内容紹介
Summary
A man in his late 50s had lumbago and thrombocytopenia. He was diagnosed with Philadelphia chromosome-positive acute lymphoblastic leukemia(Ph plus ALL). Remission induction chemotherapy was initiated with JALSG Ph plus ALL 208 protocol, but cerebral infarction in the right occipital lobe developed on day 2 and, to make matters worse, was accompanied by hemorrhagic cerebral infarction in the left occipital lobe on day 9. We decided that chemotherapy with multiple drugs was difficult to continue, and it was stopped. After improvement of the general condition, dasatinib therapy was started on day 52. After about 5 months, Ph plus ALL relapsed. Although mild disorientation and visual field defects remained due to old cerebral infarction, organ function was maintained, and patient performance status(PS)was classified as 1. Introduction of ponatinib was considered feasible, and ponatinib was started from a dose of 15 mg/day to prevent the occurrence of vaso-occlusive adverse events. It was gradually increased to 30 mg/day and continued about 4 months without recurrence of cerebral infarction. Complete molecular response was achieved with ponatinib therapy. It was suggested that, in patients with Ph plus ALL with a history of cerebral infarction, ponatinib could be a treatment option under careful risk management.
要旨
患者は50歳台後半,男性。腰痛,血小板減少で初診し,フィラデルフィア染色体陽性急性リンパ芽球性白血病[Ph+acute lymphoblastic leukemia(Ph+ALL)]と診断した。JALSG Ph+ALL 208プロトコールにて寛解導入療法を開始したが,day 2に右後頭葉に脳梗塞を来し,day 9に左後頭葉に出血性脳梗塞を伴った。多剤併用化学療法の継続は困難と判断し中断した。全身状態は改善し,day 52にdasatinibを導入した。約5か月後にPh+ALLは再発したが,陳旧性脳梗塞にて軽度見当識障害および視野欠損残存するもPS 1で臓器機能は保たれていた。ponatinibの導入は可能と判断し,血管閉塞性有害事象のリスク説明の上15 mg/dayから開始した。30 mg/dayに漸増し,脳梗塞再発なく約4か月内服し分子遺伝学的完全寛解に到達している。脳梗塞既往を有するPh+ALLにも,慎重なリスク管理の下で治療選択肢となる可能性が示唆された。
目次
A man in his late 50s had lumbago and thrombocytopenia. He was diagnosed with Philadelphia chromosome-positive acute lymphoblastic leukemia(Ph plus ALL). Remission induction chemotherapy was initiated with JALSG Ph plus ALL 208 protocol, but cerebral infarction in the right occipital lobe developed on day 2 and, to make matters worse, was accompanied by hemorrhagic cerebral infarction in the left occipital lobe on day 9. We decided that chemotherapy with multiple drugs was difficult to continue, and it was stopped. After improvement of the general condition, dasatinib therapy was started on day 52. After about 5 months, Ph plus ALL relapsed. Although mild disorientation and visual field defects remained due to old cerebral infarction, organ function was maintained, and patient performance status(PS)was classified as 1. Introduction of ponatinib was considered feasible, and ponatinib was started from a dose of 15 mg/day to prevent the occurrence of vaso-occlusive adverse events. It was gradually increased to 30 mg/day and continued about 4 months without recurrence of cerebral infarction. Complete molecular response was achieved with ponatinib therapy. It was suggested that, in patients with Ph plus ALL with a history of cerebral infarction, ponatinib could be a treatment option under careful risk management.
要旨
患者は50歳台後半,男性。腰痛,血小板減少で初診し,フィラデルフィア染色体陽性急性リンパ芽球性白血病[Ph+acute lymphoblastic leukemia(Ph+ALL)]と診断した。JALSG Ph+ALL 208プロトコールにて寛解導入療法を開始したが,day 2に右後頭葉に脳梗塞を来し,day 9に左後頭葉に出血性脳梗塞を伴った。多剤併用化学療法の継続は困難と判断し中断した。全身状態は改善し,day 52にdasatinibを導入した。約5か月後にPh+ALLは再発したが,陳旧性脳梗塞にて軽度見当識障害および視野欠損残存するもPS 1で臓器機能は保たれていた。ponatinibの導入は可能と判断し,血管閉塞性有害事象のリスク説明の上15 mg/dayから開始した。30 mg/dayに漸増し,脳梗塞再発なく約4か月内服し分子遺伝学的完全寛解に到達している。脳梗塞既往を有するPh+ALLにも,慎重なリスク管理の下で治療選択肢となる可能性が示唆された。