演題抄録

臓器別シンポジウム

開催概要
開催回
第58回・2020年・京都
 

急性前骨髄球性白血病、それは"がん"のパイオニア

演題番号 : SY23-1

[筆頭演者]
木口 亨:1 

1:中国中央病院・血液内科

 

The 5-year survival rate for acute promyelocytic leukemia (APL) has reached around 90 percent. What used to be the most lethal disease of acute leukemia is now a cure-targeting disease. It was the discovery of all-trans-retinoic acid (ATRA) that brought about this great change. It was a completely new mechanism for cancer treatment, in which APL cells were apoptotic. The impact of ATRA on cancer treatment is immeasurable. APL treatment would further lead to the discovery of arsenic trioxide (ATO). ATO will continue to evolve into the Realgar-Indigo naturalis formula (RIF). It seems that it will not be long before APL is treated by oral administration, which will be the combination of RIF and ATRA.
On the other hand, in the development of APL treatment in Japan, a combination therapy of tamibarotene (Am80) and ATO and gemtuzumab ozogamicin (GO) is being administered as post-remission therapy for recurrent APL. It became the first chemo-free regimen in Japan by eliminating molecular-targeted drugs with high APL specificity and autologous transplantation.
APL has a high cure rate, but there are still challenges. The first is life-threatening bleeding during induction. This requires frequent blood tests and thorough systemic management including blood transfusions. This problem remains unresolved. This is also the differentiation syndrome (DS). It is a famous complication with APL, but there are few hematologists who can accurately diagnose when it occurs and perform treatment without delay.
In addition, due to complications such as DS at the time of induction of remission, and fatal bleeding, and a high recurrence rate, it cannot be said that a treatment method is established for the high-risk group, as it is for the low-risk group.
Since the discovery of ATRA, APL has shine light on all cancers. It is expected that we will continue to lead the way in research, including the development of oral variants(chemo-free) of all anti-cancer drugs.

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