chronic myeloid leukemia

出典: meddic

慢性骨髄性白血病 CML

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出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2016/10/29 03:07:56」(JST)

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英文文献

  • Major molecular response during the first year of dasatinib, imatinib or nilotinib treatment for newly diagnosed chronic myeloid leukemia: a network meta-analysis.
  • Signorovitch J, Ayyagari R, Reichmann WM, Wu EQ, Chen L.Author information Analysis Group, Inc., Boston, MA 02199, USA. Electronic address: jsignorovitch@analysisgroup.com.AbstractOBJECTIVE: No randomized trials have directly compared dasatinib with nilotinib for the treatment of newly diagnosed chronic myeloid leukemia in the chronic phase. The objective of this study was to indirectly compare these therapies using evidence from randomized trials versus imatinib, the current standard of care.
  • Cancer treatment reviews.Cancer Treat Rev.2014 Mar;40(2):285-92. doi: 10.1016/j.ctrv.2013.09.004. Epub 2013 Sep 17.
  • OBJECTIVE: No randomized trials have directly compared dasatinib with nilotinib for the treatment of newly diagnosed chronic myeloid leukemia in the chronic phase. The objective of this study was to indirectly compare these therapies using evidence from randomized trials versus imatinib, the current
  • PMID 24112812
  • Microfluidic channel-assisted screening of hematopoietic malignancies.
  • Mughal F, Baldock SJ, Karimiani EG, Telford N, Goddard NJ, Day PJ.Author information Manchester Interdisciplinary Biocentre, University of Manchester, Manchester, M1, 7ND, UK.AbstractA simple microfluidic fluorescence in situ hybridization (FISH) device allowing accurate analysis of interphase nuclei in 1 hr in narrow channels is presented. Photolithography and fluorosilicic acid etching were used to fabricate microfluidic channels (referred to as FISHing lines) that allowed analysis of 10 samples on a glass microscope slide 0.2 µl of sample volume was used to fill a micro-channel, which resembled a 250-fold reduction compared to conventional FISH. FISH signals were comparable to conventional FISH, with 50-fold less probe consumption and 10-fold less time. Cells were immobilized in single file in channels just exceeding the diameter of the cells, and were used for minimal residual disease (MRD) analysis. To test the micro-channels for application in FISH, MRD was simulated by mixing K562 cells (an established chronic myeloid leukemia cell line) carrying the BCR/ABL fusion gene across 1:1 to 1:1,000 Jurkat cells (an established acute lymphoblastic leukemia cell line). The limit of detection was seen to be 1:100 cells and 1:1,000 cells for FISHing lines and conventional FISH, respectively; however, the conventional method seemed to over-score the presence of K562 cells. This may in part be attributed to FISHing lines practically eliminating the chance of duplicate screening of cells and hastened the time of screening, enhancing scoring of all cells within the channels. This was compared to 1 in 500 cells on the slide being analyzed with the conventional FISH. © 2013 Wiley Periodicals, Inc.
  • Genes, chromosomes & cancer.Genes Chromosomes Cancer.2014 Mar;53(3):255-63. doi: 10.1002/gcc.22137. Epub 2013 Dec 16.
  • A simple microfluidic fluorescence in situ hybridization (FISH) device allowing accurate analysis of interphase nuclei in 1 hr in narrow channels is presented. Photolithography and fluorosilicic acid etching were used to fabricate microfluidic channels (referred to as FISHing lines) that allowed ana
  • PMID 24339206
  • Bcr-Abl activates AURKA and AURKB in chronic myeloid leukemia cells via AKT signaling.
  • Yang J, Ikezoe T, Nishioka C, Udaka K, Yokoyama A.Author information Department of Hematology and Respiratory Medicine, Kochi University, Nankoku, Kochi, Japan; Department of Immunology, Kochi Medical School, Kochi University, Kochi University, Nankoku, Kochi, Japan.AbstractThis study explored molecular mechanisms by which Bcr-Abl induced expression of Aurora kinase A and B (AURKA and AURKB) in chronic myeloid leukemia cells. Lentiviral transduction of Bcr-Abl into either Ba/F3 or CD34(+) hematopoietic stem/progenitor cells potently increased levels of AURKA and AURKB in association with phosphorylation of AKT and stimulated their proliferation. Bcr-Abl-mediated expression of AURKA and AURKB were decreased in CD34(+) HSPCs when AKT was inactivated by an shRNA against AKT, suggesting that Bcr-Abl induced expression of AURKA and AURKB via AKT signaling. MLN8237, an inhibitor of AURKA, significantly inhibited the proliferation of freshly isolated CD34(+) CML cells in a dose-dependent manner as measured by colony forming assay. Importantly, inhibition of AURKA in CD34(+) leukemia cells freshly isolated from individuals with blast crisis of CML with Bcr-Abl T315I mutant (n = 2) by MLN8237 significantly impaired the engraftment of these cells in severely immunocompromised mice and decreased the weight of spleens. Taken together, Bcr-Abl induces expression of AURKA and AURKB at least in part via AKT. Inhibition of AURKA could be useful to overcome imatinib-resistance mediated by Bcr-Abl mutants.
  • International journal of cancer. Journal international du cancer.Int J Cancer.2014 Mar 1;134(5):1183-94. doi: 10.1002/ijc.28434. Epub 2013 Sep 3.
  • This study explored molecular mechanisms by which Bcr-Abl induced expression of Aurora kinase A and B (AURKA and AURKB) in chronic myeloid leukemia cells. Lentiviral transduction of Bcr-Abl into either Ba/F3 or CD34(+) hematopoietic stem/progenitor cells potently increased levels of AURKA and AURKB
  • PMID 23934627

和文文献

  • 慢性骨髄性白血病におけるチロシンキナーゼ阻害剤中止後の筋骨格痛 : アンケート調査
  • 第2世代TKI抵抗性CMLの病態とその克服 (特集 日常診療で遭遇する難治性造血器腫瘍の話題とそのアプローチ)
  • 白血病に対する免疫チェックポイント阻害療法の研究・開発 (特集 Immune checkpoint阻害薬)

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★リンクテーブル★
リンク元慢性骨髄性白血病」「Philadelphia-negative myeloid leukemia」「Philadelphia-positive myeloid leukemia」「chronic granulocytic leukemia
拡張検索accelerated-phase chronic myeloid leukemia」「atypical chronic myeloid leukemia
関連記事chronic」「myeloid」「leukemia」「myelo

慢性骨髄性白血病」

  [★]

chronic myeloid leukemia chronic myelogenous leukemia chronic myelocytic leukemia CML
白血病染色体異常
  • 血液・造血器 081030I
  • first aid step1 2006 p.294,303,304,309,310,

概念

  • 造血幹細胞に遺伝子的な変異が生じ、正常な分化能を保持したまま腫瘍性に増殖し、特に顆粒球系の血球の増殖をきたす。
  • 白血球は著増、血小板は増加するが、赤血球は正常もしくは減少する。
  • 慢性に経過するが、急性転化(blastic crisis)により急性白血病と同様の病態をとりうる。

検査

  • 赤血球:→or↓
  • 白血球:↑↑↑
  • 血小板:↑   → 急性転化例では↓
  • 好中球アルカリホスファターゼ:低値
  • NAPスコア:低下    → 急性転化例では↑
  • 血清ビタミンB12、LDH、尿酸、リゾチーム:高値 → 白血球の破壊による
  • 白血病裂孔:なし → 分化能は保たれているため
  • 染色体:Ph染色体の出現
→ 急性転化例では複数のPh染色体、環状Ph1、形態異常をきたしたPh染色体の出現がみられる(QB.G247)。頻度:複数のPh染色体の出現>トリソミー>17番同腕染色体>19トリソミー?(+19) (WCH.2243)。染色体の変化は血液学的な変化に数ヶ月先だって起こるが、必ずしもblast crisisに繋がるわけではない(WCH.2243)。急性転化例の2/3では骨髄性、1/3でリンパ性にtransformationする。後者の場合、MPO染色陰性、PAS染色陽性、B細胞表面抗原の発現(多くの場合CD10,CD19を発現し,sIgは欠く)、TdT発現(抗体の遺伝子再構成における多様性付与に関与)。(WCH.2243)

治療

イマチニブが第一選択となる。適応があれば同種幹細胞移植。

治療に用いる薬物・治療法

  • イマチニブ
  • 自己幹細胞移植:?
  • 同種幹細胞移植
  • 白血球除去(leukapheresis)・脾摘
  • インターフェロンα:イマチニブが登場する前は、同種幹細胞移植ができない症例において治療の選択肢の一つであった。
  • ヒドロキシウレア:。インターフェロンと併用して使われる。代謝拮抗薬。DNA合成を阻害する。骨髄抑制、二次発癌は稀。
  • シタラビン:Ara-CTPとなり、DNA合成過程のシチジン二リン酸(CDP)還元酵素やDNAポリメラーゼを阻害

慢性期

参考2

移行期

参考2

急性期

参考2
  • 1. myeloid crisisに対してはAML、lymphoid crisisに対してはALLに対する寛解導入療法に準じた化学療法を行う。
  • 2. 同種幹細胞移植

国試

参考

  • 1. 慢性骨髄性白血病 - がんプロ.com
[display]http://www.gan-pro.com/professional/cancer/child-leukemia/chronic-myelogenous-leukemia.html



Philadelphia-negative myeloid leukemia」

  [★]

フィラデルフィア陰性骨髄性白血病

chronic granulocytic leukemiachronic myelocytic leukemiachronic myelogenous leukemiachronic myeloid leukemiaPhiladelphia-positive myeloid leukemia


Philadelphia-positive myeloid leukemia」

  [★]

フィラデルフィア陽性骨髄性白血病

chronic granulocytic leukemiachronic myelocytic leukemiachronic myelogenous leukemiachronic myeloid leukemiaPhiladelphia-negative myeloid leukemia


chronic granulocytic leukemia」

  [★]

chronic myeloid leukemia


accelerated-phase chronic myeloid leukemia」

  [★]

accelerated phase myeloid leukemiaaggressive-phase myeloid leukemia


atypical chronic myeloid leukemia」

  [★] 非定型慢性骨髄性白血病


chronic」

  [★]

  • adj.
  • 慢性の、慢性的な、慢性型の
chronicallychronicity

WordNet   license wordnet

「being long-lasting and recurrent or characterized by long suffering; "chronic indigestion"; "a chronic shortage of funds"; "a chronic invalid"」

PrepTutorEJDIC   license prepejdic

「(病気が)長期にわたる,慢性の / 《名詞の前にのみ用いて》常習の,癖になった」

WordNet   license wordnet

「of long duration; "chronic money problems"」
continuing

WordNet   license wordnet

「habitual; "a chronic smoker"」
inveterate

myeloid」

  [★]

  • adj.
BMbone marrowmyelomyelocyticmyelogenous

WordNet   license wordnet

「of or relating to the spinal cord」

WordNet   license wordnet

「of or relating to bone marrow」


leukemia」

  [★] 白血病

WordNet   license wordnet

「malignant neoplasm of blood-forming tissues; characterized by abnormal proliferation of leukocytes; one of the four major types of cancer」
leukaemia, leucaemia, cancer of the blood

PrepTutorEJDIC   license prepejdic

「白血病」


myelo」

  [★]

  • comb form
  • ex.




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