FISH法にてPh陰性の自家末梢血幹細胞を移植した慢性骨髄性白血病  [in Japanese] Aoutologous transplantation of Ph-negative peripheral blood stem cells for treatment of chronic myelogenous leukemia  [in Japanese]

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Abstract

症例は21歳,男性。1997年3月慢性骨髄性白血病(CML)と診断された。IFN療法が行われたが,1998年12月に付加的染色体異常(+8)が出現し,細胞遺伝学的に移行期と考えられた。ドナーが得られず,自家末梢血幹細胞移植(auto-PBSCT)を計画した。1999年1月mini-ICE療法(IDR, AraC, ETP)にG-CSFを併用し,計12×10<sup>6</sup>/kgのCD34陽性細胞を採取した。PBSC中のPhはFISHで1%であった。3月にBU+CYの前処置後,5×10<sup>6</sup>/kgのCD34陽性細胞を移植し,血球回復は好中球>500/μ<i>l</i>, 血小板>5万/μ<i>l</i>がそれぞれ20日,38日であった。移植1カ月後の骨髄染色体分析は,すべて46XYでFISHでは2.6%であったが,6カ月後の骨髄では47XY, Ph+8(4/20)が出現した。IFN抵抗性CMLにおいて,mini-ICEによりFISHレベルでPh陰性の幹細胞を採取し安全にauto-PBSCTを行えた。ドナーのない症例,IFN抵抗例においてauto-PBSCTは治療選択肢の一つとなる可能性が示唆された。

A 21-year-old man, diagnosed in March 1997 as having chronic myelogenous leukemia (CML), received hydroxyurea followed by daily interferon (IFN) until December 1998, when the additional chromosome abnormality of +8 appeared. As no suitable matched donor was available, the patient received mobilization therapy consisting of mini-ICE (idarubicin, cytarabine, etoposide) followed by G-CSF subcutaneously. During hematopoietic recovery, a total of 12×10<sup>6</sup>/kg CD34-positive cells were harvested. Cytogenetic analysis of peripheral blood stem cell (PBSC) products using FISH revealed 1% <i>BCR/ABL</i> fusion signals. In March 1999, he received conditioning therapy consisting of busulfan (16 mg/kg) and cyclophosphamide (120 mg/kg) followed by infusion of 5×10<sup>6</sup>/kg CD34-positive cells. A neutrophil count of 500/μ<i>l</i> and a platelet count of 5×10<sup>4</sup>/μ<i>l</i> were attained by days 20 and 38, respectively. Bone marrow aspirates showed 2.6% <i>BCR/ABL</i> fusion signals on day 35 after autologous PBSC transplantation, and the patient remained in chronic phase until the sixth month, when a cytogenetic relapse (Ph, +8: 4/20) occurred. These observations suggest that Ph-negative progenitor cells can be harvested using a mini-ICE regimen followed by G-CSF, and that autologous PBSC transplantation is feasible in patients with CML resistant to IFN.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 41(8), 671-675, 2000-08-30

    The Japanese Society of Hematology

References:  15

Cited by:  1

Codes

  • NII Article ID (NAID)
    10008038120
  • NII NACSIS-CAT ID (NCID)
    AN00252940
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    04851439
  • NDL Article ID
    6295792
  • NDL Source Classification
    ZS21(科学技術--医学--内科学)
  • NDL Call No.
    Z19-295
  • Data Source
    CJP  CJPref  NDL  J-STAGE 
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