Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 33, Issue 5
Displaying 1-29 of 29 articles from this issue
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  • Recovery of Hematopoiesis after High-dose Chemotherapy and Peripheral Blood Stem Cell Autografts in Children
    Junko SATO, Yoichi TAKAUE, Yasuhiro OKAMOTO, Shin-ichi SAITO, Atsushi ...
    1992 Volume 33 Issue 5 Pages 637-645
    Published: 1992
    Released on J-STAGE: April 24, 2009
    DOIhttps://doi.org/10.11406/rinketsu.33.637
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    Hematopoietic recovery kinetics were evaluated in 34 children with therapy-refractory malignant tumors who underwent a total of 35 peripheral blood stem cell autografts (PBSCT) after marrow-ablative chemotherapy without total body irradiation. A negative correlation was found between the numbers of colony-forming units of granulocyte-macrophage (CFU-GM) infused per kilogram of the patients' body weight and the time of achieving an absolute granulocyte count (AGC) of 0.5×109/l or a platelet count of 50×109/l (granulocyte: r=-0.631, p<0.001, platelet: r=-0.590, p<0.001).
    The patients were classified into three groups; 14 patients who received <1×105 CFU-GM/kg (group A), 7 patients who received 1-3×105 CFU-GM/kg (group B), and 14 patients who received ≥ 3×105 CFU-GM/kg (group C). The AGC recovered to 0.5×109/l by 21 day in group A, 14 day in group B, and 10 day in group C. The platelet count recovered to 50×109/l 102 in group A, 23 in group B, and 16 day in group C patients. The final platelet infusion was on day 60 in group A, day 12 in group B, and day 12 in group C. Transient decrease in the blood cell count developed in all patients 3 to 7 weeks after transplantation, and two cases developed reversible ITP. In the remaining patients, the recovered hematopoietic function was sustained for 1∼48 months after transplant action. We concluded that the number of progenitor cells required for safe PBSCT is over 3×105 CFU-GM/kg in children.
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  • Clinical and Molecular Biological Study of Ph Positive Acute Leukemia: Comparison with Blast Crisis of Chronic Myelogenous Leukemia and Ph Negative Acute Lymphoblastic Leukemia
    Sadamu OKADA, Tohru SHIMIZU, Hiroshi HARADA, Yasuyoshi MIYOSHI, Hiraku ...
    1992 Volume 33 Issue 5 Pages 646-654
    Published: 1992
    Released on J-STAGE: April 24, 2009
    DOIhttps://doi.org/10.11406/rinketsu.33.646
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    Eight cases of Philadelphia positive acute leukemia (Ph+AL) were compared with 13 cases of Ph+chronic myelogenous leukemia in blast crisis (BC) and 10 cases of Ph negative acute lymphoblastic leukemia (Ph-ALL) based on the clinical and molecular biological findings. Distinguishing clinical features were a high leukocyte count (median; 147.9×103/μl) for Ph+AL, and a high incidence of tumor formation and basophilia for BC. A cytogenetic study demonstrated the disappearance or marked reduction of Ph+ metaphases in Ph+AL in remission, while Ph+cells persisted in BC. The major bcr gene was not rearranged in 4 Ph+AL cases, whereas it was found rearranged in 4 other cases of Ph+AL and 6 cases of BC. Reverse transcriptase polymerase chain reaction technique demonstrated the presence of minor bcr/abl mRNA in the former three cases, and major bcr/abl mRNA in the latter 4 cases. Remission rates were 63% for Ph+AL, 38% for BC, and 100% for Ph-ALL, and the 50% survival were 12, 5 and 29 months, respectively. It was concluded that Ph+AL can be differentiated from BC by a marked reduction of Ph+cells at remission, and that the prognosis of Ph+AL is better than BC, but worse than Ph-ALL.
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  • Study on the Therapy for Multiple Myelomas
    —Initial Induction Therapy (MP, IFNα, Steroid Pulse) and Maintenance Therapy (VMP, MP Continuous, VEP, MCNU)—
    Hideo TANAKA, Michio KAWANO, Koji IWATO, Hideki ASAOKU, Osamu TANABE, ...
    1992 Volume 33 Issue 5 Pages 655-661
    Published: 1992
    Released on J-STAGE: April 24, 2009
    DOIhttps://doi.org/10.11406/rinketsu.33.655
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    Untreated twenty patients of multiple myeloma were treated with the chemotherapy protocol as follows: Initial induction therapy; MP continuous or MP intermittent→IFNα→steroid pulse. Maintenance therapy; alkylating agents which have no cross resistance were used ((V) MP→(MP)→(V) EP→MCNU). Remission rate (CR+PR) after the initial MP therapy was 45%, and that after including IFNα and steroid pulse therapy was 50%, Fifty percent survival rate was almost as same as those reported previously (34M). Our protocol presented here was based on the idea that, initially, myeloma cells with proliferative activity could be affected by MP therapy, and subsequent IFNα therapy would have effect even on the residual myeloma cells. Serial checks of 3H-TdR uptake of myeloma cells during the therapy supported this idea. During the maintenance therapy, clinical responses to the initial induction therapy were not aggravated in the responded cases when evaluated by the variation of serum M-protein level. We propose that considering from a point of proliferative activity of myeloma cells is important for designing therapeutic protocols for multiple myeloma.
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  • The Significance of Myelodysplasia in Untreated Patients with Multiple Myeloma
    Masamitsu MORI, Takashi ABE, Takeshi TAKEI, Kaori SHIBATA
    1992 Volume 33 Issue 5 Pages 662-665
    Published: 1992
    Released on J-STAGE: April 24, 2009
    DOIhttps://doi.org/10.11406/rinketsu.33.662
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    Microscopic analysis of bone marrow smears from ten untreated patients with multiple myeloma (MM) revealed that seven patients had myelodysplastic changes. Of these, five patients had anemia alone while the other two had anemia and leucopenia. The myelodysplastic changes seen in MM were less extensive than those seen in myelodysplastic syndrome (MDS). Moreover, the dysplastic changes in MM were determined to be limited to two or three lineage cells. Dysplastic changes were observed even after clinical signs of MM had improved due to therapy. We consider that the myelodysplastic changes seen in MM can be attributed to MM itself, rather than to the coexistence of MDS and MM. Such findings suggest that the pathogenesis of MM involves a common stem cell which differentiates into multiple lineage cells.
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  • Auer Rods-Positive Neutrophils Observed at Diagnosis Increased after Remission Induction in Patient with Acute Promyelocytic Leukemia
    Eishi ASHIHARA, Katsunori OHKAWA, Hideo GOTOH, Naritoshi OKU, Tohru IN ...
    1992 Volume 33 Issue 5 Pages 666-670
    Published: 1992
    Released on J-STAGE: April 24, 2009
    DOIhttps://doi.org/10.11406/rinketsu.33.666
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    50-year-old male was admitted to our hospital because of gingival bleeding and fever in August 1987. The leukocyte count was 13,300/μl with 80.5% leukemic promyelocytes and bone marrow was hypercellular with 86.4% leukemic promyelocytes. A small number of mature nuetrophils containing Auer rods were seen in bone marrow. On a diagnosis of acute promyelocytic leukemia and treated with induction chemotherapy consisting of behenoyl-arabinofuranosyl cytosine (BHAC), daunorubicin, 6-mercaptopurine (6-MP) and prednisolone (PSL) was reformed. After cytoreduction, leukemic cells reappeared in the peripheral blood, concomitant with mature neutrophils having Auer rods. Vitamin D3 was not effective as a differentiation inducing agent. Complete remission was obtained in November 1987 by the reinduction chemotherapy consisting of BHAC, aclarubicin, 6-MP and PSL. In this case, nuetrophils with Auer rods might have been derived from the leukemic clone and differentiation of leukemic promyelocytes by intensive chemotherapy.
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  • Multiple Myeloma in a Patient in Remission from Malignant Lymphoma
    Shinichiro HASHIMOTO, Eiichiro KAWANO, Akira HIRASAWA, Satoko MORIO, N ...
    1992 Volume 33 Issue 5 Pages 671-676
    Published: 1992
    Released on J-STAGE: April 24, 2009
    DOIhttps://doi.org/10.11406/rinketsu.33.671
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    A 71-year-old man was admitted because of right cervical lymph node swelling in February 1986. Lymph node biopsy revealed that he suffered from diffuse, large cell malignant lymphoma. Immunological staining showed lymphoma characterized by B cell markers, IgG, κ type. Bone marrow aspiration, revealed no evidence of lymphoma and 0.2% plasma cells. The clinical stage was IIA. The patient was treated with the CHOP regimen (doxorubicin, cyclophosphamide, vincristine and prednisolone), which achieved complete remission. In October 1988, he was re-admitted because of a subcutaneous abscess, and biopsy of the inguinal lymph node showed reactive lymphadenitis.
    Although he improved with antibiotic therapy, laboratory date on admission showed monoclonal gammopathy. Serum immunoelectrophoresis demonstrated a monoclonal bow of IgA κ type, and bone marrow aspiration revealed hypercellularity with an increased number of plasma cells (76.8%). The patient was diagnosed as having multiple myeloma, and combination chemotherapy was begun. He now attends the out-patient department at our hospital. The development of multiple myeloma has not been reported previously during a course of malignant lymphoma. Although the association of these two B cell neoplasias was unknown, in this case both showed the characteristic of κ type light chains. This case may provide information concerning tumor cell origin.
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  • Chronic Myelomonocytic Leukemia Associated with Translocation 1; 7, Marked Platelet Aggregation and Cryofibrinogenemia: A Case Report
    Ken-ichiro HINO, Seitetsu SATO, Hideyuki UENO, Yoshihisa AKIMOTO, Akik ...
    1992 Volume 33 Issue 5 Pages 677-682
    Published: 1992
    Released on J-STAGE: April 24, 2009
    DOIhttps://doi.org/10.11406/rinketsu.33.677
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    A 64-year-old male was admitted in September 1989 with complaints of fever and muscular weakness in the extremities. A peripheral blood examination on admission revealed WBC 10,300/μl (monocytes 32%), RBC 195×104/μl, Hb 7.9 g/dl, Plt 12.8×104/μl with trilineage dysplasia. Bone marrow biopsy was normoplastic marrow with 25.7% of monocytes including immature blasts. Cytochemical analysis of the monocytes showed positive for peroxidase and dual esterase staining. Chromosomal analysis of peripheral blood revealed 46, XY, -7, +der (1) t(1;7)(p11;p11). A diagnosis of chronic myelomonocytic leukemia was made. Hemostatic studies revealed cryofibrinogenemia, marked platelet aggregation on blood smear, hyperfibrinogenemia and a marked increase in maximal amplitude of thrombelastogram. Treatment with prednisolone and VP16, resulted in a reduction of peripheral monocytes and a disappearance of cryofibrinogen, marked platelet aggregation and a decrease in muscular weakness. Nine months after diagnosis he died of DIC, pneumonia, lung abscess and sepsis.
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  • Isospora Belli Infection in a Patient with Adult T-cell Leukemia
    Fumio KAWANO, Kenro NISHIDA, Hiroharu KURISAKI, Atsuko TSUKAMOTO, Masa ...
    1992 Volume 33 Issue 5 Pages 683-687
    Published: 1992
    Released on J-STAGE: April 24, 2009
    DOIhttps://doi.org/10.11406/rinketsu.33.683
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    An adult T cell leukemia (ATL) accompanied with Isospora belli infection was described. A 65-year-old male was admitted to our hospital because of a two month history of watery diarrhea. On admission, physical examination showed slight pallor but no detectable superficial lymphadenopathies. Hepatosplenomegaly was not observed. Laboratory examination revealed a leukocyte count 5,500/μl with 10% abnormal lymphoid cells. A majority of the abnormal lymphoid cells expressed both CD 4 and CD 8 antigens. The patient was diagnosed as chronic ATL, since anti-HTLV-1 antibody in his serum and monoclonal integration of HTLV-1 proviral DNA in his peripheral mononuclear cells were detected. Isospora belli was found in his feces thereafter, and trimethoprim/sulfamethoxazole was effective for diarrhea. In Japan, there have been only 9 reported cases of lymphoproliferative disorders (including five ATL patients) accompanied with Isospora belli infection. From the descriptions in those reports, these 9 cases might all be ATL patients.
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  • Post-gastrectomized Vitamin B12 Deficient Anemia with Marked Leukoerythroblastosis and Ringed Sideroblasts
    Shizuo YOSHIMOTO, Makoto TAKEUCHI, Atsuhiko TADA, Hirokuni TAGUCHI, To ...
    1992 Volume 33 Issue 5 Pages 688-693
    Published: 1992
    Released on J-STAGE: April 24, 2009
    DOIhttps://doi.org/10.11406/rinketsu.33.688
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    A 77 year-old man, who had received total gastrectomy and splenectomy 11 years ago for gastric cancer was tranferred to our hospital because of severe macrocytic anemia. He had been treated with vitamin B1, B2, C and iron preparations for several weeks. Ten days before admission numbness developed in his legs. On physical examination he appeared severely anemic. Laboratory findings revealed severe macrocytic anemia with poikilocytosis, anisocytosis, polychromasia, red cell fragmentation, Howell-Jolly bodies, Cabot rings and marked erythroblastosis (421/100 WBC). Hypersegmented neutrophils and immature granulocytes were also seen in the blood. The bone marrow picture showed marked erythroid hyperplasia, but erythroblasts revealed only slight megaloblastic changes. On bone marrow iron staining all erythroblasts were classified as type III sideroblasts and 15% of them were ringed-form. Serum vitamin B12 was low (44 pg/ml). Methylcobalamin given intramuscularly led to the rapid improvement of all hematological abnormalities including leukoerythroblastosis. Two weeks after vitamin B12 administration, ringed sideroblasts could no longer be detected in the bone marrow. Post-gastrectomy vitamin B12 deficiency anemias combined with erythroblastosis and ringed sideroblasts is a rare condition. Splenectomy is thought to play an important role in the pathogenesis of these conditions.
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  • i(17q) Appearing in Acute Phase in Ph1-Negative, BCR-Negative CML
    Naokuni UIKE, Sayuri YAMASHITA, Kosuke OBAMA, Hiroyuki TAKAHIRA, Hiroy ...
    1992 Volume 33 Issue 5 Pages 694-699
    Published: 1992
    Released on J-STAGE: April 24, 2009
    DOIhttps://doi.org/10.11406/rinketsu.33.694
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    A 36-year-old woman was referred to our hospital because of splenomegaly in February 1989. The leukocyte count was 55,500/μl without hiatus leukemicus. The leukocyte alkaline phosphatase score was low (29). The bone marrow showed myeloid hyperplasia (24.8% myeloblasts) but no dysplastic change. The karyotype of the bone marrow cells was 46, XX and a diagnosis of Ph1 (-) CML was made. Treatment with VCR, 6MP and prednisolone made 7-month-durated chronic phase. but the abnormal karyotype [46, XX, i(17q)] gradually increased to 100% of bone marrow cells. The patient died in June 1990.
    The evidence that not only a BCR rearrangement but also messages of BCR/ABL fusion gene were negative made us able to differentiate this case from Ph1 (-), BCR (+) CML. The addition of an i(17q) results in partial monosomy of 17q (17q13; p53 gene) and partial trisomy of 17q (17q11.2-12; G-CSF gene). We examined the rearrangement of p53 gene and G-CSF-dependent tumor cell growth in vitro, demonstrating one allelic loss of p53 gene and independent cell growth on G-CSF respectively. It is thought that in Ph1 (-), BCR (-) CML as well as in Ph1 (+) CML, an i(17q) is related to the progression but not to the initiation of these leukemias. However the precise mechanism, including p53 gene inactivation by point mutation, is still to be elucidated.
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  • Neutrophilic Dermatosis in a Patient with Refractory Anemia
    Shogo BANNO, Masakazu NITTA, Atsushi WAKITA, Osamu IWAKI, Katsutoshi T ...
    1992 Volume 33 Issue 5 Pages 700-705
    Published: 1992
    Released on J-STAGE: April 24, 2009
    DOIhttps://doi.org/10.11406/rinketsu.33.700
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    A 46-year-old man diagnosed as refractory anemia was hospitalized because of high fever and extensive erythema with ulceration in the femoral region. His peripheral blood examination showed marked leukocytosis (WBC 31,500/μl: neutrophilic 90%) and anemia (Hb 8.6 g/dl. In spite of administration of antibiotics, the cutaneous ulcer rapidly extended to the right thigh and became necrotic. The bacterial culture of the cutaneous lesion showed no growth and a skin biopsy showed infiltration of neutrophils in the dermis. He became afebrile and his cutaneous lesion improved after administration of corticosteroid. When the dose of corticosteroid was decreased, cutaneous erythema and nodules appeared at other sites repeatedly, and disappeared after the dose of corticosteroid was increased. The cutaneous lesions had characteristics of both Sweet's syndrome and pyoderma gangrenosum. Moreover, the patient had immunological abnormalities and decreased neutrophilic functions (chemotaxis and O2- generation). Thus, it was suggested that the cutaneous lesions of this patient could be diagnosed as “neutrophilic dermatosis of MDS”, and corticosteroid was recognized to be very effective in treating these skin lesions.
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  • CML with Autoimmune Thrombocytopenia Observed in the Course of IgG (κ) Type Monoclonal Gammopathy
    Tsutomu NAKASE, Nobuyoshi MATSUOKA, Eiichi IWASAKI, Shigeo UKYO, Shige ...
    1992 Volume 33 Issue 5 Pages 706-708
    Published: 1992
    Released on J-STAGE: April 24, 2009
    DOIhttps://doi.org/10.11406/rinketsu.33.706
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    An 80-year-old male with IgG (κ) type benign monoclonal gammopathy was admitted to our hospital because of marked leukocytosis. At the time of admission, thrombocytopenia was also noted. A bone marrow aspirate showed marked granulocytosis with a normal megakaryocyte count. PAIgG was elevated and the NAP score was low. Ph1 chromosome and rearrangement of the breakpoint cluster region were detected. On the basis of these findings, he was diagnosed as having CML with autoimmune thrombocytopenia. This case was of interest with respect to blood cell differentiation and immunological findings.
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