急性転化後,rhG-CSF併用Cytosine Arabinoside中等量の化学療法により正常核型細胞出現と,12カ月以上の生存が得られた慢性骨髄白血病  [in Japanese] Induction of Ph-Negative Normal Clone and Long-Term Survival by Combined Treatment with G-CSF Plus Middle Dose Cytosine Arabinoside for Patients with Chronic Myeloid Leukemia in Blastic Transformation  [in Japanese]

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Abstract

G-CSF+cytosine arabinoside (Ara-C)中等量療法を中心とする化学療法を施行し,長期生存を得られた慢性骨髄性白血病急性転化(CML-BC)の3症例について報告する。化学療法はG-CSF(150μg皮下注または300μg点滴静注)24時間先行投与に引き続き,Ara-C 2∼3 g/body 6時間点滴5日間の投与を原則とし,G-CSFは末梢血好中球数が1,000/μ<i>l</i>以上になるまで継続した。また,芽球のコントロールが不十分の場合にはVP-16(80 mg/m<sup>2</sup> 2日間)の追加投与を適宜行った。本療法を施行した3症例については,いずれも1年以上の経過で比較的良好なperformance status (PS)を保ちながら生存可能であった。2症例に治療後骨髄中に正常核型細胞の出現を認め,うち1症例ではPh<sup>1</sup>染色体および付加染色体異常が完全消失し,正常骨髄所見を呈した。また,<i>in vitro</i>ではperoxidase陰性の芽球でもG-CSF刺激により細胞周期に導入され,かつ,G-CSF+Ara-C両者添加により,G-CSFまたはAra-C単独処理に比べて,芽球のアポトーシス誘導の増強傾向を認めた。本療法は絶対的に予後不良とされるCML-BCの治療法の選択肢の一つとして期待し得る。

Three patients with chronic myeloid leukemia (CML) in blastic transformation were treated with G-CSF plus middle dose cytosine arabinoside (Ara-C). G-CSF was administered (150 mg, s.c. or 300 mg, d.i.v./day) 24 hr prior to Ara-C (2∼3 g/body, 6 hour d.i.v. for 2∼5 days) and continued until the peripheral neutrophil count rose above 1,000/μ<i>l</i>. As a supplement, VP-16 (80 mg/m<sup>2</sup>, for 2 days) was administered as warranted to control the growth of blastic cells. All 3 patients survived for more than 12 months with a favorable performance status. Normal karyotypes were detected in 2 of the patients after chemotherapy. One of those patients in paticular demonstrated normal bone marrow findings with the almost complete disappearance of the Ph-positive clone. <i>In vitro</i> cultures of peroxidase-negative CML blastic cells revealed that G-CSF stimulated the induction of blastic cells into the cell cycle and that blastic cell apoptosis was more pronounced in cells cultured with G-CSF plus Ara-C than with G-CSF or Ara-C alone. G-CSF plus middle dose Ara-C therapy appears to be a strong candidate for the treatment of CML in blastic transformation with a poor prognosis.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 39(12), 1149-1156, 1998-12-30

    The Japanese Society of Hematology

References:  17

Codes

  • NII Article ID (NAID)
    10006174397
  • NII NACSIS-CAT ID (NCID)
    AN00252940
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    04851439
  • NDL Article ID
    971210
  • NDL Source Classification
    ZS21(科学技術--医学--内科学)
  • NDL Call No.
    Z19-295
  • Data Source
    CJP  NDL  J-STAGE 
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