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Volume 36, Issue 7
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[in Japanese]1995 Volume 36 Issue 7 Pages 629-637
Published: 1995
Released on J-STAGE: April 25, 2009
JOURNAL RESTRICTED ACCESSDownload PDF (725K)
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[in Japanese]1995 Volume 36 Issue 7 Pages 638-647
Published: 1995
Released on J-STAGE: April 25, 2009
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Hiroyuki MORI, Kazutaka KURIYAMA, Masayuki TAWARA, Yhuich DANNO, Kenji ...1995 Volume 36 Issue 7 Pages 648-656
Published: 1995
Released on J-STAGE: April 25, 2009
JOURNAL RESTRICTED ACCESSThirteen cases, including 10 relapse cases, of refractory acute myeloid leukemia (AML) (aged 17-70, median 46) by cytosine arabinoside (Ara-C) combined with granulocyte colony-stimulating factor (G-CSF) simultaneously to enhance the sensitivity to Ara-C. Low dose Ara-C (10∼40mg/day) combined with G-CSF was administered in most of them. Complete (CR) and partial remission (PR) were achieved in 5 and 4 patients, respectively, and response (CR+PR) rate was 69.2%. We obtained 5 CRs and 3 PRs in 10 patients with relapsed AML. However, CR and PR duration was short in all cases. None of the 3 patients with MO, AML transformed from myelodysplastic syndrome (MDS), and de novo AML with trilineage myelodysplasia (TMDS) had any response. There was no leukemic colony formation in the culture medium containing G-CSF in the nonresponding patients. The combination therapy caused severe myelosuppression, and most patients experienced prolonged neutropenia, and suffered from infections. In some patients enhanced chemosensitivity of leukemic cells induced by G-CSF was indicated but, the effect of this aproach must be determined by large scale contorolled studies.View full abstractDownload PDF (563K) -
Hisashi TSURUMI, Takahisa MIURA, Toshiki YAMADA, Michio SAWADA, Noriak ...1995 Volume 36 Issue 7 Pages 657-664
Published: 1995
Released on J-STAGE: April 25, 2009
JOURNAL RESTRICTED ACCESSWe evaluated the efficacy of continuous drip infusion therapy with low dose cytosine arabinoside (AraC) and etoposide (VP16) in poor-condition patients with acute myelogenous leukemia (AML). Patients' age ranged from 19 to 85 years with a median of 63 years. Prinicipally they received continuous drip infusion for 14 days with AraC (20 mg/day) and VP16 (50 mg/day). Complete remission (CR) rate was 58.3% (7/12) in untreated cases, 33.3% (2/6) in refractory cases to the standard chemotherapy, and 28.6% (2/7) in relapsed cases. The duration of CR ranged from 1.5 to 20 (+) months (median 8) in untreated group and from 2 to 22 months (median 10) in refractory and relapsed groups. Adverse effects such as gastroenterological symptoms appeared but were tolerable. Although infections due to myelosuppression appeared in 22 of 25 cases, they were well controlled by antibiotics. Chemotherapy-related death was not observed. Although CR rate and CR duration of this therapy were not sufficiently high, the regimen was effective in some patients with refractory or relapsed AML. Further studies are required to establish the efficacy, indication and safety of this treatment.View full abstractDownload PDF (545K)
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Akiko SAEKI, Yoji OGASAWARA, Hiroko OTSUBO, Toru SEKITA, Kaichi NISHIW ...1995 Volume 36 Issue 7 Pages 665-671
Published: 1995
Released on J-STAGE: April 25, 2009
JOURNAL RESTRICTED ACCESSA 59-year-old man was admitted to our hospital because of fever in August 1991. Bone marrow showed normocellularity with 41.5% of CD13, 14, 33 positive blasts, and a diagnosis of AMMoL was made. Laboratory investigation revealed hyponatremia and elevated serum ADH level, indicating the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Intensive chemotherapy successfully induced hematological complete remission and his serum sodlum level became normal. In February 1992, he developed proteinuria and findings were consistent with nephrotic syndrome (NS). Renal biopsy specimen showed membranous proliferative glomerulonephritis and massive infiltration of macrophages, and his serum interleukin 6 level was elevated. Five months later, he suffered from pancytopenia and elevation of biliary enzymes with increase of hemophagocytic histiocytes in his bone marrow (hemophagocytic syndrome). He transiently responded to low dose chemotherapy but he died due to severe infection. It is interesting that association between macrophages and/or cytokines with these various complications was suggested in AMMoL.View full abstractDownload PDF (897K) -
Hiroyuki TSUDA, Kenji SHIRONO, Kanako SHIMIZU, Taizo SHIMOMURA1995 Volume 36 Issue 7 Pages 672-676
Published: 1995
Released on J-STAGE: April 25, 2009
JOURNAL RESTRICTED ACCESSA 30-year-old postpartum woman was admitted to our hospital because of progressive anemia, malaise, night sweating, headache and low grade fever which began 9 days after delivery (day 0). She had normocytic hypochromic anemia accompanied with marked decrease in reticulocytes. In addition, a temporary decrease in platelets and white blood cells especially neutrophils were observed. Bone marrow smears showed an apparent decrease in erythroid cells and the presence of giant proerythroblasts (1.2%) as well as hemophagocytes (1.2%). IgM and IgG antibody against human parvovirus B19 (HPV) was detected on day 22 of the disease although negative results were abtained on day 3. The presence of the virus in the blood on admission was confirmed by dot-blot analysis. Thus, this case was diagnosed as acute pure red cell aplasia and hemophagocytic syndrome caused by HPV infection. This patient had been given iron for iron deficiency anemia before delivery and the iron deficiency was still present after the episode of the present disease although the iron metabolism data was perturbed during the disease. These fingings suggest that HPV could cause acute pure red cell aplasia not only in patients with hemolytic anemia but also in patients with iron deficiency anemia or after acute bleeding. Furthermore it is suggested that pancytopenia often observed on HPV infection could be at least partly caused by hemophagocytic syndrome.View full abstractDownload PDF (383K) -
Hirohito YAMAZAKI, Shinji NAKAO, Hideyuki TAKAMATSU, Takaaki ITO, Miki ...1995 Volume 36 Issue 7 Pages 677-681
Published: 1995
Released on J-STAGE: April 25, 2009
JOURNAL RESTRICTED ACCESSA 45-year-old female developed cytogenetic relapse of chronic mylogenous leukemia 4 years after allogeneic bone marrow transplantation. To induce a graft-versus-leukemia effect, peripheral blood buffy-coat cells were collected from the original marrow donor during 5 rounds of leukapheresis over 3 weeks, and 2.47×108 cells/kg were infused into the patient. Acute graft-versus-host disease (GVHD) did not develop even after an interval of 50 days from the last donor leukocyte transfusion (DLT). However, karyotypic analysis of bone marrow cells performed on the same day showed an apparent decrease in the proportion of Ph1 chromosome-positive cells (1/20) among all dividing cells, compared with the proportion (13/20) observed before DLT. At the same time, the proportion of red blood cells (RBCs) of donor origin among the peripheral RBCs of the patient, which was less than 10% before DLT, began to rise and reached 100% at 4 months after DLT. The karyotype of bone marrow cells obtained on day 90 after DLT was completely normal. Although chronic GVHD of the buccal mucosa and liver developed in association with pancytopenia on day 71 after DLT, this improved rapidly with oral administration of cyclosporine. The clinical course of this patient suggests that acute GVHD is not a prerequisite for elimination of Ph1-positive cells by DLT.View full abstractDownload PDF (335K) -
Hiroyasu KAYA, Shinobu NAKAMURA, Hiroto YAMAZAKI, Ichiro KUMABASHIRI, ...1995 Volume 36 Issue 7 Pages 682-686
Published: 1995
Released on J-STAGE: April 25, 2009
JOURNAL RESTRICTED ACCESSA 67-year-old woman was treated with MP-P therapy and combination chemotherapy for multiple myeloma IgG-λ type. After the therapy for about three years, pancytopenia developed. Bone marrow aspiration study revealed a few of myeloma cell and many atypical cells showing promyelocytic feature. Chromosomal abnormality was 46, X, -X, +8, -13, +mar. CD33 and CD56 were positive, but CD16 and HLA-DR were negative. We diagnosed as multiple myeloma complicated with secondary myeloid/natural killer (NK) cell acute leukemia. After she had been treated with low dose etoposide for leukemia, she obtained complete remission. But since myeloma progressed and the amount of M protein was increased, she was treated with dexamethasone and low dose etoposide, resulting in a decrease in the amount of M protein. After that, because of leukemic cell re-proliferation, she was treated with etoposide. However, she died of sepsis due to severe myelosuppression. This case was interesting one in coexist of multiple myeloma and secondary myeloid/NK cell acute leukemia, and those affecting her clinical course each other.View full abstractDownload PDF (397K) -
Shougo MORICHIKA, Midori SHIMA, Yasufumi IMANAKA, Mituru NAKAJIMA, Sat ...1995 Volume 36 Issue 7 Pages 687-693
Published: 1995
Released on J-STAGE: April 25, 2009
JOURNAL RESTRICTED ACCESSCase 1: Sensory and motor paralysis below the L3 level developed in a moderate hemophilia A due to spinal epidural bleeding following lumbar anesthesia for the resection of retro-peritoneal hematoma. By the treatment with cryoprecipitates, the patient recovered to walk with sticks after laminectomy. Case 2: the patient had severe hemophilia A with 220 Bethesda units/ml of inhibitor. The patient suffered from epidural and intramedullary spinal bleeding from C3 to C7 and developed tetraplegia. Since the inhibitor titer was high, infusion therapy with FEIBA was performed. Paralysis gradually reduced to the T5 level, but the patient had both sensory and motor paralysis of the extremities. It is required that an effective hemostastic treatment for spinal canal bleeding in hemophilia A with high-responder inhibitor is established.View full abstractDownload PDF (1047K) -
Nobuhiko NOMOTO, Hajime SAITO, Makoto KASHIMURA, Sadao AOKI, Akira SHI ...1995 Volume 36 Issue 7 Pages 694-699
Published: 1995
Released on J-STAGE: April 25, 2009
JOURNAL RESTRICTED ACCESSA 62-year-old man with aleukemic Bence Jones type multiple myeloma who developed neurologic abnormalities is reported. After admission, consciousness disturbance appeared and a lumbar puncture obtained M-protein. Though brain CT showed no abnormal findings except a punched out lesion of the temporal bone, MRI disclosed remarkable enhancement of the dura mater. Meningeal involvement by myeloma cells without leukemic blood picture is very rare though it is common in other lymphoproliferative disorders such as acute lymphocyte leukemia and malignant lymphoma. We report a case of BJ type multiple myeloma with meningeal involvement due to diffuse infiltration to the dura mater and discuss a possible mechanism of meningeal involvement in this patient.View full abstractDownload PDF (438K)
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Takayuki ISHIKAWA, Akiko MATSUSHITA, Kenichi NAGAI, Akemi SHIMAZAKI, T ...1995 Volume 36 Issue 7 Pages 700-702
Published: 1995
Released on J-STAGE: April 25, 2009
JOURNAL RESTRICTED ACCESSA 46-year-old man with primary myelofibrosis developed polyarthralgia. Marked hepatosplenomegaly was noted, and hematological examinations revealed a white cell count of 25,600/μl with 42% promyelocytes and thrombocytopenia. The promyelocytes were positive for CD4 antigen and non-specific esterase as well as peroxidase. Cytogenetic analysis of circulating mononuclear cells showed the trisomy of No. 22 chromosome in 3 of 5 cells examined. Four months later, the patient became asymptomatic, and hematological picture and hepatosplenomegaly returned to the original level. This is the first report describing the transient promyelocytic expansion in myeloproliferative disorders.View full abstractDownload PDF (266K) -
Michihiro NAKAYAMA, Yukio KOBAYASHI, Yasuo OSHIMA, Naoki UEMURA, Eiich ...1995 Volume 36 Issue 7 Pages 703-706
Published: 1995
Released on J-STAGE: April 25, 2009
JOURNAL RESTRICTED ACCESSA 64-year-old woman with multiple myeloma, IgGλ type Durie-Salmon Stage II, was admitted because of gradually developing anemia and increased blasts with abnormal karyotype in her bone marrow after 10 years of treatment. The chromosomal analysis showed 44, XX, del(5q), del(7q), -9, add(12p), -21, typical of secondary MDS due to the cumulative alkylating agents. Thrombocytosis concomitantly occurred with emergence of chromosomal abnormality, but the serum interleukin 6 level was not elevated, which suggested that it was related to development of secondary MDS.View full abstractDownload PDF (208K) -
Yoshinori SUZUKI, Kazunori NAKASE, Syozaburo NAGAYA, Shigehisa TAMAKI, ...1995 Volume 36 Issue 7 Pages 707-709
Published: 1995
Released on J-STAGE: April 25, 2009
JOURNAL RESTRICTED ACCESSWe report a case of acute promyelocytic leukemia (APL) following ulcerative colitis (UC). A 23-year-old man was diagnosed as UC in January 1991 and had been treated with salazosulfapyridine and prednisolone with good effect. In September 1993, he developed bleeding tendency and a diagnosis of APL with disseminated intravascular coagulation was made based on the results of bone marrow aspiration and coagulation profile. Complete remission was achieved with All-trans retinoic acid together with combined chemotherapy. He died of sepsis during consolidation chemotherapy in December 1993. Autopsy revealed no recurrence of UC.View full abstractDownload PDF (171K)
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