A 70-year-old woman was hospitalized for exacerbation of chronic idiopathic thrombocytopenic purpura (ITP) and disseminated intravascular coagulation (DIC) from old aortic dissection. Initially, we increased the dose of prednisolone for ITP. However, her bleeding tendency caused by DIC worsened despite the rapid recovery of her platelet count, and the required amount of fresh-frozen plasma for transfusion increased. The administration of edoxaban for atrial fibrillation led to the marked improvement of her DIC status without serious adverse events. This case suggests that a direct oral anticoagulant may be an effective treatment for DIC caused by aortic dissection.
Aortic Dissection/complications , Atrial Fibrillation/complications , Disseminated Intravascular Coagulation/complications , Disseminated Intravascular Coagulation/drug therapy , Purpura, Thrombocytopenic, Idiopathic/complications , Aged , Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Female , Humans , Platelet Count , Pyridines/therapeutic use , Thiazoles/therapeutic use
This retrospective analysis investigated the prognostic value of monitoring the response to imatinib using peripheral blood (PB) samples and the impact of the response on outcome in 133 patients with chronic myeloid leukemia (CML). We divided the response into 3 categories according to the results of neutrophil (N)-FISH and BCR-ABL transcript levels in PB; more than a 3-log reduction [major molecular response (MMR)], between a 2-log and 3-log reduction or negative with N-FISH [complete cytogenetic response equivalent (CCyRe)], N-FISH positive or less than a 2-log reduction (non-CCyRe). The median follow-up was 5.46 years. At 5 years, the overall survival (OS) rate and progression-free survival (PFS) rate were 94.4 and 92.0%, respectively. The estimated rate of the CCyRe and MMR were 81.7 and 67.1%, respectively. 106 patients achieving the CCyRe had significantly better OS and PFS than 27 patients without achieving the CCyRe. Patients with MMR had significantly better survival free from death, progression, imatinib withdrawal and a loss of the CCyRe, than patients whose response level remained in the CCyRe without achieving MMR until 18 months. Our observation suggests that the response level of the CCyRe on PB serve as a prognostic indicator, and achieving MMR provides stable long-term survival.
Antineoplastic Agents/administration & dosage , Fusion Proteins, bcr-abl/biosynthesis , In Situ Hybridization, Fluorescence , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Piperazines/administration & dosage , Polymerase Chain Reaction , Pyrimidines/administration & dosage , Adolescent , Adult , Aged , Aged, 80 and over , Asian People , Benzamides , Disease-Free Survival , Female , Follow-Up Studies , Fusion Proteins, bcr-abl/genetics , Humans , Imatinib Mesylate , Japan , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology , Male , Middle Aged , Monitoring, Physiologic/methods , Neutrophils/metabolism , Neutrophils/pathology , Survival Rate , Time Factors
