血漿交換と特続血液透析濾過の併用で多剤併用化学療法を施行し得た血球貪食症候群合併びまん性大細胞型B細胞リンパ腫  [in Japanese] Plasma exchange and continuous hemodiafiltration as an initial treatment for diffuse large B-cell lymphoma-associated hemophagocytic syndrome  [in Japanese]

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Abstract

症例は68歳,男性。発熱,黄疸があり入院した。肝脾腫,腹腔内リンパ節の腫脹,骨髄浸潤あり,びまん性大細胞型B細胞リンパ腫と診断された。血球貪食症候群(Lymphoma-associated hemophagocytic syndrome: LAHS)を合併し,PSは4で,肝性昏睡II度であった。閉塞性黄疸と重度の肝不全,腎機能低下があり,化学療法は困難と判断し,肝・腎機能の改善とHPSによる高サイトカイン血症の是正を目的とし血漿交換と持続血液透析濾過の併用療法を施行した。同時にVEPA療法と肝門部リンパ節への放射線療法(計34 Gy)施行し,肝機能は正常化し,CT上も病変は消失し寛解となった。ELISA法でTNF-α, IL-6, IL-8を測定し,血漿交換後に血中濃度の低下を確認した。重症のLAHSにおいても血液浄化療法を併用することで悪性リンパ腫の確診が得られ,化学療法を施行できることが示された。

A 68-year-old man was admitted to our hospital because of fever, jaundice and hepatosplenomegaly. A diagnosis of diffuse large cell, B-cell type malignant lymphoma, associated with hemophagocytic syndrome (LAHS), was made. CT scan revealed lymphadenopathy in the abdominal cavity and multiple tumors in the spleen. Performance status and hepatic coma grade were 4 and II, respectively. Laboratory findings showed bicytopenia (Hb 9.9 g/d<i>l</i>, platelet 35×10<sup>3</sup>/μ<i>l</i>), severe liver dysfunction (ALP 1,115 U/<i>l</i>, γ-GTP 437 U/<i>l</i>, T.Bil 15.4 mg/d<i>l</i>, D.Bil 12.8 mg/d<i>l</i>) and elevated levels of β2 microglobulin (12.9 mg/d<i>l</i>), ferritin (2,300 ng/m<i>l</i>) and sIL-2 receptor (36,900 U/m<i>l</i>). Plasma exchange (PE) and continuous hemodiafiltration (CHDF) enabled the patient to undergo diagnostic procedures, irradiation (total 34 Gy) and chemotherapy. Biopsy specimens revealed infiltration of lymphoma cells into the liver and bone marrow. We measured the blood concentrations of TNF-α, IL-6, and IL-8 before and after PE and CHDF by the ELISA method, and found normalization of hypercytokinemia after the procedure. It was suggested that initial treatment with PE and CHDF was effective for control of HPS, enabling us to perform chemotherapy for the lymphoma.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 43(1), 35-40, 2002-01-30

    The Japanese Society of Hematology

References:  14

Cited by:  2

Codes

  • NII Article ID (NAID)
    10008355783
  • NII NACSIS-CAT ID (NCID)
    AN00252940
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    04851439
  • NDL Article ID
    6293745
  • 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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