Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 38, Issue 6
Displaying 1-15 of 15 articles from this issue
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  • Prognostic Factors of Follicular Lymphoma Treated with Combination Chemotherapy
    Nozomi NIITSU, Masanori UMEDA
    1997 Volume 38 Issue 6 Pages 496-504
    Published: 1997
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.38.496
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    This study investigated 72 patients (12.4%) with follicular lymphoma among 582 patients with non-Hodgkin's lymphoma admitted to our department. Treatment achieved complete remission (CR) in 83.3% of the follicular lymphoma patients, with an overall 5-year survival rate of 63.7%. The 5-year survival rate was 76.9% for the 60 patients who achieved CR, and this rate was significantly higher than that for patients who achieved only partial remission (PR) (p<0.01). The 5-year survival rate was 40% with the CHOP regimen and 74.3% with the COP-BLAM regimen. The 3-year survival rate for biweekly COP-BLAM was 88.4%. The 5-year disease free survival rate for patients who achieved CR was 80.5%. The rate reached a plateau after 42 months, and the same survival was maintained for more than 10 years. These results suggest that intensive chemotherapy is effective even against follicular lymphoma. The 5-year survival rate for patients who achieved PR, suggesting the importance of the response to initial chemotherapy.
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  • Treatment Results in Childhood Acute Myeloblastic Leukemia
    —A Report of Clinical Trials of a Past Decade from the Japanese Children's Cancer and Leukemia Study Group (CCLSG)—
    Masahito TSURUSAWA, Naoyuki KATANO, Takahisa HIROTA, Jyunichi MIMAYA, ...
    1997 Volume 38 Issue 6 Pages 505-512
    Published: 1997
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.38.505
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    Treatment results were evaluated in 167 children with acute myeloblastic leukemia (AML) treated on four protocols (ANLL 861, 8912, 9205, APL-ATRA) of the Children's Cancer Leukemia Study Group. In the ANLL 9205 protocol, anthracycline was used with a continuous infusion of cytosine arabinoside, followed by an intensive sequential post remission chemotherapy of short duration, 42/46 patients (91.3%) achieved complete remission, and 58.8% of these patients projected a 3-year disease free survival. These results were apparently superior to those obtained with the ANLL 861 & 8912 protocols, which used conventional doses of multi drugs followed by a moderate post remission chemotherapy of long duration. This favorable response with the ANLL 9205 protocol was attributed mainly to the high induction rate of patients with the M4 and M5 FAB subtypes, as compared to those in the previous two protocols (91.3% in ANLL 9205 vs 57.9% in ANLL 861+8912; p<0.05). No significant difference in the patients outcome was found between the chemotherapy group and allogenic bone marrow transplantation group in the ANLL 9205 study. The patients with the M3 FAB subtype treated with the APL-ATRA protocol which consisted of an alternative use of all-trans retinoic acid and chemotherapy significantlly prolonged event free survival as compared with the patients treated with ANLL 861/8912 protocols without all-trans retinoic acid.
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  • Successful High-dose Chemotherapy combined with Autologous Bone Marrow Transplantation in a case of Refractory Follicular Lymphoma
    Tadanori NAGAI, Yasuo HIRAYAMA, Hidetoshi OHTA, Ryuzou KOYAMA, Takuya ...
    1997 Volume 38 Issue 6 Pages 513-519
    Published: 1997
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.38.513
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    A 34-year-old patient with follicular lymphoma who was treated with CHOP followed by COPP for 3 years, became resistant to treatment in December 1993. Histological findings and surface markers of cervical lymphnode cells revealed no change from previous findings. Tumor cell involvement of bone marrow was also observed by molecular analysis of DNA fragments with bcl-2 oncogene and J-H gene probes. Following 2 courses of salvage chemotherapy with NOAC-M regimen (novantrone, cytarabine and methylprednisolone), There was an 88% reduction of tumormass on computed tomographic findings. Through the use of polymerase chain reaction analysis of residual cells with the bcl-2 translocation, we confirmed the in vivo purging of tumor cells from bone marrow and we harvested marrow cells for autologous transplantation. After high-dose chemotherapy (HDC) with ranimustine, cisplatin, etoposide and cyclophosphamide followed by bone marrow transplantation (BMT), complete remission was achieved. The patient has survived for 16 months and remains disease free. The standard chemotherapy regimen for advanced low grade non-Hodgkin's lymphoma has not yet been defined. Although we must follow this patient carefully to determine the effect of HDC with BMT for a long time, this seemes to be an effective complementary treatment for patients responding to conventional salvage regimens.
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  • Mantle Cell Lymphoma with Multiple Extranodal Involvement
    Koji ORII, Hikaru KOBAYASHI, Mayumi UENO, Fumihiro ISHIDA, Hiroshi SAI ...
    1997 Volume 38 Issue 6 Pages 520-525
    Published: 1997
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.38.520
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    A 79-year-old male was admitted to our hospital because of general fatigue and night sweat. Physical examination showed generalized superficial lymphadenopathy, marked splenomegaly, and tumors in the conjunctiva and the abdomen. Chest X-ray and computed tomography (CT) revealed pleural effusion and intrathoracic lymphadenopathy. Abdominal ultrasonography and CT showed hepatosplenomegaly and intraperitoneal tumors. Upper gastrointestinal fiberscopy revealed multiple polypoid lesions and ulcers in the duodenum and the stomach. Involvement of relatively small-sized lymphocytes with cleaved nuclei was identified in each biopsied specimen from a cervical lymph node, a tumor in the conjunctiva, gastrointestinal polypoid lesions, and the bone marrow. Surface marker analysis of abnormal lymphocytes in the bone marrow revealed that CD5, CD19, and CD20 were strongly positive, but CD23 was weakly positive. Although (11:14)(q13:q32) translocation was not identified by chromosome analysis of bone marrow cells, Northern blot analysis of bone marrow cells revealed overexpression of the PRAD1 oncogene. Diagnosis of mantle cell lymphoma (MCL) was made. Combination chemotherapy by cyclophosphamide and vincristine was not effective, but etoposide perorally given at a dose of 50 mg per day was effective. In MCL, extranodal involvement of a digestive tract and bone marrow is well known. This case suggests that involvement of multiple organs including lacrimal glands and pleura could be characteristic of MCL cells.
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  • Sudden Cardiac Tamponade Due to Hemorrhagic Myocarditis after Preconditioning Marrow Transplantation with Cyclophosphamide in a Patient with Aplastic Anemia
    Yuji MIURA, Mikio UEDA, Yasuo KONDOU, Hiroto YAMASAKI, Akiyoshi TAKAMI ...
    1997 Volume 38 Issue 6 Pages 526-531
    Published: 1997
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.38.526
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    A 28-year-old male was diagnosed as aplastic anemia in 1983. He maintained on corticosterone with a large transfusion requirement for being resistant to other therapies, and combined with hemochromatosis at 20-year-old. In February 1994, he was admitted to the hospital for consideration of BMT. Echocardiogram was normal on admission. He was transplanted with bone marrow from his HLA-matched MLC negative sister following contained of TLI (7.5 Gy) and CY 50 mg/kg for four days on March 10 1994. Disturbance of consciousness appeared, an echocardiogram showed severe pericardial effusion on day 1 after BMT. He was diagnosed cardiac tamponade, pericardiocentesis was done immediately and 100 ml pericardial effusion was removed. Transiently he became alert, however, irreversible cardiac arrest occured on day 2. Postmortem examination revealed thickened left ventricles with intramyocardial hemorrhage. It seems necessary to reduce CY, or substitute it with anti-thymocyte globulin (ATG) or TBI etc. for BMT in aplastic anemia accompanied by hemochromatosis.
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  • Improvement of Bleeding Tendency and normalized Platelet Count Increment following Splenectomy in a Patient with Refractory Anemia
    Yasukazu KAWAI, Toshihiro FUKUSHIMA, Kiyotaka OOKURA, Nobuyuki YOSHIO, ...
    1997 Volume 38 Issue 6 Pages 532-538
    Published: 1997
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.38.532
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    A 72-year-old woman with refractory anemia had severe bleeding tendency. Since 1994, platelet transfusions (10 units three times per week) were unable to maintaining her platelet count over 10×103/μl. Her hemoglobin was decreased to 3.9 g/dl as a result of bleeding from early gastric cancer. At one-hour after posttransfusion corrected platelet count increment (1-hour CCI) was slightly low, as 14×103/μl/m2, A 24-hour posttransfusion CCI (24-hour CCI) and the (24-hour CCI)/(1-hour CCI) ratio were markedly low, as 0.5/μl/m2 and 0.36, respectively. Anti-HLA antibody was not detected. The ineffectiveness of platelet transfusion was suspected to be highly associated with splenomegaly. Her spleen had been gradually increased in size since the first clinical examination. She underwent both subtotal gastrectomy and splenectomy, while receiving 40 units of platelet transfusion. After splenectomy, the 1-hour CCI and the (1-hour CCI)/(24-hour CCI) ratio markedly improved (76×103/μl/m2 and 0.79, respectively). Cutaneous bleeding halted and there have been no further episodes, despite less frequent platelet transfusions. This is the first report in which bleeding tendency and CCI were improved by splenectomy in a case of myelodysplastic syndrome.
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  • Successful Treatment of Subdural Hematoma with Operation in a Patient with Acute Promyelocytic Leukemia
    Chizuko OKUBO, Heiwa KANAMORI, Shin SASAKI, Jun TAGUCHI, Mami OTSUKA, ...
    1997 Volume 38 Issue 6 Pages 539-543
    Published: 1997
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.38.539
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    A 51 year-old male admitted with petechiae and headache. Acute promyelocytic leukemia (APL) with disseminated intravascular coagulation (DIC) was diagnosed. He received all-trans retinoic acid (ATRA) with enocitabine and daunomycin for induction chemotherapy, and supportive therapy for DIC. On 2nd day after admission, subacute subdural hematoma was confirmed with CT scan. He had anisocoria and disturbance of consciousness, and was treated with neurosurgical operation for his life saving on the 3rd day. Although DIC was continued at this time, the operation was done without roblem. The recurrence of hematoma has not occurred after the operation. Furthermore, the findings of DIC disappeared by the day 6 following induction therapy. He achieved a complete remission including cytogenetic findings on 35th day after administration of ATRA and received 3 times of combination chemotherapy as consolidation therapy. It may be difficult to do neurosurgical treatment in the setting of DIC. However, we should consider whether the indications for surgery operation according to the condition of each patient.
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  • Splenic Lymphoma with Villous Lymphocytes and Complex Chromosomal Abnormality
    Kenjiro HAMAMOTO, Tomohiko OHNO, Hiroyuki OGAWA, Munehiro DATE, Takash ...
    1997 Volume 38 Issue 6 Pages 544-549
    Published: 1997
    Released on J-STAGE: April 28, 2009
    DOIhttps://doi.org/10.11406/rinketsu.38.544
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    We report a 70-year-old Japanese man who had splenic lymphoma with villous lymphocytes and a complex chromosomal abnormality. No monoclonal gammopathy was present. The peripheral blood film showed lymphocytes with thin and short villi arising from one or two poles of the cells. These cells were negative for tartrate-resistant acid phosphatase stain. Immunophenotyping of peripheral blood lymphocytes showed moderate to strong expression of surface membrane IgM, IgD, IgA, and λ as well as CD19, CD20, CD21, CD24, and HLA-DR. In addition, there was weak CD5, CD22, and CD25 expression, but no CD10, CD11c, CD23, CD38, or B-ly-7 expression. All 20 metaphases obtained from peripheral blood cells cultured for 5 days with lipopolysaccharide showed an abnormal karyotype: 47, XY, +der(3) t(3;13)(q26;q12) inv(3)(?), t(7;14)(q21;q11), der(13) t(3;13)(q26;q12). Our patient followed a relatively benign clinical course and splenectomy was not performed.
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