演題詳細

ポスター / Poster

ポスター 18 (Poster 18) :成人ALL:症例

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日程
2013年10月11日(金)
時間
16:50 - 17:50
会場
ポスター会場 / Poster (ロイトン札幌 3F ロイトンホールABCD)
座長・司会
杉浦 勇 (Isamu Sugiura):1
1:豊橋市民病院 血液・腫瘍内科
 
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Spontaneous fluctuation of blast cells in ALL patient depending on the kinetics of cytokine levels

演題番号 : PS-1-128

松田 安史 (Yasufumi Matsuda):1、池ヶ谷 諭史 (Satoshi Ikegaya):1、大蔵 美幸 (Miyuki Ookura):1、浦崎 芳正 (Yoshimasa Urasaki):1、岸 慎治 (Shinji Kishi):1、山内 高弘 (Takahiro Yamauchi):1、吉田 明 (Akira Yoshida):1、上田 孝典 (Takanori Ueda):1

1:Dept. of Hematol. and Oncol., Med, Univ. of Fukui, Japan

 

60 years old man was admitted to our hospital on Oct. 2012 because of bacterial colitis (E. coli O-18) and leukocytopenia. Colitis was cured by antibiotics, but WBC decreased to 600/μl. Bone marrow (BM) examination revealed that blasts occupied 60% of BM. Blasts were pathologically lymphoblastic, but surface markers of CD13, 19, 34 and HLA-DR were positive. Febrile neutropenia (FN) and DIC occurred, the patient was treated by antibiotics and recombinant thrombomodulin. He improved in several days. Platelet in peripheral blood (PB) increased from 96,000 to 350,000/μl and interestingly blasts in BM decreased to 6% without chemotherapy. He was discharged and laboratory data had been followed biweekly. One month later, blasts appeared in PB and LDH increased up to 4,900 U/l after the onset of FN and DIC again. After second admission, He was diagnosed as early precursor B-ALL (with complexed chromosomes) by BM aspiration because of additional surface marker findings that TdT and CyCD79a were positive and CyCD3, MPO and CD117 were negative. Again not only FN and DIC but also ALL improved without chemotherapy, blasts in PB decreased from 69% to 7%. But then blasts were increasing gradually, and chemotherapy was started from Feb. 2013. He didn't achieve complete remission, and has been receiving re-induction therapy. The serum cytokines IL-4, 6, 10, IFN-γ,TNF-α were examined and showed that IL-6, 10 and IFN-γ increased in parallel with number of blasts. These cytokines were supposed to play important roles in atypical clinical manifestation of the patient with ALL.

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