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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Successful treatment with dasatinib and prednisolone for a patient with hypocellular Ph+ALL

演題番号 : PS-1-132

後藤 英子 (Hideko Goto):1、笠原 千嗣 (Senji Kasahara):1、生駒 良和 (Yoshikazu Ikoma):1、高橋 健 (Takeshi Takahashi):1、鶴見 寿 (Hisashi Tsurumi):2

1:Dept. Hematol., Gifu Muni. Hosp., Japan、2:Dept. Hematol., Gifu Univ. Hosp., Japan

 

We report a case of Philadelphia chromosome positive (Ph+) hypocellular acute lymphoblastic leukemia (ALL) mimicking aplastic anemia (AA). Case: In June 2013, a 61-year-old woman was admitted with pancytopenia; WBC 0.9×109/L (neutrophils 30%, lymphocytes 64%, and blasts 0%), Hb 6.3 g/dL, PLT 5.7×109/L. A bone marrow examination revealed marked hypocellularity with 7% lymphoblasts that were positive for CD10, CD13, CD19, CD22, CD33, HLA-DR, and TdT. FISH analysis of the bone marrow proved the 10% positivity of bcr-abl fusion and chromosomal analysis showed 46, XX, t(9;22)(q34;q11.2) in 2 of 20 cells examined. A diagnosis of hypocellular Ph+ALL was made. IgM-antibody of parvovirus was negative. Surprisingly this patient was correcting her hematological parameters without any treatment in three weeks. After reassessment of residual lymphoblasts (about 5%) in bone marrow, she was treated with a tyrosine kinase inhibitor (TKI). She achieved a remission with induction of dasatinib after prednisolone. Discussion: Although a preleukemic aplastic phase is observed in approximately 2% of in childhood ALL cases, hypocellular Ph+ALL in adults is extremely rare. The hypoplastic marrow may be a result of an immunological reaction triggered by the presence of leukemic clone proliferation. Conclusion: Cytogenetic analysis is needed at diagnosis of AA or after recovery of blood counts in order to discriminate hypoplastic leukemia from AA. Dose-modified chemotherapy with TKIs should be considered for hypocellular leukemia case.

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