Inagawa Yuta, Komeno Yukiko, Saito Satoshi, Maenohara Yuji, Yamagishi Tetsuro, Kawashima Hiroyuki, Saito Taku, Abe Keiko, Iihara Kuniko, Hatada Yasumasa, Ryu Tomiko
Department of Hematology, Japan Community Healthcare Organization (JCHO) Tokyo Yamate Medical Center, Tokyo, Japan.
Department of Internal Medicine, JCHO Tokyo Yamate Medical Center, Tokyo, Japan.
Case Rep Hematol. 2019 Nov 27;2019:1616237. doi: 10.1155/2019/1616237. eCollection 2019.
A 34-year-old woman was diagnosed with acute promyelocytic leukemia. Chemotherapy was administered following the JALSG APL204 protocol. Induction therapy with all-trans retinoic acid resulted in complete remission on day 49. She developed coccygeal pain from day 18, which spread to the spine and cheekbones and lasted 5 weeks. She had similar bone pain on days 7-10 of the first consolidation therapy and on days 4-12 of the second consolidation therapy. Oral loxoprofen was prescribed for pain relief. On day 33 of the third consolidation, white blood cell and neutrophil counts were 320/L and 20/L, respectively. After she developed epigastralgia and hematemesis, she developed septic shock. Gastroendoscopy revealed markedly thickened folds and diffusely damaged mucosa with blood oozing. Computed tomography revealed thickened walls of the antrum and the pylorus. Despite emergency treatments, she died. Bacterial culture of the gastric fluid yielded and enterococci growth. Collectively, she was diagnosed with phlegmonous gastritis. Retrospective examination of serial bone marrow biopsy specimens demonstrated progressive bone marrow fibrosis, which may have caused prolonged myelosuppression. Thus, evaluation of bone marrow fibrosis by bone marrow biopsy after each treatment cycle might serve as a predictor of persistent myelosuppression induced by chemotherapy.
一名34岁女性被诊断为急性早幼粒细胞白血病。按照日本白血病研究组（JALSG）APL204方案进行化疗。全反式维甲酸诱导治疗在第49天实现完全缓解。她从第18天开始出现尾骨疼痛，疼痛蔓延至脊柱和颧骨，持续了5周。在第一次巩固治疗的第7 - 10天以及第二次巩固治疗的第4 - 12天，她出现了类似的骨痛。开具了口服洛索洛芬用于止痛。在第三次巩固治疗的第33天，白细胞计数和中性粒细胞计数分别为320/L和20/L。在她出现上腹部疼痛和呕血后，发展为感染性休克。胃镜检查显示皱襞明显增厚，黏膜弥漫性受损并有渗血。计算机断层扫描显示胃窦和幽门壁增厚。尽管进行了紧急治疗，她仍死亡。胃液细菌培养显示有粪肠球菌生长。综合判断，她被诊断为蜂窝织炎性胃炎。对系列骨髓活检标本进行回顾性检查发现骨髓纤维化进展，这可能导致了长期的骨髓抑制。因此，在每个治疗周期后通过骨髓活检评估骨髓纤维化情况，可能作为化疗诱导的持续性骨髓抑制的一个预测指标。
