初診時脳内出血を伴う急性骨髄性白血病の中枢神経病変管理における髄液細胞数モニタリングの有用性  [in Japanese] Significance of monitoring cerebrospinal fluid leukocyte counts in managing central nervous system disease of acute myeloid leukemia in patients presenting with intracerebral hemorrhage upon initial examination  [in Japanese]

Access this Article

Author(s)

    • 河原 真大 KAWAHARA Masahiro
    • 滋賀医科大学医学部 内科学講座(血液内科) Department of Medicine (Division of Hematology), Shiga University of Medical Science
    • 木藤 克之 KITO Katsuyuki
    • 滋賀医科大学医学部 内科学講座(血液内科) Department of Medicine (Division of Hematology), Shiga University of Medical Science
    • 安藤 朗 ANDOH Akira
    • 滋賀医科大学医学部 内科学講座(血液内科) Department of Medicine (Division of Hematology), Shiga University of Medical Science
    • 寺本 由加子 TERAMOTO Yukako
    • 滋賀医科大学医学部 内科学講座(血液内科) Department of Medicine (Division of Hematology), Shiga University of Medical Science
    • 浅井 愛 ASAI Ai
    • 滋賀医科大学医学部 内科学講座(血液内科) Department of Medicine (Division of Hematology), Shiga University of Medical Science
    • 永井 詩穂 NAGAI Shiho
    • 滋賀医科大学医学部 内科学講座(血液内科) Department of Medicine (Division of Hematology), Shiga University of Medical Science
    • 岩佐 磨佐紀 IWASA Masaki
    • 滋賀医科大学医学部 内科学講座(血液内科) Department of Medicine (Division of Hematology), Shiga University of Medical Science
    • 藤城 綾 FUJISHIRO Aya
    • 滋賀医科大学医学部 内科学講座(血液内科) Department of Medicine (Division of Hematology), Shiga University of Medical Science
    • 西村 理恵 NISHIMURA Rie
    • 滋賀医科大学医学部 内科学講座(血液内科) Department of Medicine (Division of Hematology), Shiga University of Medical Science
    • 南口 仁志 MINAMIGUCHI Hitoshi
    • 滋賀医科大学医学部 内科学講座(血液内科) Department of Medicine (Division of Hematology), Shiga University of Medical Science
    • 辻 篤司 TSUJI Atsushi
    • 滋賀医科大学医学部 脳神経外科学講座 Department of Neurosurgery, Shiga University of Medical Science

Abstract

<p>17歳,女性。意識障害で救急搬送され,脳内出血,白血球数233,800/<i>l</i>,芽球93%,播種性血管内凝固を認めた。骨髄検査で急性骨髄性白血病(AML, M2),t(7;11)(p15;p15)転座,キメラ遺伝子NUP98-HOXA9,FLT3-ITDを認めた。血腫除去術後,寛解導入療法を開始。スパイナルドレーンから髄液細胞数をモニターし,寛解導入療法終了後5日目と9日目に細胞数の増加を認めたので髄腔内化学療法(IT)を行い,中枢神経病変の制御と正常造血の回復を得た。高容量cytarabineを含む地固め療法で分子生物学的完全寛解を獲得後,HLA一座不一致同胞より骨髄破壊的前処置を用いた骨髄移植を施行し,発症後228日目に大きな後遺障害なく退院した。脳内出血を伴うAMLにおいて,中枢神経病変をどう管理するかは定まっていない。本例は,髄液細胞数モニタリングに基づいて適切なタイミングでITを行うことが,脳内出血後の中枢神経病変の制御に有用であることを示唆する。</p>

<p>A 17-year-old woman was urgently transported to our hospital due to consciousness disturbance. A blood examination revealed intracerebral hemorrhage, WBC 233,800/<i>l</i>, blasts 93%, and disseminated intravascular coagulation. The results of bone-marrow aspiration indicated acute myeloid leukemia (M2 in FAB classification) with t (7;11) (p15;p15) and the resulting chimeric gene <i>NUP98-HOXA9</i> and with FLT3-ITD. Following hematoma evacuation, induction therapy was initiated and the leukocytes in the cerebrospinal fluid observed in the spinal drainage were monitored. Because they increased on days 5 and 9 after the completion of induction therapy, intrathecal chemotherapy (IT) was performed; this finally contributed to controlling AML in the central nervous system (CNS), together with the restoration of normal hematopoiesis. Subsequently, after complete molecular remission with consolidation therapies containing high-dose cytarabine, a bone-marrow transplantation with a myeloablative regimen was conducted from a 1-allele mismatched sibling donor. Finally, the patient was discharged without major sequela on day 228 after the first visit. The management of CNS disease in AML with intracerebral hemorrhage remains unclear. Our case suggests that IT at the appropriate time based on the monitored number of cerebrospinal fluid leukocytes could be useful in controlling AML in the CNS after intracerebral hemorrhage.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 59(12), 2578-2582, 2018

    The Japanese Society of Hematology

Codes

  • NII Article ID (NAID)
    130007554686
  • NII NACSIS-CAT ID (NCID)
    AN00252940
  • Text Lang
    JPN
  • ISSN
    0485-1439
  • NDL Article ID
    029432595
  • NDL Call No.
    Z19-295
  • Data Source
    NDL  J-STAGE 
Page Top