6-Mercaptopurine が著効を奏した多発性骨髄腫の一例

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  • A Case Report of Multiple Myeloma (IgA type) with a Remark on 6-Mercaptopurine Therapy
  • 6-Mercaptopurineが著効を奏した多発性骨髄腫の1例
  • 6 Mercaptopurine ガ チョコウ オ ソウシタ タハツセイ コツ

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A 62 years-old female was admitted with complaints of general fatigue, loss of appetite and pallor of the face for 3 months duration. She had been pointed out as having proteinuria three years before by the life insurance survey.<BR>Clinical studies and laboratory findings on admis sion as described briefly bellow was compatible with multiple myeloma of IgA (κ) type. Peripheral blood analysis revealed hypochronic microcytic anemia with RBC 241 X 104/mm3, Hb 6.5 g/dl and Hct 21% and 7300/mm3 of WBC with left shift. Profound increase in blood sedimentation rate (lhr,144mm,2 hr,163mm), i9-hyperglobulinemia (Totalprotein 7.1g/di, Alb.59.8%, a1Gl.3.2%,α2G1.8.4%,βGl.24.6%,γG1.3,8%) and positive Bence Jones' protein in urine were noted. Determination of serum immunoglobulin disclosed marked increase in IgAglobulin, IgA being 3100mg/d1, IgG 400mg/d1 and IgM 10.5mg/b1. The skull X-ray revealed disseminated punched-out lesions.<BR>6-mercaptopurine (6MP) in combin ation with paramethasone was employed for the treatment. Oral administrations of 0.15gr of 6MP and 24mg of paramethasone for 10 days, and 0.075gr and 12mg for 4 weeks, respectively, produced a striking clinical improvement. The subjective symptoms were not complained any more, with improvement in peripheral blood and serum protein profiles including M component, and with negative Bence Jones protein. With a maintenance daily dosage of 0.04gr of 6MP and 4mg of paramethasone, the patient was thereafter doing well.<BR>According to the recent literatures, cyclophospha mide and melphalan are most widely and frequently employed for the treatment of mltiiple myeloma. However, the both drugs have a potential depressant effect on bone marrow function, and melphalan is not commercially available in Japan. There are no recent reports concerning 6MP for the treatment of multiple myeloma.<BR>As shown in the case presented above,6MP could be used with success. We would feel that 6MP should be remembered as a choice of drugs for multiple myeloma since it is easily available and has a relatively low incidence of the side effect.

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