悪性胸膜中皮腫治療後早期に著明な血小板減少を来たした1例

悪性胸膜中皮腫治療後に血小板減少を呈した症例を報告する．68歳男性．右悪性胸膜中皮腫にて右胸膜肺全摘・シスプラチン・ペメトレキセド併用化学療法後，強度変調放射線治療中に放射線肺臓炎を来したため照射中止し，ステロイドを開始した．1ヵ月後血小板2×103/μLに著減し頻回に血小板輸血を行った．サイトメガロウイルス（CMV）抗原血症の診断でガンシクロビル治療後も血小板は増加しなかった．骨髄検査で細胞密度はやや低形成であったが巨核球数は保たれており，免疫性血小板減少性紫斑病に準じ治療を行なった．免疫グロブリン治療後も数万/μLに留まり，トロンボポエチン受容体作動薬も効果不良であった．ステロイド投与中に...

Full description

Saved in:
Bibliographic Details
Published in日本呼吸器外科学会雑誌 Vol. 28; no. 6; pp. 777 - 782
Main Authors 青山, 晃博, 池田, 政樹, 伊達, 洋至, 松尾, 幸憲, 園部, 誠
Format Journal Article
LanguageJapanese
Published 特定非営利活動法人 日本呼吸器外科学会 2014
Subjects
サイトメガロウイルス
ステロイド
悪性胸膜中皮腫
放射線治療
血小板減少
Online AccessGet full text
ISSN0919-0945
1881-4158
DOI10.2995/jacsurg.28.777

Cover

Abstract 悪性胸膜中皮腫治療後に血小板減少を呈した症例を報告する．68歳男性．右悪性胸膜中皮腫にて右胸膜肺全摘・シスプラチン・ペメトレキセド併用化学療法後，強度変調放射線治療中に放射線肺臓炎を来したため照射中止し，ステロイドを開始した．1ヵ月後血小板2×103/μLに著減し頻回に血小板輸血を行った．サイトメガロウイルス（CMV）抗原血症の診断でガンシクロビル治療後も血小板は増加しなかった．骨髄検査で細胞密度はやや低形成であったが巨核球数は保たれており，免疫性血小板減少性紫斑病に準じ治療を行なった．免疫グロブリン治療後も数万/μLに留まり，トロンボポエチン受容体作動薬も効果不良であった．ステロイド投与中に発症し，薬物治療への反応が不良かつ一時的という点から，化学療法による骨髄機能低下に，放射線・薬剤・CMV感染など複合的要素が関与し血小板減少が発症・遷延したと考える．
AbstractList 悪性胸膜中皮腫治療後に血小板減少を呈した症例を報告する．68歳男性．右悪性胸膜中皮腫にて右胸膜肺全摘・シスプラチン・ペメトレキセド併用化学療法後，強度変調放射線治療中に放射線肺臓炎を来したため照射中止し，ステロイドを開始した．1ヵ月後血小板2×103/μLに著減し頻回に血小板輸血を行った．サイトメガロウイルス（CMV）抗原血症の診断でガンシクロビル治療後も血小板は増加しなかった．骨髄検査で細胞密度はやや低形成であったが巨核球数は保たれており，免疫性血小板減少性紫斑病に準じ治療を行なった．免疫グロブリン治療後も数万/μLに留まり，トロンボポエチン受容体作動薬も効果不良であった．ステロイド投与中に発症し，薬物治療への反応が不良かつ一時的という点から，化学療法による骨髄機能低下に，放射線・薬剤・CMV感染など複合的要素が関与し血小板減少が発症・遷延したと考える．
Author 松尾, 幸憲
池田, 政樹
園部, 誠
青山, 晃博
伊達, 洋至
Author_xml – sequence: 1
  fullname: 青山, 晃博
  organization: 京都大学呼吸器外科
– sequence: 1
  fullname: 池田, 政樹
  organization: 京都大学呼吸器外科
– sequence: 1
  fullname: 伊達, 洋至
  organization: 京都大学呼吸器外科
– sequence: 1
  fullname: 松尾, 幸憲
  organization: 京都大学放射線治療科
– sequence: 1
  fullname: 園部, 誠
  organization: 京都大学呼吸器外科
BookMark eNo9kE1LAkEcxocwyMxr32Jt5r-zOzNHkd5ACKLOy-w6a4pZ7Nqhmxp1KQq72IsSHSJSCukkBPZh1HE_RhtJl99z-D08h2cZJapHVYXQKsEZEMJaK0svPAmKGeAZxtgCShLOiUGJxRMoiQURBhbUWkLpMCy5GAOAyU07iXZ1s6frr9HZMLroTIbvs4eP6LyvP79m983p6Eq333TnadzoR622vrseN3rRc306uNHdbz18nA5a4-at7r6MG3GnHZNMRpcraNGXlVCl55lC-xvre7ktI7-zuZ3L5o0yUIENCQUFvkuoLxjhymZQsH1wMVBwbU6kcF1LKQDKYl3ghGLLE5RhoSzPFhYzUyj7t1sOa7KonOOgdCiDU0cGtZJXUc78Ege4Y_8i_uXfeQcyiAvmD0pKe3s
ContentType Journal Article
Copyright 2014 特定非営利活動法人　日本呼吸器外科学会
Copyright_xml – notice: 2014 特定非営利活動法人　日本呼吸器外科学会
DOI 10.2995/jacsurg.28.777
DatabaseTitleList
DeliveryMethod fulltext_linktorsrc
EISSN 1881-4158
EndPage 782
ExternalDocumentID article_jacsurg_28_6_28_777_article_char_ja
GroupedDBID ABJNI
ACGFS
ALMA_UNASSIGNED_HOLDINGS
JSF
KQ8
OK1
RJT
ID FETCH-LOGICAL-j2490-a2de2fb14f9718e672d6f2b0242b681a9bb5ee2247718d81405c94709e5c69573
ISSN 0919-0945
IngestDate Wed Sep 03 06:22:13 EDT 2025
IsDoiOpenAccess true
IsOpenAccess true
IsPeerReviewed false
IsScholarly true
Issue 6
Language Japanese
LinkModel OpenURL
MergedId FETCHMERGED-LOGICAL-j2490-a2de2fb14f9718e672d6f2b0242b681a9bb5ee2247718d81405c94709e5c69573
OpenAccessLink https://www.jstage.jst.go.jp/article/jacsurg/28/6/28_777/_article/-char/ja
PageCount 6
ParticipantIDs jstage_primary_article_jacsurg_28_6_28_777_article_char_ja
PublicationCentury 2000
PublicationDate 20140000
PublicationDateYYYYMMDD 2014-01-01
PublicationDate_xml – year: 2014
  text: 20140000
PublicationDecade 2010
PublicationTitle 日本呼吸器外科学会雑誌
PublicationTitleAlternate 日呼外会誌
PublicationYear 2014
Publisher 特定非営利活動法人 日本呼吸器外科学会
Publisher_xml – name: 特定非営利活動法人 日本呼吸器外科学会
References 13. Gomez DR, Hong DS, Allen PK, Welsh JS, Mehran RJ, Tsao AS, et al. Patterns of failure, toxicity, and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy for malignant pleural mesothelioma. J Thorac Oncol 2013; 8: 238-45.
8. Rusch VW. A proposed new international TNM staging system for malignant pleural mesothelioma. From the International mesothelioma Interest Group. Chest 1995; 108: 1122-8.
5. Ettinger DS, Akerley W, Borghaei H, Chang A, Cheney RT, Chirieac LR, et al. Malignant pleural mesothelioma. J Natl Compr Canc Netw 2012; 10: 26-41.
7. Okubo K, Sonobe M, Fujinaga T, Shoji T, Sakai H, Miyahara R, et al. Survival and Relapse Pattern after Trimodality Therapy for Malignant Pleural Mesothelioma. Gen Thorac Cardiovasc Surg 2009; 57: 585-90.
12. Allen AM, Czerminska M, Jänne PA, Sugarbaker DJ, Bueno R, Harris JR, et al. Fatal pneumonitis associated with intensity-modulated radiation therapy for mesothelioma. Int J Radiat Oncol Biol Phys 2006; 65: 640-5.
11. 桑名 正隆. 出血性疾患: 診断と治療の進歩. II. 検査法の進歩. 2. 抗血小板抗体. 日内会誌 2009; 98: 1580-5.
10. Cines DB, Liebman H, Stasi R. Pathobiology of Secondary Immune Thrombocytopenia. Semin hematol 2009; 46: S2-14.
15. 桑名 正隆. ITPの診断と治療. 血栓止血誌 2008; 19: 199-201.
6. Cao C, Tian D, Manganas C, Matthews P, Yan TD. Systematic review of trimodality therapy for patients with malignant pleural mesothelioma. Ann Cardiothorac Surg 2012; 1: 428-37.
17. Sugioka T, Kubota Y, Wakayama K, Kimura S. Severe Steroid-resistant Thrombocytopenia Secondary to Cytomegalovirus Infection in an Immunocompetent Adult. Intern Med 2012; 51: 1747-50.
1. British Thoracic Society Standards of Care Committee. BTS statement on malignant mesothelioma in the UK, 2007. Thorax 2007; 62: ii1-ii19.
4. Scherpereel A, Astoul P, Baas P, Berghmans T, Clayson H, de Vuyst P, et al. Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma. Eur Respir J 2010; 35: 479-95.
16. Papagianni A, Economou M, Tsoutsou E, Athanassiou MM. CMV-related immune thrombocytopenic purpura or CMV-induced thrombocytopenia? Br J Haematol 2010; 149: 454-5.
2. Scherpereel A. Guidelines of the French Speaking Society for Chest Medicine for management of malignant pleural mesothelioma. Respir Med 2007; 101: 1265-76.
3. Stahel RA, Weder W, Lievens Y, Felip E. Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21: v126-8.
9. Watson TD, Stark JE, Vesta KS. Pantoprazole-induced thrombocytopenia. Ann Pharmacother 2006; 40: 758-61.
14. Kristensen CA, Nøttrup TJ, Berthelsen AK, Kjaer-Kristoffersen F, Ravn J, Sørensen JB, et al. Pulmonary toxicity following IMRT after extrapleural pneumonectomy for malignant pleural mesothelioma. Radiother Oncol 2009; 92: 96-9.
References_xml – reference: 3. Stahel RA, Weder W, Lievens Y, Felip E. Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21: v126-8.
– reference: 14. Kristensen CA, Nøttrup TJ, Berthelsen AK, Kjaer-Kristoffersen F, Ravn J, Sørensen JB, et al. Pulmonary toxicity following IMRT after extrapleural pneumonectomy for malignant pleural mesothelioma. Radiother Oncol 2009; 92: 96-9.
– reference: 17. Sugioka T, Kubota Y, Wakayama K, Kimura S. Severe Steroid-resistant Thrombocytopenia Secondary to Cytomegalovirus Infection in an Immunocompetent Adult. Intern Med 2012; 51: 1747-50.
– reference: 4. Scherpereel A, Astoul P, Baas P, Berghmans T, Clayson H, de Vuyst P, et al. Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma. Eur Respir J 2010; 35: 479-95.
– reference: 15. 桑名 正隆. ITPの診断と治療. 血栓止血誌 2008; 19: 199-201.
– reference: 16. Papagianni A, Economou M, Tsoutsou E, Athanassiou MM. CMV-related immune thrombocytopenic purpura or CMV-induced thrombocytopenia? Br J Haematol 2010; 149: 454-5.
– reference: 7. Okubo K, Sonobe M, Fujinaga T, Shoji T, Sakai H, Miyahara R, et al. Survival and Relapse Pattern after Trimodality Therapy for Malignant Pleural Mesothelioma. Gen Thorac Cardiovasc Surg 2009; 57: 585-90.
– reference: 8. Rusch VW. A proposed new international TNM staging system for malignant pleural mesothelioma. From the International mesothelioma Interest Group. Chest 1995; 108: 1122-8.
– reference: 9. Watson TD, Stark JE, Vesta KS. Pantoprazole-induced thrombocytopenia. Ann Pharmacother 2006; 40: 758-61.
– reference: 13. Gomez DR, Hong DS, Allen PK, Welsh JS, Mehran RJ, Tsao AS, et al. Patterns of failure, toxicity, and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy for malignant pleural mesothelioma. J Thorac Oncol 2013; 8: 238-45.
– reference: 2. Scherpereel A. Guidelines of the French Speaking Society for Chest Medicine for management of malignant pleural mesothelioma. Respir Med 2007; 101: 1265-76.
– reference: 12. Allen AM, Czerminska M, Jänne PA, Sugarbaker DJ, Bueno R, Harris JR, et al. Fatal pneumonitis associated with intensity-modulated radiation therapy for mesothelioma. Int J Radiat Oncol Biol Phys 2006; 65: 640-5.
– reference: 6. Cao C, Tian D, Manganas C, Matthews P, Yan TD. Systematic review of trimodality therapy for patients with malignant pleural mesothelioma. Ann Cardiothorac Surg 2012; 1: 428-37.
– reference: 10. Cines DB, Liebman H, Stasi R. Pathobiology of Secondary Immune Thrombocytopenia. Semin hematol 2009; 46: S2-14.
– reference: 1. British Thoracic Society Standards of Care Committee. BTS statement on malignant mesothelioma in the UK, 2007. Thorax 2007; 62: ii1-ii19.
– reference: 5. Ettinger DS, Akerley W, Borghaei H, Chang A, Cheney RT, Chirieac LR, et al. Malignant pleural mesothelioma. J Natl Compr Canc Netw 2012; 10: 26-41.
– reference: 11. 桑名 正隆. 出血性疾患: 診断と治療の進歩. II. 検査法の進歩. 2. 抗血小板抗体. 日内会誌 2009; 98: 1580-5.
SSID ssib002223836
ssib002809429
ssib006158315
ssib000936850
ssib005901879
ssj0061428
ssib050939265
ssib003115996
ssib023160720
ssib002484544
ssib058493845
ssib006554584
Score 1.9402169
Snippet ...
SourceID jstage
SourceType Publisher
StartPage 777
SubjectTerms サイトメガロウイルス
ステロイド
悪性胸膜中皮腫
放射線治療
血小板減少
Title 悪性胸膜中皮腫治療後早期に著明な血小板減少を来たした1例
URI https://www.jstage.jst.go.jp/article/jacsurg/28/6/28_777/_article/-char/ja
Volume 28
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
ispartofPNX 日本呼吸器外科学会雑誌, 2014/09/15, Vol.28(6), pp.777-782
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrR1Na9RANNR68SKKit_04Jxk13xMJjPeZrYpRVFQWuhtSTZZoYdaanvx1Fb0oij1Uj9axIOILUrxVBDqj9k23Z_hey_Z3al4sFoIYTLvzcv7SDLvTWbeOM61KKWMp0nNlapd44mXw3ewndeyNE1yN-HCpUk0d-6K8Ul-ayqcGhqetWYtLcyn9dbjP64r-RerQh3YFVfJHsKyfaJQAWWwL5zBwnD-KxuzWDDpM62p4DIdsVgyGTAjqSCYarCY46UeZXHElGY6JlDItMFWxmfGEEghqThkJmaygSAVMa2o0GBqjMUBeJ3USjLlIRRBQCrugTSCtIecIB2XyTHCGWWGCsCGMhUIKGArnym_wtFhRad_L7xFVeORGMCZsb3pHpdhxaVuIHUgbcqCS4oIUTZNBc2ZEigtaAo5CFEvWhDxBmonVsgigiTKI_tjyAQZJW6Bfw8PeDjpvgo1DrUSwHqALxBHu6RbjiL38HmlDmDJqAE-sSCJBRSZ9_ANePukdBkxE9j0UbFxpU8Tl_hwoUhqgeY3vj2q4w3Gc5ErqRAXdRD3RAcJiCAoyQiSSVbPAHBhyHbAiyJ9m4AKUK_huH7ktrAHkXEJnCoTgtbzsguV0quBWyjtPtaX1rfE7jCjahOf0veKyo2ofu_WwWUKaTuJ1qOFuQd1X9b7zQ6kSq9exGaF2PRlU-AJsJs9GC5mBIRjznE_ijycBHz7nhWQKNyQwV4ZDi5tYAXgXPLQdoglSG8FGJi7SlkJLHFlt7T-g0P8IAPLARch_rju04NgCz6OgwAOvHmIXwbzEABVBZL3A3yB-RIpm2hlhzItLerrxkFtgYM9DeFmb6oqec8Tp5yTVdg7okv1nHaGppMzzv1ieaNY_Nx9st19tra7_XX_3bfu083i-4_9t8t7Oy-K1S_F2ofO0mZ3ZbV487KztNH9uLi39apY_1lsv9_bWuksvy7WP3WWAGcVzt7uzvOzzuRYPNEYr1V7vNSmfa7cWuJnud9OPd5W4CXnIvIz0fZTjBxSIb1EpWmY5xBngLFkhun5wpbikavysCVUGAXnnOGZhzP5eWckilpBlkciURmGRZlKuISWQdZqhy3pty84N0sVNGfLRD7NQzwvF_-n8SXnBL7j5cjtZWd4fm4hvwKxzHx6lR6_X0imAVE
linkProvider Colorado Alliance of Research Libraries
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=%E6%82%AA%E6%80%A7%E8%83%B8%E8%86%9C%E4%B8%AD%E7%9A%AE%E8%85%AB%E6%B2%BB%E7%99%82%E5%BE%8C%E6%97%A9%E6%9C%9F%E3%81%AB%E8%91%97%E6%98%8E%E3%81%AA%E8%A1%80%E5%B0%8F%E6%9D%BF%E6%B8%9B%E5%B0%91%E3%82%92%E6%9D%A5%E3%81%9F%E3%81%97%E3%81%9F1%E4%BE%8B&rft.jtitle=%E6%97%A5%E6%9C%AC%E5%91%BC%E5%90%B8%E5%99%A8%E5%A4%96%E7%A7%91%E5%AD%A6%E4%BC%9A%E9%9B%91%E8%AA%8C&rft.au=%E9%9D%92%E5%B1%B1%2C+%E6%99%83%E5%8D%9A&rft.au=%E6%B1%A0%E7%94%B0%2C+%E6%94%BF%E6%A8%B9&rft.au=%E4%BC%8A%E9%81%94%2C+%E6%B4%8B%E8%87%B3&rft.au=%E6%9D%BE%E5%B0%BE%2C+%E5%B9%B8%E6%86%B2&rft.date=2014&rft.pub=%E7%89%B9%E5%AE%9A%E9%9D%9E%E5%96%B6%E5%88%A9%E6%B4%BB%E5%8B%95%E6%B3%95%E4%BA%BA+%E6%97%A5%E6%9C%AC%E5%91%BC%E5%90%B8%E5%99%A8%E5%A4%96%E7%A7%91%E5%AD%A6%E4%BC%9A&rft.issn=0919-0945&rft.eissn=1881-4158&rft.volume=28&rft.issue=6&rft.spage=777&rft.epage=782&rft_id=info:doi/10.2995%2Fjacsurg.28.777&rft.externalDocID=article_jacsurg_28_6_28_777_article_char_ja
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0919-0945&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0919-0945&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0919-0945&client=summon