株式会社 東京プレスT
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- ときな じゅふく
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1 ALL Philadelphia ALL MLL ALL ALL ALL ALL Philadelphia MLL acute lymphoblastic leukemia, ALL Philadelphia Ph+ ALL MLL mixed lineage leukemia MLL+ ALL ALL chronic myeloid leukemia, CML imatinib ALL ALL 1 Ph t 9;22 q34;q11 22q11 bcr
2 60 breakpoint cluster region 9q34 c-abl bcr intron 1 minor bcr, m-bcr intron 2 3 major bcr, M-bcr c-abl head to tail m-bcr exon 1 B1 c-abl exon 2 a2 B1-a2 mrna p190 BCR-ABL M-bcr bcr exon 2 b2 exon 3 b3 a2 b2-a2 mrna b3-a2 mrna p210 BCR-ABL CML p210 BCR-ABL Ph+ALL p190 BCR-ABL Ph B1-a2 mrna, b2-a2 mrna, b3-a2 mrna reverse transcription (RT)-polymerase chain reaction PCR 1 Ph+ALL a2 b2-a3 b3-a3 mrna p203 BCR-ABL 1 RT-PCR bcr-abl mrna bcr-abl fluorescence-in situ hybridization FISH bcr ABL BCR-ABL ABL p145 MLL 11q23 MLL+ 30 MLL+ALL t 4;11 q21;q23 t 11;19 q23;p13 t 9;11 p21;q23 AF4, ENL, AF9 in-frame 11;19 MLL+ALL RT-PCR mrna MLL-AF4, MLL-ENL, MLL-AF9 MLL+ALL MLL MLL split signal FISH 2 Ph+ALL BCR-ABL 4 BCR- ABL BCR-ABL Ph+ leukemogenesis 2 BCR-ABL BCR- ABL CML MLL+ leukemogenesis 2 3,4 MLL 2 MLL homeobox Hoxa9 MLL histone methyltransferase cofactor complex Men1 multiple endocrine neoplasia type 1
3 61 menin Hox Men1 MLL-AF9 Hoxa9 transform menin Hox MLL+ALL leukemogenesis 5,6 MLL+ALL MEIS mouse ecotropic virus integration site 1 Hoxa9 FLT3 MLL in vitro MLL knock-in 7 Cre-lox translocation 8 MLL+ Ono R 9 MLL-SEPT6 MLL-ENL MLL-SEPT6 MLL- ENL FLT3 internal tandem duplication lineage MLL+ MLL 3 ALL Ph+ ALL ALL 1-5 MLL+ALL ALL 80 3 ALL MLL+ALL ALL acute myeloid leukemia, AML Ph+ALL MLL+ALL ALL ALL complete remission, CR 90 Ph+ALL 5 event free survival, EFS MLL+ALL 3 4 EFS ,12 1CR hematopoietic stem cell transplantation, SCT Ph+ALL 13 MLL+ALL SCT 4 ALL B CD19 CD79a CD13, CD33 Ph+ALL B-precursor ALL common ALL antigen CALLA, CD10 MLL+ALL CD10 KOR-SA3544 Ph+ALL Ph+ALL 14 CEA carcinoembrionic antigen, CD66e superfamily nonspecific cross-reacting antigen NCA 50/90 CD66c 15
4 62 5 p53 Rb ALL cyclin-dependent kinase CDK 4 CDK6 inhibitor CDKI p16/ink4a Ph+ALL T ALL MLL+ALL p16 p16 p16 5-aza-2 deoxycitidine p16 16 p16 9p21 p16 7 ALL p16 17 p16 ALL Ph+ MLL+ALL p16 1 ALL key drugs prednisolone, L-asparaginase, vincristine Hongo T 20 3 ALL 11 Ph+ MLL+ALL in vitro 40 Ph+ALL 21 ALL ALL poor responder good responder ALL 1-5 /cell /cell heat shock protein-90 HSP-90 HSP-90 Ph+ MLL+ 1 HSP-90 HSP G-CSF G-CSF G-CSFR G-CSF G-CSF MLL+ALL MLL+ALL G-CSFR G-CSFR G-CSF 23 Ph+ALL G-CSFR G-CSF
5 63 MLL+ALL ALL Ph+AML G-CSF G-CSF Ph+AML G-CSF autocrine mechanism 24 MLL+ Ph+ALL G-CSF SCT G-CSF G-CSF 2 thrombopoietin TPO TPO c-mpl c-mpl G-CSFR MLL+ Ph+ALL c-mpl c-mpl TPO 25 3 Fms-like tyrosine kinase 3 FLT3 FLT3 3 MLL+ALL FLT3 B-precursor ALL FLT3 ligand FL Ph+ALL 1;19 ALL MLL+ALL G1 arrestcdki p27/kip1 MLL+ALL STAT signal transducer and activator of transcription 5 FL MLL+ALL quiescence FL FL 26 AML VLA-4 AML minimal residual disease, MRD 27 FL MLL+ALL MRD MLL+ALL BCR-ABL BCR- ABL Ph+ leukemogenesis BCR-ABL imatinib STI571 Ph+ CML CML Ph+ALL Ph+ALL phase 1 study mg 600 mg
6 64 1 MLL+ALL MRD FL/FLT3 interaction FL MLL+ALL FL/FLT3 interaction MRD FLT3 MLL+ALL FL/FLT3 interaction MLL+ALL 260 mg/m mg/m 2 28 Ph+ALL n = 92 imatinib mg/day 29 CR 95 PCR BCR-ABL CR SCT Ph+ALL imatinib front-line therapy imatinib imatinib imatinib ABL ATP ATP BCR-ABL ATP imatinib imatinib Glu255 Thr315 CML Ph+ALL minor clone imatinib minor clone 30 imatinib Ph+ ATP ONO12380 imatinib ATP affinity nilotinib AMN107 dasatinib Lyn NS-187 CNS T315I AG490 tryphostin WP1130 Aurora MK JAK2 Janus kinase 2 JAK2
7 65 STATs interferon-γ erythropoietin TPO IL-3 GM-CSF AG490 tryphostin B-precursor ALL JAK2 35 B-precursor ALL JAK2 Ph+ALL MLL+ALL Ph+ALL MLL+ALL SCT ex vivo purging 36 3 peroxisome proliferator-activated receptor PPAR PPAR PPARα, PPARβ, PPARγ PPARγ Troglitazone TGZ PPARγ 37 TGZ Tcf-4 c-myc 38 TGZ PPARα PPARγ TZD18 Ph+ALL 39 4 FLT3 NGF TrkA CEP-701 Cephalon PKC PKC412 Novartis VEGF SU11248 Sugen FLT3 FLT3 ITD AML MLL+ALL FLT3 FLT3 D MLL+ D835 wild-type FLT3 STAT5, MAPK, Akt 40 FLT3 PKC FLT3 MLL+ALL FLT3/FL interaction MLL+ALL CEP histon deacetylase HDAC leukemogenesis histon acetyltransferase HAT histon deacetylase HDAC HDAC HDACI AML MDS ALL
8 66 HDACI trichostatin A TSA ALL Ph+ MLL+ALL 42 HSP-90 HDAC6 class IIb HDAC HDACI HSP-90 HSP-90 client proteins BCR-ABL FLT3 proteasome 43 ALL 4 Fas ligand FasL TNF-related apoptosisinducing ligand TRAIL TNF Fas DR4/DR5 FasL TRAIL T CTL NK SCT graftversus-leukemia, GVL kill FasL TRAIL 2 Ph+ALL Fas recombinant soluble FasL agonistic DR4/DR5 recombinant soluble TRAIL 44 MLL+ALL FasL DR4/DR5 TRAIL 45 3 Ph+ALL TRAIL 2 T CTL NK CTL NK FasL and/or TRAIL Fas and/or DR4/DR5 CTL NK 3 B-precursor TRAIL MLL+ALL FLT3-D835 TRAIL MLL+ALL SCT GVL MLL+ALL FasL TRAIL SCT GVL
9 67 NK NK MHC SCT NK NK perforin NK NK KIRs killer-cell immunoglobulin-like receptors CD158b KIR2DL2/3 group 1 HLA-C Cw1,Cw3 CD158a KIR2DL1 group 2 HLA- C Cw2,Cw4 ligand 46 HLA-C group 1 90 group 2 10 group 1 group 1/group 2 NK CD158a NK NK GVL AML HLA SCT MLL+ALL NK HLA-C SCT 1 47 NK MLL+ALL MLL+ALL NK MLL+ALL HLA-C group 1 HLA-C group 1/group 2 NK MLL+ALL NK GVL ALL 20 1 Inukai T, Sugita K, Suzuki T, et al: A novel 203 kd aberrant BCR-ABL product in a girl with Philadelphia chromosome positive acute lymphobastic leukaemia. Brit J Haematol 85: , Wong S, Witte ON: Modeling Philadelphia chromosome positive leukemias. Oncogene 20: , Ayton PM, Cleary ML: Molecular mechanisms of leukemogenesis mediated by MLL fusion proteins. Oncogene 20: , Daser A, Rabbitts TH: Extending the repertorie of the mixed-lineage leukemia gene MLL in leukemogenesis. Genes Dev 18: , Yokoyama A, Somervaille TC, Smith KS, et al: The menin tumor suppressor protein is an essential oncogenic cofactor for MLL-associated leukemogenesis. Cell 123: , Chen YX, yan J, Keeshan K, et al: The tumor suppressor menin regulates hematopoiesis and myeloid transformation by influencing Hox gene expression. Proc Natl Acad Sci USA 103: , Corral J, Lavenir I, Immpey H, et al: An Mll-AF9 fusion gene made by homologous recombination causes acute leukemia in chimeric mice: a method to create fusion genes. Cell 85: , Forster A, Panel R, Drynan LF, et al: Engineering de novo reciprocal chromosomal translocations associated with Mll to replicate primary events of human cancer. Cancer Cell 3: , Ono R, Nakajima H, Ozaki K, et al: Dimerization of MLL fusion proteins and FLT3 activation synergize to induce multiple-lineage leukemogenesis. J Clin Invest 115: , Arico M, Valsecchi G, Camitta B, et al: Outcome of treatment in children with Philadelphia chromosome-positive acute lymphoblastic leukemia. N Engl J Med 342: , 2000.
10 68 11 Chessles JM, Harrison CJ, Watson SL, et al: Treatment of infants with lymphoblastic leukaemia: results of the UK Infant Protocols Br J Haematol 117: , Isoyama K, Eguchi M, Hibi S, et al: Risk-directed treatment of infant acute lymphoblastic leukaemia based on early assessment of MLL gene status: results of the Japan Infant Leukaemia Study (MLL96). Br J Haematol 118: , Mori T, Manabe A, Tsuchida M, et al: Allogeneic bone marrow transplantation in first remission rescues children with Philadelphia chromosomepositive acute lymphoblastic leukemia; Tokyo children s Cancer Study Group (TCCSG) studies L89-12 and L Med Pediatr Oncol 37: , Mori T, Sugita K, Suzuki T, et al: A novel monoclonal antibody, KOR-SA3544, which reacts to Philadelphia chromosome-positive acute lymphoblastic cells with high sensitivity. Leukemia 9: , Sugita K, Mori T, Yokota S, et al: The KOR- SA3544 antigen predominantly expressed on surface of Philadelphia chromosome-positive acute lymphoblastic cells is nonspecific cross-reacting antigen-50/90 (CD66c) and invariably expressed in cytoplasm of human leukemia cells. Leukemia 13: , Nakamura M, Sugita K, Inukai T, et al: p16/mts1/ink4a gene is frequently inactivated by hypermethylation in childhood acute lymphoblastic leukemia with 11q23 translocation. Leukemia 13: , Nakamura M, Sugita K, Inukai T, et al: Abnormalities of the p16 INK4A gene in childhood B-precursor acute lymphoblastic leukemia without nonrandom translocations: analysis of seven matched pairs of primary leukemia and corresponding cell lines. Leukemia 15: , Armstrong SA, Staunton JE, Silverman JB, et al: MLL translocations specify a distinct gene expression profile that distinguishes a unique leukemia. Nature Genet 30: 41 47, Tsutsumi S, Taketani T, Nishimura K, et al: Two distinct gene expression signatures in pediatric acute lymphoblastic leukemia with MLL rearrangements. Cancer Res 63: , Hongo T, Yamada S, Yajima S, et al: Biological characteristics and prognostic value of in vitro three-drug resistance to prednisolone, L-asparaginase, and vincristine in childhood acute lymphoblastic leukemia. Int J Hematol 70: , Hongo T, Okada S, Inoue N, et al: Two groups of Philadelphia chromosome-positive childhood acute leukemia classified by pretreatment multidrug sensitivity or resistance in vitro testing. Int J Hematol 76: , Kojika S, Sugita K, Inukai Y, et al: Mechanisms of glucocorticoid resistance in human leukemic cells: implication of abnormal 90 and 70 kda heat shock proteins. Leukemia 10: , Inukai T, Sugita K, Iijima K, et al: Leukemic cells with 11q23 translocations express granulocyte colony-stimulating factor (G-CSF) receptor and their proliferation is stimulated with G-CSF. Leukemia 12: , Inukai T, Sugita K, Mitsui K, et al: Participation of granulocyte colony-stimulating factor in the growth regulation of leukemia cells from Philadelphia chromosome-positive acute leukemia and blast crisis of chronic myeloid leukemia. Leukemia 14: , Iijima K, Sugita K, Inukai T, et al: Expression of thrombopoietin receptor and its functional role in human B-precursor leukemia cells with 11q23 translocation or Philadelphia chromosome. Leukemia 14: , Furuichi Y, Goi K, Inukai T, et al: Fms-like kinase 3 ligand stimulation induces MLL-rearranged leukemia cells into quiescence resistant to antileukemic agents. Cancer Res 67: , Matsunaga T, Takemoto N, Sato T, et al: Interaction between leukemic-cell VLA-4 and stromal fibronectin is a decisive factor for minimal residual disease of acute myeologenous leukemia. Nature Med 9: , Champagne MA, Capdeville R, Krailo M, et al: Imatinib mesylate (STI571) for treatment of children with Philadelphia chromosome-positive leukemia: results from a Children s Oncology Group phase 1 study. Blood 104: , Wassmann B, Pfeifer H, Goekbuget N, et al: Alternating versus concurrent schedules of imatinib and chemotherapy as front-line therapy for Philadelphia-positive acute lymphoblastic leukemia (Ph + ALL). Blood 108: , Hofmann W, Komor M, Wassmann B, et al: presence of the BCR-ABL mutation Glu255Lys prior to STI571 (imatinib) treatment in patients with Ph+ acute lymphoblastic leukemia. Blood 102: , 2003.
11 69 31 Gumireddy K, Baker SJ, Cosenza SC, et al: A non- ATP-competitive inhibitor of BCR-ABL overrides imatinib resistance. Proc natl Acad Sci USA 102: , Weiberg E, Manley PW, Breitenstein W, et al: Characterization of AMN107, a selective inhibitor of native and mutant Bcr-Abl. Cancer Cell 7: , Talpaz m, Shah NP, Kantarjian H, et al: Dosatinib in imatinib-resistant Philadelphia chromosomepositive leukemias. N Engl J Med 354: , Kimura S, Naito H, Segawa H, et al: NS-187, a potent and selective dual Bcr-Abl/Lyn tyrosine kinase inhibitor, is a novel agent for imatinib-resistant leukemia. Blood 106: , Meydan N, Grunberger T, Dadi H, et al: Inhibition of acute lymphoblastic leukemia by a Jak-2 inhibitor. Nature 379: , Miyamoto N, Sugita K, Goi K, et al: The JAK2 inhibitor AG490 predominantly abrogate the growth of human B-precursor leukemic cells with 11q23 translocation or Philadelphia chromosome. Leukemia 15: , Sarraf P, Mueller E, Jones D, et al: Differentiation and reversal of malignant changes in colon cancer through PPARγ. Nature Med 4: , Yamakawa-Karakida, Sugita K, Inukai T, et al: Ligand activation of peroxisome proliferator-activated receptor induces apoptosis of leukemia cells by downregulating the c-myc gene expression via blockade of the Tcf-4 activity. Cell Death Differ 9: , Lui H, Zang C, Fenner MH, et al: Growth inhibition and apoptosis in human Philadelphia chromosome-positive lymphoblastic leukemia cell lines by treatment with the dual PPARalpha/gamma ligand TZD18. Blood 107; , Taketani T, Taki T, Sugita K, et al: FLT3 mutations in the activation loop of tyrosine kinase domain are frequently found in infant ALL with MLL rearrangements and pediatric ALL with hyperdiploidy. Blood 103: , Takahashi K, Goi K, Furuichi Y, et al: PKC412, a FLT3 inhibitor, effectively induces apoptosis of leukemia cells with 11q23 translocation particularly with D835 mutation. Blood 104: 522a, Sato H, Goi K, Sugita K, et al: The histon-deacetylase inhibitor Trichostatin A effectively induces p21-mediated cell cycle arrest and caspase-dependent apoptosis in B-precursor leukemia cells. Blood 102: 1382a, Rao R, Fiskus W, Herger B, et al: Inhibition of histon deacetylase (HDAC6) 6 and/or heat shock protein (HSP) 90: a strategy to abrogate multi-level protective responses to misfolded proteins induced by proteasome inhibitors in human leukemia cells. Blood 108: 80a, Uno K, Inukai T, Kayagaki N, et al: TNF-related apoptosis-inducing ligand (TRAIL) frequently induces apoptosis in Philadelphia chromosomepositive leukemia cells. Blood 101: , Inukai T, Zhang X, Goto M, et al: Resistance of infant leukemia with MLL rearrangement to TNF-related apoptosis-inducing ligand: possible mechanism for poor sensitivity to anti-leukemic immunity. Leukemia 20: , Farag S, VanDeusen JB, Fehniger TA, et al: Biology and clinical impact of human natural killer cells. Int J Hematol 78: 7 17, Triplett B, Handgretinger R, Pui CP, et al: KIR-incompatible hematopoietic-cell transplantation for poor prognosis infant acute lymphoblastic leukemia. Blood, 107: , 2006.
2 犬 飼 図 1. 小児急性リンパ性白血病の生存率が 90 に 達したことを伝える 2006 年の St Jude 小児 病院のホーム ページ 図 2. 山梨大学小児科における小児急性リンパ性白 血病症例数の推移 棒グラフは年間の症例数を 折れ線グラフは 累積症例数を示す 岳 史 図 3. 各年代
27 1 1 11 20131 1985 2010 96 1990 9 33.3 15.7 1991 2000 45 80.0 6.0 2001 2010 42 87.0 5.5 I 30 409-3898 1110 2012 9 4 2012 10 5 1 1970 1980 St Jude 90 1 2006 1985 2011 100 2 1992 3 St Jude 2 犬 飼 図 1. 小児急性リンパ性白血病の生存率が
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