臨床血液
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
27 巻, 4 号
選択された号の論文の27件中1~27を表示しています
臨床研究
  • 渕之上 真澄, 赤星 雅, 山田 修, 星野 茂, 高橋 正知, 高田 加寿子, 押味 和夫, 溝口 秀昭
    1986 年 27 巻 4 号 p. 475-479
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    Five patients with T cell lymphoma including adult T-cell leukemia-lymphoma were treated with a combination chemotherapy regimen consisting of cyclophosphamide, vincristine, doxorubicin and dacarbazine (CYVADIC). Three patients acheived complete remission and one partial remission. Toxity of CYVADIC therapy includes moderate to severe nausea and vomiting. These results suggest that CYVADIC is an effective combination chemotherapy regimen for the treatment of T-cell lymphoma. However, more trials are required for the definite evaluation of the effects of CYVADIC therapy.
  • 西平 浩一, 氣賀沢 寿人, 飯塚 敦夫, 長尾 大
    1986 年 27 巻 4 号 p. 480-487
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    From Nov. 1971 to Feb. 1985, 46 children with non-Hodgkin's lymphoma (NHL) were treated at the Kanagawa Children's Medical Center. Murphy's staging was used. Patients with more than 25% blasts in the bone marrow were included under the diagnosis of NHL as Lymphoma-Leukemia syndrome (LLS). Thirteen patients admitted from 1971 to 1976 (group A) were treated with a treatment regimen for acute lymphoblastic leukemia; 14 patients from 1977 to 1981 (group B) with the NHL1 protocol; 8 patients from 1982 to 1985 (group C) with the NHL2 protocol consisting of high dose (HD) MTX, HD-Endoxan, HD-cytosine-arabinoside, adriamycin, prednisolone and vincristine. Survival and continuous complete remission (CCR) rates were calculated by Kaplan-Mier method.
    Initial complete remission rates in group A, B, C and LLS were 62%, 71%, 100% and 73%, respectively. Three year survival rate in group A was 7.7% (SE 7.4), and in group B+C was 50.5% (SE 12.3). Although 2-year-CCR rate in group A was 0%, it was 71.1% (SE 12.4) in group B+C. Differences in survival and CCR rates among these groups were statistically significant. In groups B+C and LLS, 3-year-CCR rate of stage I+II was 100%, but those of stage III+IV and LLS were 60.6% (SE 18.4) and 0%, respectively.
    This study indicates that intensive chemotherapy can produce long-term remission in 70% of children with NHL.
  • 内藤 英明, 竹下 盛重, 岡村 秀樹, 三井 徹次, 筒井 正好, 菊池 昌弘
    1986 年 27 巻 4 号 p. 488-495
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    Neoplastic lymphoid cells obtained from lymph node biopsy of 32 patients with T cell lymphoma including 20 cases of adult T cell lymphoma/leukemia (ATLL) were analysed to detect the surface markers defined by monoclonal antibodies and functional activities on PWM induced normal B cell differentiation.
    The surface marker study could divide 32 cases into 2 groups; 8 cases of prethymocytic or thymocytic and 24 of peripheral T cell lymphoma. The latter consisted of 2 subgroups of helper/inducer (23 cases) and suppressor/cytotoxic (1 case) but no good relation to real functional activities was obtained in helper/inducer group.
    In 20 cases of ATLL, all 13 leukemic cases (ATL) showed helper/inducer phenotype, 11 of the which revealed no helper function. Positive reaction for Leu 8 was found in 10 of 12 cases examined. No differences of phenotype and functional activity were detected between lymphoid cells both in lymph node and peripheral blood in 5 of 6 examined cases. Five in 7 cases of non leukemic counterpart of ATL (NLATL) also showed helper/inducer phenotype but only one possessed helper activity. These results support to categorize ATL and NLATL into one group of ATLL from the view point of not only functional activities but also histological findings and surface markers.
    The functional activities of the neoplastic cells in ATLL had no distinctive relation to the histologic type or prognosis, but non-functional cases of ATL tended to manifest a skin infiltration.
  • 片平 潤一, 高橋 正知, 溝口 秀昭, 森 茂郎, 坂本 保己
    1986 年 27 巻 4 号 p. 496-500
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 50-years-old female was admitted because of the anemic symptoms lasting past two months On admission, the blood examination revealed severe anemia of hemoglobin 4, 6 g/dl, but the leukocyte count was within the normal range with normal differentiation. The bone marrow biopsy disclosed hyperplastic marrow with severely depressed erythropoiesis and normal granuloand megakaryo-poiesis with local diffuse invasion of small lymphoid cells. Analysis of phenotypes of these small lymphoid cells indicated the clonal proliferation of B cells. From the findings of the biopsied lymph node and bone marrow, she was diagnosed as having B cell malignant lymphoma, small lymphocytic. The peripheral blood mononuclear cells with 90.8% T cells and 10.8% B cells inhibited CFU-E derived colony formation of normal cells, but did not inhibited BEU-E and CFU-C derived colony growth. The lymph node cells also inhibited CFU-E derived colony formation.
    These data suggest that inhibition of CFU-E derived colony growth by peripheral mononuclear cells may play a role in the development of PRCA in the malignant lymphoma in this patient.
  • 勇村 啓子, 河 敬世, 石原 重彦, 原 純一, 土居 悟, 藪内 百治, 青木 智寿, 西田 勝
    1986 年 27 巻 4 号 p. 501-507
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    We analysed 7 cases of childhood ALL who survived for more than 3 years after the first relapse: 4 cases with bone marrow relapse, and 3 with CNS relapse. ALL cases were standard risk ALL in terms of initial WBC count, age at onset, and mediastinal mass. The ratio of males to females was 5 to 2, and all cases relapsed in bone marrow were male.
    Of 4 cases with BM relapse, two were followed by CNS relapse despite of the previous intrathecal administration of MTX or CA. The other two developed the second bone marrow relapse 53 and 50 months later, respectively. Two cases who had CNS relapse in their late clinical course had not received CNS prophylaxis at onset. They were successfully treated with craniospinal irradiation. The remaining case who relapsed in the CNS subsequently experienced isolated testicular relapse. He was treated with bilateral castration, and is now on the replacement therapy of androgen once by 2 or 3 months.
    From these findings, it appears that a fraction of patients who relapse either in the bone marrow or other sites in their late clinical course will survive long thereafter only with conventional chemotherapy. Further studies based on immunological and biological approach are required to dissect these patients who seems to be a unique subset of ALL.
  • —BH-AC·AMP療法とBH-AC·DMP療法の比較検討—
    竹山 英夫, 片岡 孝江, 矢野 邦夫, 福谷 久, 渡邊 英二
    1986 年 27 巻 4 号 p. 508-513
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    Aclacinomycin A (ACM) is different from other anthracycline antibiotics in the antitumor activity and clinical effect. As compared with daunomycin and adriamycin, ACM is less cardiotoxic and drug induced alopecia is very mild.
    A comparison studies of clinical effects and side effects of combination chemotherapies, BH-AC·AMP (behenoyl-ara-C, aclacinomycin A, 6-mercaputopurine, prednisolone) and BH-AC·DMP (behenoyl-ara-C, daunomycin, 6-mercaputopurine, prednisolone) on cases with adult acute leukemia were done. Twelve patients were treated with BH-AC·AMP (AMP) therapy and thirteen patients were treated with BH-AC·DMP (DMP) therapy. The AMP therapy is effective in patients not responding to the DMP therapy. However, in about half of 12 cases receiving AMP therapy we noticed severe bleeding in the urinary tract, genital organ and alimentary tract. These side effects were more frequent and severe in the AMP therapy than the DMP therapy. Care should therefore be taken with regard to mucosal injury when ACM is used.
  • —MDA法による血小板寿命の解析—
    金 鎮敬, 倉田 義之, 水谷 肇, 冨山 佳昭, 椿尾 忠博, 米沢 毅, 垂井 清一郎
    1986 年 27 巻 4 号 p. 514-518
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    The platelet-associated IgG (PAIgG) measured by micro enzyme linked immunosorbent assay and the platelet lifespan (PLS) measured by malondialdehyde method were studied in 8 patients with idiopathic thrombocytopenic purpura (ITP) and 16 patients with various disorders (liver cirrhosis 7, systemic lupus erythematosus 2, etc.). PLS was shortened in 4 of 6 ITP patients, who had elevated PAIgG values, and there was a significant correlation between PAIgG values and PLS. But, none of 10 patients with various disorders, who had also elevated PAIgG values, had shortened PLS, and there was no correlation between PAIgG values and PLS. The binding of IgG to these platelets may exert little influence upon their PLS.
症例
  • —多能性幹細胞由来のClonal Disorderであることの細胞遺伝学的証明—
    祐森 泰郎, 杉山 裕之, 高橋 隆幸, 南風原 英之, 星野 孝
    1986 年 27 巻 4 号 p. 519-525
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 77 year-old woman was admitted with progressive general malaise, weight loss, fever, productive cough and nasal bleeding. Physical examination revealed icterus and moderate hepatosplenomegaly. Hematological study showed pancytopenia with erythroblastosis and conspicuous dysplasia of trilineage blood cells. Bone marrow, aspirated with moderate difficulty, was erythroblastically hypercellular and almost consisted of megaloblastoid immature cells. Disseminited intravascular coagulation developed soon after the admission and she was treated with transfusion, heparin and low dose Ara-C. However, she died of bleeding from gastric ulcer on the 29th hospital day. An Autopsy disclosed moderate bone marrow fibrosis with proliferation of atypical megakaryocytes, erythroblasts and immature cells. Similar cells proliferated also in the liver, spleen, kidneys and para-aortic lymph nodes. In vitro hematopoietic colony formation from bone marrow and peripheral blood was markedly decreased, but some CFU-GEMM and BFU-E-derived colonies developed without exogenous erythropoietin. Erythroid cells in the mixed colonies and erythroid bursts were mostly immature megaloblasts. Cytogenetic analysis was performed on single mixed colonies and pooled erythroid bursts, and a same abnormal karyotype of 47, XX, +C was revealed as in the direct analysis on the peripheral blood cells.
    These results show that this patient had a clonal disorder originated from a multipotent stem cell, which coincides with the clinical features of acute mylodysplasia with myelofibrosis, a type of acute myelofibrosis.
  • —特に部位別エリスロポエチン活性測定の意義について—
    種市 幸二, 今野 孝彦, 芝木 秀俊, 久保田 一雄, 梶谷 幸子, 三浦 恭定
    1986 年 27 巻 4 号 p. 526-529
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 30-year-old man was admitted to the Kitami Red Cross Hospital for the evaluation of erythrocytosis. Laboratory findings on admission was as follows: RBC, 697×104/mm3; hemoglobin, 22.0 g/dl; hematocrit, 67%, WBC, 6,700/mm3; platelet, 16.1×104/mm3; arterial oxygen saturation, 96.4%; and red blood cell mass, 46.4 ml/kg. Scintiscans of liver and spleen showed a slight degree of splenomegaly. A stenosis of left renal artery was documented by arteriography. The erythropoietin activity of peripheral blood, which was determined by the CFU-E colony assay method, was elevated. From these findings a diagnosis of secondary erythrocytosis was made. Blood samples were obtained by simultaneous catheterization of the renal veins and inferior vena cava for the assay of erythropoietin. The Erythropoietin activity of left renal vein was significantlly higher than those of right renal vein and of inferior vena cava at the level of L4. The association between polycythemia and renal artery stenosis was discussed.
  • 五十嵐 忠彦, 伊藤 国明, 太枝 徹, 王 伯銘, 杉浦 ゆり, 浅井 隆善, 藤岡 成徳, 吉田 尚
    1986 年 27 巻 4 号 p. 530-535
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 50-year-old female was admitted to Narita Red Cross Hospital on Feb 28, 1983, because of recently developed jaundice and general malaise. A diagnosis of acute hepatitis was made. Pancytopenia developed since Mar 11, and she was referred to Chiba University Hospital, where a diagnosis of post-hepatitis aplastic anemia with septicemia of E. Coli was made. Laboratory findings were as follows; GOT 57 mu/ml, GPT 176 mu/ml, LDH 164 mu/ml, T. Bil 22 mg/dl, D. Bil 14.3 mg/dl, WBC 300/cmm, Hb 11.3 g/dl, Plt 7.3×104/cmm, Ret 0.2%. Bone marrow was hypoplastic.
    The patient was treated with plasma exchange, granulocyte transfusion and administration of antibiotics. She gradually recovered from pancytopenia since the beginning of April.
    Hematopoietic progenitor cells [CFU-C, CFU-E, BFU-E] were assayed and followed with her hematological recovery. Inhibitory activity against hematopoietic progenitor cells was detected in her onset serum.
  • 矢部 博樹, 石川 隆行, 永井 謙一, 中山 志郎, 谷口 郷美
    1986 年 27 巻 4 号 p. 536-539
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 65-year-old male patient complained of progressive nasal obstruction. Phymata with ulceration were found in the left nasal cavity and the right upper pharynx. No enlargement of superficial lymph nodes nor hepatosplenomegaly was found. In biopsy of the phymate, a high degree of necrosis was observed with diffuse cellular infiltration mainly by abnormal lymphocytic cells and also by histiocytes, plasma cells and neutrophils: the abnormal lymphocytic cells showed an E-rosette formation. The patient was consequently diagnosed as malignant lymphoma with diffuse T cell-type. His WBC count was 4,600/mm3, about 0.5% were abnormally indented cells. This patient and his wife had positive anti-ATLA antibodies. His phymata disappeared almost completely by a combination therapy with VEPA and Co irradiation. ATL is known to develop various types of diseases: there might have been ATL which originated from the nasal cavity exhibiting a clinical picture of progressive necrotizing rhinitis.
  • 高梨 美乃子, 泉二 登志子, 押味 和夫, 溝口 秀昭, 森 茂郎
    1986 年 27 巻 4 号 p. 540-545
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 64-year-old women had suffered from erythema on legs, fever and Raynaud's phenomenon, being diagnosed to have neoplastic angioendotheliosis (NA) by skin biopsy, and was induced to complete remission by CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) therapy. CHOP and subsequent COP therapy were continued for one year. About one year after the last therapy, she was admitted again because of fever.
    She was alert but slow in movement and emotionally flat. Laboratory data showed hypoxia without hypercapnea, elevated serum lactic dehydrogenase, mild anemia, increased C-reactive protein, beta 2-microglobulin and ferritin, and positive reaction for RA. Chest X-ray revealed multiple nodular lesions in all the lung fields. The surface-marker analysis of the cells filling small vessels of the lung indicated the monoclonal proliferation of B cells. After CHOP therapy started again, fever disappeared, hypoxia, acidosis and pancytopenia improved, and her mental activity and personality became close to normal. The multiple nodular lesions in lungs had disappeared on the 6th day of the chemotherapy.
    These studies suggest that NA is a B-cell lymphoma and causes multiple nodular lesions in lungs as a rare complication.
  • 神谷 康隆, 林 鐘声, 清沢 伸幸, 山本 徹, 才田 達, 堀井 由博, 長井 隆夫, 今宿 晋作, 杉原 洋行, 伏木 信次
    1986 年 27 巻 4 号 p. 546-552
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 14-year-old boy admitted to the hospital with dyspnea, was found to have leukocytosis (WBC 90,800/μl) without anemia (Hb 14.5 g/dl) and was diagnosed to have acute myelomonocytic leukemia (AMMoL) based on the FAB M4 morphology of leukemic blasts in blood and bone marrow, associated with chromosomal aberration of t (10; 11). Shortly after daunomycin was given for induction treatment, the patient developed chest pain and chest film revealed infiltration shadows in the left upper and lower lobes, which lasted for four months, unresponsive to intensive antibiotic administration including anti-tuberculous agents. Complete remission of the leukemia was attained in two months, however one year later a relapse occurred. Subsequently, the patient died of congestive heart failure.
    Autopsy findings revealed mural thrombi in the right atrium and ventricle, pulmonary thromboembolism, and pulmonary infarction. Retrospectively, it was concluded that the patient already had a pulmonary thrombus at the onset of leukemia, and developed pulmonary infarction soon after treatment for leukemia. The patient developed into complete occlusion of the left pulmonary artery at the time of relapse.
    Pulmonary thromboembolism occurs rarely, but should be considered for tachypnea and dyspnea in non-lymphocytic leukemia patients with remarkable increase of WBC.
  • —特に血小板膜糖蛋白異常に関する検討—
    新名主 宏一, 丸山 芳一, 丸山 征郎, 納 光弘, 井形 昭弘
    1986 年 27 巻 4 号 p. 553-559
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A case of Bernard-Soulier syndrome (BSS) was presented and investigated with particular reference to the platelet-membrane glycoprotein abnormalities and the pathogenetic mechanism of thrombocytopenia.
    The patient was a 34-yr-old woman with a life-long history of bleeding such as easy bruising, epistaxis, gingival bleeding and menorrhagia. She had a moderately decreased platelet count with giant plateletes on the peripheral blood smear and a markedly prolonged bleeding time. Aggregations of platelets to ADP, epinephrine and collagen were normal or near normal. Thrombin-induced aggregation was delayed and markedly diminished. No appreciable platelet aggregation was observed in response to ristocetin and bovine factor VIII. Tests of coagulation/fibrinolysis were all normal. From these results she was diagnosed as BSS.
    Analysis of platelet-membrane glycoproteins by one- or two-dimensional SDS-polyacrylamide gel electrophoresis revealed the absence of GPIb and GPV.
    Increased platelet aggregates, possibly formed in vitro during blood collection by hyperreactive platelets lacking GPIb- the major sialic acid source of platelet, was demonstrated by Wu and Hoak technique, suggesting a cause of thrombocytopenia in BSS.
  • 塩原 信太郎, 末永 孝生, 吉田 喬, 舟田 久, 原田 実根, 松田 保, 金沢大学骨髄移植チーム
    1986 年 27 巻 4 号 p. 560-564
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 27 year-old male with acute lymphoblastic leukemia who was treated with high-dose cyclophosphamide (120 mg/kg) and total body irradiation (1,000 rad), followed by bone marrow transplantation from his HLA-identical sister in the first relapse. Although the posttransplant clinical course was complicated with grade II acute graft-vs-host disease (GVHD), interstitial pneumonia and an extensive form of chronic GVHD, all of these complications were successfully treated. The patient is now alive and well in unmaintaned remission over 7 years after transplantation. A leukemia-free long-term survival observed in this patient suggests a probable cure of leukemia. Factors influencing on long-term survival are discussed.
  • 森 由雄, 箙 光, 進藤 芳雄, 済田 良一, 北村 創
    1986 年 27 巻 4 号 p. 565-569
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    We reported a 53 years old man with eosinophilic leukemia with trisomy of No. 8 and No. 9 chromosomes. He was admitted to our hospital because of left lower leg pain on 24, Oct. 1984. His peripheral blood count showed a remarkable leukocytosis (99,900/μl) with 58.5% eosinophiles. The bone marrow smear showed a remarkable eosinophilia with the mature and immature cells. The chromosome study showed trisomy of No. 8 and No. 9 chromosomes. He died of the cerebral hemorrage on 28, Oct. 1984. Postmortem examination revealed systemic extensive leukemic infiltration with predominant eosinophilic cells. There was asymmetric septal hypertrophy in the heart and cerebral hemorrage with extensive leukemic infiltration of eosinophiles.
  • —内外24症例の文献的考察を含めて—
    沢田 賢一, 種市 幸二, 知本 武久, 今野 孝彦, 中川 昌一
    1986 年 27 巻 4 号 p. 570-575
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 65-year-old male was admitted to the hospital because of the 4-years' history of ecchymoses and subcutaneous hematoma on August 5, 1983. Peripheral blood showed RBC 339×104/mm3, Hb 10.8 g/dl, Ht 31.7%, WBC 5,900/mm3, platelet 7.3×104/mm3. FDP was 20∼40 μg/ml and fibrinogen 54 mg/dl. The chest X-ray film showed protruded opacity in the portion of the descending thoracic aorta.
    Based on these findings, a diagnosis of chronic disseminated intravascular coagulation due to aortic aneurysm was made. Heparin sodium was administered in the dosage of 5,000 units subcutaneously every 12 hours, resulting in good control. Operative Repair of the aneurysm was suggested to the patient, but it was refused. The same dose of heparin continued to be administered by self-injection after ambulation and coagulopathy has been in good control for the following 2-years. no problem associated with self-injection of heparin has been encountered.
    Evaluation of 24 cases of disseminated intravascular coagulation associated with aortic aneurysm collected from the literature showed that heparin sodium was effective for their bleeding tendency (80%), and had life saving effects in some cases.
  • 新名主 宏一, 丸山 芳一, 丸山 征郎, 納 光弘, 井形 昭弘
    1986 年 27 巻 4 号 p. 576-582
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    Two cases of type II thrombasthenia (TA) were presented and investigated with special reference to the platelet-membrane glycoprotein abnormalities.
    They were a 15-yr-old girl and a 33-yr-old woman suffering from bleeding tendeucy such as easy bruising, epistaxis and menorrhagia from infancy. They had quite similar platelet function abnormalities characterized by a markedly prolonged bleeding time without thrombocytopenia, and absent aggregation responses to ADP and other physiologic stimulating agents except for ristocetin or bovine factor VIII. Clot retraction and the interaction between platelets and polymerizing fibrin were normal. Tests of coaqulation/fibrinolysis were all normal. These results indicated that they were type II TA.
    Analysis of platelet-membrane glycoproteins by one- or two-dimensional SDS-polyacrylamide gel electrophoresis revealed the corresponding abnormalities with type II TA, that is, not defective but decreased amounts of glycoprotein IIb and III (IIIa).
  • 浦部 晶夫, 細井 孝之, 宮園 浩平, 太田 雅貴, 佐藤 宏, 西田 淳二, 平井 久丸, 小澤 敬也, 高久 史麿
    1986 年 27 巻 4 号 p. 583-588
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    We tried to use antilymphocyte globulin (ALG) and antithymocyte globulin (ATG) in 2 severe cases of aplastic anemia. ALG was administered to a 58 year-old male patient, and ATG was administered to a 23 year-old male patient. Both of them had shown severe pancytopenia and bone marrow hypoplasia before the treatment. They responded to the ALG or ATG therapy, and reached complete remission in 8 months and in 4 months, respectively. They have maintained complete remission up to now without any treatment. Adverse reactions were chills and fever, but disappeared immediately after stopping the administration of ALG or ATG.
  • 末丸 修三, 平川 秀三, 山本 信玄, 景山 甚郷, 太田 善介, 喜多嶋 康一, 坂本 賢司, 嘉村 淳太
    1986 年 27 巻 4 号 p. 589-593
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 48-year-old woman, who had survived for 3 years after myeloid blastic crisis in Ph1-positive CML, was reported.
    On admission, she had fever and marked splenomegaly. White blood cell counts were 89,800/mm3 including 31% myeloblasts and 13% promyelocytes. Seventy-three per cent of the blasts showed TdT activity, although positive for peroxydase reaction. She responded well to vincrisine (V) and prednisolone (P) (VP therapy) and steroid pulse therapy, and attained to the chronic phase of CML. Remission had been maintained with busulfan and VP therapy. However, she died of hepatic coma probably due to hepatitis B virus-induced liver cirrhosis 3 years after the onset of blastic crisis.
  • 梶谷 博, 斉藤 憲治, 奥山 明彦, 大里 守彦, 渡辺 完爾, 山崎 竜弥, 浜口 裕之, 坂巻 壽, 榎原 英夫, 古沢 新平, 宍戸 ...
    1986 年 27 巻 4 号 p. 594-599
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 56-year-old female with multiple myeloma, IgG-κ type, obtained a complete remission after a combination chemotherapy with vincristine, cyclophosphamide, methyl-CCNU and prednisolone. Thirty one months after initial diagnosis when she was still in complete remission, she was found to have orbital tumor. Three months later, a breast tumor developed. A resected specimen showed poorly differentiated plasmacytoma. Immunoperoxidase stains revealed IgG-κ protein in the cytoplasm of the tumor cells. The orbital tumor disappeared after addition of melphalan to the above mentioned protocol. Several months later, intra- and extraskeletal tumors developed in various sites successively. In spite of temporary response to the radiotherapy and intensive chemotherapy, she died two months after leukemic conversion.
  • 平岩 明和, 吉川 敏, 佐尾 浩, 山内 辰也, 南 三郎, 吉川 治哉, 小寺 良尚, 赤尾 幸博, 内藤 和行, 山田 一正
    1986 年 27 巻 4 号 p. 600-605
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    In January 1982, a 16 year-old male suffered from epigastralgia and melena. A submucosal tumor was endoscopically found in his stomach. Then, the biopsy examination revealed that it was pathologically a Burkitt's lymphoma. The involvement of bone marrow was also clarified by bone marrow aspiration. Soon after admission to our hospital, he was treated with vincristine and prednisolone. With this therapy, a complete remission was easily attained and thereafter, a subtotal gastrectomy and splenectomy were performed for a consolidative purpose. The pathological examination of resected stomach and lymphnodes demonstrated the existence of residual tumor cells.
    On 12 March 1982, he was transplanted with bone marrow from his HLA-compatible brother; the number of infused cells was 2.5×108/kg. Intravenous injections of high dose of cyclophosphamide (3 g/day for two successive days) and fractionated total body irradiation (240 rad×4 times) were employed for preconditioning of this transplantation. His hematopoietic recovery was rapid after transplantation; that is, his peripheral leukocytes increased beyond 1,000/μl on the 21st transplantation day. However, a graft-versus-host disease (GVHD) was suspected from the observation that fever, skin rash and liver dysfunction appeared since the 16th transplantation day. Accordingly, he was treated with a combination of prednisolone (30 mg/d) and Bredinin (100 mg/d). After the treatment, all the symptoms disappeared soon. The titer of anti-cytomegalovirus antibody in his serum elevated gradually since the 21st transplantation day, with the maximum titer of ×512 (CF assay) on the 60th transplantation day. At present (September 1985), he is in healthy condition without any sign of GVHD.
  • 西郷 勝康, 湧谷 純, 広川 恵一, 上田 耕蔵, 浦井 寿, 中谷 洋子, 寮 隆吉, 山口 延男, 加納 正
    1986 年 27 巻 4 号 p. 606-611
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 70-year-old male patient had been treated as diabetes mellitus and hypertension at Kobe Kyodo Hospital. Blood examination revealed leukocytosis (20,600/μl, 95% mature granulocytes) by chance in 1973. On physical examination, mild hepatosplenomegaly was found. Elevation of serum uric acid, vitamine B12, and neutrophile alkaline phosphatase were detected. No Ph1 chromosome or colony stimulating factor was found. Based on these findings, the patient was diagnosed as having chronic neutrophilic leukemia.
    In 1977, electrophoretic pattern showed polyclonal gammopathy with 2,300 mg/dl of serum IgG In 1979, a small spike was obsered in the γ-region on electrophoresis. In 1982, this spike became conspicuous with the appearance of Bence Jones protein in the urine. The patient died of uremia in 1984 and in autopsy bone marrow and liver were found infiltrated with mature neutrophils. However, no other malignancies including multiple myeloma were observed.
    This case, with a 11-year follow-up, is the longest surviving case of chronic neutrophilic leukemia, ever reported ln Japan. The mechanisms of association with monoclonal gammopathy were also discussed.
  • 佐藤 正, 志賀 隆, 武田 寛人, 油井 徳雄, 木村 秀夫, 松田 信, 内田 立身, 刈米 重夫, 瀬上 秀雄, 阿部 正文, 若狭 ...
    1986 年 27 巻 4 号 p. 612-616
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    An unusual case of immunoblastic lymphadenopathy (IBL)-like T cell lymphoma with neoplastic proliferation of helper T cells, occurred during the course of myelodysplastic syndrome (MDS) is reported. A 72-year-old male, who had been suffered from pancytopenia for 4 years, was admitted to our hospital on June 15, 1985 because of generalized lymph node swelling and general malaise. Laboratory examination showed severe pancytopenia, polyclonal hypergammaglobulinemia, positive Coombs' test and elevated anti DNA antibody titer. The bone marrow was found to have hypercellularity with slightly increased myeloblasts and dysplastic changes in myeloid as well as platelet-megakaryocytic lineages which agree with a diagnosis of MDS. A lymph node biopsy specimen exhibited the typical histologic picture of IBL-like T cell lymphoma with focal proliferation of pale cells and proliferation of arborizing blood capillaries. Immunofluorescence study revealed that neoplastic cells were positive for Leu 1, Leu 3a, Leu 4, Leu 5b and HLA-DR monoclonal antibodies. Immunohistochemistry and immuo-electron microscopy also showed that proliferated pale cells had helper T cell markers. He died of respiratory failure 23 days after admission.
  • 富本 尚子, 広瀬 政雄, 鎌田 君代, 二宮 恒夫, 宮尾 益英, 阿部 達生
    1986 年 27 巻 4 号 p. 617-623
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A one year boy was admitted to our hospital because of nasal bleeding in January 1984. Significant physical findings included pallor, petechiae and hepatosplenomegaly. Hemoglobin content was 5.9 g/dl, platelet count was 6,000/μl, white cell was 15,300/μl with 7% blast cells and bone marrow revealed hypocellular with 31.5% blast cells.
    The majority of blast cells was characterized by large and homogenous nature with low nuclear cytoplasmic ratio, the nucleus was round or oval in shape with one to three nucleoli and a very fine chromatin pattern, the cytoplasm was light blue in color but contained no azurophilic granules. Cytochemical staining proved to be negative for PAS, POX and α-NBE activity. The serum and urinary lysozyme levels were within normal range. Those morphological and cytochemical findings of blast cells were consistent with L2-type leukemia in FAB classification.
    However, surface marker studies and immunofluorescence tests for detection of surface and cytoplasmic immunoglobulins showed that the majority of blast cells was found positive for OKM1, Fcγ-R and OKM5. The blast cells had no NK activity. Moreover, by the three days of culture with PMA, the blast cells adhered to the bottom of the plastic culture dish, spread their own cytoplasm and developed macrophage like morphology with long filamentous pseudopods. These cells turned positive in stain for α-NBE activity (NaF sensitivity), while POX reaction remained negative, which suggested that the blast cells transformed into monocyte/macrophage like nature. Chromosome analysis was performed by the G banding technique after short-term culture with colcemid/ethydium bromide and revealed complex transformation, including three translocation with same breakpoint in 11q13, in addition to trisomy 21.
    Though the diagnosis was made as L2-type leukemia according to FAB clssification, immunological and culture studies suggested that his blast cells had monocytic nature.
    Multi-combination therapy induced complete remission but three months later, he relapsed and expired in February 1985.
  • 辻本 真人, 清水 映二, 中峯 寛和, 竹中 徹, 前田 次郎
    1986 年 27 巻 4 号 p. 624-629
    発行日: 1986年
    公開日: 2009/02/02
    ジャーナル 認証あり
    A 48 year old man was admitted on December 15, 1984 with general malase and easy fatigability. Physical examination revealed anemia, icterus, splenomegaly and a few swollen lymph nodes. Peirpheral blood examination showed anemia (Hb. 6.7 g/dl) and reticulocytosis (17.6%). High level of serum bililubin and LDH, and marked decrease of haptoglobin were observed. Both direct and indirect Coombs test were positive and autoantibody was in an IgA type. On bone marrow aspiration, hand mirror like lymphocytes were noted. The lymphonode biopsy specimen diclosed malignant lymphoma, diffuse medium sized cell type. Phenotype of lymphocyte in lymph node was OKT8 positive and OKT4 negative.
    He was treated with vincristine, cyclophosphamide, predonisolone and adriamicin. After 4 corses of treatment, partial remission was achieved. At present, he has been remained on regimen 10 mg of predonosolone and his condition has been well controlled.
研究会
feedback
Top