式でダウンロード (494K) -
大西 昌之, 品田 章二, 柴田 昭1984 年 25 巻 9 号 p. 1402-1407
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありThe granulocyte chemiluminescence (CL) was examined on 22 occasions using a Monolight 401 photometer in 16 patients with chronic myeloid leukemia (CML) and paired healthy controls. The chemiluminescence index (CLI) was calculated by dividing the maximum CL value of a CML patient with that of the paired control.
Depending on the CLI, CML patients were classified into three groups; the high-index group consisting of seven patients (CLI=1.70±0.45, Mean±SD, n=9), the normal-index group of seven patients (0.99±0.12, n=10), and the low-index group of two patients (0.46±0.04, n=3).
The CLI was related to the neutrophile alkaline phosphatase (NAP) score, clinical stage, and previous busulfan therapy. The NAP score had no relation to the CLI. Two patients, so far studied, showed little changes in the CLI at different clinical stages. The mean CLI of patients with and without previous busulfan therapy was 1.27±0.45 (n=9) and 1.20±0.72 (n=9) respectively.
Our data strongly suggest the heterogeneity of the CLI in CML patients.抄録全体を表示PDF形式でダウンロード (426K) -
長阪 みはる, 前田 盛, 杉山 武敏, 馬渕 理, 見須 英雄, 中村 しのぶ1984 年 25 巻 9 号 p. 1408-1416
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありKaryotypes were analyzed by Giemsa and Quinacrine banding for 45 children with acute lymphoblastic leukemia (ALL) (25 cases), acute undifferentiated leukemia (AUL) (4 cases), malignant lymphoma (6 cases), and acute myeloid leukemia (AML) (10 cases).
Six infant cases of t(4; 11) acute leukemia had very poor prognosis and its' monocytic nature was clarified though it had been reported as ALL.
The karyotype of ALL in adolescence was very unstable and most of the cases showed hypodiploid. They were considered to be originated from more immature lymqhoid cells than common ALL (cALL) and their prognosis was also poor.
Seven cases out of 9 unsuccessful cases were cALL patients who were maintaining complete remission and thought to have a favorable prognosis in general. Although 3 hyperdiploid patients had relatively early relapse, they showed good response for drugs and total time course was 2∼3 years. Because there was no difference between the hyperdiploid and cALL group on the clinical feature, cell morphology, and surface phenotype, it will be useful to analyze the karyotype for their treatment.
Two patients out of 10 AML were AML (M2) and one had t(8; 21). 1.5-year-old patient with 21 trisomy classified as M1, had transient leukemoid reaction in infancy. Two juvenile chronic myeloid leukemia patients had a normal karyotype.抄録全体を表示PDF形式でダウンロード (785K) -
赤尾 幸博, 佐尾 浩, 田原 徹, 吉川 治哉, 吉川 敏, 森島 泰雄, 平岩 明和, 直江 知樹1984 年 25 巻 9 号 p. 1417-1426
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありCyclosporin A (CsA) was used as an immunosuppressant in 5 leukemia patients receiving allogeneic bone marrow transplantation. In cases 1 and 2, CsA was given for preventing graft versus host disease (GVHD) in doses of 10 mg/kg/day and 11.5 mg/kg/day, respectively, by continuous intravenous infusion for the first 5 days from the day before transplantation, followed by the same amount by mouth. In cases 3, 4 and 5, it was used orally to treat established GVHD every 12 hours at a daily dose of 10 mg/kg, 10 mg/kg and 5 mg/kg, respectively.
As a result, no clinical sign of GVHD was recognized in the 2 cases in whom it was used for prevention, CsA proving effective.
Although some side effects were caused by CsA, one of which was renal dysfunction (lowering of the creatinine clearance) observed in 2 out of the 5 cases, they were improved by decreasing the dose. Notable myelosuppression was also recognized in 2 cases, where medication was stopped and hematological recovery appeared promptly. This side effect as well as renal toxicity should be cautiously observed and treated.
Other side effects were hepatic toxicity, tremor and hirstism, each of which was seen in one of the cases. As a result of monitoring the trough level and peak level of CsA in serum or plasma, the correlation between the serum or plasma levels and renal toxicity was shown.
Therefore, from clinical point of view, it is desirable to design the proper dose of CsA to be given based on the serum or plasma concentration.抄録全体を表示PDF形式でダウンロード (708K) -
倉石 安庸, 尾関 博重, 高崎 信子, 益頭 尚典, 永峯 檀二郎, 薄井 紀子, 山崎 博之, 中村 督, 相羽 恵介, 横山 謙三, ...1984 年 25 巻 9 号 p. 1427-1432
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありFrom May 1977 to April 1982, a combination chemotherapy consisting of adriamycin, bleomycin and prednisolone (ABP therapy) was applied for 22 patients with advanced non-Hodgkin's lymphoma, resistant to VCP (vincristine, cyclophosphamide and prednisolone) therapy.
Histological types by Rappaport classification were 15DHL, 3DPDL, 3DML and 1DUL, and clinical stages 8III and 14IV.
Twenty patients were evaluable. Complete remission (CR) was obtained in 10/20 patients (50%), and partial remission in 6/20 (30%). The median time to reach CR was 16 days (7-56) and the median duration of CR 19 months (3-67+).
The median survival time was 9.5 months (2-69+) for all patients, 26 months (5-69+) for patients with CR and 5.5 months (2-12) for patients who had partial or no remission.
The results suggested that there was no cross-resistance between VCP and ABP.抄録全体を表示PDF形式でダウンロード (434K)
症例
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大島 幸雄, 栗林 俊夫, 黒梅 恭芳, 星野 弘1984 年 25 巻 9 号 p. 1433-1436
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありA case of monosomy-7 myeloproliferative disorder is reported. A 13-year-old boy was admitted with fever. He had no hepatosplenomegaly. The peripheral blood showed a mild anemia and leukocytosis with 75% blasts. Bone marrow aspiration revealed a normal cellularity with 23.1% peroxidase-negative blasts. Initially he was diagnosed to have ALL and received a combination chemotherapy of vincristine and prednisolone without success. The number of blasts decreased markedly after the chemotherapy was stopped.
The cytogenetic analysis of bone marrow cells showed a karyotype of 45, XY, -7. Therefore, the diagnosis was changed to monosomy-7 myeloproliferative disorder. The same karyotypic abnormality was found a month later. Subsequently, marked eosinophilia and leukemic cell infiltration into the skin and mandibular region were seen. In the terminal stage, progression to AML occurred as evidenced by peroxidase-positive blasts.抄録全体を表示PDF形式でダウンロード (335K) -
—VP 16-213, Cytosine Arabinoside併用効果—目黒 定安, 知念 俊昭, 横山 謙三, 高崎 信子, 益頭 尚典, 尾関 博重, 永峯 檀二郎, 相羽 恵介, 小林 直, 倉石 安庸, ...1984 年 25 巻 9 号 p. 1437-1441
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありRecently we experienced a 32 year-old man with chronic myelomonocytic leuekmia who showed an interesting therapeutic response. He was initially treated by oral 6-MP 30∼80 mg daily for 6 months followed by the addition of vincristine, 1.5 mg intravenously every 3 weeks, in order to control white blood cell counts. Mhen the disease became resistent to he combination chemotherapy, he recieved splenic irradiation (400 rad in total), leading to a marked pancytopenia which persisted for 3 weeks. Subsequently he showed leukocytosis due mainly to the increase of monocytoid cells, and hepatosplenomegaly occurred.
VP 16∼213, a semisynthetic podophyllotoxin derivative, 200 mg/day, was orally given for consecutive 5 days every 3∼4 weeks. His hematologic status was markedly improved along with the diminution of hepatosplenomegaly.
Currently he is periodically treated by the combination of VP 16∼213 (100∼200 mg/day for 5 days orally) and cytosine arabinoside (80∼120 mg/day intravenously), resulting in an adeqaute control of both monocytoid and granulocytic cells.抄録全体を表示PDF形式でダウンロード (438K) -
田内 美津子, 杉本 正邦, 若林 芳久, 広瀬 俊一, 佐藤 尚武, 福田 芳郎1984 年 25 巻 9 号 p. 1442-1445
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありA 70 years old woman was admitted to our hospital with the complaints of bleeding tendency, exertional palpitation, and a skull tumor on May 16, 1983. The diagnosis of lymphocytic leukemia complicated with disseminated intravascular coagulation was made from her hematological and coagulation studies. Although she recieved the therapy of heparin, prednisolone and vincristine, she died of the massive gastrointestinal bleeding.
The surface marker studies of her leukemic cells using immunological techniques revealed B-ALL phenotype. This case was definable as type L2 according to FAB classification of acute leukemia, almost all the cases of tumor forming leukemia were included in type L2 and B-ALL were included in L3.
These results suggest that there may be the interesting relationship between the immunological defined surface markers and tumor forming leukemia.抄録全体を表示PDF形式でダウンロード (385K) -
塩谷 茂, 斉藤 達也, 坪山 明寛, 坂本 忍, 三浦 恭定, 高橋 敦, 伊藤 喜久1984 年 25 巻 9 号 p. 1446-1451
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありA 71-year-old woman was admitted to the Jichi Medical School Hospital because of palpitation and easy fatigability. Physical examination revealed no remarkable findings except for anemia. The concentration of serum protein was 5.5 g/dl with 14.6% of M-component, and the value of IgA reached 1,168 mg/dl. Immunoelectrophoresis showed an increase of monoclonal immunoglobulin of IgA-κ type. In the urine, 200 mg/day of Bence Jones protein of κ type was detected. Bone marrow aspiration revealed an increase of a typical plasma cells (21.4% of the total nucleated cells) with needle-shaped cytoplasmic inclusions resembling Auer rods, many of which being randomly distributed in the shape of faggots.
A diagnosis of multiple myeloma with IgA-κ type was established. Although her clinical condition improved with combination chemotherapy, she died from pneumonia.
Needle-shaped cytoplasmic inclusions in myeloma cells were positive for acid phosphatase and negative for staining by Congo red in cytochemistry, and were detected as unstainable defects with the immunofluorescent method using FITC-labeled antisera to human α or κ chain. These cytoplasmic inclusions were identified as hexagonal crystalline structure located outside the Golgi complex and the cisternae of the endoplasmic reticulum by electron micrographs. These results suggested that cytoplasmic inclusions in this case were lysosomal granules.
The characteristics and nature of needle-shaped cytoplasmic inclusions in myeloma cells are discussed.抄録全体を表示PDF形式でダウンロード (778K) -
仲西 正憲, 外岡 立人, 大川 正人1984 年 25 巻 9 号 p. 1452-1457
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありL3 ALL is quite a rare type of childhood leukemia accounting for less than 1% of ALL according to the reports. We have encountered a patient with L3 ALL whose blastic cells showed autokaryolysis in the peripheral blood during which severe DIC was observed. We have never found such a case in the literature, thus, the cell morphology and the clinical course are reported with a brief discussion.
A six-year-old boy was admitted because of fever and swelling of the mandibula. Bone marrow examination revealed many blastic cells with prominent and intensely basophilic cytoplasm, and prominent vacuoles. PAS reaction was positive, but that of peroxidase was negative. Surface marker analysis showed that cytoplasmic Ig was positive, but any of T cell markers were negative (Surface Ig could not be analyzed). Thus the diagnosis of L3 ALL was made, and a chemotherapy consisted of prednisolone and vincristine was started. However, the number of WBC tended to increase after the start of steroid therapy. 50% of the increased leukocytes were blastic cells and 25% of the cells were morphologically quite different from the typical blasts. These atypical cells showed prominent basophilic cytoplasm, which was nearly same as that of blastic cells, but the nuclei tended to break down (possibly autokaryoklasis). The cells had several small nuclei. After the initiation of the vincristine treatment, the leukocyte count rapidly decreased, and a marked bleeding tendency due to DIC occurred. Heparin therapy apparently resulted in an improvement of the bleeding tendency. The patient obtained a hematological complete remission three weeks following admission, however he relapsed soon.抄録全体を表示PDF形式でダウンロード (918K) -
高橋 正知, 赤星 雅, 押味 和夫, 溝口 秀昭1984 年 25 巻 9 号 p. 1458-1461
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありA case of pure red cell aplasia (PRCA) which developed in the course of myelodysplastic syndrome (MDS) is reported. A 62-year-old man was admitted in January, 1982, because of severe anemia. On physical examination, the patient was anemic, and laboratory examination showed normochromic and normocytic anemia. Bone marrow aspiration showed hypercellular marrow and karyorrhexis was present in the erythroid series. Ferrokinetic studies revealed ineffective erythropoiesis. CFU-C and CFU-E were markedly decreased. He was diagnosed as having MDS and was treated with vitamin B6 and folic acid. However, anemia gradually progressed and he was readmitted in May, 1982. On laboratory examination, reticulocytes were not seen in the peripheral blood, and bone marrow aspiration showed marked erythroblastopenia. A diagnosis of PRCA was made. Peripheral blood mononuclear cells, but not serum, from the patient suppressed CFU-E of normal bone marrow in vitro. He was started on prednisolone 60 mg daily, and dramatic improvement in anemia was encountered. With tapering of prednisolone, however, anemia developed again. Cyclophosphamide, 75 mg daily, was administered, and anemia was improved.
Although mechanisms developing PRCA in the course of preleukemic state are not known, our study suggests that there may be a population of mononuclear cells in the patient's peripheral blood which suppresses normal CFU-E.抄録全体を表示PDF形式でダウンロード (296K) -
代田 常道, 中村 治道, 酒井 信彦, 伊藤 久雄, 蜂谷 哲也1984 年 25 巻 9 号 p. 1462-1465
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありWe experienced 3 cases of acute leukemia in which fungus ball of the lung developed during or after remission induction therapy. Case 1 was a 29-year-old man with acute myelogenous leukemia receiving DCMP therapy (daunorubicin, cytosine arabinoside, 6-mercaptopurine, prednisolone). Around the time of the onset of partial remission, fungus balls were detected in both lung fields, for which 5-fluorocytosine (5FC) was administered. With complete remission achieved by 7 courses of DCMP therapy, the patient was discharged. The right mass was eradicated, while the left mass was shrunk. Case 2 was a 36-year-old man with acute myelogenous leukemia receiving DCMP therapy. After complete remission was attained, a fungus ball appeared in the right upper lung field, for which 5FC was administered. Subsequent examination at the outpatient clinic showed that the mass still remained. Case 3 was a 42-year-old man who developed a fungus ball at the left hilus during induction therapy for adult T cell leukemia. 5FC produced no change in the mass. Remission of adult T cell leukemia was not attained, and the patient died of interstitial pneumonia.
Though acute leukemia is frequently complicated by mycosis of the lung, the typical fungus ball as seen in the present cases is rarely observed. The clinical picture of fungus ball was discussed.抄録全体を表示PDF形式でダウンロード (687K) -
藤井 浩1984 年 25 巻 9 号 p. 1466-1472
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありRepeated plasma exchanges were very useful for the treatment of a case of primary macroglobulinemia complicated with intraventricular hemorrhage.
A 43-year-old woman was diagnosed as primary macroglobulinemia, because of hemorrhagic diathesis, hepatosplenomegaly, high concentrations of monoclonal serum IgM-κ, characteristic ocular fundus and bone marrow infiltration in June, 1981. In January, 1983, the patient suddenly developed severe headache, nausea and vomiting. CT scan showed intraventricular hemorrhage. The patient's serum IgM level was rapidly decreased from 5,628 mg/dl to 683 mg/dl after three plasma exchanges performed at 24 hour intervals. Plasma exchange on a regular basis was started in February, 1983, and two plasma exchanges were performed at 24 hour intervals every 4th week.
Plasma exchanges were performed by continuous blood-cell separater using CS3000. Plasma was replaced by an equal volume of 3% dextran 40 in RL-8. Serial studies revealed that immediately after the exchange transfusion there was significant prolongation of the prothrombin time and the activated partial thromboplastin time with reduction of the fibrinogen, antithrombin-III, plasminogen and α2-macroglobulin. Platelet counts revealed significant decrease. All hemostatic parameters had returned to almost normal levels by 24 hours after the cxchange. The clinical hemorrhagic episodes did not develop despite abnormal coagulation parameters.
The 3% dextran 40-electrolyte solution is useful fot the replacement solution in the plasma exchange therapy of primary macroglobulinemia.抄録全体を表示PDF形式でダウンロード (684K) -
—エリトロポイエチン依存性赤血球生成の検討—小島 勢二, 殿内 力, 三間屋 純一1984 年 25 巻 9 号 p. 1473-1478
発行日: 1984年
公開日: 2009/01/26
ジャーナル 認証ありA Case of juvenile chronic myelocytic leukemia who developed an erythroblastic phase is presented. The erythroblastic phase was characterized by anemia, bone marrow erythroid hyperplasia and the appearance of nucleated red blood cells in the peripheral blood. At the erythroblastic phase transfusion resulted in a suppression of erythropoiesis in the peripheral blood and bone marrow. The in vitro methylcellulose culture studies indicated that the CFU-E in the bone marrow of this patient was dependent upon erythropoietin for the differentiation and proliferation. The erythroid progenitor was not cloned in the absence of erythropotin.
These findings suggested that the proliferation and differentiation of erythroid stem cells remain dependent upon phisiologic regulation during erythroblastic phase of juvenile chronic myelocytic leukemia.抄録全体を表示PDF形式でダウンロード (426K)
第25回総会
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1984 年 25 巻 9 号 p. 1487-1523
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 (3365K) -
1984 年 25 巻 9 号 p. 1524-1565
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 (3945K)
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