Ando S, Ando S, Otani N, Kanbe T
Department of Internal Medicine, Narita Memorial Hospital.
Rinsho Ketsueki. 1992 Dec;33(12):1890-4.
58-year-old man was admitted with cervical tumor and leukocytosis. Physical examination indicated splenomegaly and cervical abscess. Laboratory data showed WBC 55,000/microliters, Hb 7.9g/dl, and PLT 4.5 x 10(4)/microliters. After cure of the abscess, WBC counts were still high with 1,500-2,000/microliters monocytes, and anemia and thrombocytopenia persisted. Bone marrow aspiration showed myeloid hyperplasia and trilineage myelodysplasia. The Ph1 chromosome could not be detected. The case was diagnosed as chronic myelomonocytic leukemia and treated with oral etoposide (25mg/day). After 2 weeks, the dose was increased to 50mg, and then modified according to the blood counts. WBC counts are presently being maintained between 7,000 and 12,000/microliters, and RBC and PLT counts have gradually become normal. Splenomegaly almost disappeared and dysplastic change in bone marrow improved somewhat. At nine months following the start of chemotherapy with etoposide, remission is maintained by treatment with 25mg of etoposide on alternate days. This case suggests that low-dose etoposide is useful for treating CMMoL.
一名58岁男性因颈部肿瘤和白细胞增多症入院。体格检查发现脾肿大和颈部脓肿。实验室数据显示白细胞计数为55,000/微升，血红蛋白7.9克/分升，血小板4.5×10⁴/微升。脓肿治愈后，白细胞计数仍然很高，单核细胞为1500 - 2000/微升，贫血和血小板减少持续存在。骨髓穿刺显示骨髓增生和三系骨髓发育异常。未检测到Ph1染色体。该病例被诊断为慢性粒单核细胞白血病，并接受口服依托泊苷（25毫克/天）治疗。2周后，剂量增加到50毫克，然后根据血细胞计数进行调整。目前白细胞计数维持在7000至12000/微升之间，红细胞和血小板计数已逐渐恢复正常。脾肿大几乎消失，骨髓发育异常改变有所改善。在开始使用依托泊苷化疗九个月后，通过隔天服用25毫克依托泊苷维持缓解。该病例表明低剂量依托泊苷对治疗慢性粒单核细胞白血病有效。
