内容紹介
Summary
A woman in her late 50s visited our department because an abnormal shadow of her right lung was seen on her chest radiographs. She was diagnosed with StageⅠA primary lung adenocarcinoma with EGFR exon 19 deletion mutation by performing thoracoscopic middle lobe resection and lymph node dissection. After 1 and a half years, the lung metastasis recurred and she received gefitinib(GEF)monotherapy for 9 months and withdrew because of the sustained complete response(CR). Three years and 7 months after the first visit, she was diagnosed as having complication of revised international staging system(R-ISS)Ⅱ multiple myeloma with anemia, retinal vein occlusion, and M proteinemia. It was decided that treatment for myeloma should be given priority and hence, Bd, high dose chemotherapy with auto-peripheral blood stem cell transplantation(aPBSCT), Ld, ELd and Pd therapy were performed sequentially until progressive disease(PD)and survival benefit were evident. As lung metastasis of adenocarcinoma also progressed, myeloma treatment was terminated, GEF was administered intermittently and consequently, shrinkage of the lung metastasis was confirmed. Depending on sequential alternating chemotherapy for both malignancies, a relatively long survival time of 5.4 years from the initiation of treatment for myeloma and 7.5 years from the recurrence of lung adenocarcinoma was achieved.
要旨
患者は50歳台後半,女性。X年に胸部単純X線で右肺異常陰影を指摘され,胸腔鏡下中葉切除およびリンパ節郭清を施行した。右肺腺癌,StageⅠA(EGFR exon 19欠失変異)の診断となった。X+1年6か月,右肺転移再発を来し9か月間gefitinib(GEF)を内服し,complete response(CR)持続のため休薬した。X+3年7か月,貧血,網膜静脈閉塞,M蛋白血症を認め,多発性骨髄腫の診断となった。R-ISSⅡ期であり,Bd,自己末梢血幹細胞移植併用大量化学療法(auto-peripheral blood stem cell transplantation: aPBSCT),Ld,ELd,Pd療法を施行し,延命効果を得た。肺腺癌肺転移が進行したため骨髄腫治療薬を適時休薬し,GEFを間欠的に内服し,それぞれ腫瘍縮小を確認した。 X+9年で原病死したが,骨髄腫初回治療から5年5か月,肺腺癌肺転移再発から7年6か月,担癌状態で生存した。
目次
A woman in her late 50s visited our department because an abnormal shadow of her right lung was seen on her chest radiographs. She was diagnosed with StageⅠA primary lung adenocarcinoma with EGFR exon 19 deletion mutation by performing thoracoscopic middle lobe resection and lymph node dissection. After 1 and a half years, the lung metastasis recurred and she received gefitinib(GEF)monotherapy for 9 months and withdrew because of the sustained complete response(CR). Three years and 7 months after the first visit, she was diagnosed as having complication of revised international staging system(R-ISS)Ⅱ multiple myeloma with anemia, retinal vein occlusion, and M proteinemia. It was decided that treatment for myeloma should be given priority and hence, Bd, high dose chemotherapy with auto-peripheral blood stem cell transplantation(aPBSCT), Ld, ELd and Pd therapy were performed sequentially until progressive disease(PD)and survival benefit were evident. As lung metastasis of adenocarcinoma also progressed, myeloma treatment was terminated, GEF was administered intermittently and consequently, shrinkage of the lung metastasis was confirmed. Depending on sequential alternating chemotherapy for both malignancies, a relatively long survival time of 5.4 years from the initiation of treatment for myeloma and 7.5 years from the recurrence of lung adenocarcinoma was achieved.
要旨
患者は50歳台後半,女性。X年に胸部単純X線で右肺異常陰影を指摘され,胸腔鏡下中葉切除およびリンパ節郭清を施行した。右肺腺癌,StageⅠA(EGFR exon 19欠失変異)の診断となった。X+1年6か月,右肺転移再発を来し9か月間gefitinib(GEF)を内服し,complete response(CR)持続のため休薬した。X+3年7か月,貧血,網膜静脈閉塞,M蛋白血症を認め,多発性骨髄腫の診断となった。R-ISSⅡ期であり,Bd,自己末梢血幹細胞移植併用大量化学療法(auto-peripheral blood stem cell transplantation: aPBSCT),Ld,ELd,Pd療法を施行し,延命効果を得た。肺腺癌肺転移が進行したため骨髄腫治療薬を適時休薬し,GEFを間欠的に内服し,それぞれ腫瘍縮小を確認した。 X+9年で原病死したが,骨髄腫初回治療から5年5か月,肺腺癌肺転移再発から7年6か月,担癌状態で生存した。