<総説>白血病の臨床

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One hundred and eighteen patients of leukemia in the Third Department of Internal Medicine, Kinki University Hospital during 8 years were investigated on the results of cell kinetics, treatment and protection of the side effects, such as infection and bleeding. FAB classification was made in a previously untreated patients with acute leukemia, and the proliferative compartment (p.c.) was measured together with the effect of chemotherapy for the subtypes of FAB classification on the basis of the p.c. from DNA histogram obtained by flow cytometry as the parameter of proliferation kinetics. The p.c. for acute nonlymphocytic leukemia (ANLL) was little lower than in acute lymphocytic leukemia (ALL). M3 proved to have a significantly lower p.c. than the other types. The p.c. of pretreatment correlated positively with the degree of cytoreduction in the bone marrow leukemic cells during the induction therapy, especially the patients with less than 7% of the p.c. had lower cytoreductive rate and required a long period for the complete remission. DCMP two-step therapy and BHAC-DMP therapy were effective therapeutic regimens for ANLL in adults. The complete remission rate of the former was 83.3% and that of the latter 96.0%. A good result, 81.3%, was also obtained for the ALL treated by VPL or other regimens. Simplified bioclean apparatuses (clean bed and clean wall unit) were used for the protection of severe infection in treating patients with acute leukemia. The level of cleanliness as shown in the nonviable and viable particle counts was class 100 and class 1,000 at the head and foot, respectively, in the clean bed, while it was class 100 and class 10,000,respectively, in the clean wall unit. It was ascertained that, as the granulocyte count decreased, the incidence of infectious complications became significantly higher in the open wards than in the bioclean apparatuses. Massive platelet transfusions were significantly more effective to the patients of acute leukemia associated with severe thrombocytopenia. However, appearance of isoantibodies to platelets and/or lymphocytes was inhibited to the transfusion effect. In the cases administered 20 units of platelet concentrates from the Red Cross Blood Center, platelet increment at 12-18 hours after transfusion was 3.0×10^4/μl in the negative and 0.9×10^4/μl in the positive cases. In the cases transfused single random donor platelet concentrates (SD-PC) by the continuous blood cell separator, platelet recovery rate was 31.3% in the negative and 11.9% in the positive cases. However, a good recovery rate, 34.1%, was obtained in the cases of SD-PC transfusion from the negative donor on lymphocyte and platelet cross match test, although isoantibodies were positive.
近畿大学の論文
1983-12-25

<総説>白血病の臨床

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