内容紹介
Summary
A man in his early 70s visited a previous hospital because of pancytopenia and was diagnosed with acute myeloid leukemia based on a bone marrow examination. The karyotype was 46,XY, t(9;22)(q34;q11.2)[2/20], and real-time polymerase chain reaction(PCR)revealed minor bcr-abl chimeric mRNA. Finally, the patient was judged as having Philadelphia chromosome-positive acute myeloid leukemia, and remission induction chemotherapy with the JALSG AML 201 protocol was initiated in combination with dasatinib to achieve complete remission. After 3 courses of consolidation chemotherapy, the anticancer drugs were discontinued because of deterioration of his general condition and renal insufficiency. Six months after the initial treatment, he was referred to our department, and no evidence of recurrence was confirmed on bone marrow examination. However, 2 months later, right massive pleural effusion was detected, and he was admitted to the department of pneumology at our hospital. Thoracoscopic pleural biopsy was performed at the time of chest tube insertion, and he was diagnosed with acute myeloid leukemia extramedullary recurrence. Peripheral myeloblasts appeared and increased rapidly, accompanied by further exacerbation of renal function; thus, he received palliative care at the department of hematology and oncology.
要旨
患者は70歳台前半,男性。血球減少を認め,前医で骨髄穿刺にて急性骨髄性白血病の診断となった。染色体検査で,46, XY,t(9;22)(q34;q11.2)[2/20]を認め,minor bcr-ablキメラmRNAは4.5×10 5 copies/μg RNAであった。フィラデルフィア染色体陽性急性骨髄性白血病と診断し,JALSG AML201プロトコールにdasatinibを併用し寛解を得て,地固め療法を3コースまで施行した。全身状態低下および腎機能悪化にて抗がん剤を中止し,初回治療から6か月後に当科に紹介初診となった。骨髄穿刺で再発のないことを確認したが,2か月後に右大量胸水を認め,当院呼吸器内科に緊急入院した。胸腔ドレーン挿入時に胸腔鏡下胸膜生検を施行し,急性骨髄性白血病髄外再発と診断した。末梢血芽球が出現,急速に増加しさらなる腎機能悪化も伴ったため,当科にて緩和治療に移行した。
目次
A man in his early 70s visited a previous hospital because of pancytopenia and was diagnosed with acute myeloid leukemia based on a bone marrow examination. The karyotype was 46,XY, t(9;22)(q34;q11.2)[2/20], and real-time polymerase chain reaction(PCR)revealed minor bcr-abl chimeric mRNA. Finally, the patient was judged as having Philadelphia chromosome-positive acute myeloid leukemia, and remission induction chemotherapy with the JALSG AML 201 protocol was initiated in combination with dasatinib to achieve complete remission. After 3 courses of consolidation chemotherapy, the anticancer drugs were discontinued because of deterioration of his general condition and renal insufficiency. Six months after the initial treatment, he was referred to our department, and no evidence of recurrence was confirmed on bone marrow examination. However, 2 months later, right massive pleural effusion was detected, and he was admitted to the department of pneumology at our hospital. Thoracoscopic pleural biopsy was performed at the time of chest tube insertion, and he was diagnosed with acute myeloid leukemia extramedullary recurrence. Peripheral myeloblasts appeared and increased rapidly, accompanied by further exacerbation of renal function; thus, he received palliative care at the department of hematology and oncology.
要旨
患者は70歳台前半,男性。血球減少を認め,前医で骨髄穿刺にて急性骨髄性白血病の診断となった。染色体検査で,46, XY,t(9;22)(q34;q11.2)[2/20]を認め,minor bcr-ablキメラmRNAは4.5×10 5 copies/μg RNAであった。フィラデルフィア染色体陽性急性骨髄性白血病と診断し,JALSG AML201プロトコールにdasatinibを併用し寛解を得て,地固め療法を3コースまで施行した。全身状態低下および腎機能悪化にて抗がん剤を中止し,初回治療から6か月後に当科に紹介初診となった。骨髄穿刺で再発のないことを確認したが,2か月後に右大量胸水を認め,当院呼吸器内科に緊急入院した。胸腔ドレーン挿入時に胸腔鏡下胸膜生検を施行し,急性骨髄性白血病髄外再発と診断した。末梢血芽球が出現,急速に増加しさらなる腎機能悪化も伴ったため,当科にて緩和治療に移行した。