Apr. 2013 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 2 111 53 8 8 1. Ph-ALL Liposomal amphotericin B 1 2. CBT MCFG L-AMBAML 2
112 54 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 2 Apr. 2013 8 2005 3 10 8 2012 6 7 B 2 NTT 2012 6
Apr. 2013 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 2 113 55 8 1 Ph-ALL Liposomal amphotericin B 1 BL-AMB 28 33,000/ L 85% 6.1 g/dl2.3 10 4 / L 98% major minor bcr-ablph ALL JALSG-Ph ALL202 RELAL-88 2 HLA DR CPA VP-16 TBI 12Gy FK506 Short MTX FLCZ 200 mg/ Day 12 MCFG 150 mg/ Day 23 Day 30 Grade II agvhd PSL 1 mg/kg PSL Day 60 X CT 3 cm -D- MCFG VRCZ 1CT L-AMB 5 mg/kg Day 188 VATS video-assisted thoracoscopic surgery S1 S2c S3a S4a Fig. 12 cm PAS Grocott 3 L-AMB
114 56 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 2 Apr. 2013 Fig. 1. RELAL-88 L-AMB L-AMB L-AMB 9 VRCZ MCFG L-AMB
Apr. 2013 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 2 115 57 8 100% B CHAMILOS early treatment 6 delayed treatment 6 4 35% 65% 12 48% 82% Kaplan-Meier Fig. 2 Fig. 2. 5 B Fig. 3.
116 58 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 2 Apr. 2013 Fig. 4.
Apr. 2013 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 2 117 59 8 VRCZ VRCZ reversed halo sign MD ANDERSON 2002 2007 CT reversed halo sign 37 7 19% 132 1 0.75%20 CT reversed halo sign B Posaconazole CPFG MCFG Fig. 3 deferasirox Fig. 4 RODEN 929 CID 2005 96% 85% 76% 44 31 70% B reversed halo sign deferasirox Posaconazole
118 60 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 2 Apr. 2013 2 CBT MCFG L-AMBAML 2 B L-AMB AML 2 1 69 2011 AML with MRC WBC 4,100/ L Fig. 1. Reversed halo sign
Apr. 2013 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 2 119 61 8 15% 25% Hb 8.7 g/dl Plt 30,000/ L CBT FLU 180 mg/m 2 MEL 80 mg/m 2 TBI 4 Gy GVHD TAC MMF 1.5 g VRCZ Day 1 Day537.6 C WBC 10/ L CRP 11.2 mg/dl Staphylococcus haemolyticus VRCZ Day 2 0.24 mg/l Day 7 4.82 mg/l Day 6 CT reversed halo sign reversed halo sign Fig. 1 Day 6 VRCZ L-AMB 5 mg/kg MCFG Fig. 2. 1
120 62 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 2 Apr. 2013 150 mg L-AMB 10 mg/kg Day 5 VCM CFPM Day 10 6 HHV-6 FCV Day 17 Fig. 2 Day 129VATS 60 40 29 mm PCR Cunninghamella bertholletiae AMPH-B L-AMB 298 34,650 mg K, Mg, Ca, Na Cre 0.5 mg/dl 1.2 mg/dl L-AMB TAC TAC 2 4 GVHD 2 35 20 35 2010 AML with MRC Ara-C MEC 2 MEC TBI 12 Gy ubmt Day 87 CAG Azacitidine 6WT16 OP PSL OP 2011 CT OP WBC 1,600/ L16% 3% Hb 6.8g/dL Plt 21,000/ L FLU 180 mg/m 2 12.8 mg/kg MEL 80 mg/m 2 GVHD TAC VRCZ OP PSL 20 mg Day 0 Day 438 C WBC 10/ L CRP 9.4 mg/dl VRCZ 1 mg/l Day 5 CT 5 cm VRCZ L-AMB 10 mg/kg MCFG 150 mg VCM MEPM HHV-6 FCV
Apr. 2013 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 2 121 63 8 PIR pre-engraftment immune reaction HC 50 mg 1 2 JC 20 Day 19 Fig. 3 Day 96 Day 119 VATS S6 40 35 30 mm HE PAS PCR Cunninghamella bertholletiae L-AMB 10 mg/kg MCFG L-AMB 211 108,600 mg K, Mg, Ca, Na Cre 0.6 mg/dl 1.3 mg/dl AST, ALT 3 L-AMB TAC 2 4 Fig. 3. 2
122 64 THE JAPANESE JOURNAL OF ANTIBIOTICS 66 2 Apr. 2013 GVHD HC 600 Rhizopus, Rhizomucor, Mucor, Absidia, Cunninghamella, Syncephalastrum HSCT 0.2 2.0% 2 2 HSCT 75% BAL 25% reversed halo sign IPA L-AMB 5 10 mg/kg Posaconazole L-AMB 5 2 L-AMB L-AMB 10 mg/kg Day 6 Day 5 200 L-AMB 10 mg/kg MCFG 150 mg AML 2 200 FCV VCM