PMC5548683_01
Schematic drawing of the treatment procedure and the changes in hematological parameters. The clinical course is shown separately for the treatment with oral etoposide (A) to ATL, remission induction and consolidation therapies for t-AML (B), and allo-HSCT (C). WBC: white blood cell, Blast: myeloblast, Ab-lym: abnormal lymphocyte, LDH: lactate dehydrogenase, IDR: idarubicin, Ara-C: cytarabine, BM: bone marrow, BMA: bone marrow aspiration, uBMT (RIST): unrelated bone marrow transplantation (reduced intensity stem cell transplantation), GVHD: graft-versus-host disease, S: skin, DOC/QP: disturbance of consciousness and quadriplegia,  : date of death
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After the second course, the physical symptoms, including the bilateral wrist pain, improved in line with the decrease in abnormal lymphocytes (Fig. 1A). Thus, the intermittent administration of oral etoposide with a short interval was considered (Fig. 1A). ATL cells remained and increased again after day 1,410 (Fig. 1B). After administering consolidation therapy using high-dose cytarabine, the number of peripheral ATL cells decreased from 3,600 /muL (day 1,441) to 320 /muL (day 1,464; Fig. 1B). GVHD was managed by steroids for internal and external use (Fig. 1C). GVHD was not observed in the liver or gastrointestinal system.
(A) Myeloblasts and abnormal lymphocytes in the peripheral blood at day 1,404 (May-Giemsa x1,000). The black arrowheads indicate myeloblasts and the white arrowhead indicates an abnormal lymphocyte. (B) Myeloblasts in the bone marrow at day 1,393 (May-Giemsa x1,000). The black arrowheads indicate myeloblasts. Blast: myeloblast, Ab-lym: abnormal lymphocyte
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In the peripheral blood, both abnormal lymphocytes and myeloblasts were observed (Fig. 2A). On hospitalization, 87% of the nucleated cells in the BM were myeloblasts (Fig. 2B), which were positive for peroxidase staining, and CD13+CD14-CD33+ human leukocyte antigen (HLA)-DR+ by flow cytometry, but negative for nonspecific esterase staining.