地固め療法中に骨髄壊死を発症したフィラデルフィア染色体陽性急性リンパ芽球性白血病  [in Japanese] Philadelphia chromosome-positive acute lymphoblastic leukemia complicated by bone marrow necrosis during consolidation chemotherapy  [in Japanese]

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Abstract

<p>症例は腎細胞がんの手術歴がある46歳の男性。フィラデルフィア染色体陽性急性リンパ芽球性白血病(Ph-ALL)を発症したが,寛解導入療法後は分子生物学的寛解となった。しかし,地固め療法中に発熱と両側臀部痛が出現した。18F-fluorodeoxyglucose(FDG)positron emission tomography-computed tomography(PET-CT)にて,両側の腸骨と仙骨にFDGの集積を認めた。Ph-ALLおよび腎細胞がんの再発,感染症等は否定的であった。腸骨骨髄生検では広範な骨髄壊死を認めた。白血病または抗がん化学療法の治療反応に伴う病態と推察した。症状は月単位で緩徐に消退した。その後,臍帯血移植を行い,胸骨骨髄穿刺では正常造血を認めた。一方,day162とday364の腸骨骨髄生検では壊死は消退し,MF-3相当の骨髄線維化が出現した。PET-CTでは腸骨と仙骨のFDG集積が減衰しており,骨髄壊死の治癒過程における線維化を観察しているものと考えた。骨髄壊死は稀に造血器腫瘍に合併するが,広く認知されているとはいえない。そのため,症例を蓄積し,病態を明らかにする必要がある。</p>

<p>A 46-year-old man who had previously undergone open surgery for renal cell carcinoma (RCC) developed Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-ALL). After the induction therapy, he achieved complete molecular remission. However, fever and bilateral buttock pain continued during the consolidation therapy. 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) showed FDG accumulation in both iliac bones and in the sacrum; however, no causative diseases, including relapse of Ph-ALL and RCC, were detected. Iliac bone marrow biopsy revealed bone marrow necrosis (BMN), the etiology of which was presumed to be the leukemia itself and the therapeutic response to chemotherapy. Fever resolution and buttock pain alleviation were observed over the next months. We observed diffuse fibrosis in the bone marrow at day 162 and day 364 after cord blood transplantation. Moreover, the FDG accumulation was significantly reduced on PET-CT. BMN is not widely recognized despite its potential association with hematologic malignancies. Additional cases of BMN should be reviewed to clarify BMN etiology and clinical features.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 61(5), 462-467, 2020

    The Japanese Society of Hematology

Codes

  • NII Article ID (NAID)
    130007852244
  • NII NACSIS-CAT ID (NCID)
    AN00252940
  • Text Lang
    JPN
  • ISSN
    0485-1439
  • NDL Article ID
    030475319
  • NDL Call No.
    Z19-295
  • Data Source
    NDL  J-STAGE 
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