治療抵抗性のT細胞性前リンパ球性白血病に対する同種骨髄移植例  [in Japanese] Allogeneic bone marrow transplantation for chemotherapy-resistant T-prolymphocytic leukemia  [in Japanese]

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Author(s)

    • 岡村 かおり OKAMURA Kaori
    • 東海大学医学部付属病院 血液腫瘍リウマチ内科 Division of Hematology/Oncology, Department of Medicine, Tokai University School of Medicine
    • 池田 鉄輔 IKEDA Tetsusuke
    • 東海大学医学部付属病院 血液腫瘍リウマチ内科 Division of Hematology/Oncology, Department of Medicine, Tokai University School of Medicine
    • 吉場 史朗 YOSHIBA Fumiaki
    • 東海大学医学部付属病院 血液腫瘍リウマチ内科 Division of Hematology/Oncology, Department of Medicine, Tokai University School of Medicine
    • 岸 賢治 KISHI Kenji
    • 東海大学医学部付属病院 血液腫瘍リウマチ内科 Division of Hematology/Oncology, Department of Medicine, Tokai University School of Medicine
    • 安藤 潔 ANDO Kiyoshi
    • 東海大学医学部付属病院 血液腫瘍リウマチ内科 Division of Hematology/Oncology, Department of Medicine, Tokai University School of Medicine
    • 堀田 知光 HOTTA Tomomitsu
    • 東海大学医学部付属病院 血液腫瘍リウマチ内科 Division of Hematology/Oncology, Department of Medicine, Tokai University School of Medicine

Abstract

症例は34歳,女性。白血球数17,900/μ<i>l</i>(異型リンパ球58%)を指摘され精査にてT細胞性前リンパ球性白血病と診断した。2カ月後に白血球数43,600/μ<i>l</i>まで増加したため,2'deoxycoformycinおよびCHOP療法を施行するも寛解せず,非血縁BMTを目的に入院した。cytarabineとetoposideで腫瘍量を減少させた後にTBIとcyclophosphamideによる前処置を行い,非血縁BMTを施行した。GVHD予防にはcyclosporineとshort-term MTXを用いた。Day 13よりGrade IIの急性GVHD(皮膚と消化管)を発症したが,Day22の末梢血T細胞のshort tandem repeat (STR)解析でrecipient-typeが9.4%と腫瘍細胞の残存を認めた。免疫抑制剤の減量を開始するもGVHDの悪化はなく,recipient-typeのT細胞が消失した。移植後22カ月経過した現在も完全寛解を維持しており,T-PLLにおいてGVL効果が期待できることが示唆された。

A 34-year-old female was referred to our hospital for the evaluation of atypical lymphocytosis. Leukocyte count at diagnosis was 17,900/μ<i>l</i> with 58% atypical lymphocytes having a convoluted nucleus and prominent nucleoli. Because the leukocyte count increased to 43,600/μ<i>l</i>, the patient was treated with 2'deoxycoformycin followed by CHOP combination chemotherapy. However, both treatments failed to achieve remission. We planned an allogeneic bone marrow transplantation from an HLA-matched unrelated donor. The patient was treated with Ara-C and etoposide before conditioning to decrease the high leukemia burden. After administration of total body irradiation (12 Gy in six fractions) and cyclophosphamide (total dose of 120 mg/kg) unmanipulated marrow cells were infused. Under prevention of GVHD by CsA and short-term MTX, leukocyte engraft was prompt at day 16, and acute GVHD grade II was observed. Because 9.4% of residual recipient type T-cells was seen with STR analysis on day 22, we decreased the dose of CsA. After the occurrence of mild acute GVHD, the residual T-cell number decreased. The patient is still in complete remission for up to 22 months after BMT. We conclude that allogeneic SCT is effective for the treatment of T-PLL.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 46(7), 527-531, 2005-07-30

    The Japanese Society of Hematology

References:  9

Cited by:  1

Codes

  • NII Article ID (NAID)
    10016601622
  • NII NACSIS-CAT ID (NCID)
    AN00252940
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    04851439
  • NDL Article ID
    7442488
  • 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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