小児急性骨髄性白血病における寛解不能症例の検討
当科で経験した急性骨髄性白血病 (AML) の寛解不能症例について後方視的に解析した.1991～1999年の間に入院した2カ月～19歳までのAML 23例 (男児10例, 女児13例) 中, 寛解不能症例は6例 (26%) で, FAB分類ではM0が2例, M1が1例, M5が1例, M6が2例であった.このうちhyperleukocytosisを伴った2例は治療開始前の合併症で死亡し, 残りの4例は多種の寛解導入化学療法に対して抵抗性であった.化学療法無効症例はFAB分類でM0とM6であり, 諸家の報告による予後不良群と同様の傾向があった.寛解導入療法中の合併症死亡はなかった.Hyperle...
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| Published in | 日本小児血液学会雑誌 Vol. 15; no. 1; pp. 27 - 31 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本小児血液・がん学会
28.02.2001
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0913-8706 1884-4723 |
| DOI | 10.11412/jjph1987.15.27 |
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| Abstract | 当科で経験した急性骨髄性白血病 (AML) の寛解不能症例について後方視的に解析した.1991～1999年の間に入院した2カ月～19歳までのAML 23例 (男児10例, 女児13例) 中, 寛解不能症例は6例 (26%) で, FAB分類ではM0が2例, M1が1例, M5が1例, M6が2例であった.このうちhyperleukocytosisを伴った2例は治療開始前の合併症で死亡し, 残りの4例は多種の寛解導入化学療法に対して抵抗性であった.化学療法無効症例はFAB分類でM0とM6であり, 諸家の報告による予後不良群と同様の傾向があった.寛解導入療法中の合併症死亡はなかった.Hyperleukocytosis症例には, 早急かつ十分なleukapheresisと厳重な全身管理が重要である.化学療法無効症例には造血幹細胞移植 (SCT) による寛解導入療法が適応となり, さらに強い治療抵抗性が予想される症例にはdouble SCTも考慮されうる. |
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| AbstractList | 当科で経験した急性骨髄性白血病 (AML) の寛解不能症例について後方視的に解析した.1991～1999年の間に入院した2カ月～19歳までのAML 23例 (男児10例, 女児13例) 中, 寛解不能症例は6例 (26%) で, FAB分類ではM0が2例, M1が1例, M5が1例, M6が2例であった.このうちhyperleukocytosisを伴った2例は治療開始前の合併症で死亡し, 残りの4例は多種の寛解導入化学療法に対して抵抗性であった.化学療法無効症例はFAB分類でM0とM6であり, 諸家の報告による予後不良群と同様の傾向があった.寛解導入療法中の合併症死亡はなかった.Hyperleukocytosis症例には, 早急かつ十分なleukapheresisと厳重な全身管理が重要である.化学療法無効症例には造血幹細胞移植 (SCT) による寛解導入療法が適応となり, さらに強い治療抵抗性が予想される症例にはdouble SCTも考慮されうる. |
| Author | 奥田, 久美子 甲斐, 純夫 石田, 周 渡辺, 由佳 後藤, 晶子 高橋, 浩之 藤岡, 憲一郎 後藤, 裕明 船曳, 哲典 藤井, 久紀 山崎, 桜子 生田, 孝一郎 横田, 俊平 松田, 基 |
| Author_FL | OKUDA Kumiko TAKAHASHI Hiroyuki MATSUDA Motoi FUJIOKA Ken-ichiro YOKOTA Shunpei IKUTA Koichiro YAMAZAKI Sakurako KAI Sumio GOTO Shoko FUNABIKI Tetsunori FUJII Hisaki ISHIDA Amane GOTO Hiroaki WATANABE Yuka |
| Author_FL_xml | – sequence: 1 fullname: ISHIDA Amane – sequence: 2 fullname: OKUDA Kumiko – sequence: 3 fullname: FUJII Hisaki – sequence: 4 fullname: YAMAZAKI Sakurako – sequence: 5 fullname: WATANABE Yuka – sequence: 6 fullname: MATSUDA Motoi – sequence: 7 fullname: GOTO Shoko – sequence: 8 fullname: GOTO Hiroaki – sequence: 9 fullname: FUJIOKA Ken-ichiro – sequence: 10 fullname: TAKAHASHI Hiroyuki – sequence: 11 fullname: KAI Sumio – sequence: 12 fullname: FUNABIKI Tetsunori – sequence: 13 fullname: YOKOTA Shunpei – sequence: 14 fullname: IKUTA Koichiro |
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| References | 21) Elmaagacli AH, Beelen DW, Trenn G, et al : Induction of a graft-versus-leukemia reaction by cyclosporin A withdrawal as immunotherapy for leukemia relapsing after allogeneic bone marrow transplantation. Bone Marrow Transplant 23 : 771-777, 1999 8) Mazzella FM, Kowal-Vern A, Shrit MA, et al : Acute erythroleukemia : Evaluation of 48 cases with reference to classification, cell proliferation, cytogenetics, and prognosis. Am J Clin Pathol 110 : 590-598, 1998 11) Ablin AR : Supportive care for children with cancer. Guidelines of the Childrens Cancer Study Group. Managing the problem of hyperleukocytosis in acute leukemia. Am J Pediatr Hematol Oncol 6 : 287-290, 1984 6) Kuriyama K, Tomonaga M, Matsuo T, et al : Poor response to intensive chemotherapy in de novo acute myeloid leukaemia with trilineage myelodysplasia. Br J Haematol 86 : 767-773, 1994 10) Ventura GJ, Hester JP, Smith TL, et al : Acute myeloblastic leukemia with hyperleukocytosis : Risk factor for early mortality in induction. Am J Hematol 27 : 34-37, 1988 13) Bunin NJ, Kunkel K, Callihan TR : Cytoreductiveprocedures in the early management in cases of leukemia and hyperleukocytosis in children. Med Pediatr Oncol 15 : 232-235, 1987 17) Estey EH, Thall PF, Pierce S, et a1 : Randomized phase II study of fludarabine + cytosine arabinoside+idarubicin +/-all-trans retinoic acid +/-granulocyte colony-stimulating factor in poor prognosis newly diagnosed acute myeloid leukemia and myelodysplastic syndrome. Blood 93 : 2478-2484, 1999 19) 日本造血細胞移植学会 : 平成11年度全国調査報告書, 1999.12 18) Forman SJ, Schmidt GM, Nademanee AP, et al : Allogenic bone marrow transplantation as therapy for primary induction failure for patients with acute leukemia. J Clin Oncol 9 : 1570-1574, 1991 25) Michallet M, Tanguy ML, Socie G, et al : Second allogeneic haematopoietic stem cell transplantation in relapsed acute and chronic leukaemias for patients who underwent a first allogeneic bone marrow transplantation : A survey of the Societe Francaise de Greffe de moelle (SFGM). Br J Haematol 108 : 400-407, 2000 9) Ruiz-Arguelles GJ, Lobato-Mendizabal E, SanMiguel JF, et al : Long-term treatment results for acute megakaryoblastic leukemia patients : A multicentre study. Br J Haematol 82 : 671-675, 1992 15) 気賀沢寿人 : *小児難治性白血病の治療戦略4) 急性骨髄性白血病.日小血会誌13 : 220, 1999 23) 縄田 淳, 佐藤雄也, 小川晶子, 他 : Double骨髄移植の有用性について.骨髄再移植例の検討.日小血套言夫7 : 564-569. 1993 1) Schrappe M, Reiter A, Ludwig WD, et al : Improved outcome in childhood acute lymphoblastic leukemia despite reduced use of anthracyclines and cranial radiotherapy : Results of trial ALL-BFM 90. Blood 95 : 3310-3322, 2000 24) Basi A, Bacci S, Miniero R, et al : Second allogeneic bone marrow transplantation in acute leukemia : A multicenter study from the Gruppo Italiano Trapianto Di Midollo Osseo (GITMO). Leukemia 11 : 420-424, 1997 2) Raimondi SC, Chang MN, Ravindranath Y, et al : Chromosomal abnormalities in 478 children with acute myeloid leukemia : Clinical characteristics and treatment outcome in a cooperative pediatric oncology group study-POG 8821. Blood 94 : 3707-3716, 1999 4) Anderlini P, Luna M, Kantarjian HM, et al : Causes of initial remission induction failure in patients with acute myeloid leukemia and myelodysplastic syndrome. Leukemia 10 : 600-608, 1996 20) Korbling M, Przepiorka D, Huh YO, et al : Allogeneic blood stem cell transplantation for refractory leukemia and lymphoma : Potential advantage of blood over marrow allografts. Blood 85 : 1659-1665, 1995 14) Wurthner JU, Kohler G, Behringer D, et al : Leukostasis followed by hemorrhage complicating the initiation of chemotherapy in patients with acute myeloid leukemia and hyperleukocytosis : A clinicopathologic report of four cases. Cancer 85 : 368-374, 1999 7) Stasi R, Del Poeta G, Venditti A, et al : Analysis of treatment failure in patients with minimally differentiated acute myeloid leukemia (AML-MO). Blood 86 : 1619-1625, 1994 12) Cuttner J, Holland JF, Norton L, et al : Therapeutic leukapheresis for hyperleukocytosis in acute myelocytic leukemia. Med Pediatr Oncol 11 : 76-78, 1983 16) McCarthy AJ, Pitcher LA, Hann IM, et al : FLAG (fludarabine, high-dose cytarabine, and G-CSF) for refractory and high-risk relapsed acute leukemia in children. Med Pediatr Oncol 32 : 411-415, 1999 5) Preisler HD, Larson RA, Raza A, et al : The treatment of patients with newly diagnosed poor prognosis acute myelogenous leukaemia : Response to treatment and treatment failure. Br J Haematol 79 : 390-397, 1991 22) Robinson N, Sanders JE, Benyunes MC, et al : Phase I trial of interleukin-2 after unmodified HLA-matched sibling bone marrow transplantation for children with acute leukemia. Blood 87 : 1249-1254. 1996 3) Creutzig U, Zimmermann M, Ritter J, et al : Definition of a standard-risk group on children with AML. Br J Haematol 104 : 630-639, 1999 |
| References_xml | – reference: 18) Forman SJ, Schmidt GM, Nademanee AP, et al : Allogenic bone marrow transplantation as therapy for primary induction failure for patients with acute leukemia. J Clin Oncol 9 : 1570-1574, 1991 – reference: 15) 気賀沢寿人 : *小児難治性白血病の治療戦略4) 急性骨髄性白血病.日小血会誌13 : 220, 1999 – reference: 16) McCarthy AJ, Pitcher LA, Hann IM, et al : FLAG (fludarabine, high-dose cytarabine, and G-CSF) for refractory and high-risk relapsed acute leukemia in children. Med Pediatr Oncol 32 : 411-415, 1999 – reference: 25) Michallet M, Tanguy ML, Socie G, et al : Second allogeneic haematopoietic stem cell transplantation in relapsed acute and chronic leukaemias for patients who underwent a first allogeneic bone marrow transplantation : A survey of the Societe Francaise de Greffe de moelle (SFGM). Br J Haematol 108 : 400-407, 2000 – reference: 4) Anderlini P, Luna M, Kantarjian HM, et al : Causes of initial remission induction failure in patients with acute myeloid leukemia and myelodysplastic syndrome. Leukemia 10 : 600-608, 1996 – reference: 22) Robinson N, Sanders JE, Benyunes MC, et al : Phase I trial of interleukin-2 after unmodified HLA-matched sibling bone marrow transplantation for children with acute leukemia. Blood 87 : 1249-1254. 1996 – reference: 1) Schrappe M, Reiter A, Ludwig WD, et al : Improved outcome in childhood acute lymphoblastic leukemia despite reduced use of anthracyclines and cranial radiotherapy : Results of trial ALL-BFM 90. Blood 95 : 3310-3322, 2000 – reference: 6) Kuriyama K, Tomonaga M, Matsuo T, et al : Poor response to intensive chemotherapy in de novo acute myeloid leukaemia with trilineage myelodysplasia. Br J Haematol 86 : 767-773, 1994 – reference: 7) Stasi R, Del Poeta G, Venditti A, et al : Analysis of treatment failure in patients with minimally differentiated acute myeloid leukemia (AML-MO). Blood 86 : 1619-1625, 1994 – reference: 3) Creutzig U, Zimmermann M, Ritter J, et al : Definition of a standard-risk group on children with AML. Br J Haematol 104 : 630-639, 1999 – reference: 21) Elmaagacli AH, Beelen DW, Trenn G, et al : Induction of a graft-versus-leukemia reaction by cyclosporin A withdrawal as immunotherapy for leukemia relapsing after allogeneic bone marrow transplantation. Bone Marrow Transplant 23 : 771-777, 1999 – reference: 11) Ablin AR : Supportive care for children with cancer. Guidelines of the Childrens Cancer Study Group. Managing the problem of hyperleukocytosis in acute leukemia. Am J Pediatr Hematol Oncol 6 : 287-290, 1984 – reference: 19) 日本造血細胞移植学会 : 平成11年度全国調査報告書, 1999.12 – reference: 17) Estey EH, Thall PF, Pierce S, et a1 : Randomized phase II study of fludarabine + cytosine arabinoside+idarubicin +/-all-trans retinoic acid +/-granulocyte colony-stimulating factor in poor prognosis newly diagnosed acute myeloid leukemia and myelodysplastic syndrome. Blood 93 : 2478-2484, 1999 – reference: 8) Mazzella FM, Kowal-Vern A, Shrit MA, et al : Acute erythroleukemia : Evaluation of 48 cases with reference to classification, cell proliferation, cytogenetics, and prognosis. Am J Clin Pathol 110 : 590-598, 1998 – reference: 10) Ventura GJ, Hester JP, Smith TL, et al : Acute myeloblastic leukemia with hyperleukocytosis : Risk factor for early mortality in induction. Am J Hematol 27 : 34-37, 1988 – reference: 12) Cuttner J, Holland JF, Norton L, et al : Therapeutic leukapheresis for hyperleukocytosis in acute myelocytic leukemia. Med Pediatr Oncol 11 : 76-78, 1983 – reference: 13) Bunin NJ, Kunkel K, Callihan TR : Cytoreductiveprocedures in the early management in cases of leukemia and hyperleukocytosis in children. Med Pediatr Oncol 15 : 232-235, 1987 – reference: 9) Ruiz-Arguelles GJ, Lobato-Mendizabal E, SanMiguel JF, et al : Long-term treatment results for acute megakaryoblastic leukemia patients : A multicentre study. Br J Haematol 82 : 671-675, 1992 – reference: 14) Wurthner JU, Kohler G, Behringer D, et al : Leukostasis followed by hemorrhage complicating the initiation of chemotherapy in patients with acute myeloid leukemia and hyperleukocytosis : A clinicopathologic report of four cases. Cancer 85 : 368-374, 1999 – reference: 5) Preisler HD, Larson RA, Raza A, et al : The treatment of patients with newly diagnosed poor prognosis acute myelogenous leukaemia : Response to treatment and treatment failure. Br J Haematol 79 : 390-397, 1991 – reference: 23) 縄田 淳, 佐藤雄也, 小川晶子, 他 : Double骨髄移植の有用性について.骨髄再移植例の検討.日小血套言夫7 : 564-569. 1993 – reference: 24) Basi A, Bacci S, Miniero R, et al : Second allogeneic bone marrow transplantation in acute leukemia : A multicenter study from the Gruppo Italiano Trapianto Di Midollo Osseo (GITMO). Leukemia 11 : 420-424, 1997 – reference: 2) Raimondi SC, Chang MN, Ravindranath Y, et al : Chromosomal abnormalities in 478 children with acute myeloid leukemia : Clinical characteristics and treatment outcome in a cooperative pediatric oncology group study-POG 8821. Blood 94 : 3707-3716, 1999 – reference: 20) Korbling M, Przepiorka D, Huh YO, et al : Allogeneic blood stem cell transplantation for refractory leukemia and lymphoma : Potential advantage of blood over marrow allografts. Blood 85 : 1659-1665, 1995 |
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| Snippet | 当科で経験した急性骨髄性白血病 (AML) の寛解不能症例について後方視的に解析した.1991～1999年の間に入院した2カ月～19歳までのAML 23例 (男児10例, 女児13例) 中, 寛解... |
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| Title | 小児急性骨髄性白血病における寛解不能症例の検討 |
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