南予医学雑誌 第18巻
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鹿田、他:Successful resolution of relapsed MPAL with t(9;22)(q34.1;q11.2);BCR-ABL1 with ponatinib and prednisolone南予医誌 Vol.18 No. 1 2017-77-(Fig.2).Flow cytometry showed a pre-dominant cell population that was strongly positive for CD10, CD13, CD19, CD33, and HLA-DR and negative for CD3, CD14, CD20, and CD41.Chromosomal analysis of the bone marrow showed 46, XY, t(9;22)(q34.1;q11.2) in 20 out of 20 meta-phase cells.Fluorescence in situ hybridiza-tion (FISH)analysis revealed that BCR-ABL-positive cells accounted for 86.0% of cells in the bone marrow, whereas cells with a mixed lineage leukemia(MLL)gene rearrangement were not detected.A bone marrow clot section revealed infiltra-tion of small cells with abundant chroma-tin.These cells were positive for CD10, CD19, CD34, CD79a, MPO and terminal deoxynucleotidyl transferase(TdT), and negative for CD3, CD5 and CD68.From these results, we nally diagnosed this con-dition as MPAL with t(9;22)(q34.1;q11.2);BCR-ABL1.As the patient had a good performance status and adequate major organ function, he was administered imatinib(400㎎/day on days 8-63)plus combination induction chemotherapy with cyclophosphamide, daunorubicin, vin-cristine, and prednisolone.On day 42, we discontinued imatinib due to prolonged nausea and switched to dasatinib(100㎎/day).Thereafter, the patient achieved a cytogenetic complete remission(CR), and consolidation chemotherapy was introduced comprising course1(C1)with high-(Fig.1)Microscopic features of the bone marrow aspiration specimen.Morphologically, the bone marrow aspirate shows small lym-phoblast-like cells (May-Grünwald-Giemsa staining,×1,000).About 4% of these blastoid cells show myeloperoxidase staining(×1,000).

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