Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 37, Issue 9
Displaying 1-23 of 23 articles from this issue
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  • [title in Japanese]
    [in Japanese]
    1996 Volume 37 Issue 9 Pages 751-754
    Published: 1996
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.37.751
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  • [title in Japanese]
    [in Japanese]
    1996 Volume 37 Issue 9 Pages 755-759
    Published: 1996
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.37.755
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  • [title in Japanese]
    [in Japanese], [in Japanese], [in Japanese], [in Japanese]
    1996 Volume 37 Issue 9 Pages 760-765
    Published: 1996
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.37.760
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  • [title in Japanese]
    [in Japanese], [in Japanese], [in Japanese]
    1996 Volume 37 Issue 9 Pages 766-769
    Published: 1996
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.37.766
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  • The Role of Cytokines on Hyperleukocytosis Associated with Acute Promyelocytic Leukemia Induced by All-trans Retinoic Acid Therapy
    Ken-ichiro HINO, Tsuyoshi NAKAMAKI
    1996 Volume 37 Issue 9 Pages 770-776
    Published: 1996
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.37.770
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    The mechanism of the cause of hyperleukocytosis induced by differntiation induction therapy of acute promyelocytic leukemia (APL) by all-trans retinoic acid (ATRA) was studies. Of 11 patients treated by ATRA in our hospital, 3 developed hyperleukocytosis. Moreover, 2 out of 4 patients with retinoic acid syndrome (ATRA syndrome) had hyperleukocytosis. Using the patients'leukemia cells as test material, we obteined the following results. In the presence of ATRA at a concentration that induced differentiation in vitro, promotion or supression of differentiation and lineage determination during the differentiation of APL cells involved factors other than ATRA, such as cytokines. Moreover, APL cells that differentiated into monocytoid cells possessed the capability of producing endogenous cytokines such as TNFα, which might be involved in the development of ATRA syndrome. Compared to cells from patients without hyperleukocytosis they had a stronger TNF α producing capability and lower sensitivity to TGFβ, showing hyperdifferentiation in response to ATRA. Depending on the case, those with the same sensitivity to ATRA might show different sensitivities to cytokines.
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  • Low-Dose Chemotherapy
    Kiyoyuki OGATA, Takashi YAMADA, Kazuo DAN
    1996 Volume 37 Issue 9 Pages 777-781
    Published: 1996
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.37.777
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    We examined the clinical results of low-dose chemotherapy in patients with myelodysplastic syndromes (MDS) and refractory acute myelocytic leukemia (AML) who were treated in our institution. Of 34 patients with MDS treated with low-dose cytarabine, 11 achieved complete remission (CR) and six achieved partial remission (PR). The CR rate of patients whose blasts had Auer bodies was significantly higher than that of the patients whose blasts did not. Although the duration of remission was generally short, the overall survival was longer in the responders (CR cases + PR cases) than in the non-responders. Of 13 patients with MDS treated with low-dose etoposide, one achieved CR and four achieved PR. Of seven patients treated with a combination low-dose therapy consisting of cytarabine and etoposide, two achieved CR. The clinical data in some cases suggested that blasts differentiate into mature myeloid cells in vivo. Low-dose chemotherapy is one therapeutic strategy for MDS and refractory AML. Further studies on the therapy should be conducted to increase the CR rate and to prolong the duration of CR.
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  • [title in Japanese]
    [in Japanese], [in Japanese], [in Japanese], [in Japanese]
    1996 Volume 37 Issue 9 Pages 782-784
    Published: 1996
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.37.782
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  • Treatment Results for Unselected Patients with Acute Myelogenous Leukemia
    During a 10-Year Period, August 1984 to July 1994
    Teruo INO, Masami HIRANO, Hiroshi KOJIMA, Motohiro TSUZUKI, Tetsushi Y ...
    1996 Volume 37 Issue 9 Pages 817-824
    Published: 1996
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.37.817
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    In order to analyse the clinical characteristics and outcome in acute myelogenous leukemia, 129 consecutive adult patients admitted to our hospital over a 10-year period, from August 1984 to July 1994, were studied. Their median age was 51 years, 17 (13.2%) of them had antecedent myelodysplastic syndrome (MDS) and 9 (7.0%) had secondary leukemia. Seventy-eight patients (60.5%) were considered eligible for cure-oriented intensive chemotherapy. Forty-four patients were ineligible of one or more of the following; age over 70, antecedent MDS or secondary leukemia. Additional 7 patients were excluded due to concurrent severe diseases. The median survival of the 129 patients was 441 days with an actuarial 5-year survival of 28.6±4.4%, and the disease-free survival (DFS) decreased with the increasing age of the patient. In 78 patients who were eligible for intensive chemotherapy, complete remission was achieved in 84.6% and overall DFS was 41.1±5.9% at 5 years, and their survival was longer than that of ineligible patients. It was suggested that considerable selection of patients, for example, due to old age, already existed before visting our hospital. Analysis of clinical data of unselected patients might enable the development of a rational approach to the management of elderly patients.
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  • Detection of Early Cardiac Dysfunction in Patients with Transfusion-dependent Aplastic Anemia and Chronic Iron Overload in Childhood
    Stress-velocity Relation as a Sensitive Index by Echocardiography
    Kei OHNUMA, Yasunori TOYODA, Hirokazu NISHIHIRA, Akihiro IGUCHI, Ken T ...
    1996 Volume 37 Issue 9 Pages 825-832
    Published: 1996
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.37.825
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    In order to detect early-stage left ventricular dysfuntion, we examined a load-independent index, that is, the stress-velocity relation, by echocardiography in 13 patients with aplastic anemia including pure red cell anemia. Even when left ventricular contractility and pump function were within the normal range, its afterload had a tendency to increase in transfusion-dependent patients. The patients who had impairment of cardiac pump function died of congestive heart failure within one year after abnormal findings in stress-velocity relation were detected. Therefore, the stress-velocity relation is a sensitive, useful and noninvasive index for detecting asymptomatic myocardial dysfunction in patients with transfusion-dependency and chronic iron overload. It is necessary for these patients to undergo examinations of echocardiography at regular intervals. In case of abnormality in the stress-velocity relation, treatment for afterload mismatch and more effective chelation should be recommended to reduce the burden on the heart. Thereby, the heart is kept in better condition, and the prognosis of these patients will be improved.
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  • A Patient with Clinically de novo Ph-positive Acute Lymphoblastic Leukemia Had Ph Chromosome in All Metaphases at the Time of Hematological Remission
    Masahiro FUJIWARA, Norishige SOGA, Izumi KUROKAWA
    1996 Volume 37 Issue 9 Pages 833-837
    Published: 1996
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.37.833
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    A 58-year-old man was referred to our hospital because of his refractory leukemia. Laboratory examinations showed mild anemia and leukocytosis but no blast was seen in the blood. The patient's bone marrow was hyperplastic and 64.8% of marrow cells were lymphoblastoid cells. They were positive for CD10, CD19, CD34 and HLA-DR antigen. Cytogenetic analysis revealed the Ph chromosome in 17 of 20 metaphases. A Southern blot analysis demonstrated no rearrangement of M-BCR gene. A diagnosis of Ph-positive ALL was made. The patient received chemotherapy and reached a complete remission. At that time, however, his marrow cells had Ph chromosome in 7 of 7 metaphases and rearrangement of m-BCR was positive in PCR analysis. He died of septic shock during the intensive consolidation therapy. Clinically this patient seems to have de novo Ph-positive ALL, though his marrow cells had Ph chromosome in all metaphases at the time of complete remission. Recently the rare cases of Ph-positive CML with an m-BCR breakpoint are reported in the literature. This patint may have such a type of CML in blastic phase.
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  • An Allogeneic Bone Marrow Transplantation for Chronic Myelocytic Leukemia with a Large Extramedullary Tumor in the Pelvic Cavity
    Mio YOSHIDA, Tohru TAKAHASHI, Hirokazu KIMURA, Hiroaki MITA, Shina HOR ...
    1996 Volume 37 Issue 9 Pages 838-842
    Published: 1996
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.37.838
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    A 16-year-old girl developed a pain and paresis in the right hip joint in April 1994. Abdominal CT scan revealed hepatosplenomegaly and large tumor mass (6×7×13 cm) invading the right psoas muscle in the pelvic cavity. Laboratory data disclosed marked granulocytosis, the presence of Ph1 translocation and bcr-abl rearrangement, thus a diagnosis of CML was made. The tumor was shown to be consisted of granulocytes at all stages of development by a fine needle aspiration cytology. According to the criteria of IBMTR, the disease was classified as accelerated phase solely because the sum of myeloblasts and promyelocytes exceeded over 20%. The patient was treated with hydroxycarbamide, 6MP and dexamethasone, and marked reduction of the tumor mass was observed. Then an allogeneic BMT was performed from her HLA-identical brother on August 1994. She did not develop clinically significant symptoms except for grade I skin GVHD. The tumor was completely disappeared after the BMT as assessed by the abdominal CT scan. No cytological and chromosomal relapse has been observed for 20 months after the BMT.
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  • Adult T-cell Leukemia with Diffuse Panbronchiolitis-like Lung Infiltration
    Seiko IKI, Kensuke USUKI, Mitsue ENDO, Keiko ITO, Koichi KITAZUME, Mot ...
    1996 Volume 37 Issue 9 Pages 843-847
    Published: 1996
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.37.843
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    A 46-year-old man was admitted complaining of dyspnea. Physical examination revealed superficial lymph nodes swelling, and coarse crackles over the lung. Chest X-ray film showed diffuse small granular shadows, suggesting diffuse panbronchiolitis (DPB). Peripheral blood smears showed cells with flower-like nuclei. HTLV-I antibody was positive in the serum. He was diagnosed as having adult T-cell leukemia (ATL). Transbronchial lung biopsy showed diffuse infiltration of mononuclear cells around bronchioalveoli. The mononuclear cells stained positively for Pan T, CD2, CD3, CD4, CD5, CD25, and DNA from the cells showed HTLV-I provirus monoclonal integration. This is a rare case of ATL accompanied by DPB-like bronchioalveolar ATL cell infiltration.
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  • Appearance of Cytoplasmic Processes of Megakaryocytes in the Peripheral Blood in a Munchausen Syndrome with Factitious Anemia
    Takuya KOMENO, Koji OHTANI, Yuuichi HASEGAWA, Atsushi SHINAGAWA, Harum ...
    1996 Volume 37 Issue 9 Pages 848-852
    Published: 1996
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.37.848
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    Many cytoplasmic processes of megakaryocytes were seen in a 45-year-old male patient of Munchausen syndrome with sustained severe anemia due to repeated self-blood drawing.
    He had a past history of repeated infection and removal of skin-graft transplanted for giant congenital melanocytic nevus due to self-infliction (later confessed by the patient). On the admission, he presented with high fever (39∼40°C) and severe sustained anemia refractory to repeated blood transfusions. Any specific clinical data indicating bleeding or hemolysis were not found. Self-blood drawing was discovered by a nurse on his 27th hospital day. Syringes and needles for blooddrawing were also found. He recovered from anemia under intensive watching without any specific treatment. He confessed that the high fever was artificial. It was of interest that cytoplasmic processes of megakaryocytes were seen in the peripheral blood film until he recovered from anemia for one month. The serum level of erythropoietin was elevated (1540 mU/ml), but not significantly was that of thrombopoietin (1.54 fmol/ml). This case was considered to be valuable to understand the mechanism of platelet-production by megakaryocytes at persistent bleeding.
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  • Successful Treatment of Combined Interferon-α and Hydroxycarbamide for Chronic Myelogenous Leukemia Following Therapy for Malignant Lymphoma
    Atsuhiko HASEGAWA, Hiroyuki NINOMIYA, Kohsuke YANAGISAWA, Kiyonori TAK ...
    1996 Volume 37 Issue 9 Pages 853-857
    Published: 1996
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.37.853
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    A 57-year-old waman was diagnosed as having non-Hodgkin lymphoma (follicular mixed cell, B-cell type, Stage III) in February 1988. Since then, she had been treated with radiation and chemotherapy contained with alkylating agents and etoposide for 6 years. In April 1994, peripheral blood study disclosed leukocytosis with basophilia and thrombocytosis. Bone marrow was hypercellular. The karyotype of bone marrow cells was 46, XX, t(9;22)(q34;q11). Rearrengement of bcr was detected in bone marrow, but not in lymph node cells. On the basis of these findings, she was diagnosed as having the chronic phase of chronic myelogenous leukemia (CML) following the therapy for malignant lymphoma and treated with interferon-α (IFN-α) and hydroxycarbamide. Following this therapy, the lymphoadenopathy promptly disappeared and chromosome analysis showed disappearance of Ph chromosome positive cells. Although CML is rare in secondary leukemia, the present case seemed therapy-related CML and the treatment with IFN-α and hydroxycarbamide was effective for both CML and malignant lymphoma.
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  • Primary Amyloidosis Complicated with Chronic Myelomonocytic Leukemia
    Tetsuya OKUDA, Yoshikazu YUMOTO, Kunihiko KAMAKARI, Tadashi KANO
    1996 Volume 37 Issue 9 Pages 858-862
    Published: 1996
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.37.858
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    A 79-year-old male was admitted to our hospital because of abnormal shadows in both lungs on chest X-ray film. He had a 5-year history of repeated bleeding episodes of unknown etiology before admission. Transbronchial lung biopsy revealed the alveolar septal type of lung amyloidosis. His serum contained a monoclonal IgA-λ type protein but there was no evidence of multiple myeloma. A diagnosis of primary amyloidosis was made. On admission, his hematological findings revealed the coexistence of chronic myelomonocytic leukemia (CMML). Coexistence of primary amyloidosis and CMML is extremely rare. Because monocytes are known to play an essential role in the degenerative processes of serum amyloid precursor, it was suggested that his amyloidosis was accelerated by the onset of CMML through certain dysfunctions of pathological monocytes.
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