Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
Volume 36, Issue 2
Displaying 1-14 of 14 articles from this issue
  • Motoki EGASHIRA, Takako KANEKO, Kazuo OSHIMI, Hideaki MIZOGUCHI, Masas ...
    1995 Volume 36 Issue 2 Pages 69-75
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    In normal peripheral blood natural killer (NK) cells, the subset of CD16+ CD56+ cells is predominant, and that of CD16+ CD56- cells is rarely present. Because we have found the expansion of CD16+ CD56- NK cells in the peripheral blood of two patients with NK cell-lineage granular lymphocyte-proliferative disorders (NK-GLPD), the clinical findings and cellular characteristics of these patients were compared with those of CD16+ CD56+ NK-GLPD patients. Although CD16+ CD56- and CD16+ CD56+ NK-GLPD cells were morphologically different, clinical findings and courses, and NK activity did not differ significantly. Because strong NK activity was demonstrated in CD16+ CD56- NK-GLPD cells, the CD56 antigen, one of the adhesion molecules, did not seem to play a major role in NK cell-mediated cytotoxicity. The CD56 antigen is known to be more strongly expressed by immature NK cells than by mature NK cells. However, because interleukin 2-activated CD16+ CD56- NK-GLPD cells rapidly expressed the CD56 antigen, the degree of CD56 antigen expression did not always correlate with the maturity of NK cells.
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  • Hiroyuki KOGA, Sumio MIYAZAKI, Takanobu ISHIHARA, Toshirou INOUE, Hiro ...
    1995 Volume 36 Issue 2 Pages 76-83
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    Since October 1984, children with acute lymphoblastic leukemia (ALL) were treated with six protocols of the Kyushu-Yamaguchi Children's Cancer Study Group (KYCCSG). We reviewed cases in whom the first relapse sites of ALL were CNS, testis and ovary. Between October 1984 and July 1993, 302 children with ALL were registered. Ten children (3.3%) developed CNS-L. After treatment for CNS-L, four cases were alive, however one of them has had several episodes of CNS-L. Testicular relapse occurred in 8 boys and three of them are alive. One girl developed ovarian and uterine involvement 7 months after completion of treatment and she survived after intensive chemotherapy for an additional 3 years. Before September 1990, children with ALL received 18Gy cranial irradiation in standard risk group and 24Gy in high risk group. Since October 1990, children with ALL received no cranical irradation in low risk group, 15Gy in intermediate risk group and 18Gy in high risk group. Incidence of CNS-L has not increased in children treated with protocols, in which cranial irradiation was reduced.
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  • Nozomi NIITSU, Masanori UMEDA
    1995 Volume 36 Issue 2 Pages 84-90
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    G-CSF was used concomitantly with the COP-BLAM regimen, and its therapeutic results and adverse effects were evaluated. A total of 104 patients with untreated non-Hodgkin's lymphoma (NHL), including 22 in stage II, 52 in stage III and 30 in stage IV. Seventy five patients had diffuse large cell type, 18 diffuse medium cell type, and 11 diffuse mixed cell type. The treatment consisted of the COP-BLAM regimen based on the method of Laurence et al., was performed every 3 weeks. Complete remission was achieved in 98 out of 104 patients (94.2%), and the 4-year survival rate was 82.4%, while at the time of evaluation the median observation period was 26 months. The survival time was significantly prolonged in patients with low LDH values, B-cells, stage II or low CRP values. The COP-BLAM regimen with concomitant G-CSF administration achieved a high remission rate and reduced the frequency of infections. Almost all of the patients could be treated in 21-day cycle and this appeared to be effective for treatment with increased dose intensity.
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  • Shin FUJISAWA, Atsuo MARUTA, Koji OGAWA, Rika SAKAI, Jun TAGUCHI, Naot ...
    1995 Volume 36 Issue 2 Pages 91-97
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    A retrospective analysis was performed on forty nine elderly (34 males and 15 females) patients aged 65 years or more (median age 73, range 65∼82) with acute non-lymphocytic leukemia (ANLL). Patients were studied to examine factors according to age group (65∼69 years, 70∼74, 75∼79 and 80 or over), respectively. Patients were treated with either low dose Ara-C therapy or BHAC-DMP therapy according of the choice of their attending physicians. Complete remission (CR) was obtained in 20 of 49 patients (43%), and in 6 of 14 patients (43%) aged 65∼69, in 8 of 18 (44%) aged 70∼74, in 5 of 12 (42%) aged 75∼79 years and in 1 of 3 (33%) aged 80 or over, respectively. The median survivals of these groups were 263, 298, 260, 168.5 and 38.5 days, respectively. Multivariate analysis revealed that the achievement of CR was associated with normal karyotype, and serum GOT level≤30 mu/ml and GPT≤40 mu/ml. Prolonged survival was related to the achievement of CR. The results indicated that liver function before chemotherapy was an important prognostic factor.
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  • Kosei ARIMURA, Kazutaka KURIYAMA, Yasushi MIYAZAKI, Kazuhiro NAGAI, Ta ...
    1995 Volume 36 Issue 2 Pages 98-105
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    De novo AML with trilineage myelodysplasia (AML/TMDS) is reported to account for 10∼15% of de novo AML and respond poorly to conventional intensive chemotherapy, In our series, 12 (25%) of 48 patients with de novo AML were diagnosed as AML/TMDS. We found that the platelet count was significantly higher (p<0.05), and the blast percentage of the bone marrow was significantly lower (p<0.05) in the AML/TMDS group than in the AML/non-TMDS group. Sex ratio, age, WBC and RBC count did not significantly differ between the two groups. The immunological markers and the myeloperoxidase positivity of the blasts of AML/TMDS varied widely. The CR rate was 66.7% in the AML/TMDS group and 83.3% in the AML/non-TMDS group. Dysplastic changes were still detected in the bone marrow smears in 7 of 8 AML/TMDS cases who achieved complete remission. The AML/TMDS group showed significantly shorter CR duration (median; 169 days) and survival (median; 511 days, p<0.05). However, in two cases which underwent allogeneic bone marrow transplantaion (allo-BMT) during early relapse phase the disease-free survival has extended over 4 years and 2 years 8 months, respectively. Thus, we would like to propose that allo-BMT should be performed as early as possible to overcome poor outcome of AML/TMDS.
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  • Minoru TAKESHIMA, Shinobu NAKAMURA, Yasuhiro MOCHIZUKI, Noritaka HATTO ...
    1995 Volume 36 Issue 2 Pages 106-114
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    For salvage chemotheray, 30 cases of relapsed or refractory non-Hodgkin's lymphoma (NHL) were treated with MMIP regimen (mitoxantrone 15 mg/m2, methotrexate 400 mg/m2, and ifosfamide 2 g/m2 intravenously in day 1, respectively, and prednisolone 20 mg/m2 orally from day 1 to 5).
    The overall complete response rate (CR rate) was 20% and the median survival duration was 153 days. In patients with favorable performance status (PS), the CR rate and survival duration were 30% and 407 days, respectively. These results were almost equivalent to previously proposed salvage regimens. The overall disease free survival rate of CR cases at 4 years was 62%, which was excellent as compared with the other salvage regimens. Five of 8 (62.5%) patients previously treated with etoposide-non-containing regimens achieved CR, and the CR rate was significantly superior to that of patients previously treated with etoposide-containing ones. These results indicate that MMIP is a useful salvage regimen for relapsed or refractory NHL, while it seems to be difficult to salvage patients previously treated with etoposide-containing regimens.
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  • Shoichi MITSUHASHI, Toshiro NAGASAWA, Masaharu KAMOSHITA, Koji OTANI, ...
    1995 Volume 36 Issue 2 Pages 115-120
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    Sixty-seven years-old female, who was an atomic bomb survivor in Hiroshima, was pointed out as having leukopenia and anemia in 1991. She was referred to Tsukuba University Hospital in June 1992. Her peripheral blood count showed pancytopenia- 2,600/μl WBC, 10.5 g/dl hemoglobin, and 80,000/μl platelets- at that time. BM biopsy revealed hypoplastic marrow and increased peroxidase-negative blasts (32.8%). Surface marker analysis of the blasts showed a feature of CD2+ CD33+ CD34+ CD13+ CD3-. Electronmicroscopically, myeloperoxidase was positive. She was diagnosed as having hypoplastic leukemia of which the blasts had a feature of AML-M0 by FAB-group. After 6 months' silent period, her pancytopenia became profound. We successfully reduced the blasts by BAM therapy. However, she died of bacterial pneumonia during the myelosuppressive state. This is a case of minimally differentiated hypoplastic AML.
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  • Hiraku MORI, Naoki TAKAHASHI, Junichi TADA, Tsuyoshi MAEDA, Takakazu H ...
    1995 Volume 36 Issue 2 Pages 121-127
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    A 57 year-old-female was incidentally found to have leukocytosis in September 1988. Physical examination revealed anemia and marked hepatosplenomegaly. Her WBC count was 33,400/μl with 95% mature neutrophils showing toxic granules. Her neutrophil alkaline phosphatase score was 482, and serum VB12 14,600 pg/ml. Serum immunoglobulin concentrations were 582 mg/dl for IgG, 3,628 mg/dl for IgA and 48 mg/dl for IgM. IgA was determined as monoclonal orgin of λ type. Bone marrow aspiration revealed a hypercellular marrow with active granulocytopoiesis and increased plasma cells. Cytogenetic study revealed normal karyotype. The bcr rearrangement was negative for bone marrow cells. An electronmicroscopy demonstrated fibrillar inclusions in granulocytes. We diagnosed this case as a chronic neutrophilic leukemia (CNL) associated with multiple myeloma. She was treated with a course of low dose busulfan without beneficial response. She was admitted for development of huge subcutaneus hematoma of left waist in October 1990. Laboratory findings were: Hb 7.0 g/dl, WBC 55,300/μl, Platelets 3.3×104l, and IgA 6,607 mg/dl. She required frequent transfusions. She died of pneumonia in July 1991. The peculiar fibrillar inclusions with CNL has not been reported so far. The orign and significance of such structure remains uncertain.
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  • Hajime YAMATO, Keiji YAMADA, Toshiyuki KOIKE, Mizuho YOSHIDA, Satoshi ...
    1995 Volume 36 Issue 2 Pages 128-133
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    We report a case of acute myelogenous leukemia (AML), which developed from severe aplastic anemia (SAA) and was successfully treated by low-dose Ara-C and aclarubicin with concomitant use of G-CSF (CAG therapy). A 37-year-old male was admitted for scrutiny of pancytopenia and diagnosed as SAA because of hypocellular bone marrow without abnormal or dysplastic cells. Although hematopoiesis recovered with steroid pulse therapy followed by administration of anabolic steroids, 29 months after initial onset of SAA, he presented as AML (FAB-M6), as his bone marrow Contained 21.6% leukemic myeloblasts and 56% of erythroblasts. Chromosome study revealed 45, XY, -7 in 14 of 20 cells analyzed. Complete remission was achieved by administration of low-dose Ara-C (20 mg/m2 for 7 days) and aclarubicin (14 mg/m2 for 4 days) along with G-CSF (200 μg/m2 for 7 days), without any severe complications. In the previous reports in Japan since 1982, 7 out of 8 cases with AML developing from SAA died within a year. Our results indicate that CAG therapy is useful for treatment for this subset of AML with poor prognosis.
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  • Masaru NISHIKORI, Kiyo NODA, Tomoko NAGAI, Ichiro KUROKAWA, Akiharu OK ...
    1995 Volume 36 Issue 2 Pages 134-140
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    A 50-year-old woman was admitted to our hospital in May 1993 because of papules, cervical lymphadenopathy and interstitial pneumonia. Oxygen inhalation and pulse therapy of corticosteroid were started. A biopsy of the left inguinal lymphnode showed T zone enlargement and marked vascularization with polymorphous atypical lymphoblasts, consistent with angiocentric lymphoma (immunohistochemically T cell type). In situ hybridization with EBER-1 did not show association of EB virus. She was subsequently treated with ProMACE-CytaBOM successfully, but anemia had progressed before that treatment showing a reticulocyte count 0‰, LDH 870 U/l, positive direct Coombs test. Bone marrow aspiration revealed red cell aplasia and the existence of giant pronormoblasts. The hemoglobin dropped to the level of 4.7 g/dl, requiring anabolic steroid and frequent blood transfusion. Parvovirus B19-specific antibodies were negative initially by western blot assay, but IgM antibody appeared after 35 days and IgG after 71 days. In August anemia improved following a reticulocyte burst and recovery of bone marrow erythroblasts. This patient is the first reported case of angiocentric lymphoma complicated with severe anemia, perhaps resulting from autoimmune hemolytic process and parvovirus B19 infection.
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  • Takeo NIKI, Youichi KAWAMURA
    1995 Volume 36 Issue 2 Pages 141-146
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    A 46-years-old woman was admitted with purpura, nasal bleeding, gum bleeding, gross hematuria, cerebral hemorrhage, and cerebral infarction. The data of her peripheral blood were as follows: WBC 17,500/μl, Hb 5.1 g/dl, PLT 0.3×104l, LDH 924 IU/l. Primary myelofibrosis was diagnosed because of bone marrow fibrosis and extramedullary hematopoiesis of the spleen. Furthermore, she revealed marked thrombocytopenia and no response to platelet transfusion, so association of idiopathic thrombocytopenic purpura (ITP) was considered. Though she was treated with high dose predonisolone, high dose γ-globulin, and splenectomy, no hematological improvement was achieved. Administration of azathioprine (100 mg/day) was begun and 2 weeks later, her white blood cell count was approximately 10,000/μl, the platelet count 2.0×104l, and no bleeding focus was found. Four weeks later, her hemoglobin content was 13.0 g/dl without blood transfusion. The diagnosis of antiphospholipid syndrome, rather than ITP, was made because of anticardiolipin-β2GPI compex antibody and cerebral infarction. It is interesting that immunosupressant was effective both in primary myelofibrosis and in antiphospholipid syndrome.
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  • Kimitaka TAKITANI, Naohisa KAWAMURA, Hitoshi YAMAGUCHI, Wakaba MORINOB ...
    1995 Volume 36 Issue 2 Pages 147-152
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    We reportd a 17-year-old girl with relapsed acute promyelocytic leukemia (APL) who achieved complete remission and has been received maintenance therapy with all-trans retinoic acid (ATRA). The patient was diagnosed as APL in 1986. The ANLL 861 protocol of the Children's Cancer and Leukemia Study Group induced complete remission, and the chemotherapy was discontinued in 1989. However, she suffered a relapse with APL in 1991 and begun receiving ATRA (30 mg/m2/day) therapy because of disseminated intravascular coagulation. Bleeding tendency was discontinued by day 5. During the treatment, the white blood cell count increased markedly to 35,510 per μl on 15th day, however she achieved complete remission morphologically on day 18. After informed consent was obtained from the family, she has been given ATRA orally for more than three years at the time of this report. The pharmacokinetics examination (ATRA 20 mg/m2 single per os) was performed 12 and 22 months after the induction therapy. The each peak plasma level of ATRA was 89 and 149 ng/ml. The concentration of ATRA has yet reached a level despite the continuous ATRA therapy. We considere that it may be useful to monitor plasma levels of ATRA during the treatment.
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  • Koichi MORITA, Masato SHIKAMI, Yukari NISHII, Toshimichi UENO, Tetsuro ...
    1995 Volume 36 Issue 2 Pages 153-155
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    A 56-year-old female with chronic renal failure secondary to diabetic glomerulosclerosis was hospitalized and had a fluminant clinical course with pancytopenia, abnormal liver function tests, and coagulopathy. Bone marrow aspirate findings were typical of reactive hemophagocytosis. The patient died after 21 days of hospitalization and autopsy findings showed disseminated miliary tuberculosis. To our knowledge, only eight cases of miliary tuberculosis with bone marrow hemophagocytosis have previously been described. The presence of reactive hemophagocytosis requires a prompt and thorough search for treatable infections.
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  • Hidekazu MASUOKA, Masayuki KOBAYASHI, Ken KAITO, Mayumi YOSHIDA, Tohru ...
    1995 Volume 36 Issue 2 Pages 156-158
    Published: 1995
    Released on J-STAGE: April 25, 2009
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    Bilateral ankle skin ulcers developed in a 61-year-old man in the chronic phase of chronic myelogenous leukemia receiving hydroxyurea therapy. The circulating immune complex (anti-C3d antibody) was high in this case, but vasculitis was not observed in the pathological findings of biopsied skin materials. This association has been reported in patients who had chronic myelogenous leukemia or other myeloproliferative disorders and were treated with hydroxyurea. It is likely that skin ulcers are caused by hydroxyurea.
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