南予医学雑誌　第18巻

82/91

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　2017－81－and promising treatment option for elderly patients with relapsed or primary imatinib/second generation TKI-resistant Ph＋MPAL．ConsentWritten informed consent was obtained from the patient for publication of this case report and any accompanying images．Conict of interestNone of the authors have any conflicts of interest to declare．References１）　 Wolach O， Stone RM. How I treat mixed-phenotype acute leukemia．Blood 2015; 125: 2477-2485．２）　 Matutes E， Pickl WF， Van’t Veer M， et al. Mixed-phenotype acute leu-kemia：clinical and laboratory features and outcome in 100 patients defined according to the WHO 2008 classifi-cation. Blood 2011; 117: 3163-3171．３）　 Arber DA， Orazi A， Hasserjian R， et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leuke-mia. Blood 2016; 127: 2391-2405．４）　 Shimizu H， Yokohama A， Hatsumi N， et al. Philadelphia chromosome-posi-tive mixed phenotype acute leukemia in the imatinib era. Eur J Haematol 2014; 93: 297-301．５）　 Kawajiri C， Tanaka H， Hashimoto S， et al. Successful treatment of Philadel-phia chromosome-positive mixed phe-notype acute leukemia by appropri-ate alternation of second-generation tyrosine kinase inhibitors according to BCR-ABL1 mutation status. Int J Hematol 2014; 99: 513-518．６）　 Takata H， Ikebe T， Sasaki H， et al．Two Elderly Patients with Philadel-phia Chromosome Positive Mixed Phenotype Acute Leukemia Who Were Successfully Treated with Da-satinib and Prednisolone. Intern Med 2016; 55: 1177-1181．７）　 Soverini S， Vitale A， Poerio A， et al. Philadelphia-positive acute lym-phoblastic leukemia patients already harbor BCR-ABL kinase domain muta-tions at low levels at the time of diag-nosis. Haematologica 2011; 96: 552-557．８）　 Soverini S， De Benedittis C， Papayan-nidis C， et al．Drug resistance and BCR-ABL kinase domain mutations in Philadelphia chromosome-positive acute lymphoblastic leukemia from the imatinib to the second-generation tyrosine kinase inhibitor era: The main changes are in the type of muta-tions， but not in the frequency of mu-tation involvement. Cancer 2014; 120: 1002-1009．９）　 Cortes JE， Kantarjian H， Shah NP， et al. Ponatinib in refractory Philadel-phia chromosome-positive leukemias．N Engl J Med 2012; 367: 2075-2088．