多発性骨髄腫治療中に発症したreversible posterior leukoencephalopathyの1例

症例は50代,女性．多発性骨髄腫（IgG-κ）の治療後再発例で，Cr 1.53mg/dl，eGFR 26.4ml/minと低下あり，重症腎機能障害の投与量に準じてlenalidomide15mg隔日投与にて治療を開始した．Day 19より急激な腎機能障害の進行，意識障害が出現しreversible posterior leukoencephalopathy（RPLS）と診断した．lenalidomide投与を中止し，対症療法にて腎機能，意識レベルは改善した．RPLS発症の原因として腎不全，腫瘍崩壊症候群，lenalidomideの有害事象，多発性骨髄腫が挙げられ，多発性骨髄腫の治療とRPLSの...

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Published in日本内科学会雑誌 Vol. 101; no. 1; pp. 168 - 171
Main Authors 大矢, 瑛子, 水谷, 実, 関根, 隆夫
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本内科学会 2012
Subjects
lenalidomide
reversible posterior leukoencephalopathy
多発性骨髄腫
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ISSN0021-5384
1883-2083
DOI10.2169/naika.101.168

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Abstract 症例は50代,女性．多発性骨髄腫（IgG-κ）の治療後再発例で，Cr 1.53mg/dl，eGFR 26.4ml/minと低下あり，重症腎機能障害の投与量に準じてlenalidomide15mg隔日投与にて治療を開始した．Day 19より急激な腎機能障害の進行，意識障害が出現しreversible posterior leukoencephalopathy（RPLS）と診断した．lenalidomide投与を中止し，対症療法にて腎機能，意識レベルは改善した．RPLS発症の原因として腎不全，腫瘍崩壊症候群，lenalidomideの有害事象，多発性骨髄腫が挙げられ，多発性骨髄腫の治療とRPLSの関連性が示唆された．
AbstractList 症例は50代,女性．多発性骨髄腫（IgG-κ）の治療後再発例で，Cr 1.53mg/dl，eGFR 26.4ml/minと低下あり，重症腎機能障害の投与量に準じてlenalidomide15mg隔日投与にて治療を開始した．Day 19より急激な腎機能障害の進行，意識障害が出現しreversible posterior leukoencephalopathy（RPLS）と診断した．lenalidomide投与を中止し，対症療法にて腎機能，意識レベルは改善した．RPLS発症の原因として腎不全，腫瘍崩壊症候群，lenalidomideの有害事象，多発性骨髄腫が挙げられ，多発性骨髄腫の治療とRPLSの関連性が示唆された．
Author 大矢, 瑛子
関根, 隆夫
水谷, 実
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References 6) Pandy R, et al: A rare complication in a case of multiple myeloma on therapy with thalidomide and dexamethasone-reversible posterior lobe leukoencephalopathy. Leukemia and Lymphoma 47 (7): 1431-1434, 2006.
7) Dimopoulos M, et al: Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. N Engl J Med 357: 2123-2132, 2007.
1) Hinchey J, et al: A reversible posterior leukoencephalopathy syndrome. N Engl J Med 334 (8): 494-500, 1996.
5) Kelly K, et al: Bortezomib-induced reversible posterior leucoencephalopathy syndrome. Br J Haematol 141 (5): 566, 2008.
4) Terwiel E, et al: Reversible posterior encepharopathy syndrome associated with bortezomib. Intern Med J 40 (1): 69-71, 2010.
3) Lebrun C, et al: Leukoencephalopathy in multiple myeloma: two case reports. Annals of Oncology 10: 1515-1517, 1999.
2) Okeda R, et al: An autopsy case of drug-induced diffuse cerebral axonopathic leukoencephalopathy: the pathogenesis in relation to reversible posterior leukoencephalopathy syndrome. Neuropathology 27: 364-370, 2007.
References_xml – reference: 2) Okeda R, et al: An autopsy case of drug-induced diffuse cerebral axonopathic leukoencephalopathy: the pathogenesis in relation to reversible posterior leukoencephalopathy syndrome. Neuropathology 27: 364-370, 2007.
– reference: 6) Pandy R, et al: A rare complication in a case of multiple myeloma on therapy with thalidomide and dexamethasone-reversible posterior lobe leukoencephalopathy. Leukemia and Lymphoma 47 (7): 1431-1434, 2006.
– reference: 4) Terwiel E, et al: Reversible posterior encepharopathy syndrome associated with bortezomib. Intern Med J 40 (1): 69-71, 2010.
– reference: 7) Dimopoulos M, et al: Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. N Engl J Med 357: 2123-2132, 2007.
– reference: 5) Kelly K, et al: Bortezomib-induced reversible posterior leucoencephalopathy syndrome. Br J Haematol 141 (5): 566, 2008.
– reference: 1) Hinchey J, et al: A reversible posterior leukoencephalopathy syndrome. N Engl J Med 334 (8): 494-500, 1996.
– reference: 3) Lebrun C, et al: Leukoencephalopathy in multiple myeloma: two case reports. Annals of Oncology 10: 1515-1517, 1999.
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Snippet 症例は50代,女性．多発性骨髄腫（IgG-κ）の治療後再発例で，Cr 1.53mg/dl，eGFR 26.4ml/minと低下あり，重症腎機能障害の投与量に準じてlenalidomide15mg隔日投与にて治...
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SubjectTerms lenalidomide
reversible posterior leukoencephalopathy
多発性骨髄腫
Title 多発性骨髄腫治療中に発症したreversible posterior leukoencephalopathyの1例
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