経過中に芽球のマーカーが変化したと思われる急性白血病の小児例

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An 8yr-7mo-old boy with acute leukemia was admitted to the hospital on March 10, 1975. On admission he showed a very high blast cell count in the peripheral blood, lymphadenopathy and hepatosplenomegaly but no mediastinal mass.Blast cells were various in size. The results of cytochemical and surface marker examination were as follows: peroxidase, sudan black B and alkaline phosphatase were negative and PAS and acid phosphatase were positive; Sheep erythrocyte (sE)-RFC were 92%, sheep erythrocyte coated with antibody and complement (sEAC)-RFC 3%, and S-Ig 0%. Diagnosis of T-cell leukemia (ALL) was made.A combined anti-leukemic therapy achieved clinical and hematological remission immediately but relapses rapidly occurred during every course of maintenance therapy. Within 8 months the patient had 6 hematological relapses and 3 CNS leukemias, typical for T-cell leukemia in the childhood.At the 4th relapse the surface marker of blast cells in the bone marrow was 89.5% sE-RFC, 81.0% sEAC-RFC, and 1.8% S-Ig. It may be possible that the blast cells had both E and C3 receptor at the 4th relapse.A mediastinal mass, suggesting thymic in origin, was first found on chest x-rays at the 6th relapse.At autopsy, the leukemic cell infiltration in many organs, especially the bone marrow and lymph nodes, was confirmed. Thymic mass was 8×5cm, oval in shape, with a remarkable infltration with leukemic cells.
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