Maruo K, Yoshikawa H, Nagata K
Gan To Kagaku Ryoho. 1982 Apr;9(4):733-9.
A 60-year-old woman was referred to us because of tumors on the occipital and the bilateral submaxillary areas. Biopsy proved them to be well-differentiated lymphosarcoma. On admission, systemic lymphadenopathy was noted and there was 26% of plasmacytoid cells in the bone marrow of the sternum. Monoclonal gammopathy of IgM,K type was found; her disease was diagnosed as a macroglobulinemia (IgM: 8,460 mg/dl). VENP-therapy consisted of vincristine 1 mg/w, cyclophosphamide 50 mg/d procarbazine 50 mg/d and prednisolone 30 mg/d was applied for about four weeks, but in vain. Transaminase levels were elevated (GOT 575 U, GPT 480 U) and the superficial lymphnodes did hardly diminish. Therefore, after improvement of the liver dysfunctions, 5 courses of AAAP-therapy, which was consisted of ACNU 50 mg/d (IV drip over 4 hrs), adriamycin 20 mg/d (IV push), methotrexate 25 mg/d (IV push) and prednisolone 60 mg/d (IV push) once a week or three were employed with excellent clinical effects. The superficial lymphnodes disappeared, M-protein and plasmacytoid cells in the bone marrow markedly decreased. An interval of the initial remission reached to 17 months. As previously reported, AAAP-therapy was also effective to multiple myeloma and acute lymphocytic leukemia of B-cell type. Therefore, AAAP-therapy would be one of the best chemotherapies for B-cell malignancy including macroglobulinemia.
一名60岁女性因枕部和双侧颌下区肿物转诊至我院。活检证实为高分化淋巴肉瘤。入院时发现全身淋巴结肿大，胸骨骨髓中浆细胞样细胞占26%。发现IgM、K型单克隆丙种球蛋白病；她的疾病被诊断为巨球蛋白血症（IgM：8460mg/dl）。采用VENP方案治疗，即长春新碱1mg/周、环磷酰胺50mg/天、丙卡巴肼50mg/天和泼尼松龙30mg/天，持续约四周，但无效。转氨酶水平升高（谷草转氨酶575U，谷丙转氨酶480U），浅表淋巴结几乎未缩小。因此，在肝功能障碍改善后，采用了5个疗程的AAAP方案治疗，该方案包括ACNU 50mg/天（静脉滴注4小时）、阿霉素20mg/天（静脉推注）、甲氨蝶呤25mg/天（静脉推注）和泼尼松龙60mg/天（静脉推注），每周一次或每三周一次，临床效果极佳。浅表淋巴结消失，骨髓中的M蛋白和浆细胞样细胞明显减少。首次缓解期长达17个月。如先前报道，AAAP方案对多发性骨髓瘤和B细胞型急性淋巴细胞白血病也有效。因此，AAAP方案将是包括巨球蛋白血症在内的B细胞恶性肿瘤的最佳化疗方案之一。
