内分泌療法中に血小板減少を契機として急性骨髄性白血病の合併が判明した前立腺癌の2例

Abstract

69歳男(症例1), 症例1は排尿困難を主訴とし, 経直腸的前立腺生検にて中分化方型腺癌が検出された.一般血液検査でWBC5700/μlであり, 骨シンチ上多発性骨転移を認めた.前立腺癌stageD2, T3N2M2の診断にて内分泌療法を開始した.その後急性骨髄性白血病(AML)と診断され, 化学療法が施行したが死亡した.症例2は頸部痛を主訴とし経直腸的前立腺生検にて中分化方型腺癌が検出された.前立腺癌stageD2, T3N0M2の診断にて内分泌療法を開始した.WBC21900/μlであり, 白血球増多と貧血, 血小板減少を認めた.AML(M2)と診断され, 化学療法とLH-RH agonistの併用を行ったが, 多臓器不全により死亡した

Prostate is one of the most common sites of multiple primary cancer (MPC). We herein present two cases of prostate cancer associated with acute myeloid leukemia (AML) presenting as thrombocytopenia during endocrine therapy. After a diagnosis of prostate cancer (stage D2) was made, our patients received endocrine treatment with fosfestrol followed by a luteinizing hormone-releasing hormone (LH-RH) analogue and bicaltamide. Thrombocytopenia appeared 8 months and 10 months after the initiation of endocrine therapy, respectively. Because suspensions of bicaltamide resulted in further deterioration of thrombocytopenia, bone marrow aspirations were done with hematological examination revealing features of the M2 subtype of AML. Review of MPC with prostate cancer in the literature suggested that the combination of prostate cancer and AML was rare.