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ⅢDŠeŽĄ—Ă–@‚̐„§“x‚Ɖđŕ

1D‹Űó‘§“÷ÇESézary ÇŒóŒQ


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‹Űó‘§“÷Ç‚ĆSézary ÇŒóŒQ‚Ş“Żˆę‚ĚŽžŠł‚Ĺ‚ ‚é‚Š–˘‚ž‚É‹c˜_‚Ş‚ ‚é‚ŞC•aŠú•Ş—Ţ‚Í“Ż‚ś‚ŕ‚Ě‚ŞŽg—p‚ł‚ę‚Ä‚¨‚č1C2jCŽĄ—Ă–@‚ŕ‹¤’Ę“_‚Ş‘˝‚˘‚ą‚ƁC‹H‚Ĺ‚Í‚ ‚é‚Ş—źŽŇ‚ĚˆÚs—á‚Ş‚ ‚é‚ą‚Ć‚Š‚狤’Ę‚ĚCQ ‚đěŹ‚ľ‚˝B‹Űó‘§“÷Ç/Sézary ÇŒóŒQ‚ÍĹ‚ŕŒĂ‚­‚Š‚ç‚ ‚鎞ŠłŠT”O‚Ĺ‚ ‚čC‘ź‚ĚŒ´”­Ť”畆ƒŠƒ“ƒpŽî‚Ć”ä‚ׂĕp“x‚ލ‚‚˘‚ށCƒGƒrƒfƒ“ƒXƒŒƒxƒ‹‚̍‚‚˘ŽĄ—Ă–@‚ÍŠF–ł‚Ć‚˘‚Á‚Ă悢B‚ą‚ę‚Í10 ”NˆČă‚ĚŒo‰ß‚đ‚˝‚Ç‚éÇ—á‚Ş‘˝‚­CŽĄ—Éî“ü‚̐Ź”Ű‚Ě”ť’č‚Ş˘“ď‚Ĺ‚ ‚é‚ą‚ƁC—Ď—“I‚Ƀvƒ‰ƒZƒ{ƒRƒ“ƒgƒ[ƒ‹‚đ—p‚˘‚˝ƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ĚŽŔŽ{‚Ş“ď‚ľ‚˘‚ą‚Ć‚Č‚Ç‚É‚ć‚éBŽŔŰCˆŮ‚Ȃ鎥—Ă–@‚ĚŒř‰Ę‚đ•]‰ż‚ľ‚˝ƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í4Œ3`6jCƒvƒ‰ƒZƒ{ƒRƒ“ƒgƒ[ƒ‹‚Ć‚Ěƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í1 Œ7j‚ľ‚Š‘śÝ‚ľ‚Č‚˘B–{ƒKƒCƒhƒ‰ƒCƒ“‚Ĺ‚ÍěŹˆĎˆő‘Sˆő‚É‚ć‚éƒRƒ“ƒZƒ“ƒTƒX‚đdŽ‹‚ľC“úíf—Ă‚Ĺ‘ćˆę‘I‘đ‚Ć‚ł‚ę‚鎥—Ă–@‚ɂ͐„§“xB ‚đ‚‚Ż‚˝B

‹Űó‘§“÷Ç/Sézary ÇŒóŒQ‚ĚŽĄ—Ă‚ÉŠÖ‚ˇ‚é‚ŕ‚¤ˆę‚‚̖â‘č“_‚́C‰˘•Ä‚Ć”ä‚ׂĎg—p‰Â”\‚ČŽĄ—Ă‚Ş‹É’[‚ɏ­‚Č‚˘‚ą‚Ć‚Ĺ‚ ‚éBIFN- ƒż‚âƒ{ƒŠƒmƒXƒ^ƒbƒgˆČŠO‚Ě•ŞŽq•W“I—Ă–@C‘ĚŠOŒő‰ťŠw—Ă–@‚ÍŒťŽž“_‚ō‘“ŕ‚ÉŽg—p‰Â”\‚ČŽ{Ý‚Í‚Ů‚Ć‚ń‚Ç‚Č‚˘B‚ľ‚Š‚ľŠCŠO‚Ĺ‚ĚŽĄ—Ă‚Ć‚˘‚¤‘I‘đŽˆ‚âCĄŒă“ú–{‚É“ą“ü‚ł‚ę‚é‰Â”\Ť‚ŕl‚ŚC‚ą‚ę‚ç‚ĚŽĄ—Ă‚ÉŠÖ‚ľ‚Ä‚ŕCQ ‚đÝ’č‚ľ‚˝BŠCŠO‚É‚¨‚˘‚Ä‚ŕ”F‰Â‚ł‚ę‚Ä‚˘‚Č‚˘C‚˘‚í‚ä‚éŽŔŒą“IŽĄ—Ă‚ÉŠÖ‚ľ‚Ä‚Í–{ƒKƒCƒhƒ‰ƒCƒ“‚Ĺˆľ‚í‚Č‚˘‚ą‚Ć‚Ć‚ľ‚˝B

•śŒŁ

1j Willemze R, Jaffe ES, Burg G, et al: WHO-EORTC classification for cutaneous lymphomas, Blood, 2005; 105: 3768-3785.

2j Olsen E, Vonderheid E, Pimpinelli N, et al: Revisions to the staging and classification of mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous LymphomasiISCLj and the Cutaneous Lymphoma Task Force of the European Organization of Research and Treatment of CanceriEORTCj, Blood 2007; 110: 1713-1722.

3j Stadler R, Otte HG, Luger T, et al: Prospective randomized multicenter clinical trial on the use of interferon ƒż-2a plus acitretin versus interferon ƒż-2a plus PUVA in patients with cutaneous T-cell lymphoma stages Ⅰ and Ⅱ, Blood, 1998; 92: 3578-3581.

4j Stadler R, Kremer A, Luger T, Sterry W: Prospective, randomized, multicentre clinical trial on the use of interferon a 2a plus PUVA versus PUVA monotehrapy in patients with cutaneous T-cell lymphoma, stage Ⅰ and Ⅱ. J Clin Oncol, 2006 ASCO Annual Meeting Proceedings, 2006; 24: 7541.

5j Kaye FJ, Bunn PA Jr, Steinberg SM, et al: A randomized trial comparing combination electron-beam radiation and chemotherapy with topical therapy in the initial treatment of mycosis fungoides, N Engl J Med, 1989; 321: 1784-1790.

6j Child FJ, Mitchell TJ, Whittaker SJ, et al: A randomized cross-over study to compare PUVA and extracorporeal photopheresis in the treatment of plaque stageiT2j mycosis fungoides, Clin Exp Dermatol, 2004; 29: 231-236.

7j Prince HM, Duvic M, Martin A, et al: Phase Ⅲ placebo-controlled trial of denileukin diftitox for patients with cutaneous T-cell lymphoma, J Clin Oncol, 2010; 28: 1870-1877.


CQ1

‹Űó‘§“÷Ç‚ɑ΂ľ‚Ä–łŽĄ—Ă‚Ĺ‚ĚŒo‰ßŠĎŽ@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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C1i•aŠú ⅠAj
C2i•aŠú ⅠA ˆČŠOj

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•śŒŁ

1j Kim YH, Jensen RA, Watanabe GL, et al: Clinical stage ⅠAilimited patch and plaquej mycosis fungoides. A long-term outcome analysis, Arch Dermatol, 1996; 132: 1309-1313.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Toro JR, Stoll HL Jr, Stomper PC, Oseroff AR: Prognostic factors and evaluation of mycosis fungoides and Sézary syndrome, J Am Acad Dermatol, 1997; 37: 58-67.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j Zackheim HS, Amin S, Kashani-Sabet M, McMillan A: Prognosis in cutaneous T-cell lymphoma by skin stage: long-term surviv;al in 489 patients, J Am Acad Dermatol, 1999; 40: 418-425.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

4j Kim YH, Liu HL, Mraz-Gernhard S, et al: Long-term outcome of 525 patients with mycosis fungoides and Sézary syndrome: clinical prognostic factors and risk for disease progression, Arch Dermatol, 2003; 139: 857-866.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Suzuki S, Ito K, Ito M, Kawai K: Prognosis of 100 Japanese patients with mycosis fungoides and Sézary syndrome, J Dermatol Sci, 2010; 57: 37-43.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

6j van Doorn R, Van Haselen CW, van Voorst Vader PC, et al: Mycosis fungoides: disease evolution and prognosis of 309 Dutch patients, Arch Dermatol, 2000; 136: 504-510.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j Kim YH, Chow S, Varghese A, Hoppe RT: Clinical characteristics and long-term outcome of patients with generalized patch and/or plaqueiT2j mycosis fungoides, Arch Dermatol, 1999; 135: 26-32.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

8j Agar NS, Wedgeworth E, Crichton S, et al: Survival outcomes and prognostic factors in mycosis fungoides/ Sézary sundrome: validation of the revised International Society for Cutaneous Lymphomas/European Organisation for Research and Treatment of Cancer staging proposal, J Clin Oncol, 2010; 28: 4730-4739.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ2

‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚ăXƒeƒƒCƒhŠO—p—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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ƒXƒeƒƒCƒhŠO—p—Ă–@‚Í‚ˇ‚ׂĂ̕aŠú‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚ÄŠŠ‚ß‚ç‚ę‚éB

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•śŒŁ

9j Zackheim HS, Kashani-Sabet M, Amin S: Topical corticosteroids for mycosis fungoides. Experience in 79 patients, Arch Dermatol, 1998; 134: 949-954.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ3

‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚ċǏŠ‰ťŠw—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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C1

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‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚é‹ÇŠ‰ťŠw—Ă–@‚ĚŒř‰Ę‚đ•]‰ż‚ľ‚˝ƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‚Č‚˘B

‰˘•Ä‚Ĺ‚Í‘Šú‹Űó‘§“÷Ç‚ɑ΂ľ‚Ä0.01`0.02“‚ĚHN2 —n‰t‚ ‚邢‚Í“îp‚Ş—p‚˘‚ç‚ę‚Ä‚¨‚čCHN2 ŠO—p—Ă–@‚ĚŒř‰Ę‚ÉŠÖ‚ľ‚āC8 Œ‚ĚŒăŒü‚ŤƒRƒz[ƒgŒ¤‹†1, 7, 10, 11, 14`17jC1 Œ‚Ě‘OŒü‚ŤÇ—áWĎŒ¤‹†18jC1 Œ‚Ě”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą13j‚Ş‚ ‚éB•aŠú ⅠACⅠBCⅡA ‚ĚCR —Ś‚́C‚ť‚ę‚ź‚ę61`80“C35`68“C28`61“‚Ĺ‚ ‚č10`12jC•aŠú ⅠA-ⅡA ‘S‘Ě‚Ĺ‚Í51`78“‚ÉCR ‚Ş“ž‚ç‚ę10`15jC‘˝‚­‚ĚŠłŽŇ‚ÍHN2 ŠO—p—Ă–@‚Ě‚Ý‚Ĺ’ˇŠúŠÔ‚ĚˆŰŽ‚މ”\‚Ĺ‚ ‚é10C15jB•aŠú ⅠA ‚¨‚ć‚ŃT2 ‚Ě‹Űó‘§“÷Ç‚ɑ΂ˇ‚étotal skin electron beamiTSEBj—Ă–@‚ĆHN2 ŠO—p—Ă–@‚ĚŒř‰Ę‚đ”äŠr‚ľ‚˝Œ¤‹†‚ł́CCR —Ś‚ÍTSEB —Ă–@‚Ş—LˆÓ‚É—D‚ę‚Ä‚˘‚˝‚ށCś‘ś—Ś‚É‚Í—LˆÓ‚ȍˇ‚Í”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝16j, CQ1-1, 7jB‚Ü‚˝C•aŠúT2 ‚Ĺ‚ÍTSEB —Ă–@Œă‚ÉHN2 ŠO—p‚É‚ć‚éˆŰŽ—Ă–@‚đs‚¤‚ą‚Ć‚É‚ć‚č‘tŒřŠúŠÔ‚̉„’ˇ‚Ş”F‚ß‚ç‚ę‚Ä‚˘‚é16jB‘ź‚ĚŽ{Ý‚Š‚ç‚Ě•ń‚Ĺ‚ŕ•aŠú ⅠA-ⅡA ‚É‚¨‚Ż‚éCR —Ś‚ÍTSEB —Ă–@‚ŞHN2 ŠO—p—Ă–@‚ć‚č—D‚ę‚Ä‚˘‚˝‚ށi100“ vs 78“jC•aŠú ⅠA ˆČŠO‚Ĺ‚ÍTSEB —Ă–@Œă‚ĚÄ”­‚Ş‘˝‚­CHN2ŠO—p‚É‚ć‚éˆŰŽ—Ă–@‚ސ„§‚ł‚ę‚Ä‚˘‚é13jB•aŠúⅡB ‚ ‚邢‚ÍT3 ‚Ĺ‚ÍHN2 ŠO—p—Ă–@‚É‚ć‚éCR —Ś‚Í50“–˘–ž‚Ĺ‘tŒřŠúŠÔ‚ŕ’Z‚˘‚Ş10C13`17jC•aŠúⅢA-ⅣA1iT4j‚Ĺ‚ŕ60“‚ÉCR ‚Ş“ž‚ç‚ę‚˝‚Ć‚˘‚¤•ń‚Ş‚ ‚é10jBŽĺ‚Č•›ě—p‚ÍˆęŽŸŽhŒƒŤ‚Ü‚˝‚̓AƒŒƒ‹ƒM[Ť‚̐ڐG”畆‰Š‚ŁC‚ť‚Ě•p“x‚Í—n‰t‚Ĺ28`58“12C14jC“îp‚Ĺ10“–˘–ž15j‚Ĺ‚ ‚éB4`11“‚É“ńŽŸŤ”畆Šŕ‚Ş”F‚ß‚ç‚ę‚Ä‚˘‚é‚Ş15, 17jCHN2 ŠO—p—Ă–@‚Ć‚Ěˆö‰ĘŠÖŒW‚Í•s–ž‚Ĺ‚ ‚éB

BCNU ŠO—p—Ă–@‚ĚŒř‰Ę‚ÉŠÖ‚ľ‚Ä‚Í, ’PˆęŽ{Ý‚É‚¨‚Ż‚é2 Œ‚ĚŒăŒü‚ŤƒRƒz[ƒgŒ¤‹†18, 19j‚Ş‚ ‚éB0.017“—n‰t‚Ü‚˝‚Í0.01““îp‚É‚ć‚éCR —Ś‚Í•aŠú ⅠA ‚Ĺ86“CⅠB ‚Ĺ47“CⅡA ‚Ĺ55“‚Ĺ‚ ‚č18j, •aŠúT1 ‚Ě91“CT2 ‚Ě62“‚Ş36 ƒJŒŽŠÔˆČăBCNU ŠO—p—Ă–@‚Ě‚Ý‚ĹˆŰŽ‚ł‚ę‚Ä‚˘‚é19jBŽĺ‚Č•›ě—p‚Ć‚ľ‚ĉ˝‚ç‚Š‚̍g”Á‚Ş‘˝‚­‚ĚŠłŽŇ‚ɐś‚ś‚é‚ŞCƒAƒŒƒ‹ƒM[Ť‚̐ڐG”畆‰Š‚Ě•p“x‚Í10“–˘–ž‚Ĺ‚ ‚čC“ńŽŸŤ”畆Šŕ‚Í”F‚ß‚ç‚ę‚Č‚˘19jBœ‘—}§iŒy“x‚Ě”’ŒŒ‹…Œ¸­j‚Ě•p“x‚Í–ń4“‚Ć‚ł‚ę‚Ä‚˘‚é19jB

‹ÇŠ‰ťŠw—Ă–@‚Ć‚ľ‚ÄHN2 ‚ĆBCNU ‚Ě‚Ç‚ż‚ç‚Ş—LŒř‚Š‚đ”äŠr‚ľ‚˝—Տ°ŽŽŒą‚͍s‚í‚ę‚Ä‚˘‚Č‚˘‚ށC•aŠú ⅠA-ⅡA ‚Ě‘Šú‹Űó‘§“÷Ç‚ɑ΂ľ‚ÄHN2 ‚Ü‚˝‚ÍBCNU ŠO—p‚É‚ć‚é‹ÇŠ‰ťŠw—Ă–@‚Í—LŒř‚Ĺ‚ ‚čC‰˘•Ä‚Ĺ‚Í‘Šú‹Űó‘§“÷Ç‚ɑ΂ˇ‚é‘ćˆę‘I‘đ‚Ě‹ÇŠ—Ă–@‚Ć‚ľ‚ÄˆĘ’u•t‚Ż‚ç‚ę‚Ä‚˘‚éB

–{–M‚Ĺ‚ÍHN2 ‚ĆBCNU ‚Ě—źŽŇ‚Ć‚ŕ”Ě”„Eł”F‚ł‚ę‚Ä‚˘‚Č‚˘‚˝‚߁C0.2`0.4“‚ĚACNU —n‰t‚Ş—p‚˘‚ç‚ę‚Ä‚˘‚é‚Ş20jC‘tŒř—ŚE’ˇŠú—\ŒăEˆŔ‘SŤ‚ÉŠÖ‚ˇ‚é—Տ°ŽŽŒą‚͍s‚í‚ę‚Ä‚˘‚Č‚˘B“Á‚É‘SgEL”͈͂ɒˇŠúŠÔ—p‚˘‚˝ę‡‚ĚˆŔ‘SŤ‚Ş•s–ž‚Ĺ‚ ‚é‚ą‚Ć‚Š‚çC‘ćˆę‘I‘đ‚Ě‹ÇŠ—Ă–@‚Ć‚ľ‚ĐϋɓI‚ɂ͐„§‚Ĺ‚Ť‚Č‚˘‚ށC‘ź‚Ě‹ÇŠ—Ă–@‚đŽ{s˘“ď‚Č•”ˆĘ‚â‹ÇŠ—Ă–@’ďRŤ‚̏­”‚Ě•a•Ď‚ɑ΂ˇ‚é•â•“IŽĄ—Ă‚Ć‚ľ‚Ä•”•Ş“I‚ɁC‚ ‚邢‚Í’ZŠúŠÔ—p‚˘‚é‚ą‚Ƃ͉”\‚Ĺ‚ ‚éB

•śŒŁ

10j Vonderheid EC, Tan ET, Kantor AF, et al: Long-term efficacy, curative potential, and carcinogenicity of topical mechlorethamine chemotherapy in cutaneous T cell lymphoma, J Am Acad Dermatol, 1989; 20: 416-428.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

11j Kim YH: Management with topical nitrogen mustard in mycosis fungoides, Dermatol Ther, 2003; 16: 288-298.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

12j de Quatrebarbes J, Esteve E, Bagot M, et al: Treatment of early-stage mycosis fungoides with twice-weekly applications of mechlorethamine and topical corticosteroids: a Prospective study, Arch Dermatol, 2005; 141: 1117-1120.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

13j Hamminga B, Noordijk EM, van Vloten WA: Treatment of mycosis fungoides: total-skin electron-beam irradiation vs topical mechlorethamine therapy, Arch Dermatol, 1982; 118: 150-153.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

14j Ramsay DL, Halperin PS, Zeleniuch-Jacquotte A: Topical mechlorethamine therapy for early stage mycosis fungoides, J Am Acad Dermatol, 1988; 19: 684-691.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

15j Kim YH, Martinez G, Varghese A, Hoppe RT: Topical nitrogen mustard in the management of mycosis fungoides: update of the Stanford experience, Arch Dermatol, 2003; 139: 165-173.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

16j Chinn DM, Chow S, Kim YH, Hoppe RT: Total skin electron beam therapy with or without adjuvant topical nitrogen mustard or nitrogen mustard alone as initial treatment of T2 and T3 mycosis fungoides, Int J Radiat Oncol Biol Phys, 1999; 43: 951-958.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

17j Hoppe RT, Abel EA, Deneau DG, Price NM: Mycosis fungoides: management with topical nitrogen mustard, J Clin Oncol, 1987; 5: 1796-1803.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

18j Zackheim HS, Epstein EH Jr, Crain WR: Topical carmustineiBCNUj for cutaneous T cell lymphoma: a 15-year experience in 143 patients, J Am Acad Dermatol, 1990; 22: 802-810.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

19j Zackheim HS: Topical carmustineiBCNUj in the treatment of mycosis fungoides, Dermatol Ther, 2003; 16: 299-302.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

20j _•ŰFˆęC–x‰z‹MŽuC_‘ş•v: ACNU ŠO—p‚đ—p‚˘‚˝‹Űó‘§“÷Ç‚Ě‹ÇŠ‰ťŠw—Ă–@‚ĚŽŽ‚݁CŠŕ‚ƉťŠw—Ă–@C1982; 9: 1231-1236.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


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‹Űó‘§“÷Ç‚ɑ΂ˇ‚éNB-UVB —Ă–@‚ĚŒř‰Ę‚ÉŠÖ‚ľ‚ẮC1 Œ‚ĚŒăŒü‚ŤƒRƒz[ƒgŒ¤‹†26jC2 Œ‚ĚÇ—á•ń27, 28jC5 Œ‚ĚÇ—áWĎŒ¤‹†29`33j‚Ş‚ ‚éB•aŠú ⅠA/ⅠB ‚ōg”ÁŠú‚Ě‹Űó‘§“÷Ç‚ɑ΂ˇ‚éNBUVB —Ă–@‚ĚCR —Ś‚Í54`83“‚Ĺ‚ ‚é27`29jBg”ÁŠú‚ƝG•˝ZŠú‚𖞊m‚É‹ć•Ę‚ľ‚Ä‚˘‚Č‚˘•ń‚Ĺ‚ŕ•aŠú ⅠA/ⅠB ‚Ĺ70-90“26, 30`33jC•aŠúⅡA ‚Ĺ100“30, 33j‚ÉCR ‚Ş“ž‚ç‚ę‚Ä‚˘‚éBg”ÁŠú‚ƝG•˝ZŠú‚ɑ΂ˇ‚éŒř‰Ę‚đ”äŠr‚ľ‚˝Œ¤‹†‚ł́C•aŠú ⅠA-ⅡA ‚ōg”ÁŠú‚É‚¨‚Ż‚é—Տ°“ICR —Ś‚Ş100“i‘gDŠw“ICR —Ś94“j‚Ĺ‚ ‚Á‚˝‚̂ɑ΂ľ‚āCG•˝ZŠú‚Ĺ‚Í—Ő°“ICR —Ś60“i‘gDŠw“ICR —Ś20“j‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ł‚ę‚Ä‚˘‚é33jBNB-UVB —Ă–@‚ĆPUVA —Ă–@‚ĚŒř‰Ę‚đ”äŠr‚ľ‚˝3 Œ‚Ě”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ł́C•aŠú ⅠA/ⅠB ‚Ě‹Űó‘§“÷Ç‚ɑ΂ˇ‚éCR —Ś‚ÍNB-UVB —Ă–@‚Ĺ60`81“CPUVA —Ă–@‚Ĺ62`71“‚Ĺ‚ ‚čC–łÄ”­ŠúŠÔ‚ŕ“Ż’ö“x‚Ĺ‚ ‚Á‚˝34`36jB‚Ü‚˝CŠłŽŇ‚̍ś‰E”źg‚ĹŒř‰Ę‚đ”äŠr‚ľ‚˝1 Œ‚Ě”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Ĺ‚ŕ—LŒřŤ‚̍ˇ‚Í”F‚ß‚ç‚ę‚Ä‚˘‚Č‚˘37jB‚ľ‚˝‚Ş‚Á‚āCNB-UVB —Ă–@‚Í•aŠú ⅠA-ⅡA ‚Ě‘Šú‹Űó‘§“÷Ç‚ɑ΂ľ‚Ä—LŒř‚Č‹ÇŠ—Ă–@‚Ĺ‚ ‚čCPUVA —Ă–@‚Ć“Ż’ö“x‚Ě‘tŒř—ŚE‘tŒřŠúŠÔ‚đŽŚ‚ˇ‚ŕ‚Ě‚Ćl‚Ś‚ç‚ę‚éBŠ°‰đŒă‚ĚˆŰŽ—Ă–@‚Ě—LŒřŤ‚ÉŠÖ‚ľ‚Ä‚Í‹c˜_‚Ş‚ ‚č26C30C38jC”畆”­Šŕ‚ĚƒŠƒXƒN‚Ş‚ ‚é‚˝‚߂ɐϋɓI‚ɂ͐„§‚Ĺ‚Ť‚Č‚˘B

‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éPUVA —Ă–@‚ĚŒř‰Ę‚ÉŠÖ‚ľ‚āC2 Œ‚ĚÇ—áWĎŒ¤‹†39, 42jC5 Œ‚ĚŒăŒü‚ŤƒRƒz[ƒgŒ¤‹†40C41C43`45j‚Ş‚ ‚éBPUVA —Ă–@’P“Ć‚É‚ć‚éCR —Ś‚Í•aŠú ⅠA-ⅡA ‚ ‚邢‚ÍT1/T2 ‘S‘Ě‚Ĺ58`100“‚Ć•ń‚ł‚ę‚Ä‚˘‚é39`45jB•aŠúⅡBiT3j‚ɑ΂ˇ‚éŒř‰Ę‚Í’ĘíŠú‘Ň‚Ĺ‚Ť‚Č‚˘‚Ş40, 42, 43, 45jC•aŠúⅢiT4j‚Ĺ‚ŕPUVA —Ă–@’P“Ć‚Ĺ33`100“‚ÉCR ‚Ş“ž‚ç‚ę‚Ä‚˘‚é40C41C43C45jB‚˝‚ž‚ľCSézary ÇŒóŒQ‚Ĺ‚ÍPUVA —Ă–@’P“Ć‚É‚ć‚éCR ‚Í“ž‚ç‚ę‚Č‚˘41, 43jB•aŠú ⅠA ‚Ě56“C ⅠB ‚Ě39“‚ÍˆŰŽ—Ă–@’†Ž~Œă‚ŕ’ˇŠúŠÔÄ”­‚Ş‚Ý‚ç‚ę‚Č‚Š‚Á‚˝‚Ć‚˘‚¤•ń‚ŕ‚ ‚é‚Ş41jCˆŰŽ—Ă–@‚Ě—L–ł‚É‚Š‚Š‚í‚炸 ⅠA-ⅡA ‚Ě50`86“CⅢ ‚Ě‚Ů‚Ú100“‚ލĔ­‚ľ40, 41, 43, 44jC’ˇŠúŠĎŽ@‚Ĺ‚Í ⅠA-ⅡA ‚Ě–łÄ”­ŠúŠÔ’†‰›’l‚Í39 ƒJŒŽC10 ”N–ł•aś‘ś—Ś‚Í30`50“‚Ĺ‚ ‚Á‚˝44jB‚˝‚ž‚ľCÄ”­‚Ě—L–ł‚É‚ć‚鐜‘ś—Ś‚̍ˇ‚Í”F‚ß‚ç‚ę‚Ä‚˘‚Č‚˘44jB‚ľ‚˝‚Ş‚Á‚āCPUVA —Ă–@‚Í•aŠú ⅠA-ⅡA ‚Ě‘Šú‹Űó‘§“÷Ç‚ɑ΂ľ‚Ä—LŒř‚Č‹ÇŠ—Ă–@‚Ĺ‚ ‚é‚ŞCPUVA —Ă–@’P“Ć‚Ĺ‚ÍCR ‚Ş“ž‚ç‚ę‚Č‚˘‚ŠˆŰŽ‚Ĺ‚Ť‚Č‚˘ŠłŽŇ‚Ş‘śÝ‚ľC‚Ü‚˝CPUVA —Ă–@‚ސś‘śŠúŠÔ‚đ‰„’ˇ‚ˇ‚é‚Š‚Ç‚¤‚Š‚ŕ•s–ž‚Ĺ‚ ‚éBŠ°‰đŒă‚ĚˆŰŽ—Ă–@‚ÉŠÖ‚ľ‚ẮC‰˘•Ä‚̐f—ĂƒKƒCƒhƒ‰ƒCƒ“‚É‚¨‚˘‚Ä‚ŕˆÓŒŠ‚Ş•Ş‚Š‚ę‚Ä‚¨‚čCÄ”­–hŽ~‚Ě‚˝‚ß‚É—LŒř‚Ĺ‚ ‚é41, 43, 46j‚Ć‚˘‚¤ˆÓŒŠ‚Ć–łÄ”­ŠúŠÔ‚̉„’ˇ‚ÍŠú‘Ň‚Ĺ‚Ť‚¸C”畆”­Šŕ‚ĚƒŠƒXƒN‚Ş‚ ‚é‚˝‚߂ɍs‚¤‚ׂŤ‚Ĺ‚Í‚Č‚˘47, 48j‚Ć‚˘‚¤ˆÓŒŠ‚Ě—źŽŇ‚Ş‚ ‚é38jB

•śŒŁ

21j Weber F, Schmuth M, Sepp N, Fritsch P: Bath-water PUVA therapy with 8-methoxypsoralen in mycosis fungoides, Acta Derm Venereol, 2005; 85: 329-332.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

22j ’|“ŕ—•ŽqC‘O“c@WCŹ—ŃŒjŽq‚Ů‚ŠF‹Űó‘§“÷Ç‚ɑ΂ˇ‚éPUVA ƒoƒX—Ă–@‚ĚŒř‰Ę‚ĚŒŸ“˘: 2004`2007 ”N‚Ě–źŒĂ‰ŽŽs—§‘ĺŠw•a‰@‚Ĺ‚ĚÇ—á‰đÍC“ú”ç‰ďŽ , 2009; 119: 1585-1589.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

23j Ramsay DL, Lish KM, Yalowitz CB, Soter NA: Ultraviolet-B phototherapy for early-stage cutaneous T-cell lymphoma, Arch Dermatol, 1992; 128: 931-933.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

24j Resnik KS, Vonderheid EC: Home UV phototherapy of early mycosis fungoides: long-term follow-up observations in thirty-one patients, J Am Acad Dermatol, 1993; 29: 73-77.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

25j Abe M, Ohnishi K, Kan C, Ishikawa O: Ultraviolet-B phototherapy is successful in Japanese patients with earlystage mycosis fungoides, J Dermatol, 2003; 30: 789-796.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

26j Pavlotsky F, Barzilai A, Kasem R, et al: UVB in the management of early stage mycosis fungoides. J Eur Acad Dermatol Venereol, 2006; 20: 565-572.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

27j Hofer A, Cerroni L, Kerl H, Wolf P: Narrowbandi311-nmj UV-B therapy for small plaque parapsoriasis and early-stage mycosis fungoides, Arch Dermatol, 1999; 135: 1377-1380.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

28j Clark C, Dawe RS, Evans AT, et al: Narrowband TL-01 phototherapy for patch-stage mycosis fungoides. Arch Dermatol, 2000; 136: 748-752.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

29j Gathers RC, Scherschun L, Malick F, et al: Narrowband UVB phototherapy for early-stage mycosis fungoides. J Am Acad Dermatol, 2002; 47: 191-197.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

30j Boztepe G, Sahin S, Ayhan M, et al: Narrowband ultraviolet B phototherapy to clear and maintain clearance in patients with mycosis fungoides, J Am Acad Dermatol, 2005; 53: 242-246.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

31j Ghodsi SZ, Hallaji Z, Balighi K, et al: Narrow-band UVB in the treatment of early stage mycosis fungoides: report of 16 patients, Clin Exp Dermatol, 2005; 30: 376-378.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

32j Kural Y, Onsun N, Aygin S, et al: Efficacy of narrowband UVB phototherapy in early stage of mycosis fungoides, J Eur Acad Dermatol Venereol, 2006; 20: 104-105.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

33j Gokdemir G, Barutcuoglu B, Sakiz D, Koslu A: Narrowband UVB phototherapy for early-stage mycosis fungoides: evaluation of clinical and histopathological changes, J Eur Acad Dermatol Venereol, 2006; 20: 804-809.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

34j Diederen PV, van Weelden H, Sanders CJ, et al: Narrowband UVB and psoralen-UVA in the treatment of earlystage mycosis fungoides: a retrospective study, J Am Acad Dermatol, 2003; 48: 215-219.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

35j Ahmad K, Rogers S, McNicholas PD, Collins P: Narrowband UVB and PUVA in the treatment of mycosis fungoides: a retrospective study, Acta Derm Venereol, 2007; 87: 413-417.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

36j Ponte P, Serrao V, Apetato M: Efficacy of narrowband UVB vs. PUVA in patients with early-stage mycosis fungoides, J Eur Acad Dermatol Venereol, 2009; 19: PMID 19929938iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

37j El-Mofty M, El-Darouty M, Salonas M, et al: Narrow band UVBi311 nmj, psoralen UVBi311 nmj and PUVA therapy in the treatment of early-stage mycosis fungoides: a right-left comparative study, Photodermatol Photoimmunol Photomed, 2005; 21: 281-286.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

38j Carter J, Zug KA: Phototherapy for cutaneous T-cell lymphoma: online survey and literature review, J Am Acad Dermatol, 2009; 60: 39-50.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹VIj

39j Molin L, Thomsen K, Volden G, Groth O: PhotochemotherapyiPUVAj in the pretumour stage of mycosis fungoides: a report from the Scandinavian Mycosis Fungoides Study Group, Acta Derm Venereol, 1981; 61: 47-51.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

40j Honigsmann H, Brenner W, Rauschmeier W, et al: Photochemotherapy for cutaneous T cell lymphoma. A follow-up study, J Am Acad Dermatol, 1984; 10: 238-245.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

41j Abel EA, Sendagorta E, Hoppe RT, Hu CH: PUVA treatment of erythrodermic and plaque-type mycosis fungoides. Ten-year follow-up study, Arch Dermatol, 1987; 123: 897-901.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

42j Roenigk HH Jr, Kuzel TM, Skoutelis AP, et al: Photochemotherapy alone or combined with interferon alpha-2a in the treatment of cutaneous T-cell lymphoma, J Invest Dermatol, 1990; 95: 198S-205S.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

43j Herrmann JJ, Roenigk HH Jr, Hurria A, et al: Treatment of mycosis fungoides with photochemotherapyiPUVAj: long-term follow-up, J Am Acad Dermatol, 1995; 33: 234-242.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

44j Querfeld C, Rosen ST, Kuzel TM, et al: Long-term follow-up of patients with early-stage cutaneous T-cell lymphoma who achieved complete remission with psoralen plus UV-A monotherapy, Arch Dermatol, 2005; 141: 305-311.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

45j Oguz O, Engin B, Aydemir EH: The influence of psoralen { ultraviolet A treatment on the duration of remission and prognosis in mycosis fungoides, J Eur Acad Dermatol Venereol, 2003; 17: 483-485.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

46j Mycosis fungoides and the Sezary syndromeiPDQj: treatment. iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

47j Whittaker SJ, Marsden JR, Spittle M, Russell Jones R: Joint British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous T-cell lymphomas, Br J Dermatol, 2003; 149: 1095-1107.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

48j Trautinger F, Knobler R, Willemze R, et al: EORTC consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome, Eur J Cancer, 2006; 42: 1014-1030.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj


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‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éPUVA ‚ĆƒŒƒ`ƒmƒCƒh‚Ě•š—p—Ă–@‚ĚŒř‰Ę‚đ•]‰ż‚ľ‚˝ƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‚Č‚˘B•aŠú ⅠA/ⅠB ‚Ě‘Šú‹Űó‘§“÷ÇŠłŽŇ‚ɑ΂ˇ‚éPUVA —Ă–@’P“Ć‚ĆPUVA ‚ĆƒŒƒ`ƒmƒCƒhiƒGƒgƒŒƒ`ƒi[ƒgetretinate ‚Ü‚˝‚Íisotretinoinj“ŕ•ž‚Ě•š—p—Ă–@iRePUVA —Ă–@j‚ĚŒř‰Ę‚đ”äŠr‚ľ‚˝1 Œ‚Ě”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ł́C‘tŒř—Ś‚Í—źŒQ‚Ć‚ŕ100“‚Ĺ‚ ‚čCCR —Śi72“ vs 73“j‚É‚ŕˇ‚Í”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝‚ށCRePUVA —Ă–@ŒQ‚Ĺ‚ÍPUVA —Ă–@’P“ĆŒQ‚ć‚菭‚Č‚˘ĆŽË‰ń”EĆŽËü—Ę‚ĹCR ‚Ş“ž‚ç‚ę‚˝49jB‚Ü‚˝CPUVA —Ă–@‚É’ďRŤ‚ĚŠłŽŇ‚đŠÜ‚Ţ•aŠú ⅠA/ⅠB ‚Ě‘Šú‹Űó‘§“÷Ç‚ɑ΂ľ‚ÄPUVA ‚Ćbexarotene ‚Ě•š—p—Ă–@‚đs‚Á‚˝1 Œ‚ĚÇ—á•ń‚ł́C63“‚ÉCR ‚Ş“ž‚ç‚ę‚Ä‚˘‚é50jBPUVA —Ă–@‚É’ďRŤ‚Ě‘Šú‹Űó‘§“÷Ç‚ɑ΂ˇ‚éƒGƒgƒŒƒ`ƒi[ƒg“ŕ•ž‚Ě•š—p‚É‚ć‚éRePUVA —Ă–@‚ĚŒř‰Ę‚Í•s–ž‚Ĺ‚ ‚é‚ŞCƒŒƒ`ƒmƒCƒh“ŕ•ž—Ă–@’P“Ć‚Ĺ‚ŕ‚ ‚é’ö“x‚ĚŒř‰Ę‚ŞŠú‘Ň‚Ĺ‚Ť‚é‚˝‚߁iCQ7jCRePUVA —Ă–@‚Í‘Šú‹Űó‘§“÷Ç‚Ĺ‘Sg—Ă–@‚Ě•š—p‚Ş•K—v‚Čę‡‚Ě‘ćˆę‘I‘đC‚ ‚邢‚͋ǏŠ—Ă–@‚É’ďRŤ‚Ě‘Šú‹Űó‘§“÷Ç‚ɑ΂ˇ‚é‘ć“ń‘I‘đ‚ĚŽĄ—Ă‚Ć‚ľ‚ÄŽŽ‚Ý‚Ä‚ŕ‚悢B

‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éPUVA ‚ĆIFN-ƒż‚Ě•š—p—Ă–@‚ĚŒř‰Ę‚ÉŠÖ‚ľ‚Ä‚Í, 2 Œ‚Ěƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą51, 52j‚ލs‚í‚ę‚Ä‚˘‚éB•aŠú ⅠA-ⅡB ‚Ě‹Űó‘§“÷ÇŠłŽŇ‚đ‘ÎŰ‚É‚ľ‚˝IFN-ƒż‚ĆPUVA ‚Ě•š—p—Ă–@‚ĆIFN-ƒż‚ĆƒŒƒ`ƒmƒCƒhiacitretinj‚Ě•š—p—Ă–@‚Ć‚Ěƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ł́C‘tŒř—Ś80“ vs 60“CCR —Ś 70“ vs 38“‚ĹIFN-ƒż‚ĆPUVA ‚Ě•š—p—Ă–@ŒQ‚Ş—D‚ę‚Ä‚˘‚˝51jB‚Ü‚˝C•aŠú ⅠA-ⅡB ‚Ě‹Űó‘§“÷ÇŠłŽŇ‚đ‘ÎŰ‚É‚ľ‚˝PUVA —Ă–@’P“Ć‚ĆIFN-ƒż‚ĆPUVA ‚Ě•š—p—Ă–@‚Ć‚Ěƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ł́CCR —Śi72“ vs 79“j‚É‚Í—LˆÓˇ‚Í”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝‚ށCIFN-ƒż‚ĆPUVA ‚Ě•š—p—Ă–@ŒQ‚É‚¨‚˘‚ÄPUVA —Ă–@’P“ĆŒQ‚ć‚菭‚Č‚˘ĆŽË‰ń”EĆŽËü—Ę‚ĹCR ‚Ş“ž‚ç‚ęC–łisŠúŠÔ’†‰›’li113 T vs 53 Tj‚̉„’ˇ‚Ş”F‚ß‚ç‚ę‚˝52jB‚ą‚ę‚ç‚ĚŒ¤‹†‚Ĺ‚Í•aŠú ⅠAⅡA ‚ĆⅡB ‚Ş‹ć•Ę‚ł‚ę‚Ä‚˘‚Č‚˘‚ށCIFN-ƒż‚ĆPUVA ‚Ě•š—p—Ă–@‚ÍIFN-ƒż‚ĆƒŒƒ`ƒmƒCƒh‚Ě•š—p—Ă–@‚¨‚ć‚ŃPUVA —Ă–@’P“Ć‚ć‚č—D‚ę‚Ä‚˘‚é‚ƍl‚Ś‚ç‚ęC•aŠú ⅠA-ⅡB ‚Ĺ‘Sg—Ă–@‚Ş•K—v‚Čę‡‚Ě‘ćˆę‘I‘đ, ‚ ‚邢‚͋ǏŠ—Ă–@‚É’ďRŤ‚Ě‘Šú‹Űó‘§“÷Çi•aŠú ⅠA-ⅡAj‚ɑ΂ˇ‚é‘ć“ń‘I‘đ‚ĚŽĄ—Ă‚Ć‚ľ‚Đ„§‚ł‚ę‚éB‚˝‚ž‚ľ, –{–M‚Ĺ‚ÍIFN-ƒż‚Í‹Űó‘§“÷Ç‚ɑ΂ľ‚Ä–˘ł”F‚Ĺ‚ ‚éB

–{–M‚Ĺ‚Í‹Űó‘§“÷Ç‚ɑ΂ľ‚ÄIFN-ƒÁ‚ŞŽĺ‚É—p‚˘‚ç‚ę‚Ä‚Ť‚˝‚ށiCQ8jCPUVA ‚Ć‚Ě•š—p—Ă–@‚ĚŒř‰Ę‚đ•]‰ż‚ľ‚˝ƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‚Č‚˘B–{–M‚É‚¨‚Ż‚é1 Œ‚Ě”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚É‚¨‚˘‚Ä,•aŠú ⅠA-ⅡA ‚ŝG•˝ZŠú‚Ě‘Šú‹Űó‘§“÷ÇŠłŽŇ‚ɑ΂ˇ‚é“V‘RŒ^IFN-ƒÁ‚ĆŠO—pPUVA ‚Ě•š—p—Ă–@‚É‚ć‚č‘tŒř—Ś100“CCR —Ś58“‚Ć‚˘‚¤Œ‹‰Ę‚Ş“ž‚ç‚ę‚Ä‚˘‚é‚ŞCˆę’UCR ‚Ş“ž‚ç‚ę‚Ä‚ŕˆŰŽ—Ă–@’†‚É57“‚ލĔ­‚ľ‚Ä‚˘‚é53jB‚ą‚ĚŒ¤‹†‚Ĺ‚Í“V‘RŒ^IFN-ƒÁ‚Ć“ŕ•žPUVA ‚Ě•š—p—Ă–@‚ŕs‚í‚ę‚Ä‚˘‚é‚ŞCÇ—ᐔ‚ޏ­‚Č‚­•]‰ż‚͍˘“ď‚Ĺ‚ ‚éB

•śŒŁ

49j Thomsen K, Hammar H, Molin L, Volden G: Retinoids plus PUVAiRePUVAj and PUVA in mycosis fungoides, plaque stage. A report from the Scandinavian Mycosis Fungoides Group, Acta Derm Venereol, 1989; 69: 536-538.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

50j Singh F, Lebwohl MG: Cutaneous T-cell lymphoma treatment using bexarotene and PUVA: a case series, J Am Acad Dermatol, 2004; 51: 570-573.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

51j Stadler R, Otte HG, Luger T, et al: Prospective randomized multicenter clinical trial on the use of interferon ƒż-2a plus acitretin versus interferon ƒż -2a plus PUVA in patients with cutaneous T-cell lymphoma stages Ⅰ and Ⅱ, Blood, 1998; 92: 3578-3581.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

52j Stadler R, Kremer A, Luger T, Sterry W: Prospective, randomized, multicentre clinical trial on the use of interferon a 2a plus PUVA versus PUVA monotehrapy in patients with cutaneous T-cell lymphoma, stage Ⅰ and Ⅱ, J Clin Oncol, 2006 ASCO Annual Meeting Proceedings, 2006; 24: 7541.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

53j ’ˇ’J“N’j, ‚–ě—•Žq, Š—Œ´@‹B‚Ů‚ŠF‹Űó‘§“÷Ç‚ɑ΂ˇ‚éPUVA —Ă–@: Œo‰ßCSkin Cancer, 2007; 22: 183-189.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj


CQ6

‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä•úŽËü—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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B

‹ÇŠ•úŽËüĆŽË‚Í•aŠú‚É‚Š‚Š‚í‚炸‹Űó‘§“÷Ç‚ĚŒÂX‚̋ǖʁEŽîᎂɑ΂ˇ‚éŒĆ‘§“IŽĄ—Ă‚Ć‚ľ‚ÄŠŠ‚ß‚ç‚ę‚éB‘Sg”畆“dŽqütotal skin electron beamiTSEBj—Ă–@‚Í•aŠú ⅠB-ⅡAiT2j‚Ě‹Űó‘§“÷Ç‚ɑ΂ˇ‚鎥—Ă‚Ć‚ľ‚ÄŠŠ‚ß‚ç‚ę‚éB

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‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚é•úŽËü—Ă–@‚ĚŒř‰Ę‚đ•]‰ż‚ľ‚˝ƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‚Č‚˘B

‹Űó‘§“÷Ç‚ɑ΂ˇ‚é‹ÇŠ•úŽËüĆŽË‚ĚŒř‰Ę‚ÉŠÖ‚ľ‚ẮC3 Œ‚ĚÇ—áWĎŒ¤‹†54`56j‚Ş‚ ‚éB•a•Ď‚Ş’Pˆę‚Ě‹Űó‘§“÷Çunilesional mycosis fungoides ‚ɑ΂ˇ‚éĆŽËü—Ę30.6 Gy ‚Ě‹ÇŠ“dŽqüĆŽË‚É‚ć‚č100“‚ÉCR ‚Ş“ž‚ç‚ęCĆŽË–ě“ŕ‚ĚÄ”­‚Í”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚˘‚é54jB“Ż—l‚Éunilesional ‚ ‚邢‚͐”ŒÂ‚Ě•a•Ď‚Ş’Pˆę‚Ü‚˝‚͋ߐڂľ‚˝ĆŽË–ě“ŕ‚ÉŒŔ‹Ç‚ľ‚Ä‚˘‚é"minimal"‚Č•aŠú ⅠA ‚Ě‹Űó‘§“÷Ç‚ɑ΂ˇ‚éX ü‚Ü‚˝‚Í“dŽqü‚É‚ć‚é‹ÇŠĆŽË‚ł́C‚Ů‚Ú‘S•a•Ď‚ĹCR ‚Ş“ž‚ç‚ęCĆŽË–ě“ŕ‚ĚÄ”­‚͏Ʈːü—Ę20 Gy –˘–ž‚Ĺ‚Í17“C20 Gy ˆČă‚Ĺ‚Í8“‚Ĺ‚ ‚Á‚˝55jB‚ľ‚˝‚Ş‚Á‚āCunilesional ‚ ‚邢‚Í"minimal" ‚Č•aŠú ⅠA ‚Ě‹Űó‘§“÷Ç‚ɑ΂ľ‚Ä20`30 Gy ˆČă‚Ě‹ÇŠ•úŽËüĆŽË‚Í—LŒř‚Ĺ‚ ‚éB‹Űó‘§“÷Ç‚ĚŒÂX‚̋ǖʁEŽîᎂɑ΂ˇ‚éŒĆ‘§“I‚Č‹ÇŠ•úŽËüĆŽË‚É‚ć‚čCüŽí‚É‚Š‚Š‚í‚炸ĆŽËü—Ę>20 Gy ‚Ĺ‘S•a•Ď‚ÉCR ‚Ş“ž‚ç‚ęC>30 Gy ‚ĹĆŽË–ě“ŕ‚ĚÄ”­‚Ş”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚˘‚é56jB‚ľ‚˝‚Ş‚Á‚āCŒÂX‚̋ǖʁEŽîᎂɑ΂ˇ‚éŒĆ‘§“IĆŽË‚ł́CĆŽËü—Ę>30 Gy ‚đ„§‚ˇ‚éB

‹Űó‘§“÷Ç‚ɑ΂ˇ‚éTSEB —Ă–@‚ÉŠÖ‚ľ‚Ä‚Í, EORTC ‚É‚ć‚éƒKƒCƒhƒ‰ƒCƒ“‚Ş”­•\‚ł‚ę‚Ä‚˘‚é57jBTSEB —Ă–@‚Ě‘tŒř—Ś‚Í•aŠúE“dŽqƒGƒlƒ‹ƒM[EĆŽËü—Ę‚É‚ć‚Á‚ÄŒˆ‚Ü‚č58jC4`5.5 MeV ‚Ĺ31`36 Gy ‚ĚĆŽË‚Ş„§‚ł‚ę‚Ä‚˘‚é57jB

‰‰ńŽĄ—Ă‚Ć‚ľ‚ÄTSEB —Ă–@‚đs‚Á‚˝ę‡C•aŠú ⅠAi‚¨‚ć‚ŃT1N1M0B0 ‚ĚⅡAj‚ĚCR —Ś‚Í–ń95“‚Ĺ10 ”N–łisś‘ś—Ś‚Í50“‚Ĺ‚ ‚č58jCTSEB —Ă–@Œă‚ɍĔ­‚ľ‚Ä‚ŕ’ʏí‚ÍHN2 ŠO—p—Ă–@‚Ü‚˝‚ÍPUVA —Ă–@‚É”˝‰ž‚ˇ‚é59jB‚ľ‚Š‚ľC‘Oq‚̂悤‚É•aŠú ⅠA ‚Ě‹Űó‘§“÷ÇŠłŽŇ‚̐ś‘ś—Ś‚ĆƒRƒ“ƒgƒ[ƒ‹W’c‚Ě—\‘ސś‘ś—Ś‚ɂ͍ˇ‚Ş‚Č‚­iCQ1jC•aŠú ⅠA ‚ɑ΂ˇ‚éTSEB —Ă–@‚ĆHN2 —Ă–@‚ĚŒř‰Ę‚đ”äŠr‚ľ‚˝•ń‚É‚¨‚˘‚āCCR —Ś‚ÍTSEB —Ă–@‚Ş—D‚ę‚Ä‚˘‚Ä‚ŕś‘ś—Ś‚ɂ͍ˇ‚Ş‚Č‚˘‚ą‚Ć‚ŞŽŚ‚ł‚ę‚Ä‚˘‚é‚˝‚߁iCQ3jC•›ě—p‚đl—ś‚ˇ‚é‚ĆTSEB —Ă–@‚đ•aŠú ⅠA ‚ɑ΂ˇ‚é‘ćˆę‘I‘đ‚ĚŽĄ—Ă‚Ć‚ľ‚Ă͐„§‚Ĺ‚Ť‚Č‚˘Bˆę•űCă‹L‚ĚƒKƒCƒhƒ‰ƒCƒ“‚Ĺ‚Í‹ÇŠ•úŽËüĆŽË‚Ě“K‰ž‚Ĺ‚ ‚é"minimal" ‚Č•aŠú ⅠA ‚ɑ΂ľ‚Ä‚Ě‚ÝTSEB ‚͐„§‚Ĺ‚Ť‚Č‚˘‚Ć‚ľ‚Ä‚˘‚é57jB

•aŠú ⅠBi‚¨‚ć‚ŃT2N1M0B0 ‚ĚⅡAj‚Ĺ‚ŕTSEB —Ă–@‚É‚ć‚鏉‰ńŽĄ—Ă‚ĚCR —Ś‚Í–ń90“‚Ĺ‚ ‚é‚ŞC‚—Ś‚ɍĔ­‚Ş”F‚ß‚ç‚ęC10 ”N–łÄ”­ś‘ś—Ś‚Í20“–˘–ž‚Ĺ‚ ‚é58jB‘Oq‚̂悤‚É•aŠúT2iⅠB/ⅡAj‚Ĺ‚ÍTSEB —Ă–@Œă‚ĚÄ”­‚đ–hŽ~‚ˇ‚é‚˝‚ß‚ÉHN2 ŠO—p‚É‚ć‚éˆŰŽ—Ă–@‚ސ„§‚ł‚ę‚Ä‚˘‚é‚Ş59j CQ3-13, 16jC–{–M‚Ĺ‚ÍHN2 ‚Í–˘”­”„E–˘ł”F‚Ĺ‚ ‚éB‚ť‚Ě‘ź‚ĚˆŰŽ—Ă–@‚ÉŠÖ‚ľ‚ẮC•aŠú‚É‚Š‚Š‚í‚炸‰ťŠw—Ă–@‚Ě•š—p‚Ě—LŒřŤ‚͔ے肳‚ę‚Ä‚¨‚č59, 60jCƒGƒgƒŒƒ`ƒi[ƒg59, 61j‚âIFN-ƒż62j‚Ć‚Ě•š—pEˆŰŽ—Ă–@‚Ĺ‚ŕ‘tŒřŠúŠÔ‚Ě—LˆÓ‚ȉ„’ˇ‚Í”F‚ß‚ç‚ę‚Ä‚˘‚Č‚˘B1 Œ‚ĚŒăŒü‚ŤƒRƒz[ƒgŒ¤‹†63j‚É‚ć‚č, •aŠú ⅠA/ⅠB ‚ɑ΂ˇ‚éTSEB —Ă–@Œă‚ĚPUVA ‚É‚ć‚éˆŰŽ—Ă–@‚Í‘tŒřŠúŠÔ‚đ‰„’ˇ‚ł‚š‚é‰Â”\Ť‚ŞŽŚ‚ł‚ę‚Ä‚˘‚é59jB

1 Œ‚ĚÇ—áWĎŒ¤‹†‚É‚¨‚˘‚āC•aŠúⅡB ‚Ĺ‚ŕ•a•Ď‚Ě”ÍˆÍ‚Ş‘Ě•\–ʐςĚ10“–˘–ž‚Ěę‡‚͏‰‰ńŽĄ—Ă‚Ć‚ľ‚ÄTSEB —Ă–@‚đs‚¤‚ą‚Ć‚É‚ć‚č100“‚ÉCR ‚Ş“ž‚ç‚ęC3 ”N–ł•aś‘ś—Ś‚Í50“‚Ć•ń‚ł‚ę‚Ä‚˘‚é‚Ş64jCś‘śŠúŠÔ‚đ‰„’ˇ‚ˇ‚é‚Š‚Ç‚¤‚Š‚ÉŠÖ‚ľ‚Ä‚Í‹c˜_‚Ş‚ ‚éCQ3-13j, 16jB•aŠúⅡB ‚Ĺ•a•Ď‚Ě”ÍˆÍ‚Ş‘Ě•\–ʐςĚ10“ˆČă‚Ěę‡‚ĚCR —Ś‚Í74“‚Ĺ‚ ‚é‚ŞC18 ƒJŒŽˆČ“ŕ‚É100“‚ލĔ­‚ľCTSEB —Ă–@‚ÍŒĆ‘§“IŽĄ—Ă‚Ć‚ľ‚ÄˆĘ’u•t‚Ż‚ç‚ę‚é64jB

1 Œ‚ĚŒăŒü‚ŤƒRƒz[ƒgŒ¤‹†‚É‚¨‚˘‚Ä, •aŠúT4iⅢA-ⅣBj‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQ‘S‘Ě‚Ĺ‚ÍTSEB —Ă–@‚É‚ć‚é”畆•a•Ď‚ĚCR —Ś‚Í60“‚Ĺ‚ ‚čC5 ”N–łisś‘ś—Ś‚Í26“‚Ć•ń‚ł‚ę‚Ä‚˘‚é65jB‚ľ‚Š‚ľ, ––˝ŒŒ•a•Ď‚Ě‚Č‚˘•aŠúⅢA ‚Ĺ‚Í32`40 Gy ‚ĚTSEB —Ă–@‚É‚ć‚č100“‚ÉCR ‚Ş“ž‚ç‚ęC5 ”N–łisś‘ś—Ś‚Í69“‚Ĺ‚ ‚Á‚˝B•aŠúⅢB ‚¨‚ć‚ŃSézary ÇŒóŒQ‚đŠÜ‚ŢⅣA1-ⅣB ‚ɑ΂ľ‚Ä‚ÍTSEB —Ă–@‚ÍŒĆ‘§“IŽĄ—Ă‚Ć‚ľ‚ÄˆĘ’u•t‚Ż‚ç‚ęC‰˝‚ç‚Š‚Ě‘Sg—Ă–@‚Ć‚Ě•š—p‚Ş•K—v‚Ĺ‚ ‚éB•aŠúT3/T4 ‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éTSEB Œă‚ĚˆŰŽ—Ă–@‚Ć‚ľ‚Ä‘ĚŠOŒő‰ťŠw—Ă–@extracorporeal photochemotherapyiECPj/photopheresis ‚ƉťŠw—Ă–@‚đ”äŠr‚ľ‚˝1 Œ‚Ě”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ł́CECP ŒQ‚̐ś‘ś—Ś‚މťŠw—Ă–@ŒQ‚¨‚ć‚ŃˆŰŽ—Ă–@‚đs‚í‚Č‚Š‚Á‚˝ŒQ‚ć‚č‚‚˘‚ą‚Ć‚ŞŽŚ‚ł‚ę‚Ä‚˘‚é66jB‚Ü‚˝C•aŠúT4iⅢA-ⅣBj‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQŠłŽŇ‚đ‘ÎŰ‚É‚ľ‚˝1 Œ‚Ě”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą67j‚ł́CTSEB —Ă–@’P“ĆŒQ‚É”ä‚ׂÄTSEB ‚ĆECP ‚Ě•š—p—Ă–@ŒQ‚Ě–ł•aś‘ś—Ś‚ލ‚‚˘‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚˘‚é59jB‚ľ‚˝‚Ş‚Á‚Ä, g”çÇŒ^i•aŠúT4j‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQ‚Ĺ‚ÍTSEB ‚ĆECP ‚Ě•š—p—Ă–@‚đŒŸ“˘‚ľ‚Ä‚ŕ‚悢‚ށC–{–M‚Ĺ‚ÍECP ‚Í–˘ł”F‚Ĺ‚ ‚čCŽ{s‰Â”\‚ČŽ{Ý‚Í‚Ů‚Ć‚ń‚Ç‚Č‚˘B

ˆČă‚ć‚čC‰‰ńŽĄ—Ă‚Ć‚ľ‚Ä‚ĚTSEB —Ă–@’P“Ć‚Ĺ’ˇŠúŠÔ‚ĚŠ°‰đ‚ŞŠú‘Ň‚Ĺ‚Ť‚é‚Ě‚Í•aŠúT1iⅠA/ⅡAj‚ĆŒŔ‹ÇŤ‚ĚⅡB ‚¨‚ć‚ŃⅢA ‚Ě‹Űó‘§“÷ÇŠłŽŇ‚Ěˆę•”‚Ě‚Ý‚Ĺ‚ ‚čCT2iⅠB/ⅡAj‚Ĺ‚ÍPUVA —Ă–@‚É‚ć‚éˆŰŽ—Ă–@‚đC‚ť‚Ě‘ź‚Ě•aŠú‚ł͉˝‚ç‚Š‚Ě‘Sg—Ă–@‚Ě•š—p‚Ş•K—v‚Ĺ‚ ‚é57jB‚Ü‚˝CŽĄ—Ă’ďRŤ‚Ě‘Šúi•aŠú ⅠA-ⅡAj‹Űó‘§“÷Ç‚ɑ΂ˇ‚é‘ć“ń‘I‘đ‚ĚŽĄ—Ă‚Ć‚ľ‚ÄTSEB —Ă–@‚đs‚Á‚˝ę‡‚Ĺ‚ŕ’ˇŠúŠÔ‚ĚŠ°‰đ‚ŞŠú‘Ň‚Ĺ‚Ť‚é‚Ş57jC‰‰ńŽĄ—Ă‚Ć‚ľ‚čs‚Á‚˝ę‡‚ć‚čŒř‰Ę‚Í—ň‚é‚˝‚ß59jC•š—p—Ă–@‚đŒŸ“˘‚ˇ‚ׂŤ‚Ĺ‚ ‚éBTSEB —Ă–@Œă‚ĚÄ”­Žž‚ɍēxTSEB —Ă–@‚đŽ{s‚ˇ‚é‚ą‚Ƃ͉”\‚Ĺ‚ ‚é‚Ş68, 69jC2 ‰ń–ÚˆČ~‚ĚTSEB —Ă–@‚ÍŒĆ‘§“IŽĄ—Ă‚Ć‚ľ‚ÄˆĘ’u•t‚Ż‚ç‚ę‚éB

•śŒŁ

54j Micaily B, Miyamoto C, Kantor G, et al: Radiotherapy for unilesional mycosis fungoides, Int J Radiat Oncol Biol Phys, 1998; 42: 361-364.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

55j Wilson LD, Kacinski BM, Jones GW: Local superficial radiotherapy in the management of minimal stage ⅠA cutaneous T-cell lymphomaiMycosis Fungoidesj, Int J Radiat Oncol Biol Phys, 1998; 40: 109-115.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

56j Cotter GW, Baglan RJ, Wasserman TH, Mill W: Palliative radiation treatment of cutaneous mycosis fungoides--a dose response, Int J Radiat Oncol Biol Phys, 1983; 9: 1477-1480.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

57j Jones GW, Kacinski BM, Wilson LD, et al: Total skin electron radiation in the management of mycosis fungoides: Consensus of the European Organization for Research and Treatment of CanceriEORTCj Cutaneous Lymphoma Project Group, J Am Acad Dermatol, 2002; 47: 364-370.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

58j Jones GW, Hoppe RT, Glatstein E: Electron beam treatment for cutaneous T-cell lymphoma, Hematol Oncol Clin North Am, 1995; 9: 1057-1076.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅵj

59j Jones G, Wilson LD, Fox-Goguen L: Total skin electron beam radiotherapy for patients who have mycosis fungoides, Hematol Oncol Clin North Am, 2003; 17: 1421-1434.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅵj

60j Kaye FJ, Bunn PA Jr, Steinberg SM, et al: A randomized trial comparing combination electron-beam radiation and chemotherapy with topical therapy in the initial treatment of mycosis fungoides, N Engl J Med, 1989; 321: 1784-1790.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

61j Jones G, McLean J, Rosenthal D, et al: Combined treatment with oral etretinate and electron beam therapy in patients with cutaneous T-cell lymphomaimycosis fungoides and Sézary syndromej, J Am Acad Dermatol, 1992; 26: 960-967.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

62j Roberge D, Muanza T, Blake G,et al: Does adjuvant alpha-interferon improve outcome when combined with total skin irradiation for mycosis fungoides?, Br J Dermatol. 2007; 156: 57-61.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

63j Quiros PA, Jones GW, Kacinski BM, et al: Total skin electron beam therapy followed by adjuvant psoralen/ultraviolet- A light in the management of patients with T1 and T2 cutaneous T-cell lymphomaimycosis fungoidesj, Int J Radiat Oncol Biol Phys, 1997; 38: 1027-1035.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

64j Quiros PA, Kacinski BM, Wilson LD: Extent of skin involvement as a prognostic indicator of disease free and overall Survival of patients with T3 cutaneous T-cell lymphoma treated with total skin electron beam radiation therapy, Cancer, 1996; 77: 1912-1917.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

65j Jones GW, Rosenthal D, Wilson LD: Total skin electron radiation for patients with erythrodermic cutaneous Tcell lymphomaimycosis fungoides and the Sézary syndromej, Cancer, 1999; 85: 1985-1995.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

66j Wilson LD, Licata AL, Braverman IM, et al: Systemic chemotherapy and extracorporeal photochemotherapy for T3 and T4 cutaneous T-cell lymphoma patients who have achieved a complete response to total skin electron beam therapy, Int J Radiat Oncol Biol Phys, 1995; 32: 987-995.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

67j Wilson LD, Jones GW, Kim D, et al: Experience with total skin electron beam therapy in combination with extracorporeal photopheresis in the management of patients with erythrodermiciT4j mycosis fungoides, J Am Acad Dermatol, 2000; 43: 54-60.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

68j Wilson LD, Quiros PA, Kolenik SA, et al: Additional courses of total skin electron beam therapy in the treatment of patients with recurrent cutaneous T-cell lymphoma, J Am Acad Dermatol, 1996; 35: 69-73.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

69j Becker M, Hoppe RT, Knox SJ: Multiple courses of high-dose total skin electron beam therapy in the management of mycosis fungoides, Int J Radiat Oncol Biol Phys, 1995; 32: 1445-1449.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ7

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B-C1

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‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éisotretinoin “ŕ•ž—Ă–@‚Ě‘tŒř—Ś‚Í43`100“CƒGƒgƒŒƒ`ƒi[ƒg“ŕ•ž—Ă–@‚Ě‘tŒř—Ś‚Í55`67“‚Ć•ń‚ł‚ę‚Ä‚˘‚é‚Ş70jC—źŽŇ‚ĚŒř‰Ę‚đ”äŠr‚ľ‚˝1 Œ‚Ě”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚É‚¨‚˘‚Ä, isotretinoin ‚ĆƒGƒgƒŒƒ`ƒl[ƒg‚Ě‘tŒř—Śi59“ vs 67“jECR —Śi—źŽŇ‚Ć‚ŕ21“jE“ŐŤ‚ɂ͍ˇ‚Ş‚Č‚­CŽĄ—ĂŒp‘ą’†‚É‚ť‚ę‚ź‚ę26“C22“‚ɍĔ­‚Ş‚Ý‚ç‚ę‚Ä‚˘‚é71jBIsotretinoin ‚¨‚ć‚ŃƒGƒgƒŒƒ`ƒi[ƒg‚Ě“ŕ•ž—Ă–@‚É‚ć‚é‘tŒřŠúŠÔ‚Í3`13 ƒJŒŽ‚Ć•ń‚ł‚ę‚Ä‚˘‚é72jBAcitretin “ŕ•ž—Ă–@‚Ě‘tŒř—ŚE‘tŒřŠúŠÔ‚ÉŠÖ‚ˇ‚é•ń‚Í‚Č‚˘B

‹Űó‘§“÷ÇESézary ÇŒóŒQŠłŽŇ‚đ‘ÎŰ‚É‚ľ‚˝‘OŒü‚ŤŒ¤‹†‚ލs‚í‚ę‚Ä‚˘‚é‚Ě‚Íbexarotene “ŕ•ž—Ă–@‚Ě‚Ý‚Ĺ‚ ‚éBŽĄ—Ă’ďRŤ‚Ě‘Šúi•aŠú ⅠA-ⅡAj‹Űó‘§“÷ÇŠłŽŇ‚đ‘ÎŰ‚É‚ľ‚˝bexarotene “ŕ•ž—Ă–@‚Ě‘ćⅡ/Ⅲ‘ŠŽŽŒą‚ł́C2 ‚‚̓Š—^—Ę‚Ěƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ލs‚í‚ę‚˝‚Ş, ŽŠ“K—Ę‚Ĺ‚ ‚é300 mg/m2 “Š—^ŒQ‚É‚¨‚Ż‚é‘tŒř—Ś‚Í54“CCR —Ś7“‚Ĺ‚ ‚čCÄ”­‚Í13“‚É”F‚ß‚ç‚ę‚˝73jBŽĺ‚Č•›ě—p‚͍‚Ž‰ŒŒÇ‚ƍbó‘B‹@”\’ቺÇ‚Ĺ‚ ‚Á‚˝BŽĄ—Ă’ďRŤ‚̐isŠúi•aŠúⅡB-ⅣBj‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚ébexarotene ‚Ě‘tŒř—Ś‚Í45“iⅡB ‚Ĺ57“CSézary ÇŒóŒQ‚đŠÜ‚ŢⅢm‹Œ•aŠú•Ş—ށn‚Ĺ32“CⅣA2 ‚Ĺ44“CⅣB ‚Ĺ40“CSézary ÇŒóŒQ‚Ĺ24“jCCR —Ś‚Í2“‚Ĺ‚ ‚Á‚˝74jBÄ”­‚Í36“‚É”F‚ß‚ç‚ęC‘tŒřŠúŠÔ’†‰›’l‚Í299 “ú‚Ĺ‚ ‚Á‚˝B‚ľ‚˝‚Ş‚Á‚āCbexarotene ‚Í‘Šú‚¨‚ć‚ѐisŠú‚ĚŽĄ—Ă’ďRŤ‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä’P“Ć‚Ĺ‚ŕ—LŒř‚Ĺ‚ ‚čCŒťÝ‚ł‚Ü‚´‚Ü‚Č•š—p—Ă–@‚ŞŽŽ‚Ý‚ç‚ę‚Ä‚˘‚é75jB

ŽĄ—Ă’ďRŤ‚Ě•aŠú ⅠB-ⅣB ‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éATRA ‚Ćbexarotene ‚ĚŒř‰Ę‚đ”äŠr‚ľ‚˝1 Œ‚Ě”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ł́C—źŽŇ‚Ě‘tŒř—ŚE‘tŒřŠúŠÔEś‘śŠúŠÔE“ŐŤ‚ɍˇ‚Í”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝76jB‚ľ‚˝‚Ş‚Á‚āC–{–M‚Ĺ—p‚˘‚ç‚ę‚Ä‚˘‚éƒGƒgƒŒƒ`ƒi[ƒg‚஡—Ă’ďRŤ‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Äbexarotene ‚Ć“Ż’ö“x‚É—LŒř‚Ĺ‚ ‚é‰Â”\Ť‚Ş‚ ‚éB‚ľ‚Š‚ľ, ƒGƒgƒŒƒ`ƒi[ƒg“ŕ•ž—Ă–@’P“Ć‚Ĺ‚Ě‘tŒřŠúŠÔ‚Í’Ęí’Z‚­C‘ź‚ĚŽĄ—Ă‚Ć‚Ě•š—p—Ă–@‚đŒŸ“˘‚ˇ‚ׂŤ‚Ĺ‚ ‚éB‚˝‚ž‚ľCƒGƒgƒŒƒ`ƒi[ƒg“ŕ•ž‚Ć‚Ě•š—p—Ă–@‚Ĺ—LŒřŤ‚ŞŽŚ‚ł‚ę‚Ä‚˘‚é‚Ě‚Í‘Oq‚Ě‘Šú‹Űó‘§“÷Ç‚ɑ΂ˇ‚éPUVA ‚Ć‚Ě•š—p—Ă–@iRePUVA —Ă–@j‚Ě‚Ý‚Ĺ‚ ‚éiCQ5jB

•Ä‘‚Ĺ‚ÍŽĄ—Ă’ďRŤ‚Ě‘Šú‹Űó‘§“÷Ç‚ɑ΂ľ‚Äbexarotene ŠO—p–ňi1“ bexarotene gelj‚ޏł”F‚ł‚ę‚Ä‚˘‚éB•aŠú ⅠA-ⅡA ‚Ě‘Šú‹Űó‘§“÷Ç‚ɑ΂ˇ‚é‘ć Ⅰ-Ⅲ‘ŠŽŽŒą‚É‚¨‚Ż‚é‘tŒř—Ś‚Í44`63“CCR —Ś8`21“‚Ĺ‚ ‚Á‚˝77, 78jBBexarotene ŠO—p—Ă–@‚Í•aŠú ⅠA-ⅡA ‚Ě‘Šú‹Űó‘§“÷Ç‚ɑ΂ľ‚Ä—LŒř‚Č‹ÇŠ—Ă–@‚Ĺ‚ ‚é‚ŞCbexarotene ŠO—p–ň‚Í–{–M‚Ĺ‚Í–˘”­”„E–˘ł”F‚Ĺ‚ ‚éB

•śŒŁ

70j Kempf W, Kettelhack N, Duvic M, Burg G: Topical and systemic retinoid therapy for cutaneous T-cell lymphoma, Hematol Oncol Clin North Am, 2003; 17: 1405-1419.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅵj

71j Molin L, Thomsen K, Volden G, et al: Oral retinoids in mycosis fungoides and Sézary syndrome: a comparison of isotretinoin and etretinate. A study from the Scandinavian Mycosis Fungoides Group, Acta Derm Venereol, 1987; 67: 232-236.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

72j Zhang C, Duvic M: Retinoids; therapeutic applications and mechanisms of action in cutaneous T-cell lymphoma, Dermatol Ther, 2003; 16: 322-330.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅵj

73j Duvic M, Martin AG, Kim Y, et al: Phase 2 and 3 clinical trial of oral bexaroteneiTargretin capsulesj for the treatment of refractory or persistent early-stage cutaneous T-cell lymphoma, Arch Dermatol, 2001; 137: 581-593.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

74j Duvic M, Hymes K, Heald P, et al: Bexarotene is effective and safe for treatment of refractory advanced-stage cutaneous T-cell lymphoma: multinational phase Ⅱ-Ⅲ trial results, J Clin Oncol, 2001; 19: 2456-2471.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

75j Gniadecki R, Assaf C, Bagot M, et al: The optimal use of bexarotene in cutaneous T-cell lymphoma, Br J Dermatol, 2007; 157: 433-440.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

76j Querfeld C, Rosen ST, Guitart J, et al: Comparison of selective retinoic acid receptor- and retinoic X receptormediated efficacy, tolerance, and Survival in cutaneous t-cell lymphoma, J Am Acad Dermatol, 2004; 51: 25-32.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

77jBreneman D, Duvic M, Kuzel T, et al: Phase 1 and 2 trial of bexarotene gel for skin-directed treatment of patients with cutaneous T-cell lymphoma, Arch Dermatol, 2002; 138: 325-332.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

78j Heald P, Mehlmauer M, Martin AG, et al: Topical bexarotene therapy for patients with refractory or persistent early-stage cutaneous T-cell lymphoma: results of the phase Ⅲ clinical trial, J Am Acad Dermatol, 2003; 49: 801-815.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ8

‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚ăCƒ“ƒ^[ƒtƒFƒƒ“—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

B-C1

ƒCƒ“ƒ^[ƒtƒFƒƒ“interferoniIFNj-ƒż—Ă–@‚Í‘Sg—Ă–@‚Ş•K—v‚Č‘Šúi•aŠú ⅠA-ⅡAj‚¨‚ć‚ѐisŠúiⅡB-ⅣA1j‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚ÄŠŠ‚ß‚ç‚ę‚é‚ŞC–{–M‚Ĺ‚Í–˘ł”F‚Ĺ‚ ‚éB–{–M‚Ĺ‹Űó‘§“÷Ç‚ɑ΂ľ‚Ä—p‚˘‚ç‚ę‚Ä‚Ť‚˝IFN-ƒÁ‚ÍIFN-ƒż‚Ć“Ż’ö“x‚ĚŒř‰Ę‚đ—L‚ˇ‚é‚ƍl‚Ś‚ç‚ęC—L—p‚Ĺ‚ ‚é‰Â”\Ť‚Ş‚ ‚éB

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


Ą‰đŕ

‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä—p‚˘‚ç‚ę‚Ä‚˘‚ébiological response modifieriBRMj‚Ć‚ľ‚Ä‘Oq‚ĚƒŒƒ`ƒmƒCƒhiCQ7jˆČŠO‚ɂ́CIFN-ƒż‚ĆIFN-ƒÁ‚Ş‚ ‚éB‰˘•Ä‚Ĺ‚ÍŽĺ‚ÉIFN-ƒż-2ai‚Ü‚˝‚ÍIFN-ƒż-2bj‚ŞŽg—p‚ł‚ę‚Ä‚˘‚é‚ŞC–{–M‚Ŕ̔„‚ł‚ę‚Ä‚˘‚éIFN-ƒżťÜi“V‘RŒ^IFN-ƒżCIFN-ƒż-2bCIFN-alfacon-1CPEG-IFN-ƒż-2aCPEG-IFN-ƒż-2bj ‚Í‚ˇ‚×‚Ä‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä–˘ł”F‚Ĺ‚ ‚éB–{–M‚Ĺ‚Íˆâ“`Žq‘gŠˇ‚ŚŒ^IFN-ƒÁ-1a ťÜ‚Ć“V‘RŒ^IFN-ƒÁ-n1 ťÜ‚Ş‹Űó‘§“÷Ç‚ɑ΂ľ‚ďł”F‚ł‚ę‚Ä‚˘‚˝‚ށC—źŽŇ‚Ć‚ŕ‚ˇ‚łɔ̔„‚Ş’†Ž~‚ł‚ę‚Ä‚˘‚éB–{–M‚ĹŒťÝ”Ě”„‚ł‚ę‚Ä‚˘‚éˆâ“`Žq‘gŠˇ‚ŚŒ^IFN-ƒÁ-1a ťÜ‚Í‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä–˘ł”F‚Ĺ‚ ‚钍jB

’jIFN-ƒÁ-1a ‚Í2014 ”N‚É•ŰŒŻ“K—p‚É‚Č‚Á‚˝i•âˆâŽQĆjB

‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éIFN-ƒż—Ă–@’P“Ć‚ĚŒř‰Ę‚ÉŠÖ‚ľ‚Ä‚Í‘˝‚­‚Ě•ń‚Ş‚ ‚é‚ŞCƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‚Č‚­, ‘Ώ۩łŽŇ‚Ě•aŠú‚¨‚ć‚ŃIFN-ƒż‚Ě“Š—^—ʁE“Š—^ƒXƒPƒWƒ…[ƒ‹E“Š—^ŠúŠÔ‚Ş•ń‚É‚ć‚čˆŮ‚Č‚é‚˝‚߁C“‡“I‚Č•]‰ż‚͍˘“ď‚Ĺ‚ ‚éB•ń‘S‘Ě‚Ĺ‚Ě‘tŒř—Ś‚Í54“CCR —Ś17“C‘tŒřŠúŠÔ’†‰›’l5`41 ƒJŒŽ‚Ć‚ł‚ę‚Ä‚¨‚č79, 80jC’PÜ‰ťŠw—Ă–@‚Ć‚Ů‚Ú“Ż’ö“x‚Ě‘tŒř—Ś‚Ş“ž‚ç‚ę‚Ä‚˘‚é79jB’á—p—ĘIFN- ƒż—Ă–@’P“Ć‚É‚ć‚é’ˇŠúŠĎŽ@‚đs‚Á‚˝1 Œ‚ĚŒăŒü‚ŤƒRƒz[ƒgŒ¤‹†‚ł́C‘tŒř—Ś67“iⅠA-ⅡA ‚Ĺ89“CⅡB ‚Ĺ77“CSézary ÇŒóŒQ‚đŠÜ‚ŢⅢA-ⅣA1 ‚Ĺ28“CⅣA2/ⅣB ‚Ĺ0“jCCR —Ś41“i•aŠú ⅠA-ⅡA ‚Ĺ67“CⅡB ‚Ĺ43“CSézary ÇŒóŒQ‚đŠÜ‚ŢⅢA-ⅣA1 ‚Ĺ18“j‚Ĺ‚ ‚čC‘˝‚­‚Ěę‡CR ‚Í6 ƒJŒŽˆČ“ŕ‚É“ž‚ç‚ę‚˝81jBÄ”­‚Í•aŠú‚Ć‚Í–łŠÖŒW‚É57“‚É”F‚ß‚ç‚ę‚Ä‚˘‚éB‚ľ‚˝‚Ş‚Á‚āCIFN-ƒż—Ă–@‚͔畆ŠO•a•Ď‚𔺂¤•aŠúⅣA2/ⅣB ‚đœ‚­‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä—LŒř‚Č‘Sg—Ă–@‚Ĺ‚ ‚č80jC‘Sg—Ă–@‚Ş•K—v‚Č‘Šúi•aŠú ⅠA-ⅡAj‚¨‚ć‚ѐisŠúiⅡB-ⅣA1j‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚é‘ćˆę‘I‘đ‚ĚŽĄ—Ă, ‚ ‚邢‚͋ǏŠ—Ă–@‚É’ďRŤ‚Ě‘Šú‹Űó‘§“÷Ç‚ɑ΂ˇ‚é‘Sg—Ă–@‚Ć‚ľ‚Đ„§‚ł‚ę‚éB

‘Oq‚̂悤‚É•aŠú ⅠA-ⅡB ‚Ě‹Űó‘§“÷ÇŠłŽŇ‚đ‘ÎŰ‚É‚ľ‚˝2 Œ‚Ěƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚É‚ć‚čIFN-ƒż‚ĆPUVA ‚Ě•š—p—Ă–@‚ÍIFN-ƒż‚ĆƒŒƒ`ƒmƒCƒh‚Ě•š—p—Ă–@‚¨‚ć‚ŃPUVA —Ă–@’P“Ć‚ć‚č—D‚ę‚Ä‚˘‚é‚ą‚Ć‚ŞŽŚ‚ł‚ę‚Ä‚˘‚éiCQ5jBă‹L‚Ěƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒąCQ5-51jˆČŠO‚É‚ŕIFN-ƒż‚ĆƒŒƒ`ƒmƒCƒhiƒGƒgƒŒƒ`ƒi[ƒg‚Ü‚˝‚Íisotretinoinj‚Ě•š—p—Ă–@‚Ě•ń‚Í‘˝‚˘‚ށCIFN-ƒż‚ĆƒŒƒ`ƒmƒCƒh‚Ě•š—p—Ă–@‚Ě‘tŒř—Ś60“CCR —Ś11“‚ÍIFN-ƒż—Ă–@’P“Ć‚Ě‘tŒř—Ś54“CCR —Ś17“‚ƍˇ‚Ş‚Č‚˘79, 80jBBexarotene ‚ÉŠÖ‚ľ‚Ä‚ŕIFN-ƒż‚Ćbexarotene ‚Ě•š—p—Ă–@‚É‚ć‚č’á—p—Ę‚Ěbexarotene ‚Ĺ‚ŕŒř‰Ę‚Ş“ž‚ç‚ę‚é‰Â”\Ť‚ŞŽŚ´‚ł‚ę‚Ä‚˘‚é‚Ş82jCIFN-ƒż‚Ć’Ęí‚ĚŽŠ“K—Ę‚Ěbexarotene ‚Ě•š—p—Ă–@‚Ě‘tŒř—Ś‚Íbexarotene —Ă–@’P“Ć‚Ćˇ‚Ş‚Č‚˘83jB‚ľ‚˝‚Ş‚Á‚āCIFN-ƒż‚ĆPUVA ‚Ě•š—p—Ă–@‚Í•aŠú ⅠA-ⅡB ‚Ě‹Űó‘§“÷Ç‚ɑ΂ľ‚Ä—LŒř‚Ĺ‚ ‚é‚ŞiCQ5jCIFN-ƒż‚ĆƒŒƒ`ƒmƒCƒh‚Ě•š—p—Ă–@‚Í‚˘‚¸‚ę‚Ě•aŠú‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä‚ŕĎ‹É“I‚ɂ͐„§‚Ĺ‚Ť‚Č‚˘B

‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éIFN-ƒÁ—Ă–@’P“Ć‚ĚŒř‰Ę‚đƒvƒ‰ƒZƒ{ƒRƒ“ƒgƒ[ƒ‹‚ ‚邢‚Í‘ź‚ĚŽĄ—Ă–@‚Ć”äŠr‚ľ‚˝ƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‚Č‚˘B•Ä‘‚É‚¨‚Ż‚é•aŠú ⅠB-ⅣB ‚ĚŽĄ—Ă’ďRŤ‹Űó‘§“÷ÇESézary ÇŒóŒQŠłŽŇ‚đ‘ÎŰ‚É‚ľ‚˝ˆâ“`Žq‘gŠˇ‚ŚŒ^IFN-ƒÁ‚Ě‘ćⅡ‘ŠŽŽŒą‚ł́CCR ‚Í“ž‚ç‚ę‚Č‚Š‚Á‚˝‚ށC31“‚ÉPR ‚Ş“ž‚ç‚ęiⅣB ‚Ĺ‚Í‘tŒř—Ś0“jC‘tŒřŠúŠÔ’†‰›’l‚Í10 ƒJŒŽ‚Ĺ‚ ‚Á‚˝84jB–{–M‚É‚¨‚Ż‚é•aŠú ⅠA-ⅣB ‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éˆâ“`Žq‘gŠˇ‚ŚŒ^IFN-ƒÁ-1a ‚ĚŒăŠú—Տ°‘ćⅡ‘ŠŽŽŒą‚ł́C“_“HĂ’“Š—^‚É‚ć‚é‹Űó‘§“÷Ç‚ɑ΂ˇ‚é‘tŒř—Ś‚Í58“iⅠA-ⅡA ‚Ĺ58“CⅡB ‚Ĺ50“CⅣA2 ‚Ĺ33“jCCR —Ś8“i‚˝‚ž‚ľCR ‚ÍⅠA/ⅠB ‚̂݁jC‘tŒřŠúŠÔ’†‰›’l85 “ú‚Ĺ‚ ‚Á‚˝‚ށCSézary ÇŒóŒQ‚Ě1 —á‚ɑ΂ľ‚Ä‚ÍŒř‰Ę‚Ş”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝85jB‚Ü‚˝C–{–M‚É‚¨‚Ż‚é•aŠú ⅠA-ⅣB ‚Ě‹Űó‘§“÷Ç‚ɑ΂ˇ‚é“V‘RŒ^IFN-ƒÁ-n1 ‚ĚŒăŠú—Տ°‘ćⅡ‘ŠŽŽŒą‚ł́C‘tŒř—Ś58“iⅠA-ⅡA ‚Ĺ63“CⅡB ‚Ĺ38“CⅢ‚Ĺ100“CⅣB ‚Í0“jCCR —Ś8“C‘tŒřŠúŠÔ’†‰›’l74 “ú‚Ĺ‚ ‚Á‚˝86jB‚ľ‚˝‚Ş‚Á‚Ä, IFN-ƒÁ‚͏­‚Č‚­‚Ć‚ŕ•aŠú ⅠA-ⅢA/ⅣA2 ‚Ě‹Űó‘§“÷Ç‚ɑ΂ľ‚Ä—LŒř‚Č‘Sg—Ă–@‚Ĺ‚ ‚čC‘tŒř—ŚE‘tŒřŠúŠÔ‚ÍIFN-ƒż‚Ć“Ż’ö“x‚ ‚邢‚Í‚â‚â—ň‚é’ö“x‚ƍl‚Ś‚ç‚ę‚éB‘Oq‚̂悤‚ÉIFN-ƒÁ‚ĆPUVA ‚Ě•š—p—Ă–@‚ÉŠÖ‚ˇ‚éƒGƒrƒfƒ“ƒX‚Í–R‚ľ‚­iCQ5jCIFN-ƒÁ‚ĆƒŒƒ`ƒmƒCƒh‚Ě•š—p—Ă–@‚ÉŠÖ‚ˇ‚é—Տ°ŽŽŒą‚͍s‚í‚ę‚Ä‚˘‚Č‚˘B

•śŒŁ

79j Bunn PA Jr, Hoffman SJ, Norris D, et al: Systemic therapy of cutaneous T-cell lymphomasimycosis fungoides and the Sézary syndromej, Ann Intern Med, 1994; 121: 592-602.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅵj

80j Olsen EA, Bunn PA: Interferon in the treatment of cutaneous T-cell lymphoma. Hematol Oncol Clin North Am, 1995; 9: 1089-1107.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅵj

81j Jumbou O, N'Guyen JM: Tessier MH, et al: Long-term follow-up in 51 patients with mycosis fungoides and Sézary syndrome treated by interferon-alfa, Br J Dermatol, 1999; 140: 427-431.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

82j McGinnis KS, Junkins-Hopkins JM, Crawford G, et al: Low-dose oral bexarotene in combination with low-dose interferon alfa in the treatment of cutaneous T-cell lymphoma: clinical synergism and possible immunologic mechanisms, J Am Acad Dermatol, 2004; 50: 375-379.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

83j Straus DJ, Duvic M, Kuzel T, et al: Results of a phase Ⅱ trial of oral bexaroteneiTargretinj combined with interferon alfa-2biIntron-Aj for patients with cutaneous T-cell lymphoma, Cancer, 2007; 109: 1799-1803.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

84j Kaplan EH, Rosen ST, Norris DB, et al: Phase Ⅱ study of recombinant human interferon gamma for treatment of cutaneous T-cell lymphoma, J Natl Cancer Inst, 1990; 82: 208-212.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

85j ÎŒ´˜a”VC’r“cd—YCX@r“ń‚Ů‚Š: ”畆ˆŤŤŽîᇂɂ¨‚Ż‚éSUN4800 ŒăŠú—Տ°‘ćⅡ ‘ŠŽŽŒąCź“ú”畆C1989; 51: 766-775.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

86j ÎŒ´˜a”V: ‹Űó‘§“÷Ç‚ɑ΂ˇ‚éOH-6000 ŒăŠú—Տ°‘ćⅡ ‘ŠŽŽŒąCSkin Cancer, 1993; 8: 352-367.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj


CQ9

‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä‘ĚŠOŒő‰ťŠw—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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Big”çÇŒ^‹Űó‘§“÷ÇESézary ÇŒóŒQj
C1ig”çÇˆČŠO‚Ě•aŒ^j

‘ĚŠOŒő‰ťŠw—Ă–@extracorporeal photochemotherapyiECPj/photopheresis ‚Í•aŠúT4 ‚̍g”çÇŒ^‹Űó‘§“÷Ç‚¨‚ć‚ŃSézary ÇŒóŒQ‚ɑ΂ľ‚ÄŠŠ‚ß‚ç‚ę‚éBg”çÇŒ^ˆČŠO‚Ě‹Űó‘§“÷Ç‚ɑ΂ľ‚ẮCŽĄ—Ă’ďRŤ‚Ĺ‚ ‚ę‚ÎŽŔŽ{‚đl—ś‚ľ‚Ä‚ŕ‚悢BECP ‚Í–{–M‚Ĺ‚Í–˘ł”F‚Ĺ‚ ‚čCŒťÝ–{–M‚ĹECP ‚đŽ{s‚ľ‚Ä‚˘‚éŽ{Ý‚Í‚Ů‚Ć‚ń‚Ç‚Č‚˘B

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‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éECP ‚ĚŒř‰Ę‚ÉŠÖ‚ľ‚āC2 Œ‚ĚƒVƒXƒeƒ}ƒeƒBƒbƒNEƒŒƒrƒ…[^ƒKƒCƒhƒ‰ƒCƒ“87, 88j‚Ş‚ ‚éB‰˘•Ä‚Ĺ‚ÍECP ‚ÍŽĺ‚É•aŠúT4 ‚̍g”çÇŒ^‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä—p‚˘‚ç‚ę‚Ä‚¨‚č, ‘tŒř—Ś‚Í31`86“‚Ĺ‚ ‚é‚ŞCCR —Ś‚Í0`62“‚ŁCECP ‚É‚ć‚čSézary ÇŒóŒQ‚̐ś‘śŠúŠÔ‚މ„’ˇ‚ˇ‚é‚Š‚Ç‚¤‚Š‚ɂ‚˘‚Ä‚Í‹c˜_‚Ş‚ ‚é87, 88jBPCR ‚Ĺ––˝ŒŒT ×–EƒNƒ[ƒ“—zŤ‚Ě•aŠú ⅠB ‚Ě‹Űó‘§“÷Ç‚ɑ΂ˇ‚éPUVA —Ă–@‚ĆECP ‚ĚƒNƒƒXƒI[ƒo[EƒfƒUƒCƒ“‚Ěƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ł́C‘tŒř—Ś‚É‚¨‚˘‚ÄPUVA —Ă–@‚Ş—LˆÓ‚É—D‚ę‚Ä‚˘‚˝89jB‚ľ‚˝‚Ş‚Á‚āCECP‚͍g”çÇŒ^‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä—LŒř‚Ĺ‚ ‚é‚ŞCg”çÇŒ^ˆČŠO‚Ě‹Űó‘§“÷Ç‚ɑ΂ľ‚Ä‚Í‘ćˆę‘I‘đ‚ĚŽĄ—Ă‚Ć‚ľ‚Đ„§‚Ĺ‚Ť‚Č‚˘B

ECP ‚ĆIFN-ƒż‚Ě•š—p—Ă–@‚É‚ć‚čECP ’P“Ć‚É”ä‚ׂč‚‚˘‘tŒř—Ś‚Ş“ž‚ç‚ę‚˝‚Ć‚˘‚¤•ń‚Í‘˝‚˘‚ށCƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚͍s‚í‚ę‚Ä‚˘‚Č‚˘87, 88jB

–{–M‚Ĺ‚ÍECP ‚Í–˘ł”F‚Ĺ‚ ‚čCŒťÝECP ‚đŽ{s‚ľ‚Ä‚˘‚éŽ{Ý‚Í‚Ů‚Ć‚ń‚Ç‚Č‚˘B

•śŒŁ

87j McKenna KE, Whittaker S, Rhodes LE, et al: Evidence-based practice of photopheresis 1987-2001: a report of a workshop of the British Photodermatology Group and the U.K. Skin Lymphoma Group, Br J Dermatol, 2006; 154: 7-20.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

88j Scarisbrick JJ, Taylor P, Holtick U, et al: U.K. consensus statement on the use of extracorporeal photopheresis for treatment of cutaneous T-cell lymphoma and chronic graft-versus-host disease, Br J Dermatol, 2008; 158: 659-678.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

89j Child FJ, Mitchell TJ, Whittaker SJ, et al: A randomized cross-over study to compare PUVA and extracorporeal photopheresis in the treatment of plaque stageiT2j mycosis fungoides, Clin Exp Dermatol, 2004; 29: 231-236.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj


CQ10

‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä•ŞŽq•W“I—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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B-C1

Denileukin diftitoxCƒ{ƒŠƒmƒXƒ^ƒbƒgvorinostatCromidepsin ‚͍Ĕ­EŽĄ—Ă’ďRŤ‚Ě‹Űó‘§ “÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä—L—p‚Ĺ‚ ‚é‰Â”\Ť‚Ş‚ ‚é‚ŞC–{–M‚ŏł”F‚ł‚ę‚Ä‚˘‚é‚Ě‚Íƒ{ƒŠƒm ƒXƒ^ƒbƒg‚Ě‚Ý‚Ĺ‚ ‚éB

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‚ł‚Ü‚´‚Ü‚Č•ŞŽq•W“IŽĄ—Ă–ň‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éŒř‰Ę‚Ş•ń‚ł‚ę‚Ä‚˘‚é‚ŞC–{–M‚Ĺ‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚鎥—Ă–ň‚Ć‚ľ‚ďł”F‚ł‚ę‚Ä‚˘‚é‚Ě‚Íƒ{ƒŠƒmƒXƒ^ƒbƒgvorinostat/suberoylanilide hydroxamic acidiSAHAj‚Ě‚Ý‚Ĺ‚ ‚éB

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‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éR‘ĚŽĄ—Ă‚ĹĹ‚ŕ•ń‚Ş‘˝‚˘‚Ě‚Íƒqƒg‰ťRCD52 R‘Ěalemtuzumab/Campath-1H ‚Ĺ‚ ‚éBAlemtuzumab ‚͉˘•Ä‚Ĺ‚ÍB ×–EŤ–Ť”’ŒŒ•a‚ĚŽĄ—Ă–ň‚Ć‚ľ‚ďł”F‚ł‚ę‚Ä‚˘‚é‚ŞC–{–M‚Ĺ‚Í–˘”­”„E–˘ł”F‚Ĺ‚ ‚éB‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éalemtuzumab ‚ĚŒř‰Ę‚đ•]‰ż‚ľ‚˝ƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‚Č‚˘‚ށC2 Œ‚ĚÇ—áWĎŒ¤‹†93, 94j‚Ć1 Œ‚ĚÇ—á•ń95j‚Ş‚ ‚č, isŠú‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚é‘tŒř—Ś‚Í38`55“‚Ĺ‚ ‚éB’˜–ž‚ȖƉu—}§‚Ě‚˝‚߂Ɉę”Ę‚É‚ÍŽg—p‚ł‚ę‚Ä‚˘‚Č‚˘‚ށCĹ‹ßCSézary ÇŒóŒQ‚ɑ΂ˇ‚é’á—p—Ę‚Ĺ‚Ě—LŒřŤ‚Ş•ń‚ł‚ę‚Ä‚˘‚é96jB

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ƒ{ƒŠƒmƒXƒ^ƒbƒg‚ÍŒoŒű“Š—^‰Â”\‚ČHDAC ‘jŠQ–ň‚Ĺ‚ ‚čC•Ä‘‚É‚¨‚Ż‚ébexarotene ‚đŠÜ‚Ţ2 ‚ÂˆČă‚Ě‘Sg—Ă–@‚É’ďRŤ‚đŽŚ‚ˇ•aŠú ⅠB-ⅣA ‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQŠłŽŇ‚đ‘ÎŰ‚É‚ľ‚˝1 “ú400 mg ˜A“ú“ŕ•ž‚Ĺ‚ĚŒăŠú—Տ°‘ćⅡ ‘ŠŽŽŒą‚ł́C‘tŒř—Ś30“iⅡB-ⅣA2 ‚Ĺ‚ŕ30“jC‘tŒřŠúŠÔ‚Í185 “úˆČă‚Ɛ„’č‚ł‚ę‚˝97jBŽĺ‚Č—LŠQŽ–Ű‚͉ş—ŸEŒ‘‘ÓŠ´EˆŤSEH—~’ቺ‚Č‚Ç‚Ĺ‚ ‚Á‚˝Bƒ{ƒŠƒmƒXƒ^ƒbƒg‚ÍŽĄ—Ă’ďRŤ‚̐isŠú‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä—LŒř‚ČŽĄ—Ă–ň‚Ĺ‚ ‚čC•Ä‘‚Ĺ‚Í2006 ”N‚ɍĔ­EŽĄ—Ă’ďRŤCTCL ‚ɑ΂ľ‚ďł”F‚ł‚ę‚˝‚ށC–{–M‚Ĺ‚ŕ2011 ”N‚ÉCTCL ‚ɑ΂ˇ‚鎥—Ă–ň‚Ć‚ľ‚ďł”F‚ł‚ę‚˝B

Ä”­EŽĄ—Ă’ďRŤCTCL ‚đ‘ÎŰ‚É‚ľ‚˝romidepsin/depsipeptide ‚Ě2 Œ‚Ě‘ćⅡ ‘ŠŽŽŒą‚ł́C1 “ú14 mg/m2 ‚Ěromidepsin ‚đ‘ć1C8C15 “ú‚ɐҍ“Š—^‚ľC28 “úƒTƒCƒNƒ‹‚ĹŒJ‚č•Ô‚ˇ“Š—^–@‚Ş—p‚˘‚ç‚ę‚˝98, 99jB—źŽŇ‚đ‚Ü‚Ć‚ß‚˝‘tŒř—Ś‚Í35“CCR —Ś6“C‘tŒřŠúŠÔ’†‰›’l13.8 ƒJŒŽ‚Ĺ‚ ‚Á‚˝BŽĺ‚Č—LŠQŽ–Ű‚͈ŤSEšq“fEŒ‘‘ÓŠ´EH—~•sUEŒŒ‹…Œ¸­‚Č‚Ç‚Ĺ‚ ‚Á‚˝98, 99jBRomidepsin‚ÍŽĄ—Ă’ďRŤ‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä—LŒř‚ČHDAC ‘jŠQ–ň‚Ĺ‚ ‚čC•Ä‘‚Ĺ‚Í2009 ”N‚É1 ‚ÂˆČă‚Ě‘Sg—Ă–@‚đŽó‚Ż‚˝‚ą‚Ć‚Ě‚ ‚éCTCL ‚ɑ΂ľ‚ďł”F‚ł‚ę‚˝‚ށC–{–M‚Ĺ‚Í–˘”­”„E–˘ł”F‚Ĺ‚ ‚éB

•śŒŁ

90j Olsen E, Duvic M, Frankel A, et al: Pivotal phase Ⅲ trial of two dose level_pus of denileukin diftitox for the treatment of cutaneous T-cell lymphoma, J Clin Oncol, 2001; 19: 376-388.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

91j Prince HM, Duvic M, Martin A, et al: Phase Ⅲ placebo-controlled trial of denileukin diftitox for patients with cutaneous T-cell lymphoma, J Clin Oncol, 2010; 28: 1870-1877.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

92j Negro-Vilar A, Dziewanowska Z, Groves E, Lombardy E, Stevens V: Phase Ⅲ study of denileukin diftitoxiONTAK?jto evaluate efficacy and safety in CD25 { and CD25- cutaneous T-cell lymphomaiCTCLj patients. BloodiASH Annual Meeting Abstractsj, 2006; 108: Abstract 696.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

93j Lundin J, Osterborg A, Brittinger G, et al: CAMPATH-1H monoclonal antibody in therapy for previously treated low-grade non-Hodgkin's lymphomas: a phase Ⅱ multicenter study, European Study Group of CAMPATH-1H Treatment in Low-Grade Non-Hodgkin's Lymphoma, J Clin Oncol, 1998; 16: 3257-3263.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

94j Lundin J, Hagberg H, Repp R, et al: Phase 2 study of alemtuzumabianti-CD52 monoclonal antibodyj in patients with advanced mycosis fungoides/Sézary syndrome, Blood, 2003; 101: 4267-4272.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

95j Kennedy GA, Seymour JF, Wolf M, et al: Treatment of patients with advanced mycosis fungoides and Sézary syndrome with alemtuzumab, Eur J Haematol, 2003; 71: 250-256.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

96j Bernengo MG, Quaglino PQ, Comessatti A, et al: Low-dose intermittent alemtuzumab in the treatment of Sézary syndrome: clinical and immunologic findings in 14 patients, Haematologica, 2007; 92: 784-794.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

97j Olsen EA, Kim YH, Kuzel TM, et al: Phase ⅡB multicenter trial of vorinostat in patients with persistent, progressive, or treatment refractory cutaneous T-cell lymphoma, J Clin Oncol, 2007; 25: 3109-3115.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

98j Piekarz RL, Frye R, Turner M, et al: Phase Ⅱ multi-institutional trial of the histone deacetylase inhibitor romidepsin as monotherapy for patients with cutaneous T-cell lymphoma, J Clin Oncol, 2007; 27: 5410-5417.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

99j Kim Y, Whittaker S, Demierre MF, et al: Clinically significant responces achieved with romidepsin in treatmentrefractory cutaneous T-cell lymphoma: final results from a phase 2B, international, multicenter, registration study, BloodiASH Annual Meeting Abstructsj, 2008; 112: Abstract 263.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ11

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Di‘Šú‹Űó‘§“÷Çj

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‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚ẮC‚ł‚Ü‚´‚܂ȉťŠw—Ă–@–ň‚Ş’PÜ‚ ‚邢‚Í‘˝Ü•š—p‚ĹŽŽ‚Ý‚ç‚ę‚Ä‚˘‚é‚ŞC‘tŒřŠúŠÔ‚Í’Ęí’Z‚­Cś‘śŠúŠÔ‚̉„’ˇ‚É‚Í‚Â‚Č‚Ş‚ç‚Č‚˘100jB‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚é’PÜ‰ťŠw—Ă–@‚Ě‘tŒř—Ś‚Í62“CCR —Ś33“C‘tŒřŠúŠÔ‚Í3`22 ƒJŒŽ‚Ć‚ł‚ę‚Ä‚˘‚é‚ŞCƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚͍s‚í‚ę‚Ä‚˘‚Č‚˘‚˝‚߁C‚Ç‚Ě–ňÜ‚Ş—D‚ę‚Ä‚˘‚é‚Š‚Í–ž‚ç‚Š‚Ĺ‚Í‚Č‚˘CQ8-79jBisŠú‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚é‘˝Ü•š—p‰ťŠw—Ă–@‚Ě‘tŒř—Ś‚Í81“CCR —Ś38“C‘tŒřŠúŠÔ‚Í5`41 ƒJŒŽ‚Ĺ‚ ‚čC’PÜ‰ťŠw—Ă–@‚Ć‘˝Ü•š—p‰ťŠw—Ă–@‚Ě—LŒřŤ‚É‚Í–ž‚ç‚Š‚ȍˇ‚Í‚Č‚˘CQ8-79jB

isŠú‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éCHOP —Ă–@‚đ‘ă•\‚Ć‚ľ‚˝‰–Ž_ƒhƒLƒ\ƒ‹ƒrƒVƒ“doxorubicin ‚đŠÜ‚Ţ‘ć1 ˘‘ă‚Ě‘˝Ü•š—p‰ťŠw—Ă–@‚ĚŒř‰Ę‚ÉŠÖ‚ľ‚ẮC1 Œ‚Ěƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą101j‚Ć1 Œ‚ĚÇ—á•ń102j‚Ş‚ ‚éB‘tŒř—Ś‚Í90“CCR —Ś‚Í40“’ö“x‚Ĺ‚ ‚é‚ŞC‘tŒřŠúŠÔ‚Í6 ƒJŒŽˆČ“ŕ‚Ĺ‚ ‚čC‰–Ž_ƒhƒLƒ\ƒ‹ƒrƒVƒ“‚đŠÜ‚Ţ‚Š‚Ç‚¤‚Š‚É‚Š‚Š‚í‚炸C’ˇŠúŠÔ‚ĚCR ‚ÍŠú‘Ň‚Ĺ‚Ť‚Č‚˘101, 102jB‘ć3 ˘‘ă‚Ě‘˝Ü•š—p‰ťŠw—Ă–@‚Ĺ‚ ‚éVICOP-B —Ă–@‚̐isŠú‹Űó‘§“÷Ç‚ɑ΂ˇ‚éŒř‰Ę‚đ•]‰ż‚ľ‚˝1 Œ‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚ŕC‘tŒř—Ś‚Í84“CCR —Ś‚Í32“C‘tŒřŠúŠÔ’†‰›’l‚Í9 ƒJŒŽ‚Ć•ń‚ł‚ę‚Ä‚˘‚é103jB‚ľ‚˝‚Ş‚Á‚āCÄ”­EŽĄ—Ă’ďRŤ‚̐isŠú‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚鉝Šw—Ă–@‚ÍŒĆ‘§“IŽĄ—Ă‚Ć‚ľ‚ÄˆĘ’u•t‚Ż‚ç‚ęC‘tŒř—Ś‚Ş‘ź‚Ě–ňÜEŽĄ—Ă‚ć‚č–ž‚ç‚Š‚É—D‚ę‚Ä‚˘‚鉝Šw—Ă–@–ňE‘˝Ü•š—p‰ťŠw—Ă–@‚Í‘śÝ‚ľ‚Č‚˘‚˝‚߁C—Տ°ŽŽŒą‚đœ‚˘‚Ä’Ęí‚Í’PÜ‚É‚ć‚鉝Šw—Ă–@‚đ‘ćˆę‘I‘đ‚É‚ˇ‚é‚ą‚Ć‚đ„§‚ˇ‚éB

’PÜ‚ĹŽg—p‚ł‚ę‚鉝Šw—Ă–@–ň‚Ć‚ľ‚Ä‚ÍMTX ‚ÉŠÖ‚ˇ‚é•ń‚ŞĹ‚ŕ‘˝‚˘‚ށC‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éMTX ‚ĚŒř‰Ę‚đ•]‰ż‚ľ‚˝ƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‚Č‚˘B1 Œ‚ĚŒăŒü‚ŤƒRƒz[ƒgŒ¤‹†‚É‚¨‚˘‚āC’á—p—ĘMTX ‚đ—p‚˘‚˝’PÜ‰ťŠw—Ă–@‚É‚ć‚čC•aŠúT2 ‚Ĺ‚Í‘tŒř—Ś33“CCR —Ś12“C‘tŒřŠúŠÔ’†‰›’l15 ƒJŒŽ‚Ć•ń‚ł‚ę‚Ä‚˘‚é‚ŞCT3 ‚Ĺ‚ÍCR ‚Í“ž‚ç‚ę‚Ä‚˘‚Č‚˘104jB“ŻˆęŽ{Ý‚É‚¨‚Ż‚é•aŠúT4 ‚̍g”çÇŒ^‹Űó‘§“÷ÇESézary ÇŒóŒQ‚đ‘ÎŰ‚É‚ľ‚˝Ç—áWĎŒ¤‹†‚Ĺ‚Í, ‘tŒř—Ś58“CCR —Ś41“C‘tŒřŠúŠÔ’†‰›’l31 ƒJŒŽ‚Ć•ń‚ł‚ę‚Ä‚˘‚é105jB‚ľ‚˝‚Ş‚Á‚Ä, MTX ‚Í•aŠúT4 ‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä—LŒř‚ČŽĄ—Ă–ň‚Ĺ‚ ‚éB–{–M‚Ĺ‚Í‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä’á—p—ĘƒGƒgƒ|ƒVƒhetoposideiETPj/VP-16 “ŕ•ž—Ă–@106j‚Ş—p‚˘‚ç‚ę‚é‚ą‚Ć‚Ş‘˝‚­CƒXƒeƒƒCƒh‚ŕ’P“Ć‚ ‚邢‚͉ťŠw—Ă–@–ň‚Ć‚Ě•š—p‚ĹŽg—p‚ł‚ę‚éB

‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚鉖Ž_ƒQƒ€ƒVƒ^ƒrƒ“gemcitabine ‚ĚŒř‰Ę‚đ•]‰ż‚ľ‚˝ƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‚Č‚˘‚Ş, 1 Œ‚ĚÇ—áWĎŒ¤‹†‚É‚¨‚˘‚āCŽĄ—Ă’ďRŤ‚̐isŠú‹Űó‘§“÷Çi•aŠúⅡB/Ⅲj‚ɑ΂ľ‚Ä’PÜ‚Ĺ—p‚˘‚˝ę‡C‘tŒř—Ś70“CCR —Ś10“‚Ć•ń‚ł‚ę‚Ä‚˘‚é107jBisŠú‹Űó‘§“÷Çi•aŠúⅡB/Ⅲj‚ĆSézary ÇŒóŒQi1 —áj‚ɑ΂ˇ‚鏉‰ńŽĄ—Ă‚Ć‚ľ‚ĉ–Ž_ƒQƒ€ƒVƒ^ƒrƒ“‚đ—p‚˘‚˝1 Œ‚ĚÇ—áWĎŒ¤‹†‚ł́CSézary ÇŒóŒQ‚É‚Í–łŒř‚Ĺ‚ ‚Á‚˝‚ށC‹Űó‘§“÷Ç‚Ĺ‚Í‘tŒř—Ś73“CCR —Ś23“‚Ĺ‚ ‚Á‚˝108jB‚ą‚ę‚ç‚ĚŒ¤‹†‚Ě‘ÎŰ‚É‚Í‹Űó‘§“÷ÇESézary ÇŒóŒQˆČŠO‚̔畆•a•Ď‚𔺂¤––˝T ×–EƒŠƒ“ƒpŽîŠłŽŇ‚ŕŠÜ‚Ü‚ę‚Ä‚˘‚é‚˝‚߁C‹Űó‘§“÷ÇŠłŽŇ‚Ě‚Ý‚Ĺ‚Ě‘tŒřŠúŠÔ‚Í•s–ž‚Ĺ‚ ‚é‚ŞCCR ‚Ş“ž‚ç‚ę‚˝ŠłŽŇ‘S‘Ě‚Ě‘tŒřŠúŠÔ’†‰›’l‚Í10`15 ƒJŒŽ‚Ĺ‚ ‚Á‚˝107, 108jB‘ź‚ĚŽ{Ý‚É‚¨‚Ż‚é”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Ĺ‚ŕ“Ż—l‚ČŒ‹‰Ę‚Ş•ń‚ł‚ę‚Ä‚¨‚č109jC‰–Ž_ƒQƒ€ƒVƒ^ƒrƒ“‚͐isŠú‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä’PÜ‚ĹŒř‰Ę‚ŞŠú‘Ň‚Ĺ‚Ť‚é–ňÜ‚Ĺ‚ ‚éB‚ľ‚Š‚ľ, –{–M‚ł͉–Ž_ƒQƒ€ƒVƒ^ƒrƒ“‚͈ŤŤƒŠƒ“ƒpŽî‚ɑ΂ľ‚Ä–˘ł”F‚Ĺ‚ ‚éB

ƒvƒŠƒ“ƒAƒiƒƒO‚Ĺ‚ ‚éƒyƒ“ƒgƒXƒ^ƒ`ƒ“pentostatin/2-deoxycoformycinCƒNƒ‰ƒhƒŠƒrƒ“cladribine/2-chlorodeoxyadenosineCƒŠƒ“Ž_ƒtƒ‹ƒ_ƒ‰ƒrƒ“fludarabine ‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éŒř‰Ę‚ÉŠÖ‚ľ‚Ä‚Í‘˝‚­‚Ě•ń‚Ş‚ ‚é‚ŞCƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚͍s‚í‚ę‚Ä‚˘‚Č‚˘B2 Œ‚ĚƒRƒz[ƒgŒ¤‹†‚¨‚ć‚Ń1 Œ‚ĚÇ—áWĎŒ¤‹†‚É‚¨‚Ż‚éƒyƒ“ƒgƒXƒ^ƒ`ƒ“‚ĚSézary ÇŒóŒQ‚ɑ΂ˇ‚é‘tŒř—Ś‚Í33`71“CCR —Ś5`29“‚Ć•ń‚ł‚ę‚Ä‚˘‚é‚ŞC‹Űó‘§“÷Ç‚Ĺ‚Í‘tŒř—Ś0`57“CCR —Ś0`14“‚Ĺ‚ ‚čCSézary ÇŒóŒQ‚ć‚č”˝‰ž‚ވŤ‚˘110`112jB‚Ü‚˝C‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éƒyƒ“ƒgƒXƒ^ƒ`ƒ“‚Ě‘tŒřŠúŠÔ’†‰›’l‚Í2`9 ƒJŒŽ‚Ć’Z‚˘110, 111, 113jB1 Œ‚ĚÇ—áWĎŒ¤‹†‚É‚¨‚˘‚āCƒyƒ“ƒgƒXƒ^ƒ`ƒ“‚ĆIFN-ƒż‚Ě•š—p—Ă–@‚É‚ć‚čC‘tŒř—Ś‚̓yƒ“ƒgƒXƒ^ƒ`ƒ“’P“Ć‚Ć“Ż’ö“x‚Ĺ‚ ‚é‚ŞC‘tŒřŠúŠÔ‚މ„’ˇ‚ˇ‚é‚ą‚Ć‚ŞŽŚ‚ł‚ę‚Ä‚˘‚é114jBƒNƒ‰ƒhƒŠƒrƒ“‚¨‚ć‚ŃƒŠƒ“Ž_ƒtƒ‹ƒ_ƒ‰ƒrƒ“‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éŒř‰Ę‚̓yƒ“ƒgƒXƒ^ƒ`ƒ“‚ć‚č—ň‚é‚ƍl‚Ś‚ç‚ęC2 Œ‚ĚÇ—á•ń‚¨‚ć‚Ń1Œ‚ĚÇ—áWĎŒ¤‹†‚É‚¨‚Ż‚éƒNƒ‰ƒhƒŠƒrƒ“‚Ě‘tŒř—Ś‚Í25`38“CCR —Ś0`14“‚Ć•ń‚ł‚ę‚Ä‚˘‚é115`117jBƒNƒ‰ƒhƒŠƒrƒ“‚Ĺ‚ŕSézary ÇŒóŒQŠłŽŇ‚Ě‚Ý‚đ‘ÎŰ‚É‚ľ‚˝1 Œ‚ĚÇ—á•ń‚Ĺ‚Í, ‘tŒř—Ś66“CCR —Ś13“‚Ş“ž‚ç‚ę‚Ä‚˘‚é‚ŞCŠ´őÇ‚É‚ć‚č50“‚ŞŽ€–S‚ľ‚Ä‚˘‚é118jB1 Œ‚ĚÇ—áWĎŒ¤‹†‚É‚¨‚Ż‚郊ƒ“Ž_ƒtƒ‹ƒ_ƒ‰ƒrƒ“’PÜ‚Ě‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚é‘tŒř—Ś‚Í19“CCR —Ś‚Í3“‚Ć’á‚Š‚Á‚˝‚˝‚ß119jC‚ł‚Ü‚´‚Ü‚Č•š—p—Ă–@‚ŞŽŽ‚Ý‚ç‚ę‚Ä‚˘‚éB1 Œ‚ĚÇ—áWĎŒ¤‹†‚É‚¨‚˘‚āCƒŠƒ“Ž_ƒtƒ‹ƒ_ƒ‰ƒrƒ“‚ĆIFN-ƒż‚Ě•š—p—Ă–@‚É‚ć‚é‘tŒř—Ś‚Í51“CCR —Ś‚Í11“‚Ĺ‚ ‚čC•aŠúⅣB‚¨‚ć‚Ńƒyƒ“ƒgƒXƒ^ƒ`ƒ“‚ĆIFN-ƒż‚Ě•š—p—Ă–@‚É’ďRŤ‚ĚŠłŽŇ‚Ĺ‚ŕŒř‰Ę‚Ş”F‚ß‚ç‚ę‚Ä‚˘‚é120jB1 Œ‚ĚÇ—áWĎŒ¤‹†‚É‚¨‚˘‚āCƒŠƒ“Ž_ƒtƒ‹ƒ_ƒ‰ƒrƒ“‚ĆƒVƒNƒƒzƒXƒtƒ@ƒ~ƒh‚Ě•š—p—Ă–@‚ĚSézary ÇŒóŒQ‚ɑ΂ˇ‚é—LŒřŤ‚ŞŽŚ‚ł‚ę‚˝‚ށC‘tŒřŠúŠÔ’†‰›’l‚Í10 ƒJŒŽ‚Ĺ‚ ‚čCœ‘“ŐŤ‚Ş‹­‚­ś‘śŠúŠÔ‚̉„’ˇ‚Í”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝121jB1 Œ‚Ě”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ł́CƒŠƒ“Ž_ƒtƒ‹ƒ_ƒ‰ƒrƒ“‚ĚSézary ÇŒóŒQ‚ɑ΂ˇ‚é‘tŒř—Ś‚Í35“CCR —Ś‚Í18“‚Ĺ‚ ‚čC‹Űó‘§“÷Ç‚ɑ΂ˇ‚é‘tŒř—Ś26“CCR —Ś4“‚ć‚č‚‚­C‚Ü‚˝, ƒŠƒ“Ž_ƒtƒ‹ƒ_ƒ‰ƒrƒ“‚É‚ć‚é’PÜ‰ťŠw—Ă–@Œă‚ÉECP ‚đs‚¤‚ą‚Ć‚É‚ć‚čC‚ł‚ç‚É‘tŒř—Ś‚͍‚‚­‚Č‚é‚ŞC‘tŒřŠúŠÔEś‘śŠúŠÔ‚Ě—LˆÓ‚ȉ„’ˇ‚Í”F‚ß‚ç‚ę‚Č‚˘‚Ć•ń‚ł‚ę‚˝122jB‚ľ‚˝‚Ş‚Á‚Ä, ƒyƒ“ƒgƒXƒ^ƒ`ƒ“‚Ü‚˝‚̓Šƒ“Ž_ƒtƒ‹ƒ_ƒ‰ƒrƒ“‚É‚ć‚é’PÜ‰ťŠw—Ă–@‚¨‚ć‚ŃIFN-ƒż‚Ć‚Ě•š—p—Ă–@‚ÍSézary ÇŒóŒQ‚ɑ΂ľ‚Ä—LŒř‚Ĺ‚ ‚é‚ŞC–{–M‚Ĺ‚Í‚˘‚¸‚ę‚ŕ‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä–˘ł”F‚Ĺ‚ ‚éB

‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éƒhƒLƒ\ƒ‹ƒrƒVƒ“‰–Ž_‰–ƒŠƒ|ƒ\[ƒ€’ŽËÜpegylated liposomal doxorubicin ‚ĚŒř‰Ę‚đ•]‰ż‚ľ‚˝ƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‚Č‚˘‚ށC4 Œ‚ĚÇ—áWĎŒ¤‹†‚Ş‚ ‚é123`126jBisŠú‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚é’PÜ‰ťŠw—Ă–@‚Ě‘tŒř—Ś‚Í56`87“CCR —Ś‚Í20`42“‚Ĺ‚ ‚čC‘tŒřŠúŠÔ’†‰›’l‚Í5`12 ƒJŒŽ‚Ć•ń‚ł‚ę‚Ä‚˘‚é123`125jB‚Ü‚˝C1 Œ‚ĚÇ—áWĎŒ¤‹†‚ł́C•aŠúⅣB ‚Ě‹Űó‘§“÷Ç‚Ĺ‚ŕ30“‚ÉPR ‚Ş“ž‚ç‚ę‚Ä‚˘‚é126jB‚ľ‚˝‚Ş‚Á‚āCƒhƒLƒ\ƒ‹ƒrƒVƒ“‰–Ž_‰–ƒŠƒ|ƒ\[ƒ€’ŽËÜ‚͐isŠú‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä’PÜ‚ĹŒř‰Ę‚ŞŠú‘Ň‚Ĺ‚Ť‚é–ňÜ‚Ĺ‚ ‚é‚ŞC–{–M‚Ĺ‚Í‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚Ä–˘ł”F‚Ĺ‚ ‚éB

•śŒŁ

100jRosen ST, Foss FM: Chemotherapy for mycosis fungoides and the Sézary syndrome, Hematol Oncol Clin North Am, 1995; 9: 1109-1116.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅵj

101jGrozea PN, Jones SE, McKelvey EM, et al: Combination chemotherapy for mycosis fungoides: a Southwest Oncology Group study, Cancer Treat Rep, 1979; 63: 647-653.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅱj

102jMolin L, Thomsen K, Volden G, et al: Combination chemotherapy in the tumour stage of mycosis fungoides with cyclophosphamide, vincristine, vp-16, adriamycin and prednisoloneicop, chop, cavopj: a report from the Scandinavian mycosis fungoides study group, Acta Derm Venereol, 1980; 60: 542-544.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

103jFierro MT, Doveil GC, Quaglino P, et al: Combination of etoposide, idarubicin, cyclophosphamide, vincristine, prednisone and bleomyciniVICOP-Bj in the treatment of advanced cutaneous T-cell lymphoma: Dermatology, 1997; 194: 268-272.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

104jZackheim HS, Kashani-Sabet M, McMillan A: Low-dose methotrexate to treat mycosis fungoides: a retrospective study in 69 patients, J Am Acad Dermatol, 2003; 49: 873-878.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

105jZackheim HS, Kashani-Sabet M, Hwang ST: Low-dose methotrexate to treat erythrodermic cutaneous T-cell lymphoma: results in twenty-nine patients, J Am Acad Dermatol, 1996; 34: 626-631.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

106jˆä‘ş–ž_Cź‘ş‘×—mC‹gě‹`Œ°‚Ů‚ŠF”畆ƒŠƒ“ƒtƒH[ƒ}‚ɑ΂ˇ‚éŒoŒűÜetoposide ‚ĚŒř‰ĘC”畆‚ĚƒŠƒ“ƒtƒH[ƒ}C1993; Xii: 112-115.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

107jZinzani PL, Baliva G, Magagnoli M, et al: Gemcitabine treatment in pretreated cutaneous T-cell lymphoma: experience in 44 patients, J Clin Oncol, 2000; 18: 2603-2606.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

108jMarchi E, Alinari L, Tani M, et al: Gemcitabine as frontline treatment for cutaneous T-cell lymphoma: phase Ⅱ study of 32 patients. Cancer, 2005; 104: 2437-2441.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

109jDuvic M, Talpur R, Wen S, et al: Phase Ⅱ evaluation of gemcitabine monotherapy for cutaneous T-cell lymphoma. Clin Lymphoma Myeloma, 2006; 7: 51-58.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

110jMercieca J, Matutes E, Dearden C, et al: The role of pentostatin in the treatment of T-cell malignancies: analysis of response rate in 145 patients according to disease subtype, J Clin Oncol, 1994; 12: 2588-2593.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

111jKurzrock R, Pilat S, Duvic M: Pentostatin therapy of T-cell lymphomas with cutaneous manifestations, J Clin Oncol, 1999; 17: 3117-3121.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

112jHo AD, Suciu S, Stryckmans P, et al: PentostatiniNipentj in T-cell malignancies. Leukemia Cooperative Group and the European Organization for Research and Treatment of Cancer, Semin Oncol, 2000; 27: 52-57.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

113jGreiner D, Olsen EA, Petroni G: Pentostatini2'-deoxycoformycinj in the treatment of cutaneous T-cell lymphoma, J Am Acad Dermatol, 1997; 36: 950-955.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

114jFoss FM, Ihde DC, Breneman DL, et al: Phase Ⅱ study of pentostatin and intermittent high-dose recombinant interferon alfa-2a in advanced mycosis fungoides/Sézary syndrome, J Clin Oncol, 1992; 10: 1907-1913.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

115jSaven A, Carrera CJ, Carson DA, et al: 2-Chlorodeoxyadenosine: an active agent in the treatment of cutaneous T-cell lymphoma, Blood, 1992; 80: 587-592.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

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121jScarisbrick JJ, Child FJ, Clift A, et al: A trial of fludarabine and cyclophosphamide combination chemotherapy in the treatment of advanced refractory primary cutaneous T-cell lymphoma, Br J Dermatol, 2001; 144: 1010-1015.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

122jQuaglino P, Fierro MT, Rossotto GL, et al: Treatment of advanced mycosis fungoides/Sézary syndrome with fludarabine and potential adjunctive benefit to subsequent extracorporeal photochemotherapy, Br J Dermatol, 2004; 150: 327-336.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

123jWollina U, Dummer R, Brockmeyer NH, et al: Multicenter study of pegylated liposomal doxorubicin in patients with cutaneous T-cell lymphoma, Cancer, 2003; 98: 993-1001.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

124jPulini S, Rupoli S, Goteri G, et al: Pegylated liposomal doxorubicin in the treatment of primary cutaneous T-cell lymphomas. Haematologica, 2007; 92: 686-689.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

125jQuereux G, Marques S, Nguyen J-M, et al: Prospective multicenter study of pegylated liposomal doxorubicin treatment in patients with advanced or refractory mycosis fungoides or Sézary syndrome, Arch Dermatol, 2008; 144: 727-733.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

126jDi Lorenzo G, Di Trolio R, Delfino M, De Placido S: Pegylated liposomal doxorubicin in stage ⅣB mycosis fungoides, Br J Dermatol, 2005; 153: 183-185.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


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Ç—á•ń‚¨‚ć‚ŃÇ—áWĎŒ¤‹†‚đ“‡‚ľ‚˝1 Œ‚Ěƒƒ^ƒAƒiƒŠƒVƒX‚É‚¨‚˘‚āCisŠú‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ľ‚ÄŽŠ‰Ć‘˘ŒŒŠ˛×–EˆÚA•š—p‘ĺ—ʉťŠw—Ă–@‚đs‚Á‚Ä‚ŕC‘˝‚­‚Í’ZŠúŠÔ‚ĹÄ”­‚ˇ‚é‚ą‚Ć‚ŞŽŚ‚ł‚ę‚Ä‚˘‚é127jB‚ľ‚˝‚Ş‚Á‚Ä, ŒťŽž“_‚Ĺ‚Í‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚鎊‰Ć‘˘ŒŒŠ˛×–EˆÚA•š—p‘ĺ—ʉťŠw—Ă–@‚̐ϋɓI‚Č“K‰ž‚Í‚Č‚­C‘tŒřŠúŠÔ‚̉„’ˇ‚Ě‚˝‚߂ɂ͈ڐAŒă‚ĚÄ”­‚đ–hŽ~‚Ĺ‚Ť‚éŒř‰Ę“I‚ČˆŰŽ—Ă–@‚ĚŠJ”­‚Ş•K—v‚Ĺ‚ ‚éB

“ŻŽí‘˘ŒŒŠ˛×–EˆÚA‚ł́Cgraft-versus-lymphoma/Leukemia Œř‰Ę‚É‚ć‚čisŠú‹Űó‘§“÷ÇESézary ÇŒóŒQ‚Ĺ‚ŕ’ˇŠúŠÔ‚ĚCR ‚ŞŠú‘Ň‚Ĺ‚Ť‚é‚Ş127jC“KŘ‚Čƒhƒi[‚Ě‘śÝ‚Ş•K—v‚Ĺ‚ ‚čCGVHD ‚⊴őÇ‚Č‚Ç‚ĚˆÚAŠÖ˜A‡•šÇ‚¨‚ć‚ŃˆÚAŠÖ˜AŽ€‚Ě•p“x‚ލ‚‚˘‚˝‚ß“K‰ž‚ÍŒŔ’č‚ł‚ę‚éBœ‘”ń”j‰ó“I‘Oˆ’u‚đ—p‚˘‚˝“ŻŽí‘˘ŒŒŠ˛×–EˆÚAiRISTj‚Í”äŠr“I‚—îŽŇ‚ɑ΂ľ‚Ä‚ŕŽ{s‰Â”\‚Ĺ‚ ‚é‚ŞC‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚éRIST ‚ɂ‚˘‚Ă͍ĄŒă‚ł‚ç‚Č‚é•]‰ż‚Ş•K—v‚Ĺ‚ ‚éB‚ľ‚Š‚ľCŒťŽž“_‚ł́CisŠú‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɑ΂ˇ‚鎥—Ă‚Ĺ’ˇŠúŠÔ‚ĚCR ‚ŞŠú‘Ň‚Ĺ‚Ť‚é‚ŕ‚Ě‚Í“ŻŽí‘˘ŒŒŠ˛×–EˆÚA‚Ě‚Ý‚Ĺ‚ ‚é‚˝‚߁CŽá”N‚̐isŠú‹Űó‘§“÷ÇESézary ÇŒóŒQŠłŽŇ‚ɑ΂ľ‚Ä‚Í—Ő°ŽŽŒą‚Ć‚ľ‚Ä‚Ě“ŻŽí‘˘ŒŒŠ˛×–EˆÚA‚Ě“K‰ž‚đŒŸ“˘‚ľ‚Ä‚ŕ‚悢B

•śŒŁ

127jWu PA, Kim YH, Lavori PW, Hoppe RT, Stockerl-Goldstein KE: A meta-analysis of patients receiving allogeneic or autologous hematopoietic stem cell transplant in mycosis fungoides and Sézary syndrome, Biol Blood Marrow Transplant, 2009; 15: 982-990.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj


2DŽĺ‚Ȕ畆T/NK ×–EƒŠƒ“ƒpŽîi‹Űó‘§“÷ÇESézary ÇŒóŒQˆČŠOj


ŸŠTŕ

‹Űó‘§“÷ÇESézary ÇŒóŒQˆČŠO‚̔畆T/NK ×–EƒŠƒ“ƒpŽî‚ÉŠÖ‚ˇ‚éCQ ‚đ‰đŕ‚ˇ‚éBNK ×–EƒŠƒ“ƒpŽî‚Í•@oE•›•@o‚Ȃǔ畆ˆČŠO‚̐ߊO‘ŸŠí‚É”­ś‚ˇ‚é‚ą‚Ć‚Ş‘˝‚˘‚˝‚ß•Ę€–Ú‚Ć‚ľ‚˝B

‹Űó‘§“÷ÇESézary ÇŒóŒQˆČŠO‚̔畆T/NK ×–EƒŠƒ“ƒpŽî‚ÍWHO-EORTC •Ş—Ţ‚Ĺ‚Í”äŠr“I‹}‘Ź‚ɐis‚ľ—\Œă•s—Ç‚Ĺ‚ ‚é•aŒ^iAggressive groupj‚Ʃɏ™isŤ‚Őś–˝—\Œă—ǍD‚Č•aŒ^iindolent groupj‚É‘ĺ•Ę‚ł‚ę‚éBAggressive groupiŒ´”­Ť”畆CD8 —zŤisŤ•\”çŒüŤ×–EŠQŤT ×–EƒŠƒ“ƒpŽîCŒ´”­Ť”畆ƒÁƒÂ×–EƒŠƒ“ƒpŽîC––˝ŤT ×–EƒŠƒ“ƒpŽîC”ń“Á’čj‚Í“Œv“I‚É‚Í5 ”Nś‘ś—Ś10“‘ä‚Ĺ‚ ‚čCś–˝—\Œă‚Í‹É‚ß‚Ä•s—Ç‚Ĺ‚ ‚é‚ŞC‚ť‚Ě‚Č‚Š‚ɂ͔畆•a•Ď‚Ě‚Ý‚Ĺ’ˇŠú‚É‚í‚˝‚čŒo‰ß‚ľ‚Ä‚˘‚éÇ—á‚Č‚Ç‚ŕŠÜ‚Ü‚ę‚Ä‚¨‚čŒo‰ß‚Íˆę—Ľ‚Ĺ‚Í‚Č‚˘1`7jB”畆•a•Ď‚Ě‚Ý‚ĹŒo‰ß‚ľC‘SgÇó‚â’˜‚ľ‚˘ŒŸ¸’lˆŮí‚Ş‚Č‚˘Ç—á‚ɂ‚˘‚Ä‚Í‹Űó‘§“÷ÇESézary ÇŒóŒQ‚ɏ€‚ś‚˝skin-directed therapy ‚ŞŽĺ‘Ě‚Ć‚Č‚čCƒŠƒ“ƒpßE“ŕ‘ŸZ‚â‘SgÇóC’˜‚ľ‚˘ŒŸ¸’lˆŮí‚Č‚Ç‚đ—ˆ‚˝‚ľ‚˝Ç—á‚Í‘Sg‰ťŠw—Ă–@‚Ě“K‰ž‚ƍl‚Ś‚ç‚ę‚é‚ŞCŒÂX‚ĚŠłŽŇ‚̏ó‘Ԃɉž‚ś‚ÄŽĄ—Ă•ű–@‚đŒŸ“˘‚ˇ‚ׂŤ‚Ĺ‚ ‚čCˆę—Ľ‚ÉŽĄ—Ă•űj‚đŽŚ‚ˇ‚Ě‚Í“ď‚ľ‚˘‚˝‚ßCQ ‚Ě‘ÎŰ‚Ć‚Í‚ľ‚Č‚Š‚Á‚˝BIndolent groupiŒ´”­Ť”畆–˘•Ş‰ť‘ĺ×–EƒŠƒ“ƒpŽîC”牺Ž‰–bD‰Š—lT ×–EƒŠƒ“ƒpŽîCŒ´”­Ť”畆CD4 —zŤŹE’†×–EŒ^T ×–EƒŠƒ“ƒpŽîj‚Í•aŒ^‚˛‚Ć‚É“Á’Ľ“I‚Č—Ő°ŠŒŠCŒo‰ß‚đŽŚ‚ˇ‚˝‚߁CŒÂX‚Ě•aŒ^‚ɂ‚˘‚ÄCQ ‚đěŹ‚ľ‚˝B

‹Űó‘§“÷ÇESézary ÇŒóŒQˆČŠO‚̔畆T/NK ×–EƒŠƒ“ƒpŽî‚Í‹Űó‘§“÷ÇESézary ÇŒóŒQ‚Ć‚ÍˆŮ‚Č‚é”畆•a•Ď‚̍L‚Ş‚čCi“W‚đŽŚ‚ˇ‚˝‚߁C‹Űó‘§“÷Ç‚đ‘ÎŰ‚Ć‚ľ‚˝•aŠú•Ş—Ţ‚Í“K‰ž‚Ĺ‚Ť‚Č‚˘B2007 ”N‚ÉISCL ‚¨‚ć‚ŃEORTC ‹¤“Ż‚Ĺ‹Űó‘§“÷ÇESézary ÇŒóŒQˆČŠO‚̔畆ƒŠƒ“ƒpŽî‚đ‘ÎŰ‚Ć‚ľ‚˝•aŠú•Ş—ŢˆÄ‚Ş’ńĽ‚ł‚ę‚˝8jB‚ą‚Ě•aŠú•Ş—Ţ‚Ě‘Ă“–Ť‚Í‚Ü‚žŒŸŘ‚ł‚ę‚Ä‚¨‚炸C‚ą‚Ě•Ş—Ţ‚É]‚Á‚ăKƒCƒhƒ‰ƒCƒ“‚đěŹ‚ˇ‚é‚Ě‚Í–{—ˆ‚ÍŽžŠúŽ‘‚Ĺ‚ ‚éB‚ľ‚Š‚ľC‘ź‚É‘Ă“–‚Č•aŠú•Ş—Ţ‚ÍŒŠ‚ç‚ꂸCĄŒă‚ĚƒKƒCƒhƒ‰ƒCƒ“‰ü’č‚ĚŰ‚É‚Í‹¤’Ę‚Ě•aŠú•Ş—Ţ‚É—§‹r‚ľ‚˝—Տ°î•ń‚̏WĎ‚ޏd—v‚Ĺ‚ ‚é‚˝‚߁C‚ą‚ą‚Ĺ‚Í‚ą‚Ě•aŠú•Ş—ŢˆÄ‚đĚ—p‚ľ‚˝B

•śŒŁ

1j Willemze R, Jaffe ES, Burg G, et al: WHO-EORTC classification for cutaneous lymphomas. Blood, 2005; 105: 3768-3785.

2j Toro JR, Beaty M, Sorbara L, et al: Gamma delta T-cell lymphoma of the skin: a clinical, microscopic, and molecular study, Arch Dermatol, 2000; 136: 1024-1032.

3j Santucci M, Pimpinelli N, Massi D, et al: Cytotoxic/natural killer cell cutaneous lymphomas. Report of EORTC Cutaneous Lymphoma Task Force Workshop, Cancer, 2003; 97: 610-627.

4j Lu D, Patel KA, Duvic M, Jones D: Clinical and pathological spectrum of CD8-positive cutaneous T-cell lymphomas, J Cutan Pathol, 2002; 29: 465-472.

5j Toro JR, Liewehr DJ, Pabby N, et al: Gamma-delta T-cell phenotype is associated with significantly decreased Survival in cutaneous T-cell lymphoma, Blood, 2003; 101: 3407-3412.

6j Bekkenk MW, Vermeer MH, Jansen PM, et al: Peripheral T-cell lymphomas unspecified presenting in the skin: analysis of prognostic factors in a group of 82 patients, Blood, 2003; 102: 2213-2219.

7j Berti E, Tomasini D, Vermeer MH, et al: Primary cutaneous CD8-positive epidermotropic cytotoxic T cell lymphomas. A distinct clinicopathological entity with an Aggressive clinical behavior, Am J Pathol, 1999; 155: 483-492.

8j Kim YH, Willemze R, Pimpinelli N, et al: ISCL and the EORTC. TNM classification system for primary cutaneous lymphomas other than mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous LymphomasiISCLj and the Cutaneous Lymphoma Task Force of the European Organization of Research and Treatment of CanceriEORTCj, Blood, 2007; 110: 479-484.


CQ13

Œ´”­Ť”畆–˘•Ş‰ť‘ĺ×–EƒŠƒ“ƒpŽî‚ɑ΂ľ‚Ä•úŽËü—Ă–@‚ ‚邢‚ÍŠO‰Č“IŘœ‚Č‚Ç‚Ě‹ÇŠ—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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B

•úŽËü—Ă–@‚âŠO‰Č“IŘœ‚É‚ć‚č‘˝‚­‚ĚÇ—á‚ĹŠ°‰đ“ą“ü‚މ”\‚Č‚˝‚߁CŽ{s‰Â”\‚ČÇ—á‚É‚Í‚ą‚ę‚ç‚ĚŽĄ—Ă‚ŞŠŠ‚ß‚ç‚ę‚éB

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‚ą‚ę‚Ü‚Ĺ‚ĚŒ´”­Ť”畆–˘•Ş‰ť‘ĺ×–EƒŠƒ“ƒpŽîiprimary cutaneous anaplastic large cell lymphoma: cALCLj ‚ÉŠÖ‚ˇ‚é•ń‚͏ǗáWĎŒ¤‹†1`4j‚âÇ—á•ń5`7j‚Ě‚Ý‚Ĺ‚ ‚čC•úŽËüŽĄ—Ă‚âŠO‰Č“IŽĄ—Ă‚Ě—LŒřŤ‚đ”äŠrŒŸ“˘‚ľ‚˝•ń‚ÍŒŠ‚ç‚ę‚Č‚˘B‚ą‚ę‚Ü‚Ĺ‚Ě•ń‚Ĺ‚ÍcALCL ‚ɑ΂ľ‚Ä‚Í•úŽËü—Ă–@‚âŠO‰Č“IŘœ‚Č‚Ç‚Ě‹ÇŠ—Ă–@C’PÜ‚ ‚邢‚Í‘˝Ü•š—p‰ťŠw—Ă–@‚Č‚Ç‚Ě‘Sg—Ă–@‚ލs‚í‚ę‚Ä‚˘‚éBLiu ‚ç‚Ě25 —á‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚ÍAnn Arbor stage ⅠE ‚Ě11 —á‚ɑ΂ľ‚Ä•úŽËü—Ă–@‚ ‚邢‚ÍŠO‰Č“IŘœ‚ŞŽ{s‚ł‚ę‚Ä‚¨‚čC•úŽËü—Ă–@‚Ĺ‚Í7 —á’†6 —áCŠO‰ČŘœ‚Ĺ‚Í4 —á‘S—áCR ‚Ć‚Č‚Á‚Ä‚˘‚é1jBBeljaards ‚ç‚Í47 —á‚ĚÇ—áWĎŒ¤‹†‚Ĺ•úŽËü—Ă–@i5 —ájCŠO‰Č“IŘœi11 —áj‚¨‚ć‚Ń—źŽŇ‚Ě•š—pi4 —áj‚đŽ{s‚ľC‘S—á‚ĹCR ‚Ć•ń‚ľ‚Ä‚˘‚é2jBBekkenk ‚ç‚Í79 —á‚ĚÇ—áWĎŒ¤‹†‚Ĺ•úŽËü—Ă–@i38 —ájCŠO‰Č“IŘœi15 —ájCŽ‡ŠOü—Ă–@i3 —ájCƒXƒeƒƒCƒhŠO—pi3 —áj‚đŽ{s‚ľC‚Ů‚Ú‘S—á‚ĹCR ‚Ć•ń‚ľ‚Ä‚˘‚é3jB‚ą‚ę‚ç‚ĚŒ‹‰Ę‚Š‚çCcALCL ‚͋ǏŠ—Ă–@‚Ŕ畆•a•Ď‚̐§Œä‚͉”\‚Ĺ‚ ‚éB‚˘‚¸‚ę‚Ě•ń‚Ĺ‚ŕ‹ÇŠ—Ă–@‚É‚ć‚éÄ”­‚Í–ń”ź”‚É‚Ý‚ç‚ę‚é‚ŞC‘˝Ü•š—p‰ťŠw—Ă–@‚Ĺ‚ŕ”ź”—áˆČă‚ĹÄ”­‚ľ‚Ä‚¨‚čiCQ14jCŽĄ—Ă–@‚É‚ć‚芰‰đ—ŚCÄ”­—Ś‚É–ž‚ç‚Š‚ȍˇ‚ÍŒŠ‚ç‚ę‚Č‚˘BcALCL ‚Ě5 ”Nś‘ś—Ś‚Í90“ˆČă‚Ć‚ˇ‚é•ń‚Ş‘˝‚­1, 3, 4jCś–˝—\Œă—ǍD‚Č•aŒ^‚Ĺ‚ ‚čC‘Sg—Ă–@‚Ĺ‚ŕÄ”­‚Ş‚Ý‚ç‚ę‚é‚˝‚ߋǏŠ—Ă–@‚ŞŽ{s‰Â”\‚ČÇ—á‚Í‘Sg—Ă–@‚ć‚č‚ŕNPC•›ě—p‚ĚŒy“x‚Č‹ÇŠ—Ă–@‚đ‘I‘đ‚ˇ‚é‚ą‚Ć‚Ş–]‚Ü‚ľ‚˘B]‚Á‚āC’P”­•a•Ď‚âŒŔ‹ÇŤ•a•ĎiT1CT2j‚Ĺ‚Í•úŽËü—Ă–@‚Ü‚˝‚ÍŠO‰Č“IŘœ‚Ş‘ćˆę‘I‘đ‚Ĺ‚ ‚čC”Ä”­•a•ĎiT3j‚ɑ΂ľ‚Ä‚ŕ•úŽËü—Ă–@‚މ”\‚Ĺ‚ ‚ę‚Αćˆę‘I‘đ‚Ć‚ľ‚ÄŠŠ‚ß‚ç‚ę‚éB‚˝‚ž‚ľC–{–M‚Ĺ‚ÍCHOP —Ă–@ŒăÄ”­—á‚É‘ćŽO˘‘㉝Šw—Ă–@‚đ—v‚ľ‚˝—á‚⃊ƒ“ƒpß‚¨‚ć‚Ń“ŕ‘ŸZ‚𐜂ś‚˝—\Œă•s—ǏǗá‚Č‚Ç‚Ş•ń‚ł‚ę‚Ä‚¨‚čCŒľd‚ČŒo‰ßŠĎŽ@‚Í•K—v‚Ĺ‚ ‚é5`7jB

•śŒŁ

1j Liu HL, Hoppe RT, Kohler S, Harvell JD, Reddy S, Kim YH: CD30{cutaneous lymphoproliferative disorders: the Stanford experience in lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma, J Am Acad Dermatol, 2003; 49: 1049-1058.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Beljaards RC, Kaudewitz P, Berti E, et al: Primary cutaneous CD30-positive large cell lymphoma: definition of a new type of cutaneous lymphoma with a favorable prognosis. A European Multicenter Study of 47 patients, Cancer, 1993; 71: 2097-2104.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j Bekkenk MW, Geelen FA, van Voorst Vader PC, et al: Primary and secondary cutaneous CD30 { lymphoproliferative disorders: a report from the Dutch Cutaneous Lymphoma Group on the long-term follow-up data of 219 patients and guidelines for diagnosis and treatment, Blood, 2000; 95: 3653-3661.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

4j Vergier B, Beylot-Barry M, Pulford K, et al: Statistical Evaluation of Diagnostic and Prognostic Features of CD30 { Cutaneous lymphoproliferative Disorders: A Clinicopathologic Study of 65 Cases. Am J Surg Pathol, 1998; 22: 1192-1202.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Tokura Y, Sugita K, Yagi H, Shimauchi T, Kabashima K, Takigawa M: Primary cutaneous anaplastic large cell lymphoma with fatal leukemic outcome in Association with CLA and CCR4-negative conversion, J Am Acad Dermatol, 2007; 57: S92-96.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

6j Isogai R, Fukao M, Kawada A: Successful treatment for recurrence of primary cutaneous anaplastic large-cell lymphoma in elderly patient with etoposide, mitoxantrone, cyclophosphamide, vincristine, prednisolone and bleomyciniVNCOP-Bj therapy, J Dermatol, 2007; 34: 556-560.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

7j Sugiyama H, Asagoe K, Morizane S, Oono T, Okazaki F, Iwatsuki K: Leukocyte common antigen-negative, Aggressive cutaneous anaplastic large cell lymphoma with prominent pseudocarcinomatous hyperplasia, Eur J Dermatol, 2008; 18: 74-77.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj


CQ14

Œ´”­Ť”畆–˘•Ş‰ť‘ĺ×–EƒŠƒ“ƒpŽî‚ɑ΂ľ‚ĉťŠw—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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C1i”畆•a•Ď‚Ě‚Ýę‡j

”畆•a•Ď‚Ě‚Ý‚Ĺ‚ŕ•úŽËü—Ă–@‚âŘœ‚Č‚Ç‚Ě‹ÇŠ—Ă–@‚ɑ΂ľ‚ÄŽĄ—Ă’ďRŤ‚ĚÇ—á‚â‘˝”­—á‚ɑ΂ľ‚Ă͉ťŠw—Ă–@‚ĚŽŔŽ{‚đl—ś‚ľ‚Ä‚ŕ‚悢BƒŠƒ“ƒpß•a•Ď‚â“ŕ‘ŸZ—á‚ɑ΂ľ‚Ă͉ťŠw—Ă–@‚ŞŠŠ‚ß‚ç‚ę‚éB

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‚ą‚ę‚Ü‚Ĺ‚ĚcALCL ‚ÉŠÖ‚ˇ‚é•ń‚͏ǗáWĎŒ¤‹†8j, CQ13-1`3j‚âÇ—á•ń9j‚Ě‚Ý‚Ĺ‚ ‚čC‰ťŠw—Ă–@‚Ě—LŒřŤ‚đ”äŠr‚ľ‚˝•ń‚ÍŒŠ‚ç‚ę‚Č‚˘BcALCL ‘΂ˇ‚鉝Šw—Ă–@‚Ć‚ľ‚Ä‚Š‚‚ĂÍCHOP —Ă–@‚Ě•ń‚Ş‘˝‚­CLiu ‚ç‚Ě25 —á‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚ÍAnn Arbor stage ⅠE ‚Ě5 —áCAnn Arbor stage Ⅳ ‚Ě6 —á‚ɑ΂ľ‚Ä‘˝Ü•š—p‰ťŠw—Ă–@iCHOP —Ă–@j‚ŞŽ{s‚ł‚ę‚Ä‚¨‚čC11 —á’†10 —á‚ĹCR ‚Ć‚Č‚Á‚Ä‚˘‚éCQ13-1jBBeljaards ‚ç‚Ě47 —á‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚Í7 —áCBekkenk ‚ç‚Ě79 —á‚ĚÇ—áWĎŒ¤‹†‚Ĺ6 —á‚É‘˝Ü•š—p‰ťŠw—Ă–@‚ŞŽ{s‚ł‚ęC‘S—á‚ĹCR ‚Ć•ń‚ł‚ę‚Ä‚˘‚éCQ13-2, 3jB‚ľ‚Š‚ľCLiu ‚ç‚Ě•ńCQ13-1j‚Ĺ‚Í–ń”ź”‚ĚÇ—á‚ŁCBeljaards ‚ç‚Ě•ńCQ13-2j‚Ĺ‚Í85“‚ĚÇ—á‚ĹÄ”­‚ľ‚Ä‚¨‚čC‰ťŠw—Ă–@‚ÍŞŽĄ“IŽĄ—Ă‚É‚Í‚Č‚ç‚Č‚˘‚ą‚Ć‚Ş‘˝‚˘CQ13-3jB]‚Á‚āC”畆•a•Ď‚Ě‚Ý‚ĚÇ—á‚ɑ΂ľ‚Ä‚Í•úŽËü—Ă–@‚âŘœ‚Č‚Ç‚Ě‹ÇŠ—Ă–@‚đs‚˘iCQ13jC‚ť‚ĚŒă‚ɍĔ­‚đŒJ‚č•Ô‚ˇę‡‚â‚ą‚ę‚ç‹ÇŠ—Ă–@‚ލ˘“ď‚Č‘˝”­•a•Ď‚đ—L‚ˇ‚éÇ—áiT3j‚ɂ͉ťŠw—Ă–@‚đl—ś‚ľ‚Ä‚ŕ‚悢BcALCL ‚ɑ΂ˇ‚鉝Šw—Ă–@‚ɂ‚˘‚āC‚ł‚Ü‚´‚܂ȉťŠw—Ă–@Ü‚Ě‘tŒř—Ś‚Č‚Ç‚đ”äŠrŒŸ“˘‚ľ‚˝•ń‚ÍŒŠ‚ç‚ꂸCÇ—áWĎŒ¤‹†CQ13-3j‚âÇ—á•ń8, 9j‚ŞŒŠ‚ç‚ę‚é‚Ě‚Ý‚Ĺ‚ ‚é‚ŞCƒƒgƒgƒŒƒLƒT[ƒgiMTXj‚Ě’PÜ‰ťŠw—Ă–@‚đ‘ćˆę‘I‘đ‚Ć‚ˇ‚é•ń‚Ş‘˝‚˘10j, CQ13-3jB‚˝‚ž‚ľC‘OqiCQ13j‚̂悤‚É–{–M‚𒆐S‚Ć‚ľ‚ÄcALCL ‚Ě—\Œă•s—Ç—á‚Ş•ń‚ł‚ę‚Ä‚¨‚čC’PÜ‰ťŠw—Ă–@Ž{sŒă‚ŕŽîᇑޏk‚Ş‚Ý‚ç‚ę‚Č‚˘ę‡‚É‚Í‘˝Ü•š—p‰ťŠw—Ă–@‚đ‘I‘đ‚ˇ‚éB‚Ü‚˝C‘˝”­•a•Ď‚ޏo–v‚đŒJ‚č•Ô‚ˇę‡‚ɂ̓Šƒ“ƒpŽî—l‹u]Ç‚Ć‚ĚŠÓ•Ę‚Ş•K—v‚Ĺ‚ ‚éB‚ť‚Ě‚˝‚ß”ç]‚ĚŒo‰ß‚Ş•s–ž‚Čę‡‚É‚Í•a•Ď•”‚̏o–v‚Ě—L–ł‚đŠm”F‚ˇ‚é‚˝‚߁C4 T‚Š‚ç8 TŠÔŒo‰ßŠĎŽ@‚Ć‚˘‚¤‘I‘đ‚ŕ‚ ‚éCQ13-3jB‚Č‚¨CƒŠƒ“ƒpŽî—l‹u]Ç‚ɑ΂ˇ‚鉝Šw—Ă–@‚ÍMTX ‚đ„§‚ˇ‚é•ń‚Ş‘˝‚˘11, 12j

”畆•a•Ď‚̏Š‘ŽƒŠƒ“ƒpß—Ěˆć‚Ě‚Ý‚ÉƒŠƒ“ƒpß•a•Ď‚đ—L‚ˇ‚éÇ—á‚͔畆•a•Ď‚Ě‚Ý‚Ěę‡‚Ć“Ż—l‚ɐś–˝—\Œă‚͗ǍD‚Ĺ‚ ‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é‚ŞCQ13-3jC‰ß‹Ž‚Ě•ń‚ŏŠ‘ŽƒŠƒ“ƒpß•a•Ď‚đ—L‚ˇ‚éÇ—á‚Í‚Ů‚Ć‚ń‚Ç‚Ş‘˝Ü•š—p‰ťŠw—Ă–@‚đŽ{s‚ł‚ę‚ÄCR ‚Ć‚Č‚Á‚Ä‚˘‚é‚˝‚ßCQ13-3jC•úŽËü—Ă–@‚â’PÜ‰ťŠw—Ă–@‚Ĺ‚ĚŒř‰Ę‚Í•s–ž‚Ĺ‚ ‚čC‘˝Ü•š—p‰ťŠw—Ă–@‚Ş‘ćˆę‘I‘đ‚Ć‚ľ‚ÄŠŠ‚ß‚ç‚ę‚éB“ŕ‘Ÿ•a•Ď‚𐜂ś‚Ä‚˘‚éÇ—á‚ɂ‚˘‚ẮCcALCL ‚ĚŽžŠłŠT”O‚Š‚çŠO‚ę‚é‚˝‚߁Canaplastic large cell lymphoma, ALKnegative ‚ɏ€‚ś‚˝ŽĄ—Ă•ű–@‚đ‘I‘đ‚ˇ‚×‚Ť‚Ĺ‚ ‚čC‘˝Ü•š—p—Ă–@‚ŞŠî–{‚Ć‚Č‚éB

•śŒŁ

8j Vonderheid EC, Sajjadian A, Kadin ME: Methotrexate is effective therapy for lymphomatoid papulosis and other primary cutaneous CD30-positive lymphoproliferative disorders, J Am Acad Dermatol, 1996; 34: 470-481.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

9j Fujita H, Nagatani T, Miyazawa M, et al: Primary cutaneous anaplastic large cell lymphoma successfully treated with low-dose oral methotrexate, Eur J Dermatol, 2008; 18: 360-361.

10j Willemze R, Jaffe ES, Burg G, et al: WHO-EORTC classification for cutaneous lymphomas, Blood, 2005; 105: 3768-3785.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

11j Wantzin LG, Thomsen K: Methotrexate in lymphomatoid papulosis, Br J Dermatol. 1984; 111: 93-95.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

12j Christensen HK, Thomsen K, Vejlsgaard GL: Lymphomatoid papulosis: a follow-up study of 41 patients, Semin Dermatol. 1994; 13: 197-201.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ15

”牺Ž‰–bD‰Š—lT ×–EƒŠƒ“ƒpŽî ‚ɑ΂ľ‚Ä•úŽËü—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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C1

ŒŔ‹ÇŤ•a•Ď‚ɑ΂ľ•úŽËü—Ă–@‚đs‚¤‚ą‚Ć‚É‚ć‚čCĆŽË•”ˆĘ‚ĚƒRƒ“ƒgƒ[ƒ‹‚͉”\‚Ĺ‚ ‚éB‘SgÇó‚𔺂킸CŒŔ‹Ç‚ľ‚˝”͈́iT1CT2j‚É•a•Ď‚ŞŒŠ‚ç‚ę‚éÇ—á‚̏‰ŠúŽĄ—Ă‚Ć‚ľ‚Ä‚ÍŽŔŽ{‚đl—ś‚ľ‚Ä‚ŕ‚悢B

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”牺Ž‰–bD‰Š—lT ×–EƒŠƒ“ƒpŽîisubcutaneous panniculitis-like T-cell lymphoma : SPTCLj‚Ě•ń“–‰‚ÍAggressive ‚ɐis‚ľś–˝—\Œă•s—Ç—á‚Ş‘˝‚˘‚Ć‚ł‚ę‚Ä‚˘‚˝13jB‚ť‚ĚŒăÇ—á‚̏WĎ‚É‚Ć‚ŕ‚Č‚˘C×–EŠQŤƒżƒŔT ×–EC×–EŠQŤƒÁƒÂT ×–ECNK ×–E‚Č‚Ç‚ł‚Ü‚´‚Ü‚Čphenotype/genotype ‚đŽŚ‚ˇ‚ŕ‚Ě‚Ş‚ ‚é‚ą‚Ć‚Ş’m‚ç‚ę‚é‚悤‚É‚Č‚čCŽîᇍזE‚̐Zƒpƒ^[ƒ“C—\Œă‚ŞˆŮ‚Č‚é‚ą‚Ć‚Ş–ž‚ç‚Š‚É‚ł‚ę‚Ä‚Ť‚˝14, 15jBƒÁƒÂT ×–E‚ĚÇ—á‚͐^”ç‚â”畆ŠO‚ւ̐Z‚𐜂ś‚é‚ą‚Ć‚Ş‘˝‚­CAggressive ‚ɐis‚ľ‚ăżƒŔT ×–E‚ĚÇ—á‚ć‚č‚ŕ—\Œă‚ވŤ‚˘‚˝‚ß16jCWHO-EORTC •Ş—Ţ‚Ĺ‚ÍSPTCL ‚đƒżƒŔT ×–E‚Ě•\–ĘŒ`Žż‚đ—L‚ˇ‚é×–EŠQŤT ×–E‚É‚ć‚郊ƒ“ƒpŽî‚Ć’č‹`‚ľ‚Ä‚˘‚éCQ14-10jBWHO-EORTC •Ş—Ţ‚Ĺ’č‹`‚ł‚ę‚˝SPTCL ‚Ě5 ”Nś‘ś—Ś‚Í–ń80“‚Ĺ‚ ‚čCindolent ŒQ‚É•Ş—Ţ‚ł‚ę‚Ä‚˘‚é‚ŞCŒŒ‹…ćÐHÇŒóŒQihemophagocytic syndrome: HPSj‚𐜂ś‚˝Ç—á‚Ĺ‚Í—\Œă•s—Ç—á‚Ş‘˝‚˘B

SPTCL ‚ɑ΂ľ‚Ä•úŽËü—Ă–@’P“Ć‚Ě—LŒřŤ‚đ”äŠrŒŸ“˘‚ľ‚˝•ń‚ÍŒŠ‚ç‚ꂸC•úŽËüüŽĄ—Ă‚ĚŒř‰Ę‚ÉŒž‹y‚ľ‚Ä‚˘‚éÇ—áWĎŒ¤‹†‚Ş2 •Ň•ń‚ł‚ę‚Ä‚˘‚é16, 17jBWillemze ‚ç‚É‚ć‚č•ń‚ł‚ę‚˝‰˘B‚Ě‘˝Ž{Ý‚É‚ć‚éÇ—áWĎŒ¤‹†‚Ĺ‚Í63 —á‚ĚSPTLC ‚ɑ΂ľC3 —á‚É•úŽËüŽĄ—Ă‚Ş‘I‘đ‚ł‚ę‚Ä‚˘‚éB‚˘‚¸‚ę‚ŕCR ‚Ć‚Č‚Á‚Ä‚˘‚é‚ŞŠ°‰đŠúŠÔ‚Ě‹LÚ‚Í‚Č‚˘17jB‚ť‚Ě‚¤‚ż1 —á‚Ĺ‚ÍÄ”­•a•Ď‚ɑ΂ľÄ“x•úŽËü—Ă–@‚đŽ{s‚ľCCR ‚Ć‚Č‚Á‚Ä‚˘‚éB‚Ü‚˝C2003 ”N‚Ü‚Ĺ‚ÉSPTCL ‚Ć‚ľ‚Ä•ń‚ł‚ę‚Ä‚˘‚é156 —á‚ĚƒŒƒrƒ…[iƒÁƒÂT ×–E‚Ě•\–ĘŒ`Žż‚đ—L‚ˇ‚éÇ—á‚đŠÜ‚ށj‚ł́C•úŽËü—Ă–@’P“Ć‚Í11 —á‚ ‚čC‚˘‚¸‚ę‚ŕŽlŽˆ‚ĚŒŔ‹ÇŤ•a•Ď‚Ş‘ÎŰ‚Ĺ‚ ‚é16jB‚ť‚Ě‚¤‚żCR ‚Ş4 —ái36“jCPR ‚Ş5 —ái45“j‚Ĺ‚ ‚čC‘tŒř—Ś‚Í81“‚Ĺ‚ ‚Á‚˝BCR ‚Ě1 —á‚Í1 ”NˆČă‚Ě’ˇŠúŠ°‰đ‚đŽŚ‚ľ‚Ä‚˘‚é‚ŞC1 —á‚͐”ƒJŒŽ‚ĹÄ”­‚ľC‚ť‚Ě‘ź‚ĚÇ—á‚ĚŒo‰ß‚Í•s–ž‚Ĺ‚ ‚éBCR ‚ÉŽŠ‚Á‚Ä‚˘‚Č‚˘Ç—Ⴈ‚ć‚ŃÄ”­—á‚Í‚ť‚ĚŒă‘Sg‰ťŠw—Ă–@‚đŽ{s‚ł‚ę‚Ä‚˘‚é‚˝‚߁C•úŽËü—Ă–@‚Ě‚Ý‚Ĺ’ˇŠú‚ĚŠ°‰đˆŰŽ‚Í“ď‚ľ‚˘B‚ľ‚Š‚ľCSPTCL ‚Ĺ‚Í‚Ü‚ę‚ÉŽŠ‘RŠ°‰đ—á‚ŕ•ń‚ł‚ę‚Ä‚¨‚č14, 18jC•a•Ď‚ޏŹ”͈͂ɌŔ‹ÇiT1CT2j‚ľC”­”M‚âŠĚ‹@”\áŠQCŒŒ‹…Œ¸­CHPS ‚Č‚Ç‚Ě‘SgÇó‚Ş‚Č‚˘Ç—á‚É‚Í•úŽËü—Ă–@‚đ‘ćˆę‘I‘đ‚Ć‚ľ‚čl—ś‚ľ‚Ä‚ŕ‚悢B‘SgÇó‚Ě‚ ‚éÇ—á‚ɑ΂ľ‚Ä‚Í•úŽËü—Ă–@ˆČŠO‚Ě‘Sg—Ă–@‚đl—ś‚ˇ‚ׂŤ‚Ĺ‚ ‚éB‚Č‚¨C‰ťŠw—Ă–@‚Ć•úŽËü—Ă–@‚đ•š—p‚ľ‚Ä‚˘‚é•ń‚͏­‚Č‚­C•š—p‚ĚŒř‰Ę‚Í•s–ž‚Ĺ‚ ‚éB

•śŒŁ

13j Gonzalez CL, Medeiros J, Braziel RM, Jaffe ES: T-cell lymphoma involving subcutaneous tissue. A clinicopathologic entitiy associated with hemophagocytic syndrome, Am J Surg Pathol, 1991; 15: 17-27.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

14j Salhany KE, Macon WR, Choi JK, et al: Subcutaneous panniculitis-like T-cell lymphoma: clinicopathologic, immunophenotypic, and genotypic analysis of alpha/beta and gamma/delta subtype, Am J Surg Pathol, 1998; 22: 881-893.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

15j Kumar S, Krenacs L, Mederidos J, et al: Subcutaneous panniculitic T-cell lymphoma is a tumor of cytotoxic T lymophocytes, Hum Pathol, 1998; 29: 397-403.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

16j Go RS, Wester SM: Immunophenotypic and molecular features, clinical outcomes, treatments, and prognostic factors associated with subcutaneous panniculitis-like T-cell lymphoma: a systematic analysis of 156 patients reported in the literature, Cancer, 2004; 101: 404-413.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

17j Willemze R, Jansen PM, Cerroni L, et al: Subcutaneous panniculitis-like T-cell lymphoma: definition, classification, and prognostic factors: an EORTC Cutaneous Lymphoma Group Study of 83 cases, Blood, 2008; 111: 838-845.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

18j Santucci M, Pimpinelli N, Massi D, Kadin ME, Meijer CJ, Müller-Hermelink HK, Paulli M, Wechsler J, Willemze R, Audring H, et al: EORTC Cutaneous Lymphoma Task Force. Cytotoxic/natural killer cell cutaneous lymphomas. Report of EORTC Cutaneous Lymphoma Task Force Workshop, Cancer, 2003; 97: 610-627.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj


CQ16

”牺Ž‰–bD‰Š—lT ×–EƒŠƒ“ƒpŽî‚ɑ΂ˇ‚éƒXƒeƒƒCƒh“ŕ•ž‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

B

ƒXƒeƒƒCƒh‚Ě‚Ý‚Ĺ”­”M‚âŠĚ‹@”\ˆŮí‚Č‚Ç‚Ě‘SgÇó‚̉ü‘PC’ˇŠúŠ°‰đ—á‚Ě•ń‚Ş‚ ‚čCƒXƒeƒƒCƒh“ŕ•ž‚ÍŠŠ‚ß‚ç‚ę‚éB

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Ą‰đŕ

SPTCL ‚ɑ΂ľ‚ăXƒeƒƒCƒh“ŕ•ž—Ă–@‚Ě—LŒřŤ‚đ”äŠrŒŸ“˘‚ľ‚˝Œ‹‰Ę‚ÍŒŠ‚ç‚ꂸCƒXƒeƒƒCƒh“ŕ•ž‚ĚŽĄ—ĂŒř‰Ę‚ÉŒž‹y‚ľ‚Ä‚˘‚éÇ—áWĎŒ¤‹†‚Í2 •Ň•ń‚ł‚ę‚Ä‚˘‚éCQ15-16, 17jB‰˘B‚Ě‘˝Ž{Ý‚É‚ć‚éÇ—áWĎŒ¤‹†‚Ĺ‚Í63 —á‚ɑ΂ľC24 —ái38“j‚Ĺ‘˝Ü•š—p‰ťŠw—Ă–@ˆČŠO‚Ě‘Sg—Ă–@‚Ş‘I‘đ‚ł‚ę‚Ä‚˘‚éCQ15-17jB‚ť‚Ě“ŕ–ó‚̓XƒeƒƒCƒh“ŕ•ž19 —áCƒVƒNƒƒXƒ|ƒŠƒ“5 —áCƒNƒƒ‰ƒ“ƒuƒ`ƒ‹3 —áCƒƒgƒgƒŒƒLƒT[ƒg2 —á‚Č‚Ç‚Ĺ‚ ‚čC‚ą‚ę‚ç‚Ě’P“Ć‚¨‚ć‚Ń‚˘‚¸‚ę‚Š‚Ě•š—p‚ލs‚í‚ę‚Ä‚˘‚éBCR ‚Í16—áCPR ‚Í5 —áCNC ‚Ü‚˝‚ÍPD ‚Ş3 —á‚Ĺ‚ ‚čC‘tŒř—Ś‚Í88“‚Ĺ‚ ‚Á‚˝BCR16 —á’†9 —á‚ŞÄ”­‚ľ‚Ä‚˘‚é‚ŞC‚ť‚Ě‚¤‚ż5 —á‚̓XƒeƒƒCƒh“ŕ•ž‚Ü‚˝‚͖Ɖu—}§Ü‚É‚ć‚čÄ“xCR ‚Ć‚Č‚Á‚Ä‚˘‚éBÄ”­•a•Ď‚ɑ΂ľ‚ÄCHOP ‚Č‚Ç‚Ě‘˝Ü•š—p—Ă–@‚đŽ{s‚ł‚ę‚˝‚Ě‚Í8 —á‚Ĺ‚ ‚čC‚ť‚Ě‚¤‚ż3 —á‚ŞCR ‚Ć‚Č‚Á‚Ä‚˘‚éB•ńŽž“_‚Ĺ14 —á‚Í–ł•aś‘śC6 —á‚Í—L•aś‘śC4 —á‚ŞŽ€–S‚ľ‚Ä‚˘‚éBŽ€–S—á‚Í3 —á‚ŞHPS ‚đ‡•š‚ľ‚Ä‚¨‚čC1 —á‚Í‘ź•aŽ€‚Ĺ‚ ‚éB2003 ”N‚Ü‚Ĺ‚ÉSPTCL ‚Ć‚ľ‚Ä•ń‚ł‚ę‚Ä‚˘‚é156 —á‚ĚƒŒƒrƒ…[iƒÁƒÂT ×–E‚Ě•\–ĘŒ`Žż‚đ—L‚ˇ‚éÇ—á‚đŠÜ‚ށj‚Ĺ‚Í‰ŠúŽĄ—Ă‚Ć‚ľ‚Ä20 —á‚ĹƒXƒeƒƒCƒh“ŕ•ž‚Ş‘I‘đ‚ł‚ę‚Ä‚˘‚é‚ŞCCR ‚Í30“CPR20“‚Ĺ‘tŒř—Ś50“‚Ĺ‚ ‚Á‚˝CQ15-16, 17jBŠ°‰đ—á‚ĚŠ°‰đŠúŠÔ‚Í6 ƒJŒŽ–˘–ž‚Ĺ‚ ‚čƒXƒeƒƒCƒhŒ¸—Ę‚Ć‚Ć‚ŕ‚ɍĔ­‚ˇ‚é—á‚Ş‘˝‚˘‚ށCHPS ‚đ‡•š‚ľ‚Ä‚˘‚Č‚˘4 Ç—á‚Ĺ‚Í’†‰›’l‚Ĺ36 ƒJŒŽˆČă‚Ě’ˇŠúŠ°‰đ‚đŽŚ‚ľ‚Ä‚˘‚éBƒXƒeƒƒCƒh“ŕ•žˆČŠO‚Ĺ‚ÍƒVƒNƒƒXƒ|ƒŠƒ“4 —áCƒVƒNƒƒtƒHƒXƒtƒ@ƒ~ƒh3 —áCƒƒgƒgƒŒƒLƒT[ƒg2 —áCƒNƒƒ‰ƒ“ƒuƒ`ƒ‹1 —á‚Ĺ‚ ‚čC4 —á‚ŞPR ‚Ć‚Č‚Á‚˝‚ŞCR ‚Í‚Č‚Š‚Á‚˝B‚ą‚Ě•ń‚Ĺ‚ÍSPTCL ‚ĆƒÁƒÂT ×–EƒŠƒ“ƒpŽî‚ŞŒľ–§‚É‹ć•Ę‚ł‚ę‚Ä‚˘‚Č‚˘‚˝‚߁C‘tŒř—Ś‚Ş’á‚˘‚Ě‚ÍƒÁƒÂT ×–EƒŠƒ“ƒpŽî‚ĚÇ—á‚ŞŠÜ‚Ü‚ę‚Ä‚˘‚é‚˝‚߂̉”\Ť‚Ş‚ ‚éB‚ą‚ę‚ç‚Ě•ń‚Ě‚Ů‚Š‚É‚ŕƒXƒeƒƒCƒh“ŕ•ž‚Ü‚˝‚͖Ɖu—}§Ü‚Ě•š—p—Ă–@‚đ‰ŠúŽĄ—Ă‚Ć‚ľ‚Ä19j, 20jC‚ ‚邢‚Í‘˝Ü•š—p—Ă–@‚É•s‰žŤ‚Ĺ‚ ‚Á‚˝Ç—á21j‚ɑ΂ľ‚ÄŽ{s‚ľCR ‚Ć‚Č‚Á‚˝•ń‚ŞŒŠ‚ç‚ę‚éBSPTCL ‚Í’ˇŠúŠÔ‚É‚í‚˝‚芰‰đÄ”R‚đ‚­‚č•Ô‚ˇÇ—á‚⎊‘RŠ°‰đ‚ˇ‚éÇ—áC•a‰Šú‚ÉŒ‹ßŤg”Á‚Ȃǂ̉ŠÇŤŽžŠł‚Ć‚ĚŠÓ•Ę‚Ć˘“ď‚ČÇ—á‚Ş‚ ‚é‚ą‚Ć‚đl—ś‚ˇ‚é‚ƁC‘ćˆę‘I‘đ‚Ć‚ľ‚Äˆę—Ľ‚É‘˝Ü•š—p‰ťŠw—Ă–@‚đs‚¤‚ą‚Ć‚Í“KŘ‚Ĺ‚Č‚­C‰ŠúŽĄ—Ă‚Ć‚ľ‚Ă̓XƒeƒƒCƒh“ŕ•ž‚Ȃǂ̐NP‚ޏ­‚Č‚˘ŽĄ—Ă‚ŞŠŠ‚ß‚ç‚ę‚éB‚ľ‚Š‚ľCƒXƒeƒƒCƒh‚ĚŽŠ“K—p—ʁC“Š—^ŠúŠÔ‚ÍŒŸ“˘‚ł‚ę‚Ä‚˘‚Č‚˘B‚Ü‚˝CƒXƒeƒƒCƒh“ŕ•ž‚ĹŒř‰Ę‚Ş‚Č‚˘ę‡‚É‚Í‘˝Ü•š—p‰ťŠw—Ă–@‚đl—ś‚ˇ‚éB

•śŒŁ

19j Al Zolibani AA, Al Robaee AA, Qureshi MG, Al Nosian H: Subcutaneous panniculitis-like T-cell lymphoma with hemophagocytic syndrome successfully treated with cyclosporin A, Skinmed, 2006; 5: 195-197.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

20j Tsukamoto Y, Katsunobu Y, Omura Y, et al: Subcutaneous panniculitis-like T-cell lymphoma: successful initial treatment with prednisolone and cyclosporin A, Intern Med, 2006; 45: 21-24.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

21j Rojnuckarin P, Nakorn TN, Assanasen T, Wannakrairot P, Intragumtornchai T: Cyclosporin in subcutaneous panniculitis-like T-cell lymphoma, ILeuk Lymphoma, 2007; 48: 560-563.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj


CQ17

”牺Ž‰–bD‰Š—lT ×–EƒŠƒ“ƒpŽî‚ɑ΂ľ‚Ä‘˝Ü•š—p‰ťŠw—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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B-C1

ƒXƒeƒƒCƒh‚É‚ć‚鎥—Ă‚É’ďR‚đŽŚ‚ˇÇ—á‚ɑ΂ľ‚Ä‚Í‘˝Ü•š—p‰ťŠw—Ă–@‚ĚŽŔŽ{‚đl—ś‚ľ‚Ä‚ŕ‚悢B‚Ü‚˝CŒŒ‹…ćÐHÇŒóŒQ‚đ‡•š‚ľ‚˝Ç—á‚Ě—\Œă‚Í•s—Ç‚Ĺ‚ ‚čC‘˝Ü•š—p‰ťŠw—Ă–@‚ŞŠŠ‚ß‚ç‚ę‚éB

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Ą‰đŕ

SPTCL ‚ɑ΂ľ‚Ä‘˝Ü•š—p‰ťŠw—Ă–@‚Ě—LŒřŤ‚đ”äŠrŒŸ“˘‚ľ‚˝Œ‹‰Ę‚ÍŒŠ‚ç‚ꂸC‘˝Ü•š—p‰ťŠw—Ă–@‚ĚŽĄ—ĂŒř‰Ę‚ÉŒž‹y‚ľ‚Ä‚˘‚éÇ—áWĎŒ¤‹†‚Í2 •Ň•ń‚ł‚ę‚Ä‚˘‚éCQ15-16, 17jB‰˘B‚Ě‘˝Ž{Ý‚É‚ć‚éÇ—áWĎŒ¤‹†‚Ĺ‚Í63 —á‚ɑ΂ľC ‰ŠúŽĄ—Ă‚Ć‚ľ‚Ä31 —á‚É‘˝Ü•š—p‰ťŠw—Ă–@‚ŞŽ{s‚ł‚ę‚Ä‚˘‚éCQ15-17jB‚ť‚Ě‘˝‚­‚ŞCHOP ‚Ü‚˝‚ÍCHOP —ŢŽ—‚Ě‘˝Ü•š—p‰ťŠw—Ă–@‚Ĺ‚ ‚éB‚ą‚ę‚ç‚ĚÇ—á‚Ĺ‚Í19 —ái62“j‚ŞCRC3 —ái10“j‚ŞPR ‚Ĺ‚ ‚č‘tŒř—Ś‚Í72“‚Ĺ‚ ‚éBŠĎŽ@ŠúŠÔ‚Í‹LÚ‚ł‚ę‚Ä‚˘‚Č‚˘‚ށC•ńŽž“_‚ĹCR ‚ĚÇ—á’†‚ĚÄ”­‚Í2 —á‚Ě‚Ý‚Ĺ‚ ‚Á‚˝BCR ‚ÉŽŠ‚ç‚Č‚Š‚Á‚˝Ç—á‚Ě‚¤‚ż2 —á‚̓XƒeƒƒCƒh“ŕ•ž’P“ƁCƒXƒeƒƒCƒh‚ĆƒƒgƒgƒŒƒLƒT[ƒg•š—p‚ĹCR ‚Ć‚Č‚Á‚Ä‚˘‚éBˆę•űC2003 ”N‚Ü‚Ĺ‚ÉSPTCL ‚Ć‚ľ‚Ä•ń‚ł‚ę‚Ä‚˘‚é156 —á‚ĚƒŒƒrƒ…[iƒÁƒÂT ×–E‚Ě•\–ĘŒ`Žż‚đ—L‚ˇ‚éÇ—á‚đŠÜ‚ށj‚ł́C60 —á‚ÉCHOP ‚đŽĺ‘Ě‚Ć‚ľ‚˝‘˝Ü•š—p‰ťŠw—Ă–@‚ŞŽ{s‚ł‚ęCCR21 —ái35“jCPR11 —ái18“j‚Ĺ‚ ‚č‘tŒř—Ś‚Í–ń50“‚Ĺ‚ ‚Á‚˝CQ15-16jB’ʏí—ʂ̉ťŠw—Ă–@‚Ş–łŒř‚Ü‚˝‚͍Ĕ­—á‚ɑ΂ľ‚Ä‘˘ŒŒŠ˛×–EˆÚA•š—p‘ĺ—ʉťŠw—Ă–@‚đŽ{s‚ľ‚˝Ç—á‚Ĺ‚ÍŠ°‰đ—á‚Ě•ń‚Ş‘˝‚˘22jB‚ľ‚Š‚ľC’ʏí—ʂ̉ťŠw—Ă–@‚Ü‚˝‚Í‘ĺ—ʉťŠw—Ă–@‚đs‚¤‚ą‚Ć‚É‚ć‚萜–˝—\Œă‚މü‘P‚ˇ‚é‚Š”Ű‚Š‚ɂ‚˘‚Ä‚Í–ž‚ç‚Š‚É‚ł‚ę‚Ä‚˘‚Č‚˘B

‚ą‚ę‚ç‚Ě•ń‚É‚ć‚é‚Ć‘˝Ü•š—p‰ťŠw—Ă–@‚̓XƒeƒƒCƒh“ŕ•ž‚Č‚Ç‚ĚŽĄ—Ă‚ĆŠ°‰đ—Ś‚Í‘ĺ‚Ť‚ȍˇ‚Í‚Ý‚ç‚ꂸC‘˝Ü•š—p‰ťŠw—Ă–@‚Ş–łŒř‚ĹƒXƒeƒƒCƒh“ŕ•ž‚ĹŠ°‰đ‚É‚Č‚Á‚˝Ç—á‚ŕ‚ ‚é‚˝‚߁C‘˝Ü•š—p‰ťŠw—Ă–@‚ރXƒeƒƒCƒh“ŕ•ž‚Č‚Ç‚ć‚č‚ŕ–ž‚ç‚Š‚ÉŽĄ—ĂŒř‰Ę‚ލ‚‚˘‚Ć‚˘‚¤Ş‹’‚É‚Í–R‚ľ‚˘B‚ą‚ę‚ç‚ĚÇ—áWĎŒ¤‹†‚Ěƒf[ƒ^‚͏dÇ—á‚É‘˝Ü•š—p‰ťŠw—Ă–@‚đŽ{s‚ľ‚Ä‚˘‚˝‰Â”\Ť‚Ş‚ ‚é‚˝‚߁C‘˝Ü•š—p‰ťŠw—Ă–@‚Ě—LŒřŤ‚đ”ے股‚é‚ŕ‚Ě‚Ĺ‚Í‚Č‚˘‚ށCCQ16 ‚Ĺ‚ŕ‹LÚ‚ľ‚˝‚悤‚ÉSPTCL ‚Ĺ‚Í•a‰Šú‚ɃŠƒ“ƒpŽî‚Ć‚Ě˘“ď‚ČÇ—á‚Ş‚ ‚é‚ą‚Ć‚Š‚ç‘˝Ü•š—p‰ťŠw—Ă–@‚̓XƒeƒƒCƒh‚Č‚Ç‚ĚŽĄ—Ă‚ĹŒř‰Ę‚Ş–R‚ľ‚˘ę‡C‚Ü‚˝‚̓XƒeƒƒCƒh‘QŒ¸‚É‚ć‚čÄ”­‚ˇ‚éÇ—á‚Ş“K‰ž‚É‚Č‚é‚ƍl‚Ś‚ç‚ę‚éB

HPS ‡•š—á‚ɑ΂ľ‚Ä‚Í‘˝Ü•š—p‰ťŠw—Ă–@CƒXƒeƒƒCƒh‚Ć‚ŕ‚É‘tŒř—Ś‚Í’á‚­CQ15-16, 17jC‘˝Ü•š—p‰ťŠw—Ă–@‚ŞHPS ‡•š—á‚ɑ΂ľ‚ăXƒeƒƒCƒh‚ć‚č‚ŕˆęŠT‚ÉŒř‰Ę‚ލ‚‚˘‚Ć‚ÍŒž‚Ś‚Č‚˘B‚ľ‚Š‚ľCSPTCL ‚ĚŽžŠłŠÖ˜AŽ€‚Í‚Ů‚Ć‚ń‚Ç‚ŞHPS ‚Ĺ‚ ‚čCHPS ‡•š—á‚ɑ΂ľ‚Ä‘˝Ü•š—p‰ťŠw—Ă–@‚③ŒŒŠ˛×–EˆÚA•š—p‘ĺ—ʉťŠw—Ă–@‚đŽ{s‚ľ—LŒř‚Ĺ‚ ‚Á‚˝•ń‚ŕ‚ ‚é‚˝‚ß23`25jCHPS ‡•š—á‚ɑ΂ľ‚Ä‚Í‘˝Ü•š—p‰ťŠw—Ă–@‚ŞŠŠ‚ß‚ç‚ę‚éB

•śŒŁ

22j Alaibac M, Berti E, Pigozzi B, et al: High-dose chemotherapy with autologous Blood stem cell transplantation for Aggressive subcutaneous panniculitis-like T-cell lymphoma, J Am Acad Dermatol, 2005; 52: S121-3.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

23j Koh MJ, Sadarangani SP, Chan YC, et al: Aggressive subcutaneous panniculitis-like T-cell lymphoma with hemophagocytosis in two childrenisubcutaneous panniculitis-like T-cell lymphomaj, J Am Acad Dermatol, 2009; 61: 875-881.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

24j Medhi K, Kumar R, Rishi A, Kumar L, Bakhshi S: Subcutaneous panniculitislike T-cell lymphoma with hemophagocytosis: complete remission with BFM-90 protocol, J Pediatr Hematol Oncol, 2008; 30: 558-561.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

25j Ichii M, Hatanaka K, Imakita M, Ueda Y, Kishino B, Tamaki T: Successful treatment of refractory subcutaneous panniculitis-like T-cell lymphoma with allogeneic peripheral Blood stem cell transplantation from HLA-mismatched sibling donor, ILeuk Lymphoma, 2006; 47: 2250-2252.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj


CQ18

Œ´”­Ť”畆CD4 —zŤ ŹE’†Œ^T ×–EƒŠƒ“ƒpŽî‚É•úŽËü—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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B

•úŽËü—Ă–@‚É‚ć‚č‘˝‚­‚ĚÇ—á‚ĹŠ°‰đ“ą“ü‚މ”\‚Ĺ‚ ‚čCś–˝—\Œă‚Í”äŠr“I—ǍD‚Ĺ‚ ‚é‚˝‚߁C’P”­‚âŒŔ‹ÇŤ•a•ĎiT1,T2j‚ĚÇ—á‚ɑ΂ľ‚Ä‚Í•úŽËü—Ă–@‚ŞŠŠ‚ß‚ç‚ę‚éB

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Œ´”­Ť”畆CD4 —zŤ ŹE’†Œ^T ×–EƒŠƒ“ƒpŽî‚Í‚Ü‚ę‚Č•aŒ^‚Ĺ‚ ‚čC•úŽËü—Ă–@‚Ě—LŒřŤ‚đ”äŠrŒŸ“˘‚ľ‚˝•ń‚ÍŒŠ‚ç‚ꂸCÇ—áWĎŒ¤‹†‚Ş3 •ŇŒŠ‚ç‚ę‚é‚Ě‚Ý‚Ĺ‚ ‚é26`28jBFriedmann ‚ç‚É‚ć‚é11 —ái‘˝”­7 —áCŒŔ‹ÇŤ1 —áC’P”­3 —áj‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚Í’P”­Ť•a•Ď‚đ—L‚ˇ‚é3 —á‚É•úŽËüŽĄ—Ă‚đs‚˘C‘S—áCR ‚Ć‚Č‚Á‚Ä‚˘‚é26jB‚ą‚ę‚ç‚ĚÇ—á‚Í6~48 ƒJŒŽ‚ĹÄ”­‚ľ‚Ä‚˘‚é‚ŞCÄ”­•a•Ď‚ÍĆŽË–ěŠO‚Ĺ‚ ‚éBBekkenk ‚ç‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚Í19 —ái‘˝”­10 —áCŒŔ‹ÇŤ5 —áC’P”­4 —áj‚ɑ΂ľ12 —á‚É•úŽËüŽĄ—Ă‚Ş‘I‘đ‚ł‚ęC10 —á‚ŞCR ‚Ć‚Č‚Á‚Ä‚˘‚é27jB‚Ü‚˝CGarcia-Herrera ‚ç‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚Í16 —ái‘˝”­2 —áC’P”­14 —áj‚ɑ΂ľC5 —á‚Ĺ•úŽËü—Ă–@‚Ş‘I‘đ‚ł‚ę‚Ä‚˘‚é28jB‚ą‚Ě•ń‚Ĺ‚Í•úŽËüŽĄ—Ă‚Ĺ‚ĚŠ°‰đ—Ś‚Ě‹LÚ‚Í‚Č‚˘‚ށCŠO‰Č“IŘœi8 —áj‚âƒXƒeƒƒCƒhŠO—pi1—áj‚đŠÜ‚ß‚˝14 —á’†12 —á‚ŞCR ‚Ć‚Č‚Á‚Ä‚˘‚éBˆČă‚Š‚çC–{•aŒ^‚Í•úŽËüŠ´ŽóŤ‚ޗǍD‚Ĺ‚ ‚čC‚Ć‚­‚É’P”­‚¨‚ć‚ŃŒŔ‹ÇŤ•a•ĎiT1,T2j‚ɑ΂ˇ‚鏉ŠúŽĄ—Ă‚Ć‚ľ‚Ä•úŽËü—Ă–@‚ŞŠŠ‚ß‚ç‚ę‚éB‚Ü‚˝CŘœ‰Â”\‚Č’P”­•a•Ď‚ɑ΂ľ‚Ä‚ÍŠO‰ČŘœ‚ŕ‘I‘đ‰Â”\‚Ĺ‚ ‚é28, 29jB‘˝”­•a•Ď‚ɑ΂ľ‚Ä‚Í•úŽËü—Ă–@‰Â”\‚Ĺ‚ ‚ę‚Αćˆę‘I‘đ‚Ć‚ľ‚Ä‚ŕ‚悢‚ށCĆŽË–ěŠO‚ĚÄ”­‚Ş‘˝‚˘‚ą‚Ć‚đl—ś‚ˇ‚é‚Ć•a•Ď‚ލL”͈͂ɂ¨‚ć‚Ôę‡iT3j‚É‚Í‘Sg—Ă–@‚ŕl—ś‚ˇ‚éB–{•aŒ^‚Íindolent ‚ČŒo‰ß‚đŽŚ‚ˇś–˝—\Œă—ǍD‚Č•aŒ^‚Ĺ‚ ‚č30jC•úŽËü—Ă–@ˆČŠO‚Ě‹ÇŠ—Ă–@‚஡—Ă‚ĚŒó•â‚Ć‚Č‚é‚ŞCPUVA —Ă–@‚Í2 –ź‚ÉŽ{s‚ł‚ꂢ‚¸‚ę‚ŕPR ‚Ĺ‚ ‚Á‚˝26, 29jB‚Ü‚˝Cmechlorethamine ‚ĚŠO—p—á‚Ĺ‚ÍŒř‰Ę‚Ş“ž‚ç‚ę‚Č‚Š‚Á‚˝‚Ć‚Ě•ń‚ŕ‚ ‚č26jCŽ‡ŠOü—Ă–@‚¨‚ć‚ŃŠO—p—Ă–@‚ÍŒř‰Ę‚Ş–R‚ľ‚˘‚Ɛ„‘Ş‚ł‚ę‚é‚˝‚߁C‘ćˆę‘I‘đ‚Ć‚ľ‚Ä‚ÍŠŠ‚ß‚ç‚ę‚Č‚˘B

•śŒŁ

26j Friedmann D, Wechsler J, Delfau MH, et al: Primary cutaneous pleomorphic small T-cell lymphoma. A review of 11 cases. The French Study Group on Cutaneous Lymphomas, Arch Dermatol, 1995; 131: 1009-1015.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

27j Bekkenk MW, Vermeer MH, Jansen PM, et al: Peripheral T-cell lymphomas unspecified presenting in the skin: analysis of prognostic factors in a group of 82 patients, Blood, 2003; 102: 2213-2219.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

28j Garcia-Herrera A, Luis Colomo, Mireia CamoLs, et al: Primary cutaneous small/medium CD4 { T-cell lymphomas: A heterogeneous group of tumors with different clinicopathologic features and outcome, J Clin Oncol, 2008; 26: 3364-3371.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

29j von den Driesch P, Coors EA: Localized cutaneous small to medium-sized pleomorphic T-cell lymphoma: a report of 3 cases stable for years, J Am Acad Dermatol, 2002; 46: 531-535.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

30j Beltraminelli H, Leinweber B, Kerl H, Cerroni L: Primary cutaneous CD4 { small-/medium-sized pleomorphic T-cell lymphoma: a cutaneous nodular proliferation of pleomorphic T lymphocytes of undetermined significance? A study of 136 cases, Am J Dermatopathol, 2009, 31: 317-322.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ19

Œ´”­Ť”畆CD4 —zŤ ŹE’†Œ^T ×–EƒŠƒ“ƒpŽî‚ɉťŠw—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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C1

‘˝”­•a•Ď‚đ—L‚ˇ‚錴”­Ť”畆CD4 —zŤ ŹE’†Œ^T ×–EƒŠƒ“ƒpŽîiT3j‚ɑ΂ľ‚ẮC‰ťŠw—Ă–@‚ĚŽŔŽ{‚đl—ś‚ľ‚Ä‚ŕ‚悢B

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–{•aŒ^‚ɑ΂ľ‚Ä’PÜ‚ ‚邢‚Í‘˝Ü•š—p‰ťŠw—Ă–@‚Ě—LŒřŤ‚đ”äŠr‚ľ‚˝•ń‚ÍŒŠ‚ç‚ꂸC‰ťŠw—Ă–@‚ÉŒž‹y‚ľ‚Ä‚˘‚éÇ—áWĎŒ¤‹†‚Ş2 •ŇŒŠ‚ç‚ę‚é‚Ě‚Ý‚Ĺ‚ ‚éCQ18-26C27jBFriedmann ‚ç‚É‚ć‚é11 —á‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚Í‘˝Ü•š—p—Ă–@‚đŽ{s‚ľ‚˝Ç—á‚Í‚Č‚­C’PÜ‰ťŠw—Ă–@‚Ĺ‚ÍƒVƒNƒƒtƒHƒXƒtƒ@ƒ~ƒh‚đŒoŒű“Š—^‚ľ‚˝6 —áiƒVƒNƒƒtƒHƒXƒtƒ@ƒ~ƒh’P“Ć2 —áCƒXƒeƒƒCƒh“ŕ•ž•š—p4 —áj‚ĹCRCPR ‚Ş‚ť‚ę‚ź‚ę3 —Ⴘ‚‚ł ‚Á‚˝CQ18-26jB’PÜ‰ťŠw—Ă–@‚͍‚‚˘‘tŒř—Ś‚ŞŠú‘Ň‚Ĺ‚Ť‚é‚ŞCCR Ç—á‚Í1 ”NˆČ“ŕ‚ɍĔ­‚ľ‚Ä‚˘‚éBBekkenk ‚ç‚Ě19 —á‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚Í‘˝Ü•š—p‰ťŠw—Ă–@‚Ş5 —áC’PÜ‰ťŠw—Ă–@‚Ş1 —á‚ÉŽ{s‚ł‚ęC‘˝Ü•š—p‰ťŠw—Ă–@‚Ě5 —á’†2 —á‚ŞCR ‚Ć‚Č‚Á‚Ä‚˘‚é‚ŞC’PÜ‰ťŠw—Ă–@‚Ĺ‚ÍCR ‚Ć‚Č‚Á‚Ä‚˘‚Č‚˘CQ18-27jB‚ą‚ę‚ç‚ĚŒ‹‰Ę‚Š‚ç’PÜC‘˝Ü•š—p‰ťŠw—Ă–@‚Ě‘tŒř—Ś‚͍‚‚˘‚ŕ‚̂́CCR ‚Í–ń50“‚Ĺ‚ ‚é‚˝‚߁C•úŽËüŽĄ—Ă‚Č‚Ç‹ÇŠ—Ă–@‚މ”\‚Čę‡‚É‚Í‚ť‚ę‚ç‚ĚŽĄ—Ă‚đ‘I‘đ‚ˇ‚é‚Ě‚Ş–]‚Ü‚ľ‚­C‰ťŠw—Ă–@‚͍L”͈͂ɕa•Ď‚đ—L‚ˇ‚éÇ—áiT3j‚â•úŽËü—Ă–@‚É‚ć‚鏉ŠúŽĄ—ĂŒă‚ĚÄ”­—á‚Ş“K‰ž‚É‚Č‚é‚ƍl‚Ś‚ç‚ę‚éB‘I‘đ‚ˇ‚×‚Ť‰ťŠw—Ă–@Ü‚đ„§‚ˇ‚鍪‹’‚Í–R‚ľ‚˘‚ށCś–˝—\Œă‚Ş”äŠr“I—ǍD‚Č•aŒ^‚Ĺ‚ ‚é‚ą‚Ć‚Š‚ç‘˝Ü•š—p‰ťŠw—Ă–@‚ć‚č‚Í’PÜ‰ťŠw—Ă–@‚Ş“K‰ž‚É‚Č‚é‚ƍl‚Ś‚ç‚ę‚éB‚Č‚¨C‰ťŠw—Ă–@ˆČŠO‚Ě‘Sg—Ă–@‚Ć‚ľ‚Ă̓Cƒ“ƒ^[ƒtƒFƒƒ“-ƒż‚É‚ć‚鎥—Ă‚Ş5 —á‚ɍs‚í‚ęC2 —á‚ŞCR,3 —á‚ŞPR ‚Ĺ‚ ‚éCQ18-26jB‘ź‚ĚŽĄ—Ă‚Ş‘tŒř‚ľ‚Č‚˘Ç—á‚âÄ”­—á‚É‚Í—L–]‚ČŽĄ—Ă–@‚Ĺ‚ ‚é‚ŞCƒCƒ“ƒ^[ƒtƒFƒƒ“-ƒż‚Í–{–M‚Ĺ‚ÍƒŠƒ“ƒpŽî‚ɑ΂ľ‚Ä•ŰŒŻ“K‰ž‚Ş‚Č‚˘B

•śŒŁ

CQ 18 ‚Ě•śŒŁ‚đŽQĆiV‚ľ‚˘•śŒŁ‚Č‚ľjB


3D”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚鐏lT ×–E”’ŒŒ•aEƒŠƒ“ƒpŽî


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ATLL ‚́CHTLV-I ‚đŒ´ˆöƒEƒCƒ‹ƒX‚Ć‚ľ‚Ä—lX‚Č‘ŸŠí‚É”­Ç‚ˇ‚éT ×–EƒŠƒ“ƒpŽî‚Ĺ‚ ‚éBf’f‚Ě‚˝‚ß‚ĚŽĺ—vŠŒŠ‚Í3 €–Ú‘śÝ‚ľC1jŒ`‘ÔŠw“I‚ÉˆŮí‚ĹT ×–E‚Ě•\–ʍRŒ´‚đ—L‚ˇ‚郊ƒ“ƒp‹…‚̏oŒťi“TŒ^“I‚É‚ÍCD4 { , CD25 {jC2jŒŒ´’†‚̍R HTLV-I R‘Ě‚ĚŘ–žC3jƒTƒUƒ“ƒuƒƒbƒg–@‚ĹŘ–ž‚ł‚ę‚éŽîᇍזE‚Ö‚ĚHTLV-I ƒvƒƒEƒCƒ‹ƒX‚Ěƒ‚ƒmƒNƒ[ƒiƒ‹‚Č‘g‚ݍž‚Ý‚Ĺ‚ ‚é1jB”畆Çó‚đATLL ‚Ě“ÁˆŮ]‚Ɛf’f‚ˇ‚é‚˝‚߂ɂ́C1j‚Ć3j‚ޔ畆‘gD‚ĹŘ–ž‚ł‚ę‚é•K—v‚Ş‚ ‚čC“Á‚É‹Űó‘§“÷Ç‚Č‚Ç‘ź‚̔畆ƒŠƒ“ƒpŽî‚Ć‚ĚŠÓ•Ę‚É‚Í3j‚Ş•K{‚Ĺ‚ ‚é2jB

ATLL ƒKƒCƒhƒ‰ƒCƒ“ěŹ‚É‚¨‚Ż‚é–â‘č“_‚́C”畆‰Č‚Ĺ‚Ç‚Ě”ÍˆÍ‚Ü‚Ĺ‚đˆľ‚¤‚Š‚Ć‚˘‚¤“_‚Ĺ‚ ‚钍jBATLL ‘S”Ę‚ÉŠÖ‚ˇ‚éƒKƒCƒhƒ‰ƒCƒ“‚đěŹ‚ˇ‚é‚Ć‚˘‚¤‚ą‚Ć‚É‚Č‚é‚ĆŒŒ‰t“ŕ‰Č‚đŠÜ‚ß‚˝‘ź‰ČƒKƒCƒhƒ‰ƒCƒ“‚Ć‚Ě‹Ś’˛Ť‚␎‡Ť‚đŽ‚˝‚š‚é‚ą‚Ć‚Ş•K{‚Ĺ‚ ‚čC”畆‰Č’P“Ć‚ĹěŹ‚ˇ‚é‚ą‚Ć‚Í•s‰Â”\‚Ĺ‚ ‚éB‚ť‚ą‚ŁC”畆‰ČƒKƒCƒhƒ‰ƒCƒ“‚ł́CŠłŽŇ‚ޔ畆‰Č‚đĹ‰‚ÉŽóf‚ˇ‚é‚Ĺ‚ ‚낤u”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚é—áv‚Ě‚Ý‚đ‘ÎŰ‚Ć‚ľ‚Ĉľ‚¤‚ą‚Ć‚Ć‚ľ‚˝B‚ľ‚Š‚ľ‚Č‚Ş‚ç]—ˆ‚Š‚ç’ńĽ‚ł‚ę‚Ä‚˘‚é”畆Œ^ATLL2`5j‚́C‚ť‚̐f’f‚ÉŠÖ‚ˇ‚铝ˆę‚ł‚ę‚˝Šî€‚Í‚Č‚­C‘śÝŽŠ‘̂ɔےč“I‚ȍl‚Ś‚ŕ‚ ‚éB‚ą‚ĚƒKƒCƒhƒ‰ƒCƒ“‚ł́C‰ťŠw—Ă–@‚âˆÚA‚Č‚Ç‚Ě‘Sg—Ă–@‚Ě•K—v‚ČÇ—á‚͈ľ‚킸CATLL ‚É”ş‚¤”畆Çó‚ÉŠÖ‚ľ‚āCskin-directed therapy ‚ŞŽĺ‚Ć‚Č‚é—á‚đˆľ‚¤‚ą‚Ć‚Ć‚ľ‚˝6jB

ATLL ‚Ě“ÁˆŮ]‚Ƃ́CATLL ‚Ě—Ő°Œ^‚Í–â‚킸ŒŒ´RHTLV-1 R‘Ě—zŤ‚ŁC ”畆‘gD‚ÉHTLV-1 ‚Ěƒ‚ƒmƒNƒ[ƒiƒ‹‚ČŽć‚荾‚Ý‚Ě‚Ý‚ç‚ę‚˝”畆Çó‚Ć’č‹`‚ˇ‚éBĄ‰ń‚́u]—ˆ‚Š‚ç”畆Œ^‚Ć‚ľ‚Ä•ń‚ł‚ę‚Ä‚Ť‚˝‚ŕ‚́v‚đŠÜ‚߁Cu––˝ŒŒ’†‚ĚATLL ×–E‚Ş5“–˘–ž‚ŁC”畆Œ^‚Ü‚˝‚Í‚­‚ˇ‚Ô‚čŒ^ˆČŠO‚Ě—Ő°Œ^‚É‘Ž‚ł‚Č‚˘‚ŕ‚́v‚đŽb’č“I‚ɁCu”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚éATLLv‚Ć‚ľ‚Ĉľ‚Á‚˝BATLL ‚Ě”ç]‚É‚ć‚Á‚Ä—\Œă‚ŞˆŮ‚Č‚éŒ‹‰Ę‚ŞŽŚ‚ł‚ę‚˝BŒ‹ßEŽîᎌ^‚ƍg”çÇŒ^‚ĚATLL ‚Í—\Œă•s—Ç‚Ĺ‚ ‚é7jB

’jŹlT ×–E”’ŒŒ•aEƒŠƒ“ƒpŽî‚ɂ‚˘‚ẮC“ú–{ŒŒ‰tŠw‰ďu‘˘ŒŒŠíŽîᇐf—ĂƒKƒCƒhƒ‰ƒCƒ“vi2013 ”N ”Łj‚ŞŒöŠJ‚ł‚ę‚˝B

•śŒŁ

1j Shimoyama M: Diagnostic criteria and classification of clinical subtypes of adult T-cell leukaemia-lymphoma. A report from the Lymphoma Study Groupi1984-87j, Br J Haematol, 1991; 79: 428-437.

2j Setoyama M, Katahira Y, Kanzaki T: Clinicopathologic analysis of 124 cases of adult T-cell Leukemia/lymphoma with cutaneous manifestations: the smouldering type with skin manifestations has a poorer prognosis than previously thought, J Dermatol, 1999; 26: 785-790.

3j Takahashi K, Tanaka T, Fujita M, Horiguchi Y, Miyachi Y, Imamura S: Cutaneous-type adult T-cell Leukemia/ lymphoma. A unique clinical feature with monoclonal T-cell proliferation detected by Southern blot analysis, Arch Dermatol, 1988; 124: 399-404.

4j Johno M, Ohishi M, Kojo Y, Yamamoto S, Ono T: Cutaneous manifestations of adult T-ell Leukemia/lymphoma, Gann Monogr Cancer Res, 1992; 39: 33-42.

5j Amano M, Kurokawa M, Ogata K, Itoh H, Kataoka H, Setoyama M: New intity, definition and Diagnostic criteria of cutaneous adult T-cell Leukemia/lymphoma: Human T-lymphotropic virus type 1 proviral DNA load can distinguish between cutaneous and smoldering types, J Dermatol, 2008; 35: 270-275.

6j “V–쐳G, ŁŒËŽR [FŹlT ×–E”’ŒŒ•aEƒŠƒ“ƒpŽî‚̐f’f‚ĆŽĄ—Ă, Derma, 2003; 80: 49-57.

7j Sawada Y, Hino R, Hama K, et al: Type of skin eruption is an independent prognostic indicator for adult T-cell Leukemia/lymphoma, Blood, 2011; 117: 3961-3967.


CQ20

”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚éATLL ‚ɑ΂ľ‚ÄŽ‡ŠOü—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š
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B-C1

”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚éATLL ‚ɑ΂ľ‚ÄPUVA —Ă–@‚ÍŠ°‰đ‚đ“ą“ü‚ˇ‚é‚ą‚Ć‚Ş‚Ĺ‚ŤC—L—p‚Ĺ‚ ‚é‰Â”\Ť‚Ş‚ ‚éB”畆ˆČŠO‚Ö‚Ě•a•Ď‚Ě—L–ł‚ÉŠÖ‚í‚炸CPUVA —Ă–@‚͔畆Çó‚ĚŠÉ˜aŒř‰Ę‚ÍŠú‘Ň‚Ĺ‚Ť‚é‚ŞC”畆ˆČŠO‚̏Ǐó‚Ö‚ĚŒř‰Ę‚␜–˝—\Œă‚̉ü‘P‚ɑ΂ˇ‚éŒř‰Ę‚ÍŠm”F‚ł‚ę‚Ä‚˘‚Č‚˘B

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ATLL ‚Ě“ÁˆŮ]‚ɑ΂ˇ‚鎇ŠOü—Ă–@‚ĚŒř‰Ę‚đ•]‰ż‚ˇ‚郉ƒ“ƒ_ƒ€‰ť‹y‚Ń”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‘śÝ‚ľ‚Č‚˘B”畆ˆČŠO‚É‚ŕ•a•Ď‚Ş‘śÝ‚ľ‚˝—á‚đŠÜ‚ß‚˝ATLL “ÁˆŮ]‚ɑ΂ˇ‚é22 —á‚ĚÇ—áWĎŒ¤‹†‚ł́C‰”­—á‚Ĺ‚Í4 —á’†4 —á‚ŞPR ‚Ĺ‚ ‚Á‚˝‚̂ɑ΂ľCÄ”­—á‚ł́C9 —á’†7 —á‚ŞPRC2 —á‚ŞNC ‚Ĺ‚ ‚Á‚˝1jB”ç]‚ĚŒ^‚É‚ć‚éŒř‰Ę‚ł́Cg”Á‚Ĺ‚Í7 —á’†6 —á‚ŞPRC1 —á‚ŞNCC‹u]‚Ĺ‚Í3 —á’†2 —á‚ŞPRC1 —á‚ŞNCCŒ‹ß‚ł́C3 —á’†3 —á‚ŞPR ‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ł‚ę‚Ä‚˘‚é1jB‚Ü‚˝C1 Œ‚ĚÇ—á•ń‚Ĺ‚Í‚ ‚é‚ŞC‘Sg‚̍g”Á‹u]‚đ—L‚ˇ‚é‹}ŤŒ^ATLL ‚É‚¨‚˘‚ÄPUVA —Ă–@‚đŽŽ‚Ý‚˝‚Ć‚ą‚ë––˝ŒŒ‚ŕŠÜ‚ß‚ÄCR ‚Ş“ž‚ç‚ę‚˝‚Ć‚˘‚¤•ń‚Ş‚ ‚é2jB‚ľ‚Š‚ľC‘SgÇó‚␜–˝—\Œă‚̉ü‘PŒř‰Ę‚ÍŒŸ“˘‘ÎŰ‚Ć‚ľ‚Ä‚˘‚Č‚˘‚˝‚߁Cskin-directed therapy ‚ޔ畆ˆČŠO‚̏Ǐó‚ŕ‰ü‘P‚ł‚š‚é‚Ć‚˘‚¤‰źŕ‚đ—§Ř‚ł‚š‚¤‚é‚ž‚Ż‚ĚŞ‹’‚É–R‚ľ‚˘BˆČă‚Š‚çCATLL ‚É‚¨‚Ż‚é“ÁˆŮ]‚ł́CPUVA —Ă–@‚͔畆Çó‚ĚŠÉ˜a‚É‚ÍŒř‰Ę‚ŞŠú‘Ň‚Ĺ‚Ť‚鎥—Ă–@‚Ĺ‚ ‚éB‚˝‚ž‚ľ”畆ˆČŠO‚̏Ǐó‚Ö‚ĚŒř‰Ę‚âCś–˝—\Œă‚ŕŠÜ‚ß‚˝\•Ş‚Č—Ő°ă‚ĚŒř‰Ę‚ÍŒŸ“˘‚ł‚ę‚Ä‚˘‚Č‚˘B

‚Č‚¨Cƒiƒ[ƒoƒ“ƒhUVB ‚É‚ć‚é—Տ°Œř‰Ę‚Í–˘‚ž\•Ş‚ÉŒŸ“˘‚ł‚ę‚Ä‚˘‚Č‚˘B

•śŒŁ

1j •Đ•˝[•F, aŒűŽu^Žq, “c’†şl, ŁŒËŽR [, _č •ŰFŹlT ×–E”’ŒŒ•aiATLjŠłŽŇ‚̔畆•a•Ď‚ɑ΂ˇ‚鎥—Ă–@‚Ě”äŠrŒŸ“˘C”畆‚ĚƒŠƒ“ƒtƒH[ƒ} , 1999; XVIII: 46-49.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j ’|XM’j, •˝ˆäŽK: ŹlT ×–E”’ŒŒ•a‚ĚŽĄ—Ă‚É‚¨‚Ż‚éPUVA —Ă–@‚ĚˆÓ‹`DPUVA —Ă–@‚Í”’ŒŒ•a×–E‚ĚƒAƒ|ƒg[ƒWƒX‚đ—U”­CHuman Cell, 1995; 8: 121-126.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj


CQ21

”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚éATLL ‚ɑ΂ľ‚Ä•úŽËü—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

B

”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚éATLL ‚ɑ΂ľ‚Ä•úŽËü—Ă–@‚́CÇó‚ĚŠÉ˜aŒř‰Ę‚ŞŠú‘Ň‚Ĺ‚ŤCŠŠ‚ß‚ç‚ę‚éB‚ľ‚Š‚ľ‚Č‚Ş‚çś–˝—\Œă‚̉ü‘P‚ɑ΂ˇ‚éŒř‰Ę‚ÍŠm”F‚ł‚ę‚Ä‚˘‚Č‚˘B

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”畆‚É•a•Ď‚ŞŒŔ‹Ç‚ˇ‚éATLL ‚ɑ΂ˇ‚é•úŽËü—Ă–@‚ĚŒř‰Ę‚ÉŠÖ‚ˇ‚郉ƒ“ƒ_ƒ€‰ť‹y‚Ń”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‘śÝ‚š‚¸C1 Œ‚ĚÇ—áWĎŒ¤‹†‚Ć6 Œ‚ĚÇ—á•ń‚Ş‚ ‚éB“dŽqü‚É‚ć‚鎥—Ă‚Ě•ń‚́C”畆‚ĚŒ‹ß‚âŽîᎂɑ΂ľ‚čs‚í‚ę3`7jCŽîᇂ̏kŹ‚âÁ‘Ţ‚Ć‚˘‚Á‚˝Œř‰Ę‚ŞŒŠ‚ç‚ęC1 —á‚Ĺ‚Í20 Gy ‚ĚĆŽË‚É‚ć‚čŽîáŽ‚ŞÁ‘Ţ‚ľ‚˝Œă‚ɁC”畆Z×–E‚ĚPCR –@‚É‚ÄŽîᇍזE‚̏Á‘Ţ‚đŘ–ž‚ľ‚Ä‚˘‚é5jB‚Ü‚˝“ƒ“ƒgƒQƒ“üiƒfƒ‹ƒ‚ƒpƒ“jĆŽË‚ம‚Ý‚ç‚ę7jŽîᇏkŹŒř‰Ę‚Ş“ž‚ç‚ę‚Ä‚˘‚éB”畆ˆČŠO‚É‚ŕ•a•Ď‚Ş‘śÝ‚ľ‚˝—á‚đŠÜ‚ß‚˝ATLL “ÁˆŮ]‚ɑ΂ˇ‚éŒř‰Ę‚ĚŒŸ“˘‚ł́C5 —áig”Á1 —áCŒ‹ß2 —áCŽîáŽ2 —áj‚Ě“ÁˆŮ]‚ɑ΂ľ‚Ä•úŽËü—Ă–@‚đs‚˘‘S—á‚ĹCR ‚Ĺ‚ ‚Á‚˝‚Ć‚˘‚¤•ń‚Ş‚ ‚éCQ20-1jB––˝ŒŒ‚ÉˆŮŒ^ƒŠƒ“ƒp‹…‚ĚŒŠ‚ç‚ę‚˝—á‚É‚¨‚Ż‚é”畆Žîᎂɑ΂ľ‚Ä‚ĚƒŠƒjƒAƒbƒNX üĆŽË‚É‚ÄŽîᎂ̏Á‘Ţ‚Ć––˝ŒŒ‚Š‚ç‚ĚˆŮŒ^×–E‚̏Á‘Ţ‚ŞŒŠ‚ç‚ę‚˝‚Ć‚˘‚¤•ń‚ŕ‚ ‚é8jBˆČă‚Ě‚ą‚Ć‚Š‚çCATLL ‚É‚¨‚Ż‚é“ÁˆŮ]‚ł́C”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚é—á‚Ĺ‚ŕ”畆ˆČŠO‚É‚ŕ•a•Ď‚đ—L‚ˇ‚é—á‚Ĺ‚ŕC”畆Çó‚ĚŠÉ˜a‚É‚ÍŒř‰Ę‚ŞŠú‘Ň‚Ĺ‚Ť‚鎥—Ă–@‚Ĺ‚ ‚éB‚˝‚ž‚ľś–˝—\Œă‚ŕŠÜ‚ß‚˝\•Ş‚Č—Ő°ă‚ĚŒř‰Ę‚ÍŒŸ“˘‚ł‚ę‚Ä‚˘‚Č‚˘B

•śŒŁ

3j ’Ă“c‹B•FCÎě‰ëŽmC”ş–ě•ü—T‚Ů‚Š: ’ˇŠú‚Ě—Ő°Œo‰ß‚đ‚˝‚Ç‚č”畆Œ^ATL ‚ƍl‚Ś‚˝1 —áC”畆‚ĚƒŠƒ“ƒtƒH[ƒ}C2002; XXI: 78-81.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

4j ’r–ěŽj“TCŕ_“c—ŒbC´‰Ćł”ŽCŹ‹Ę ”ŁFŽîᇍזEZ‚É‚ć‚鍜—Z‰đ‚Ş‘ą”­‚ľ‚˝”畆Œ^ATLLD”畆—Տ°C2004; 46: 29-32.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

5j Suga M, Yamaguchi M, Ichimiya M, Yoshikawa Y, Hamamoto Y, Muto M: A rare case of the cutaneous form of adult T-cell leukaemia/lymphoma: assessment of remission by PCR for clonal T-cell receptor gamma gene rearrangements in an electron beam-irRadiated cutaneous lesion, Clin Exp Dermatol, 2005; 30: 40-42.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

6j ‘şźd“TCÔ–x@˜jC•OŠ_iŽq‚Ů‚ŠFŹlT ×–E”’ŒŒ•a/ ƒŠƒ“ƒpŽî‚ĚŒo‰ß’†‚É•š”­‚ľ‚˝Œă“VŤ‹›—ŘᝂĚ1 —áCŠp‰ťÇŒ¤‹†‰ď‹L˜^W , 2007; 21: 119-122.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

7j •ő@‰ĂŽqCŽR–{—YˆęC•˝—ǐ´l‚Ů‚Š: ”畆Žîᎂ̏o–v‚Ş‚Ý‚ç‚ę‚˝’ˇŠúś‘ś’†‚ĚAdult T-cell Leukemia/LymphomaiATLLj‚Ě 1 —áCź“ú”畆C2007; 69: 521-526.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

8j ŠĄ’J´“żCˆéŠL‘P‘ C‹{˜e‚ł‚¨‚č: ”w•”‚É’P”­Žîᎂđ”F‚ß‚˝ŹlT ×–E”’ŒŒ•aEƒŠƒ“ƒpŽî‚Ě1 —áC”畆—Տ°C2005; 47: 375-379.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj


CQ22

”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚éATLL ‚ɑ΂ľ‚ăŒƒ`ƒmƒCƒh‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

C1

”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚éATLL ‚ɑ΂ľ‚ăŒƒ`ƒmƒCƒh‚ÍŠ°‰đ‚đ“ą“ü‚Ĺ‚Ť‚é‰Â”\Ť‚Ş‚ ‚čCŽg—p‚đl—ś‚ľ‚Ä‚ŕ‚悢B

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–{–M‚Ĺ”­”„‚ł‚ę‚Ä‚˘‚郌ƒ`ƒmƒCƒh‚̓GƒgƒŒƒ`ƒi[ƒg‚ĆƒgƒŒƒ`ƒmƒCƒ“‚Ě‚Ý‚Ĺ‚ ‚čC‚˘‚¸‚ę‚ŕATLL ‚ɑ΂ľ‚Ä‚Í–˘ł”F‚Ĺ‚ ‚éBATLL ‚̔畆Çó‚ɑ΂ˇ‚éƒGƒgƒŒƒ`ƒi[ƒg‚ĚŒř‰Ę‚ÉŠÖ‚ľ‚āCƒ‰ƒ“ƒ_ƒ€‰ť‹y‚Ń”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‘śÝ‚ľ‚Č‚˘B1 Œ‚ĚÇ—á•ń‚ł́CƒGƒgƒŒƒ`ƒi[ƒg‚đ60 mg ‚Š‚çŠJŽn‚ľC34 ƒJŒŽ‚Š‚Ż‚Ä‘QŒ¸‚ľ‚Ä1 ‰ń–Ú‚đI—š‚ľ47 ƒJŒŽ‚ĚŠ°‰đŠúŠÔ‚đ“ž‚Ä‚˘‚éB‚ť‚ĚŒă‚͍Ĕ­‚̂‚Ç30 mg ‚Š‚çŠJŽn‚ľ‚ÄŠ°‰đ‚ľ‚Ä‚˘‚é9jBƒgƒŒƒ`ƒmƒCƒ“iƒI[ƒ‹ƒgƒ‰ƒ“ƒXƒŒƒ`ƒmƒCƒ“Ž_CATRAj‚́C‘“ŕ‚Ĺ‚ÍŒťÝ‚Ě‚Ć‚ą‚ë‹}Ť‘Oœ‘‹…Ť”’ŒŒ•a‚ĚŽĄ—Ă‚Éł”F‚ł‚ę‚Ä‚˘‚é‚ŞCATLL ‚Ö‚Ě“K‰ž‚Í‚Č‚˘B”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚éATLL ‚ɑ΂ˇ‚é2 Œ‚ĚÇ—áWĎŽŽŒą‚ł́C6 —á’†3 —á‚ŞPRi”畆Çó‚Ş50“ˆČă‰ü‘Pj‚Ĺ‚ ‚čd“Ä‚Č•›ě—p‚͏oŒť‚ľ‚Č‚Š‚Á‚˝10jB‚ť‚Ě“ŕ‚Ě1 —á‚ł́C”畆śŒŸ‘gD‚ĹHTLV-I porviral DNA ‚ޏÁŽ¸‚ľ‚˝11jB

‚ą‚ę‚ç‚Ě‚ą‚Ć‚Š‚çC\•Ş‚ȉđÍ‚É‚ć‚éƒGƒrƒfƒ“ƒX‚Í“ž‚ç‚ę‚Ä‚˘‚Č‚˘‚ށC”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚éATLL ‚ɑ΂ľ‚ăŒƒ`ƒmƒCƒh‚Í—L‰v‚Ĺ‚ ‚éB

•śŒŁ

9j Inozume T, Matsue H, Furuhashi M, et al: Successful use of etretinate for long-term management of a patient with cutaneous-type adult T-cell leukaemia/lymphoma, Br J Dermatol, 2005; 153: 1239-1241.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

10j Maeda Y, Yamaguchi T, Hijikata Y, et al: Clinical efficacy of all-trans retinoic acid for treating adult T cell Leukemia, J Cancer Res Clin Oncol, 2008; 134: 673-677.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

11j Maeda Y, Yamaguchi T, Ueda S, Miyazato H, Matsuda M, Kanamaru A: All-trans retinoic acid reduced skin involvement of adult T-cell Leukemia, Leukemia, 2004; 18: 1159-1160.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ23

”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚éATLL ‚ɑ΂ľ‚ăCƒ“ƒ^[ƒtƒFƒƒ“—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

C1

”畆‚É•a•Ď‚ŞŒŔ‹Ç‚ˇ‚éATLL ‚ɑ΂ľ‚āCƒCƒ“ƒ^[ƒtƒFƒƒ“ƒKƒ“ƒ}‚͏Ǐó‚đŠÉ˜a‚Ĺ‚Ť‚é‰Â”\Ť‚Ş‚ ‚čCŽg—p‚đl—ś‚ľ‚Ä‚ŕ‚悢B”畆ˆČŠO‚̏Ǐó‚Ö‚ĚŒř‰Ę‚␜–˝—\Œă‚̉ü‘P‚ɑ΂ˇ‚éŒř‰Ę‚ÍŠm”F‚ł‚ę‚Ä‚˘‚Č‚˘B

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”畆‚É•a•Ď‚ŞŒŔ‹Ç‚ˇ‚éATLL ‚ɑ΂ˇ‚éƒCƒ“ƒ^[ƒtƒFƒƒ“ƒKƒ“ƒ}‚ĚŒř‰Ę‚ÉŠÖ‚ˇ‚郉ƒ“ƒ_ƒ€‰ť‹y‚Ń”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‘śÝ‚ľ‚Č‚˘B1 Œ‚ĚÇ—áWĎŒ¤‹†‚ł́C”畆‚É•a•Ď‚ŞŒŔ‹Ç‚ˇ‚éATLL ‘Ώ۩łŽŇ22 —á‚Ě‚¤‚żCCR ‚Ş5 —áCPR ‚Ş7 —á‚Ĺ‘tŒř—Ś‚Í54.5“i22 —á’†12 —ájCR —Ś22.7“i22 —á’†5 —áj‚Ĺ‚ ‚Á‚˝12jB2000 ”N‚Š‚çIFN-ƒÁ-n1 ‚́CATLL ‚̔畆Çó‚ɑ΂ľ‚ÄŒ’•Ű“K‰ž‚ޏł”F‚ł‚ę‚Ä‚˘‚钍jB2 Œ‚ĚÇ—á•ń‚ł́CŽĄ—ĂŒř‰Ę‚Ş“ž‚ç‚ę‚˝—á‚Ć‚ľ‚Ä‘ĺŒ^‚ĚŽîᎂ̏kŹ13j‚âg”ÁC‹u]‚Ě2 Ç—á14j‚Č‚Ç‚ĚŽg—pŒoŒą‚Ş•ń‚ł‚ę‚Ä‚˘‚éBIFN-ƒÁ-n1 ‚Í•›ě—p‚Ć‚ľ‚āC”’ŒŒ‹…Œ¸­CŠĚ‹@”\áŠQCt•s‘SC‚¤‚CƒVƒ‡ƒbƒN‚Č‚Ç‚Ş•ń‚ł‚ę‚Ä‚˘‚é‚ŞATLL ŠłŽŇ‚É‚¨‚Ż‚é”­Œť•p“x‚Í•s–ž‚Ĺ‚ ‚éBƒXƒeƒƒCƒhŠO—pÜ‚⎇ŠOü—Ă–@‚É’ďRŤ‚ĚÇ—á‚Ĺ‚ÍŽŽ‚Ý‚Ä‚ŕ‚悢ŽĄ—Ă–@‚Ĺ‚ ‚é‚ŞC•›ě—p‚đŠÜ‚ß‚˝—L—pŤ‚âC”畆ˆČŠO‚̏Ǐó‚Ö‚ĚŒř‰ĘCś–˝—\Œă‰ü‘PŒř‰Ę‚ÉŠÖ‚ľ‚ẮCŽs”ĚŒă—Տ°ŽŽŒą‚ĚŒ‹‰Ę‚đ‘Ň‚˝‚Č‚Ż‚ę‚΂Ȃç‚Č‚˘B

’jIFN-ƒÁ-n1 ‚͐ť‘˘E”Ě”„‚Ş’†Ž~‚ł‚ę‚˝i•âˆâŽQĆjB

•śŒŁ

12j ÎŒ´˜a”VFŹlT ×–E”’ŒŒ•aEƒŠƒ“ƒpŽî‚đ‘ÎŰ‚Ć‚ľ‚˝OH-6000 ‚ĚŒăŠú—Տ°‘ćⅡ ‘ŠŽŽŒąCSkin Cancer, 1997; 12: 301-314.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

13j Oba T, Suzuki R, Miyamura K, Kodera Y: Huge mass of cutaneous-type adult T-cell Leukemia which responded to interferon gamma, Intern Med, 2007; 46: 147.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

14j •Đ•˝[•F, •Ÿd’qŽq, ŁŒËŽR [, _č •Ű: IFN- ƒÁ‚ŞATL “ÁˆŮ]‚ɑ΂ľ—LŒř‚Ĺ‚ ‚Á‚˝2 —áCź“ú”畆C2002; 64: 769.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj


CQ24

”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚éATLL ‚ɑ΂ľ‚Ä’PÜ‰ťŠw—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

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B-C1

Skin-directed therapy ‚ɑ΂ľ‚ÄŽĄ—Ă’ďRŤ‚ŁC‘˝Ü•š—p‰ťŠw—Ă–@‚Ě“K‰ž‚Ş‚Č‚˘Ç—á‚ɑ΂ľ‚āC’PÜ‰ťŠw—Ă–@‚Í—L—p‚Ĺ‚ ‚é‰Â”\Ť‚Ş‚ ‚éB‚ľ‚Š‚ľCś–˝—\Œă‚̉ü‘P‚ɑ΂ˇ‚éŒř‰Ę‚ÍŠm”F‚ł‚ę‚Ä‚˘‚Č‚˘B

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Ą‰đŕ

‹}ŤŒ^CƒŠƒ“ƒpŽîŒ^‚ĚAggressive ATLL ‚ɑ΂ˇ‚鉝Šw—Ă–@‚ÍmLSG15iVCAP, AMP, VECPj‚ސ„§‚ł‚ę‚Ä‚˘‚é‚ŞC‚­‚ˇ‚Ô‚čŒ^C—\Œă—ǍD‚Č–ŤŒ^ATL ‚đŠÜ‚Ţindolent type ATL ‚ɑ΂ľ‚Ä‚Í’ˆÓ[‚˘Œo‰ßŠĎŽ@‚ ‚邢‚ÍAZT/IFN-ƒż—Ă–@‚ސ„§‚ł‚ę‚Ä‚˘‚é15jB]‚Á‚āC”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚éATLL ‚ɑ΂ˇ‚鉝Šw—Ă–@‚đ„§‚ˇ‚éƒGƒrƒfƒ“ƒX‚ÍŒťÝ‚Ě‚Ć‚ą‚ë‚Č‚˘B‚ľ‚Š‚ľC‘Oq‚̂悤‚ɁC“ÁˆŮ]‚𔺂¤ATLL ‚͔畆Çó‚𔺂í‚Č‚˘‚­‚ˇ‚Ô‚čŒ^ATLL ‚ć‚č—\Œă•s—Ç‚Ĺ‚ ‚é‚ą‚ƁC‚Ü‚˝•›t”玿ƒXƒeƒƒCƒhŠO—pCŽ‡ŠOü—Ă–@C•úŽËü—Ă–@CƒCƒ“ƒ^[ƒtƒFƒƒ“ƒKƒ“ƒ}—Ă–@‚Č‚Ç‚É‚ć‚éskin-directed therapy ‚É‚ć‚éÇóŠÉ˜a‚ލ˘“ď‚Ĺ‚ ‚čC‚Š‚‘˝Ü‰ťŠw—Ă–@‚Ě“K‰ž‚Ş‚Č‚˘Ç—á‚ɑ΂ľ‚ẮCŽĄ—Ă‚Ě‘I‘đŽˆ‚Ć‚ľ‚čl—ś‚š‚´‚é‚đ“ž‚Č‚˘‚Ě‚ŞŒťó‚Ĺ‚ ‚éB

ŒťÝCATLL ‚ɑ΂ˇ‚é’PÜ‰ťŠw—Ă–@‚Ć‚ľ‚ẮCŒoŒű“ŕ•žÜ‚Ć‚ľ‚ÄVP-16iƒGƒgƒ|ƒVƒhj‚âƒ\ƒuƒ]ƒLƒTƒ“C“_“H’ŽËÜ‚Ć‚ľ‚ăyƒ“ƒgƒXƒ^ƒ`ƒ“‚ŞŽg—p‚ł‚ę‚éBATLL ‚ɑ΂ˇ‚é’PÜ‰ťŠw—Ă–@‚ÉŠÖ‚ľ‚āCƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‚Č‚˘B‚ľ‚Š‚ľC’á—e—ĘƒGƒgƒ|ƒVƒh“ŕ•ž—Ă–@‚ÉŠÖ‚ľ‚ẮC‘S‚Ä‚Ě—Ő°Œ^‚đŠÜ‚ß‚˝1 Œ‚Ě”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Ć3 Œ‚ĚÇ—á•ń‚Ş‘śÝ‚ˇ‚éBVP-16 25 mg { ƒvƒŒƒhƒjƒ]ƒƒ“10 mg ‚Ě˜A“ú“ŕ•ž—Ă–@i8 —áj‚ĆOPEC/MPEC ‘˝Ü•š—p‰ťŠw—Ă–@i79 —áj‚Ě”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ł́Cmedian Survival times ‚Ĺ‘OŽŇ‚Ş18.0 ƒJŒŽ‚ɑ΂ľ‚ÄŒăŽŇ‚Í7.1 ƒJŒŽ‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ł‚ę‚Ä‚˘‚é16jB‚Ü‚˝C7 —á‚ĚATLL ‚ɑ΂ˇ‚éƒGƒgƒ|ƒVƒh­—Ę’ˇŠúŒoŒű“Š—^i25`100 mgj‚ł́C7 —á’†4 —á‚ÉCR ‚Ş“ž‚ç‚ęiCR —Ś57.1“jCPR —á1 —á‚đŠÜ‚ß‚˝—LŒř—Ś‚Í71.4“‚Ć‚ˇ‚é•ń‚Ş‚ ‚é17jB‚ľ‚Š‚ľC‚ą‚Ě•ń‚ÍŠůŽĄ—Ă—á‚â‘ź‚̉ťŠw—Ă–@Ü‚Ć‚Ě•š—p—á‚ŕŠÜ‚Ü‚ę‚éBƒŠƒ“ƒpŽîŒ^ATLL ‚ɑ΂ľ‚Ä’á—e—ĘƒGƒgƒ|ƒVƒh“ŕ•ž—Ă–@‚đ‰‰ńŽĄ—Ă‚Ć‚ľ‚˝•ń‚Ş1 —á‚ ‚čCƒGƒgƒ|ƒVƒh@50 mg˜A“ú“ŕ•ži14`21 “úŠÔŒp‘ą“Š—^j‚ɂāC—LŒř‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ł‚ę‚Ä‚˘‚é18jB”畆Çó‚ɑ΂ˇ‚éŒř‰Ę‚ɂ‚˘‚ẮCVP-16 50 mg ‚Ě˜A“ú“ŕ•ži3 T“Š–ňC2 T‹x–ň‚đ1 ƒN[ƒ‹‚Ć‚ľC4 ƒN[ƒ‹Ž{sj‚ɂčg”Á‚̐F‘f’ž’…‚đ”F‚ß‚˝‚Ć‚˘‚¤•ń‚Ş‚Č‚ł‚ę‚Ä‚˘‚é19jBƒ\ƒuƒ]ƒLƒTƒ“‚Ćƒyƒ“ƒgƒXƒ^ƒ`ƒ“‚ɂ‚˘‚ẮC’P“Ć“Š—^‚É‚¨‚Ż‚é”畆Çó‚Ö‚ĚŒř‰Ę‚Í–˘‚ž\•Ş‚ÉŒŸ“˘‚ł‚ę‚Ä‚˘‚Č‚˘BˆČă‚Š‚çC”畆‚Ě‚Ý‚É•a•Ď‚đ—L‚ˇ‚éATLL ‚ɑ΂ˇ‚é’PÜ‰ťŠw—Ă–@‚ĚŒř‰ĘC—\Œă‰ü‘P‚ ‚邢‚Í—\ŒăˆŤ‰ť‚ÉŠÖ‚ˇ‚é—ÇŽż‚ČƒGƒrƒfƒ“ƒX‚Í‘śÝ‚š‚¸CĄŒă‚ĚŒŸ“˘‚Ş•K—v‚Ĺ‚ ‚éB

•śŒŁ

15j Tsukasaki K, Hermine O, Bazarbachi A, et al: Definition, prognostic factors, treatment, and response criteria of adult T-cell Leukemia-lymphoma: a proposal from an international consensus meeting, J Clin Oncol, 2009; 27: 453-459.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅵj

16j Matsushita K, Matsumoto T, Ohtsubo H, et al: Long-term maintenance combination chemotherapy with OPEC/ MPECiVincristin or Methotrexate, Prednisolone, Etoposide and Cyclophosphamidej or with daily oral etoposide and prednisolone can improve Survival and quality of life in adult T-cell Leukemia/lymphoma, ILeuk Lymphoma, 1999; 36: 67-75.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

17j ]•›Ę”TCK“c‹v•˝C•˝ŽR‘אś‚Ů‚Š: Etoposide ­—Ę’ˇŠúŒoŒű“Š—^‚Ş‘tŒř‚ľ‚Ä’ˇŠúś‘ś‚Ş“ž‚ç‚ę‚˝ŹlT ×–E”’ŒŒ•a‚Ě2 —áCŠŕ‚ƉťŠw—Ă–@ , 1995; 22: 547-552.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

18j •t@V‰ŔC–”–ě’ő–çC–Ô’J–ÎŽ÷‚Ů‚Š: d“Ä‚ČzŠÂŠíŽžŠł‚đ‚ŕ‚‚—lT ×–E”’ŒŒ•a^ƒŠƒ“ƒpŽî‚ɑ΂ˇ‚é’á—e—ĘEtoposide ‚Ě—LŒřŤCŠŕ‚ƉťŠw—Ă–@ , 2001; 28: 1269-1272.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj

19j ˆÉě—FC‹ŕŒ´‘ń˜YC‚“c ŽŔCâˆäé•FCŽR“c—SŽĄC”Ţ’J—TN: ‚ƒJƒ‹ƒVƒEƒ€ŒŒÇ‚đ’ć‚ľ‚˝”畆g”Á‹u]Œ^ŹlT ×–E”’ŒŒ•aEƒŠƒ“ƒpŽîC”畆—Տ° , 2005; 47: 381-384.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅴj


4D‚ť‚Ě‘ź‚Ě‹H‚Č•aŒ^

1jßŠOŤNK/T ×–EƒŠƒ“ƒpŽî,@•@Œ^iExtranodal NK/T cell lymphoma, nasal typej
2j‰č‹…ŤŒ`Žż×–E—lŽ÷ó×–EŽîᇁiBlastic plasmacytoid dendritic cell neoplasmj
3jŽí“——l…ávÇ—lƒŠƒ“ƒpŽîiHydroa vacciniforme-like lymphomaj

ŸŠTŕ

WHO •Ş—ށi2008j‚ł́CßŠOŤNK/T ×–EƒŠƒ“ƒpŽî‚ɉÁ‚Ś‚āC–{–M‚đŠÜ‚ŢƒAƒWƒACƒƒLƒVƒRCƒyƒ‹[‚Š‚ç•ń‚Ě‚ ‚éŽí“——l…ávÇ—lƒŠƒ“ƒpŽîihydroa vacciniforme-like lymphomaj‚ސV‚˝‚É“Ć—§ŽžŠł‚Ć‚ľ‚ĉÁ‚Ś‚ç‚ę‚˝BŽí“——l…ávÇ—lƒŠƒ“ƒpŽî‚́CEB ƒEƒCƒ‹ƒXŠÖ˜A‚Տ­”N‚ɍD”­‚ˇ‚éT ×–EƒŠƒ“ƒpŽî‚ŁC‚ľ‚΂ľ‚Î’ŽŽh‚âŒőü‚ɑ΂ˇ‚é‰ß•q”˝‰ž‚Ş‚ ‚éB—\Œă‚Í—lX‚Ĺ‚ ‚é‚ŞCŒŒ‹…ćÐHÇŒóŒQ‚̍‡•š‚Č‚Ç‘SgŤ‚ÉŠg‘ĺ‚ľ‚˝ę‡‚Í—\Œă•s—Ç‚Ĺ‚ ‚éB‚ą‚ĚŽžŠł’P“Ć‚Ĺ‚ĚŽĄ—Ă‚ÉŠÖ‚ˇ‚é•ń‚Í–ł‚­C–ŤŠˆ“ŽŤEB ƒEƒCƒ‹ƒXŠ´őÇ‚âEB ƒEƒCƒ‹ƒX—zŤT/NK ×–E‘BŤŽžŠł‚ɂ‚˘‚āCŽĄ—Ă‚ÉŠÖ‚ˇ‚é•ń‚ŞŽUŒŠ‚ł‚ę‚éBƒAƒVƒNƒƒrƒ‹‚âƒKƒ“ƒVƒNƒƒrƒ‹‚É‚ć‚éRƒEƒCƒ‹ƒX—Ă–@CƒCƒ“ƒ^[ƒtƒFƒƒ“ƒż‚âƒCƒ“ƒ^[ƒƒCƒLƒ“2 ‚Ȃǂ̖Ɖu—Ă–@C•›t”玿ƒRƒ‹ƒ`ƒRƒXƒeƒƒCƒh–ň‚ĆƒGƒgƒ|ƒVƒh•š—p‚̉ťŠw—Ă–@‚Č‚Ç‚Ş‚Ý‚ç‚ę‚é‚Ş2jC­”—á‚Ĺ‚Ě•ń‚Ş’†S‚Ĺ‹Lq“IŒ¤‹†‚Ć‚ľ‚Ä‚ŕ\•Ş‚Ć‚˘‚Ś‚é‚ŕ‚Ě‚Ĺ‚Í‚Č‚˘B‹ß”NCŠ˛×–EˆÚA‚ɂ‚˘‚Ä‚Ě•ń‚ŞŽUŒŠ‚ł‚ęCCQ ‚Í“ŻŽíŠ˛×–EˆÚA‚ŞŽĄ—Ă‚Ć‚ľ‚Ä—L‰v‚ŠC‚Ě1 €–ڂɂ‚˘‚ÄŒŸ“˘‚ľ‚˝B

•śŒŁ

1j Jaffe ES, Harris NL, Stein H, et al: Induction and overview of the classification of the lymphoid neoplasms. Swerdlow SH, Campo E, Harris NL et al, editors. WHO Classification of Haematopoietic and Lymphoid Tissue. Lyon, France: IARC Press 2008.

2j Cohen JI, Kimura H, Nakamura S, et al: Epstein-Barr virus-associated lymphoproliferative disease in non-immunocompromised hosts: a status report and summary of an international meeting, 8-9 September 2008, Ann Oncol, 2009; 20: 1472-1482.


CQ25

ßŠOŤNK/T ×–EƒŠƒ“ƒpŽîC•@Œ^‚ɑ΂ľ‚ÄCHOP ‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

C2

ßŠOŤNK/T ×–EƒŠƒ“ƒpŽîC•@Œ^‚ɑ΂ˇ‚éCHOP —Ă–@‚ÍŠT‚ľ‚Ä”˝‰ž‚͈Ť‚˘‚ŠCˆęŽž“I‚Č‚Ě‚ĹŠî–{“I‚É‚ÍŠŠ‚ß‚ç‚ę‚Č‚˘B

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Ą‰đŕ

Ç—ᐔ‚ޏ­‚Č‚­C\•Ş‚ČŒŸ“˘‚Í‚ł‚ę‚Ä‚˘‚Č‚˘‚ށC2 Œ‚ĚÇ—áWĎŒ¤‹†‚Š‚çC‘˝‚­‚͉ťŠw—Ă–@‚É’ďRŤ‚đŽŚ‚ˇ‚Ć‚ł‚ę‚Ä‚˘‚éBŽîᇍזE‚́C‘˝Ü‘ϐŤˆâ“`ŽqP “œ’`”’‚đ”­Œť‚ľ‚Ä‚˘‚é‚ą‚Ć‚Ş‘˝‚­CCHOP —Ă–@‚ޏ\•Ş‚ČŒř‰Ę‚đ”­Šö‚ľ‚Č‚˘——R‚Ěˆę‚Â‚Ćl‚Ś‚ç‚ę‚Ä‚˘‚é1`3jB

•śŒŁ

1j Yamaguchi M, Kita K, Miwa H, et al: Frequent expression of P-glycoprotein/MDR1 by nasal T-cell lymphoma cells, Cancer, 2001; 76: 2351-2356.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Yamamoto T, Iwasaki T, Watanabe N, et al: Expression of multidrug resistance@P-glycoprotein on peripheral blood mononuclear cells of patients with granular lymphocyte-proliferative disorders. Blood, 1993; 81: 1342-1346.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j Oshimi K: Progress in understanding and managing natural killer-cell malignancies, Br J Haematol, 2007; 139: 532-544.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅵj


CQ26

ßŠOŤNK/T ×–EƒŠƒ“ƒpŽîC•@Œ^‚ɑ΂ľ‚Ä•úŽËü—Ă–@‚ƉťŠw—Ă–@‚Ě•š—p‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

B

ŒŔ‹ÇŤ•a•Ď‚ɑ΂ľ‚Ä‚Í•úŽËü—Ă–@‚ÉŽŸ‚˘‚Ĺ‚ ‚邢‚Í“ŻŽž‚ÉDeVIC —Ă–@‚đ‰Á‚Ś‚鎥—Ă‚ŞŠŠ‚ß‚ç‚ę‚éB

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Ą‰đŕ

ßŠOŤNK/T ×–EƒŠƒ“ƒpŽî‚ɑ΂ˇ‚鎥—Ă‚ÉŠÖ‚ľ‚āC3 Œ‚Ě”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Ş‚ ‚éBŒŔ‹ÇŤ•a•Ď‚Ě•@ŤßŠOŤNK/T ×–EƒŠƒ“ƒpŽî‚ɑ΂ˇ‚é•úŽËü—Ă–@‚Ć2/3 —Ę‚ĚDeVIC —Ă–@‚Ć‚Ě•š—p—Ă–@‚ÉŠÖ‚ˇ‚é”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚ł́C26 —á’†20 —á‚ŞCRiCR —Ś77“jC1 —á‚ŞPR ‚ĚŒř‰Ę‚Ş”F‚ß‚ç‚ęC2 ”Nś‘ś—Ś‚Í78“‚Ĺ‚ ‚Á‚˝B‚ą‚ę‚Í‘źŽ{Ý‚Š‚ç•ń‚ł‚ę‚˝•úŽËüŽĄ—Ă‚Ě‚Ý‚Ě45“‚Ć”äŠr‚ľ‚ėǍD‚ČŒ‹‰Ę‚Ş“ž‚ç‚ę‚Ä‚˘‚é4jBisŠú‚ ‚邢‚Í‘˝”­Ť•a•Ď‚ɑ΂ľ‚ẮCSMILE-PⅡ@‚ĚƒvƒƒgƒR[ƒ‹iJCOG: j‚ސi‚ß‚ç‚ę‚Ä‚˘‚é‚ŞC‚ť‚Ě•]‰ż‚͍ĄŒă‚̉đÍ‚đ‘Ň‚˝‚Č‚­‚Ä‚Í‚Č‚ç‚Č‚˘’jB@`ƒOƒ‹[ƒv‚ÍProMACE / CytaBOM ‚É‘ą‚ŤC•úŽËü—Ă–@‚đs‚Á‚Ä‚Ť‚˝‚Ş‚ť‚ĚŽĄ—ĂŒř‰Ę‚Ě•]‰ż‚Í•s–ž‚Ĺ‚ ‚éB@–{Ç‚ɑ΂ˇ‚éCHOP —Ă–@‚ĚŒř‰Ę‚ÍˆęŽž“I‚ŠC’ďRŤ‚đŽŚ‚ˇ‚ą‚Ć‚Ş‘˝‚˘4C5jB“ŻŽíŒŒ‰tŠ˛×–EˆÚA‚Ě‘˝Ž{Ý‚ł̐ŹŃ‚ł́CNK ×–EŽîᇑS‘̂ł́C2 ”NŠÔ‚Ě•aóis‚Ě‚Č‚˘ś‘ś—Ś‚Í34“‚ŁC‘S‘Ě‚Ě2 ”Nś‘ś—Ś‚Í40“‚Ĺ‚ ‚Á‚˝6jB10 ƒJŒŽŠÔÄ”­‚âis‚Ş‚Č‚˘Ç—á‚ł́CŠĎŽ@ŠúŠÔ’†‚͐ś‘ś‚Ş”F‚ß‚ç‚ę‚˝BOshimi ‚ç‚̉uŠw’˛¸‚Š‚çCś–˝—\Œă‚Ş3C4 ”NˆČ~ƒvƒ‰ƒg[‚É‚Č‚éŒXŒü‚Ş‚Ý‚ç‚ęCÇ—á‚Ě’†‚É‚ÍŠ°‰đ“ą“ü‚މ”\‚ČÇ—á‚Ş‘śÝ‚ˇ‚éCQ25-3jB‚ą‚ę‚ç‚Ěƒf[ƒ^‚́CŽĄ—Ă‚É”˝‰ž‚ľ‚ÄŠ°‰đ‚É“ą“ü‚Ĺ‚Ť‚éÇ—á‚Ş‘śÝ‚ˇ‚é‚ą‚Ć‚đŽŚ‚ľ‚Ä‚˘‚é‚ĆŽv‚í‚ę‚éB

’j“ú–{ŒŒ‰tŠw‰ďu‘˘ŒŒŠíŽîᇐf—ĂƒKƒCƒhƒ‰ƒCƒ“vi2013 ”N”Łj‚ÉŽĄ—Ă•űj‚ŞŽŚ‚ł‚ę‚˝B

•śŒŁ

4j Yamaguchi M, Tobinai K, Oguchi M, Ishizuka N, Kobayashi Y, Isobe Y, Ishizawa K, Maseki N, Itoh K, Usui N, Wasada I, Kinoshita T, Ohshima K, Matsuno Y, Terauchi T, Nawano S, Ishikura S, Kagami Y, Hotta T, Oshimi K: Phase Ⅰ/Ⅱ study of concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma: Japan Clinical Oncology Group Study JCOG0211, J Clin Oncol, 2009; 27: 5594-5600.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

5j Yamaguchi M, Ogawa S, Nomoto, et al: Treatment outcome of nasal NK-cell lymphoma: a report of 12 consecutively-diagnosed cases and a review of the literature, J Clin Exp Haematopathol, 2001; 41: 93-99.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj

6j Mutashige N, Kami M, Kishi Y, et al: Allogenic haematopoietic stem cell transplantation as a promising treatment for natural killer-cell neoplasms, Br J Haematol, 2005; 130: 561-567.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅲj


CQ27

‰č‹…ŤŒ`Žż×–E—lŽ÷ó×–EŽîᇂɉťŠw—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

C1

‰č‹…ŤŒ`Žż×–E—lŽ÷ó×–EŽîᇂɑ΂ľ‚ăXƒ^ƒ“ƒ_[ƒh‚ČŽĄ—Ă‚ÍŠm—§‚ľ‚Ä‚˘‚Č‚˘‚˝‚߁C‘˝Ü•š—p—Ă–@‚ĚŽŔŽ{‚đl—ś‚ľ‚Ä‚ŕ‚悢B‚ľ‚Š‚ľŒř‰Ę‚ÍˆęŽž“I‚ŁC‚Ů‚Ć‚ń‚Ç‚Ě—á‚Ş””N‚Ĺ•sK‚Č“]‹A‚đ‚Ć‚éB

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


Ą‰đŕ

–{Ç‚ĚŽîᇍזE‚́CCD123iIL-3R ƒż˝j‚ĆTCL1ilymphoid protooncogenej‚Ş—zŤ‚É‚Č‚čCplasmacytoid dendritic cell ‘O‹ě×–E—R—ˆ‚ĚŽîᇂƍl‚Ś‚ç‚ęCƒŠƒ“ƒpŽî‚ĚƒJƒeƒSƒŠ[‚Š‚çŠO‚ę‚é‚˝‚߂ɏă‹L‚ĚŒÄĚ‚Ć‚Č‚Á‚˝B1 Œ‚Ěƒƒ^ƒAƒiƒŠƒVƒX‚Ć1 Œ‚ĚÇ—áWĎŒ¤‹†‚ł́C’jŤ‚É–ń2 ”{‘˝‚­C•˝‹Ď”­Ç”N—î‚Í67 Îi8`89 Îj‚Ĺ‚ ‚é7jBf’fŽž‚É‚ˇ‚Ĺ‚É46“‚Ě—á‚ōœ‘Z‚đ”F‚߁CŒo‰ß’†‚É72“‚ōœ‘Z‚ސś‚ś‚éBCHOP —Ă–@‚Ş—p‚˘‚ç‚ę‚é‚ą‚Ć‚Ş‘˝‚˘‚ށCŽĄ—ĂŒř‰Ę‚Í–R‚ľ‚­C•˝‹Ďś‘śŠúŠÔ‚͔畆•a•Ď‚ĚÇ—á‚Ĺ‚Í–ń25 ƒJŒŽ7C8j‚Ĺ‚ ‚čC”畆ŠO•a•Ď‚đ—L‚ˇ‚éę‡‚Í‚ł‚ç‚É’Z‚˘BŒŒ‰tŠ˛×–EˆÚA‚É‚ć‚Á‚Đś‘ś‰„’ˇ‚މ”\‚Ć‚˘‚¤1 Œ‚ĚÇ—áWĎŒ¤‹†‚Ş‚ ‚é‚ŞCŽĄ—ĂŒř‰Ę‚Ě•]‰ż‚͍ĄŒă‚Ě–â‘č‚Ĺ‚ ‚éCQ26-6jB

•śŒŁ

7j Bekkenk MW, Jansen PM, Meijer CJLM, Willemze R: CD56 { hematological neoplasms presenting in the skin: a retrospective analysis of 23 new cases and 130 cases from the literature, Ann Oncol, 2004; 15; 1097-1108.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj

8j Suzuki R, Nakamura S, Suzumiya J, et al: Blastic natural killer cell lymphoma/LeukemiaiCD56-positive blastic tumorj. Prognostication and categorization according to anatomic sites of involvement, Cancer, 2005; 104: 1022-1031.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ28

Ží“——l…ávÇ—lƒŠƒ“ƒpŽî‚É“ŻŽí‘˘ŒŒŠ˛×–EˆÚA‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

B-C1

Ží“——l…ávÇ—lƒŠƒ“ƒpŽî‚ĚŽĄ—Ă–@‚Ć‚ľ‚āC“ŻŽíŠ˛×–EˆÚA‚Í—L—p‚Ĺ‚ ‚é‰Â”\Ť‚Ş‚ ‚éB

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


Ą‰đŕ

‘ÎŰ‚đŽí“——l…ávÇ—lƒŠƒ“ƒpŽî‚ÉŒŔ’č‚ľ‚˝“ŻŽí‘˘ŒŒŠ˛×–EˆÚA‚ĚŒř‰Ę‚ÉŠÖ‚ˇ‚é”äŠrŽŽŒą‚¨‚ć‚ŃÇ—áWĎŒ¤‹†‚Í‘śÝ‚ľ‚Č‚˘B–ŤŠˆ“ŽŤEB ƒEƒCƒ‹ƒXŠ´őÇiCAEBVj‚ɑ΂ˇ‚é“ŻŽí‘˘ŒŒŠ˛×–EˆÚA‚ĚŒř‰Ę‚ÉŠÖ‚ˇ‚é2 •Ň‚ĚÇ—áWĎŒ¤‹†‚É‚ć‚é‚ƁCCAEBV 15 —á‚ɑ΂ľ‚Ä“ŻŽíœ‘‚Ü‚˝‚Í––˝ŒŒŠ˛×–EˆÚA‚đŒŒ‰ŽŇŠÔ‚Ü‚˝‚Í”ńŒŒ‰ŽŇŠÔ‚ĹŽ{s‚ľ‚˝Œ‹‰ĘCś’…‚ľ‚Č‚Š‚Á‚˝1 —á‚đœ‚˘‚Ä7 —á‚Şś‘śC7 —á‚ŞˆÚAŒă1`16 ƒJŒŽ‚ĹŽ€–S‚ľ‚˝‚ށC‚ť‚Ě’†‚Ě3 —á‚ŞˆÚAŠÖ˜AŽ€‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚é9jB‚ŕ‚¤1 •Ň‚Í‘˝Ž{ÝŠÔ‚ĚÇ—áWĎŒ¤‹†‚ŁC42 —á‚ĚCAEBV ŠłŽŇ‚É“ŻŽíŠ˛×–EˆÚAiœ‘Š˛×–EˆÚA25 —áC––˝ŒŒŠ˛×–EˆÚA10 —áCä`‘ŃŒŒˆÚA4 —áCCD34 —zŤ×–EˆÚA3 —áj‚đŽ{s‚ľ‚˝ŹŃ‚đ•ń‚ľ‚Ä‚˘‚é10jB‘S‘Ě‚Ě26“‚É‚ ‚˝‚é11 —á‚͍œ‘”ń”j‰ó“I‘Oˆ’u‚É‚ć‚éˆÚAiRISTj‚Ĺ‚ ‚Á‚˝B1 ”NŒă‚Ě–łÄ”­ś‘ś—Ś‚Í56.1“‚Ć•ń‚ľ‚Ä‚˘‚éBˆÚAŠÖ˜A‡•šÇ‚Ş‘˝‚­CŽí“——l…ávÇ—lƒŠƒ“ƒpŽî‚Ě‚Ý‚Ĺ‚ĚŽĄ—ÐŹŃ‚Ě•ń‚Í‚Č‚˘‚ށCEB ƒEƒCƒ‹ƒX—Ę‚đŠÄŽ‹‚ľ‚ÄŒo‰ßŠĎŽ@‚ľC‘SgŤ‚É‘ˆŤŒXŒü‚ŞŒŠ‚ç‚ę‚ę‚Α‹}‚É‘˘ŒŒŠ˛×–EˆÚA‚đŒv‰ćE€”ő‚ˇ‚é‚ą‚Ć‚Ş„§‚ł‚ę‚éB

•śŒŁ

9j Gotoh K, Ito Y, Shibata-Watanabe Y, et al: Clinical and virological characteristics of 15 patients with chronic active Epstein-Barr virus infection treated with hematopoietic stem cell transplantation, Clin Infect Dis, 2008; 46: 1525-1534.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

10j Sato E, Ohga S, Kuroda H, et al: Allogeneic hematopoietic stem cell transplantation for Epstein-Barr virus-associated T/natural killer-cell lymphoproliferative disease in Japan, Am J Hematol, 2008; 83: 721-727.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


5. ”畆B ×–EƒŠƒ“ƒpŽî


ŸŠTŕ

”畆B ×–EƒŠƒ“ƒpŽî‚́C2005 ”N‚ĚWHO-EORTC •Ş—Ţ1j‚Ĺ‚ÍŒ´”­Ť”畆•Ó‰‘ŃB ×–EƒŠƒ“ƒpŽîiprimary cutaneous marginal zone B-cell lymphoma, PCMZLjCŒ´”­Ť”畆ŕh–E’†SƒŠƒ“ƒpŽîiprimary cutaneous follicle center cell lymphoma, PCFCLjCŒ´”­Ť”畆‚Ń‚Ü‚ńŤ‘ĺ×–EŒ^B ×–EƒŠƒ“ƒpŽî, ‰şŽˆŒ^iprimary cutaneous diffuse large B-cell lymphoma, leg type, PCLBCL, leg typejCŒ´”­Ť”畆‚Ń‚Ü‚ńŤ‘ĺ×–EŒ^B ×–EƒŠƒ“ƒpŽî, ‚ť‚Ě‘źiPCLBCL, otherj‚¨‚ć‚ŃŒŒŠÇ“ŕ‘ĺ×–EŒ^B ×–EƒŠƒ“ƒpŽîiintravascular large B-cell lymphoma: ⅣLj ‚É•Ş—Ţ‚ł‚ę‚˝‚ށC2008 ”N‚ɉü’ů‚ł‚ę‚˝‘˘ŒŒŒnŽîᇂĚWHO •Ş—Ţ2j‚ł́CuŒ´”­Ť”畆v•Ó‰‘ŃB ×–EƒŠƒ“ƒpŽî‚Ě•a–ź‚ލ폜‚ł‚ęCußŠOŤv•Ó‰‘ŃƒŠƒ“ƒpŽîiMALT ƒŠƒ“ƒpŽîj‚É‚Ü‚Ć‚ß‚ç‚ę‚˝BŒ´”­Ť”畆‚Ń‚Ü‚ńŤ‘ĺ×–EŒ^B ×–EƒŠƒ“ƒpŽîC‰şŽˆŒ^ ‚Í•a–ź‚Ć‚ľ‚Ä‹LÚ‚ł‚ę‚˝‚ށC‚Ń‚Ü‚ńŤ‘ĺ×–EŒ^B ×–EƒŠƒ“ƒpŽîC”ń“Á’činot otherwise specifiedj‚̉şˆĘ‚É“ü‚čCŒ´”­Ť”畆‚Ń‚Ü‚ńŤ‘ĺ×–EŒ^B ×–EƒŠƒ“ƒpŽî, ‚ť‚Ě‘ź‚͍폜‚ł‚ę‚˝B—\ŒăˆöŽq‚Ć‚ľ‚Ä‚Í•aŒ^•Ş—Ţ‚Şd—v‚ČˆöŽq‚Ĺ‚ ‚čCŒ´”­Ť”畆ŕh–E’†SƒŠƒ“ƒpŽî‚ƐߊOŤ•Ó‰‘ŃƒŠƒ“ƒpŽî‚Í—\Œă—ǍD‚Ěindolent ŒQC‚Ń‚Ü‚ńŤ‘ĺ×–EŒ^B ×–EƒŠƒ“ƒpŽî‚¨‚ć‚ŃŒŒŠÇ“ŕ‘ĺ×–EŒ^B ×–EƒŠƒ“ƒpŽî‚Í—\Œă•s—ÇŒQ‚É•Ş—Ţ‚ł‚ę‚Ä‚˘‚éB‚ą‚ą‚ł́C—\Œă‚đdŽ‹‚ľ‚āuindolent ŒQv‚Ɓu‚Ń‚Ü‚ńŤ‘ĺ×–EŒ^v‚É•Ş‚Ż‚ÄCQ ‚đÝ’č‚ľ‚˝B‚ą‚ĚŽžŠłŒQ‚Ĺ‚ŕRCT ‚Í‘śÝ‚š‚¸‹Lq“IŒ¤‹†‚ރƒCƒ“‚Ĺ‚ ‚é‚ŞC2008 ”N‚ɉߋŽ‚Ě•ń‚đ‚Ü‚Ć‚ß‚ÄEORTC ‚ĆISCL ‚É‚ć‚é”畆B ×–EƒŠƒ“ƒpŽî‚ĚŽć‚čˆľ‚˘Žwj‚ŞŽŚ‚ł‚ę‚Ä‚˘‚é3jBŽĄ—Âɂ‚˘‚ẮC‹ÇŠ—Ă–@‚Ć‚ľ‚Ä•úŽËüĆŽË‚ĆŠO‰Č“IŘœC‘Sg—Ă–@‚Ć‚ľ‚ĉťŠw—Ă–@‚ĆƒŠƒcƒLƒVƒ}ƒu“Š—^‚É‚ć‚鎥—Ă•ń‚Ş‘ĺ‘˝”‚đč‚ß‚éBˆę•ű‚ŁC­”‚Č‚Ş‚çƒCƒ“ƒ^[ƒtƒFƒƒ“ƒż‚Ě‹ÇŠ“Š—^‚âŒőü—ÍŠw“I—Ă–@‚Ě•ń‚Ş‚ ‚éB

•śŒŁ

1j Willemze R, Jaffe ES, Burg G, et al: WHO-EORTC classification for cutaneous lymphomas, Blood, 2005; 105: 3768-3785.

2j Jaffe ES, Harris NL, Stein H, et al: Induction and overview of the classification of the lymphoid neoplasms. Swerdlow SH, Campo E, Harris NL et al, editors. WHO Classification of Haematopoietic and Lymphoid Tissue. Lyon, France: IARC Press 2008; 158.

3j Sneff NJ, Noordijk EM, Kim YH, et al: European Organization for Research and Treatment of Cancer and International. Society for Cutaneous Lymphoma consensus recommendations for the management of cutaneous Bcell lymphomas, Blood, 2008; 112: 1600-1609.


CQ29

”畆B ×–EƒŠƒ“ƒpŽîIndolent ŒQ‚ɑ΂ľ‚Ä•úŽËü—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

B

Indolent ŒQiPCMZL, PCFCLj‚ł́CŘœ‰Â”\‚Č•a•Ď‚ɑ΂ľ‚ẮCŠO‰Č“IŘœ‚ŞŠŠ‚ß‚ç‚ę‚éB

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


Ą‰đŕ

Indolent ŒQiPCMZL, PCFCLj‚ɑ΂ˇ‚é•úŽËü—Ă–@‚ĚŒř‰Ę‚ÉŠÖ‚ˇ‚郉ƒ“ƒ_ƒ€‰ť‹y‚Ń”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‘śÝ‚ľ‚Č‚˘B1 •Ň‚ĚÇ—áWĎŒ¤‹†‚ł́C‰ŠúŽĄ—Ă‚Ć‚ľ‚ÄPCMZL 83 —áCPCFCL 134 —á‚ɑ΂ľ‚ÄŽ{s‚ľ‚˝•úŽËü—Ă–@‚ĚŒ‹‰ĘC‚ť‚ę‚ź‚ę97.6“C97.8“‚ĚCR ‚đ“ž‚˝‚Ć•ń‚ľ‚Ä‚˘‚é1jBˆę•ű‚ŁCCR ‚đ“ž‚˝Ç—á‚Ě‚¤‚ż‚ť‚ę‚ź‚ę46.9“C49.6“‚ɍĔ­‚Ş‚Ý‚ç‚ę‚˝‚Ć•ń‚ľ‚Ä‚˘‚éB2 •Ň–Ú‚ĚÇ—áWĎŒ¤‹†‚Í‘˝Ž{ÝŠÔ‚Ě153 —á‚ĚPCBCL ŠłŽŇ‚É‚¨‚Ż‚é•úŽËü—Ă–@‚Ě—LŒřŤ‚đŒŸ“˘‚ľCPCMZL 25 —áCPCFCL 101 —á‚ɂ‚˘‚ĉđÍ‚ľ‚Ä‚˘‚é2jBŒ‹‰Ę‚Í‚˘‚¸‚ę‚ŕ‘S—á‚ŞCR ‚đ“ž‚Ä‚˘‚éˆę•űC‚ť‚ę‚ź‚ę60“C29“‚ɍĔ­‚Ş‚Ý‚ç‚ę‚˝‚ށC5 ”Nś‘ś—Ś‚Í‚ť‚ę‚ź‚ęC95“C97“‚Ć—ÇD‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚éB3 •Ň–Ú‚ĚÇ—áWĎŒ¤‹†‚É‚ć‚é‚ĆPCMZL 17 —á‚É•úŽËü—Ă–@‚đŽ{s‚ľC16 —á‚ŞCR ‚đ“ž‚˝‚Ć•ń‚ľ‚Ä‚˘‚é3jB‚˘‚¸‚ę‚ŕ—\Œă—ǍD‚ČŽžŠł‚Ĺ•úŽËü—Ă–@‚Ö‚Ě”˝‰ž‚͗ǍD‚Ĺ‚ ‚莥—Ă–@‚Ć‚ľ‚Đ„§‚ł‚ę‚éB

•śŒŁ

1j Zinzani PL, Quaglino P, Pimpinelli N, et al: Prognostic factors in primary cutaneous B-cell lymphoma: The Italian study group for cutaneous lymphoma, J Clin Oncol, 2006; 24: 1376-1382.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

2j Senff NJ, Hoefnagel JJ, Keelis KJ, et al: Results of radiotherapy in 153 primary cutaneous B-cell lymphomas classified according to the WHO-EORTC classification, Arch Dermatol, 2007; 143: 1520-1526.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

3j Hoefnagel JJ, Vermeer MH, Jansen PM, et al: Primary cutaneous marginal zone B-cell lymphoma - clinical and therapeutic features in 50 cases, Arch Dermatol, 2005; 141: 1139-1145.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ30

”畆B ×–EƒŠƒ“ƒpŽîIndolent ŒQ‚ɑ΂ľ‚ÄŠO‰Č“IŘœ‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

B

Indolent ŒQiPCMZL, PCFCLj‚ł́CŘœ‰Â”\‚Č•a•Ď‚ɑ΂ľ‚ẮCŠO‰Č“IŘœ‚ŞŠŠ‚ß‚ç‚ę‚éB

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


Ą‰đŕ

Indolent ŒQiPCMZL, PCFCLj‚ɑ΂ˇ‚éŠO‰Č“IŘœ‚ĚŒř‰Ę‚ÉŠÖ‚ˇ‚郉ƒ“ƒ_ƒ€‰ť‹y‚Ń”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‘śÝ‚ľ‚Č‚˘B1 •Ň‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚Í‰ŠúŽĄ—Ă‚Ć‚ľ‚ÄPCMZL 39 —áCPCFCL 64 —á‚ɑ΂ľ‚ÄŽ{s‚ľ‚˝•úŽËü—Ă–@‚ĚŒ‹‰Ę‚đC‚ť‚ę‚ź‚ę97.4“C96.8“‚ĚCR ‚đ“ž‚Ä•úŽËü—Ă–@‚ĚŽĄ—ĂŒř‰Ę‚Ć“Ż“™‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚éCQ29-1jBˆę•ű‚ŁCCR ‚đ“ž‚˝Ç—á‚Ě31.6“C37.1“‚ɍĔ­‚Ş‚Ý‚ç‚ę‚˝‚Ć•ń‚ľ‚Ä‚˘‚éB‚ŕ‚¤1 •Ň‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚ÍPCMZL 10 —á‚ÉŠO‰Č“IŘœ‚đŽ{s‚ľC‘S—á‚ŞCR ‚đ“ž‚˝‚Ć•ń‚ľ‚Ä‚˘‚éCQ29-3jBŠO‰Č“IŘœ‚Í•úŽËü—Ă–@‚Ć“Ż—l‚ÉŽĄ—Ă–@‚Ć‚ľ‚Đ„§‚ł‚ę‚éB

•śŒŁ

CQ 29 ‚Ě•śŒŁ1j, 3j‚đŽQĆB


CQ31

”畆B ×–EƒŠƒ“ƒpŽîIndolent ŒQ‚ɑ΂ľ‚ăŠƒcƒLƒVƒ}ƒu’PÜ—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

B-C1

Indolent ŒQiPCMZL, PCFCLj‚É‚¨‚˘‚āC“Á‚É‘˝”­•a•Ď‚đ—L‚ˇ‚éÇ—á‚ł́CƒŠƒcƒLƒVƒ}ƒu’PÜ“Š—^‚Ş—L—p‚Ĺ‚ ‚é‰Â”\Ť‚Ş‚ ‚éB

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


Ą‰đŕ

Indolent ŒQiPCMZL, PCFCLj‚ɑ΂ˇ‚郊ƒcƒLƒVƒ}ƒu’PÜ“Š—^‚ĚŒř‰Ę‚ÉŠÖ‚ˇ‚郉ƒ“ƒ_ƒ€‰ť‹y‚Ń”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‘śÝ‚ľ‚Č‚˘B1 •Ň‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚ÍPCBCL 10 —áiPCMZL 1 —áCPCFCL 8 —áCDLCBL 1 —áj‚ɑ΂ľCƒŠƒcƒLƒVƒ}ƒu 8 ƒN[ƒ‹‚Ě‘Sg“Š—^‚đs‚˘C70“‚ĚÇ—á‚ĹCR ‚Ć‚Č‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚é4jB2 •Ň–Ú‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚ÍPCBCLiPCMZL 4 —áCPCFCL5 —áj‚Ě‚¤‚ż2 —á‚ɃŠƒcƒLƒVƒ}ƒu‚Ě‘Sg“Š—^‚đs‚˘CRC7 —á‚Ĺ‹ÇŠ“Š—^‚đs‚˘PCMZL ‚Ě1 •a•Ď‚đœ‚ŤC6 —á‚ĹCR ‚đ“ž‚˝‚Ć•ń‚ľ‚Ä‚˘‚é5jB3 •Ň–Ú‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚Í9 —á‚ĚPCBCLiPCMZL 4 —áCPCFCL 4 —áj‚ŁCPCMZL 3 —áCPCFCL 3 —á‚ɋǏŠ“Š—^CPCMZL 1 —áCPCFCL 1 —á‚É‘Sg“Š—^‚đs‚˘C‚ˇ‚×‚Ä‚ĚÇ—á‚ĹCR ‚Ć‚Č‚Á‚˝‚ށC‹ÇŠ“Š—^ŒQ‚Ĺ‚Í4 —á‚ɍĔ­‚đ”F‚ß‚˝‚Ć•ń‚ľ‚Ä‚˘‚é6jB4 •Ň–Ú‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚Í15 —á‚Ěindolent ŒQiPCMZL 5 —áCPCFCL 10 —áj‚ɃŠƒcƒLƒVƒ}ƒu‚Ě‘Sg“Š—^‚đs‚˘CCR 60“CPR 27“‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚é7jB­”—á‚Ě•ń‚΂Š‚č‚Ĺ‚Í‚ ‚é‚ŞCƒŠƒcƒLƒVƒ}ƒu‚Ě’PÜ“Š—^‚ŕ—L—p‚ŁC“Á‚ÉT2C ‚âT3 ‚É‘Š“–‚ˇ‚é‘˝”­Ç—á‚Ĺ‚ÍŽĄ—Ă–@‚Ć‚ľ‚Đ„§‚ł‚ę‚éB

•śŒŁ

4j Gellrich S, Muche JM, Wilks A, et al: Systemic eight-cycle anti-CD20 monoclonal antibodyirituximabj therapy in primary cutaneous B-cell lymphomas-an applicational observation, Br J Dermatol, 2005; 153: 167-173.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

5j Fink-Puches R, Wolf IH, Zalaudekl, et al: Treatment of primary cutaneous B-cell lymphoma with rituximab. J Am Acad Dermatol, 2005; 52: 847-853.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

6j Kerl K, Prins C, Saurat JH, et al: Intralesional and intravenous treatment of cutaneous B-cell lymphoma with the monoclonal anti-CD20 antibody rituximab: report and follow-up of eight cases, Br J Dermatol, 2006; 155: 1197-1200.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

7j Morales AV, Advani R, Horwitz SM, et al: Indolent primary cutaneous B-cell lymphoma: experience using systemic rituximab, J Am Acad Dermatol, 2008; 59: 953-957.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ32

”畆×–EB ×–EƒŠƒ“ƒpŽîIndolent ŒQ‚ɑ΂ľ‚Ä‘˝Ü•š—p‰ťŠw—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

C1

Indolent ŒQ‚ɑ΂ľ‚ẮC‘ź‚ĚŽĄ—Ă–@‚É’ďR‚ˇ‚éÇ—á‚â”畆ŠOi“W—á‚ÉŒŔ‚čC‘˝Ü•š—p‰ťŠw—Ă–@‚ĚŽŔŽ{‚đl—ś‚ľ‚Ă悢B

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


Ą‰đŕ

Indolent ŒQiPCMZL, PCFCLj‚ɑ΂ˇ‚é‘˝Ü•š—p‰ťŠw—Ă–@‚ĚŒř‰Ę‚ÉŠÖ‚ˇ‚郉ƒ“ƒ_ƒ€‰ť‹y‚Ń”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‘śÝ‚ľ‚Č‚˘B1 •Ň‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚ÍPCMZL ‚Ĺ85“CPCFCL ‚Ĺ85“‚ŞCR ‚đ“ž‚˝‚ƉđÍ‚ľ‚Ä‚˘‚éCQ29-2jB‚ľ‚Š‚ľCś–˝—\Œă—ǍD‚Čindolent ŒQ‚ɑ΂ľ‚āC‘˝Ü•š—p‰ťŠw—Ă–@‚Í‘ćˆę‘I‘đ‚Ć‚Í‚Č‚č‚Ś‚¸C“K‰ž‚ÍŒŔ’č“I‚Ĺ‚ ‚éB

•śŒŁ

CQ 29 ‚Ě•śŒŁ2 ‚Ɉř—pB


CQ33

‚Ń‚Ü‚ńŤ‘ĺ×–EŒ^B ×–EƒŠƒ“ƒpŽî‚ɑ΂ľ‚Ä‘˝Ü•š—p‰ťŠw—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

B

 

‚Ń‚Ü‚ńŤ‘ĺŒ^×–EŒ^B ×–EƒŠƒ“ƒpŽî

PCLBCL, leg type ‚¨‚ć‚ŃŒŒŠÇ“ŕ‘ĺ×–EŒ^B ×–EƒŠƒ“ƒpŽîiⅣLj‚ɑ΂ľ‚Ä‚Í‘˝Ü•š—p‰ťŠw—Ă–@C“Á‚ɃŠƒcƒLƒVƒ}ƒu‚đ•š—p‚ľ‚˝‘˝Ü•š—p‰ťŠw—Ă–@‚ŞŠŠ‚ß‚ç‚ę‚éB

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


Ą‰đŕ

‚Ń‚Ü‚ńŤ‘ĺ×–EŒ^B ×–EƒŠƒ“ƒpŽî‚Ĺ‚ÍR-CHOP ‚Ş‘ćˆę‘I‘đ‚Ć‚ł‚ę‚Ä‚˘‚é‚ŞCDLCBL, leg type ‚͍‚—îŽŇ‚Ĺ‚Ě”­Ç‚Ş‘˝‚­CÇ—ᐔ‚ŕ­‚Č‚˘‚˝‚ß‚É‘˝Ü•š—p‰ťŠw—Ă–@C’†‚Ĺ‚ŕR-CHOP ‚ĚŒř‰Ę‚ÉŠÖ‚ˇ‚郉ƒ“ƒ_ƒ€‰ť‹y‚Ń”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‘śÝ‚ľ‚Č‚˘B1 •Ň‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚Í‰ŠúŽĄ—Ă‚Ć‚ľ‚ÄPCLBCL, leg type 20 —á‚ɑ΂ľ‚ĉťŠw—Ă–@‚đŽ{s‚ľ‚˝Œ‹‰ĘC80.0“‚ĚCR ‚đ“ž‚˝‚Ć•ń‚ľ‚Ä‚˘‚éCQ29-1jBˆę•ű‚ŁCCR ‚đ“ž‚˝Ç—á‚Ě62.5“‚ɍĔ­‚Ş‚Ý‚ç‚ę‚˝B2 •Ň–Ú‚ĚÇ—áWĎŒ¤‹†‚ł́CPCLBCL,leg type 25 —á‚ɑ΂ľƒŠƒcƒLƒVƒ}ƒu‚đ•š—p‚ľ‚˝‰ťŠw—Ă–@i‚ť‚Ě‚¤‚żCR-CHOP ‚Í21 —áj‚́C23 —á‚ĹCR ‚đ“ž‚˝‚Ć•ń‚ľ‚Ä‚˘‚é8jB3 •Ň–Ú‚ĚÇ—áWĎŒ¤‹†‚ł́C‘˝Ž{ÝŠÔ‚Ě60 Ç—á‚É‚ć‚錟“˘‚đs‚Á‚Ä‚¨‚čCƒŠƒcƒLƒVƒ}ƒu‚đ•š—p‚ľ‚˝‘˝Ü•š—p‰ťŠw—Ă–@ŒQ‚Ş“ŒvŠw“I—LˆÓ‚ł‚Í‚Č‚˘‚ŕ‚Ě‚Ě91.6“‚ĹCR ‚đ“ž‚Ä‚¨‚čCƒŠƒcƒLƒVƒ}ƒu‚đŽg—p‚ľ‚Č‚˘‘źŽĄ—ĂŒQ‚ć‚č‚ŕ’ZŠúŠÔ‚ł̐ś‘ś—Ś‚ލ‚‚Š‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚é9jBⅣL ‚ɂ‚˘‚Ä‚ŕ‘˝Ü•š—p‰ťŠw—Ă–@C’†‚Ĺ‚ŕR-CHOP ‚ĚŒř‰Ę‚ÉŠÖ‚ˇ‚郉ƒ“ƒ_ƒ€‰ť‹y‚Ń”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‘śÝ‚ľ‚Č‚˘B1 •Ň‚ĚÇ—áWĎŒ¤‹†‚ł́C106 —á‚̉ťŠw—Ă–@‚đŽ{s‚ľ‚˝ⅣL Ç—á‚Ě‚¤‚żC49 —á‚ĚƒŠƒcƒLƒVƒ}ƒu•š—pŒQ‚Ć57 —á‚ĚƒŠƒcƒLƒVƒ}ƒu”ń“Š—^ŒQ‚đ”äŠr‚ľCCR ‚Í‚ť‚ę‚ź‚ę82“C51“C2 ”NŒă‚Ě‘Sś‘ś—Ś‚Í‚ť‚ę‚ź‚ę66“C46“‚ĹƒŠƒcƒLƒVƒ}ƒu•š—pŒQ‚Ş—LˆÓ‚ɗǍD‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚é10jB2 •Ň–Ú‚ĚÇ—áWĎŒ¤‹†‚ł́C10 —á‚ĚƒŠƒcƒLƒVƒ}ƒu•š—pŒQ‚Ć20 —á‚Ě”ń“Š—^ŒQ‚đ”äŠr‚ľCCR ‚Í‚ť‚ę‚ź‚ę90“C50“C3 ”NŒă‚Ě‘Sś‘ś—Ś‚Í‚ť‚ę‚ź‚ę89“C38“‚ĹƒŠƒcƒLƒVƒ}ƒu•š—pŒQ‚Ş—LˆÓ‚ɗǍD‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚é11jB‚Ń‚Ü‚ńŤ‘ĺ×–EŒ^‚Ĺ‚ÍƒŠƒcƒLƒVƒ}ƒu‚đ•š—p‚ľ‚˝‘˝Ü•š—p‰ťŠw—Ă–@‚Ş‘ćˆę‘I‘đ‚Ć‚ľ‚Đ„§‚ł‚ę‚éB

•śŒŁ

8j Grange F, Maubec E, Bagot M, et al: Treatment of cutaneous B-cell lymphoma, leg type, with age-adapted combinations of chemotherapies and rituximab, Arch Dermatol, 2009; 145: 329-330.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

9j Grange F, Beylot-Barry M, Courville P, et al: Primary cutaneous diffuse large B-cell lymphoma, leg type: clinicopathologic features and prognostic analysis in 60 cases, Arch Dermatol, 2007; 143: 1144-1150.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

10j Shimada K, Matsue K, Yamamoto K, et al: retrospective analysis of intravascular large B-cell lymphoma treated with rituximab-containing chemotherapy as reported by the ⅣL study group in Japan, J Clin Oncol, 2008; 26: 3189-3195.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj

11j Ferreri AJ, Dognini GP, Bairey O, et al: The addition of rituximab to anthracycline-based chemotherapy significantly improves outcome in 'Western' patients with intravascular large B-cell lymphoma, Br J Haematol, 2008; 143: 253-257.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj


CQ34

‚Ń‚Ü‚ńŤ‘ĺ×–EŒ^B ×–EƒŠƒ“ƒpŽî‚ɑ΂ľ‚ăŠƒcƒLƒVƒ}ƒu’PÜ—Ă–@‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

B

‚Ń‚Ü‚ńŤ‘ĺ×–EŒ^B ×–EƒŠƒ“ƒpŽîiPCLBCLj‚Ĺ‚ŕC‚—î‚⍇•šÇ‚Č‚Ç‚Ě–â‘č‚Ĺ‘˝Ü•š—p‰ťŠw—Ă–@‚ލ˘“ď‚ČÇ—á‚ł́CƒŠƒcƒLƒVƒ}ƒu’PÜ“Š—^‚ŞŠŠ‚ß‚ç‚ę‚éB

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


Ą‰đŕ

‚Ń‚Ü‚ńŤ‘ĺ×–EŒ^‚ɑ΂ˇ‚郊ƒcƒLƒVƒ}ƒu’PÜ—Ă–@‚ĚŒř‰Ę‚ÉŠÖ‚ˇ‚郉ƒ“ƒ_ƒ€‰ť‹y‚Ń”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‘śÝ‚ľ‚Č‚˘‚ށC‰ß‹Ž‚Ě•ń‚đ‚Ü‚Ć‚ß‚˝1 •Ň‚Ěƒƒ^ƒAƒiƒŠƒVƒX‚Ĺ‚ÍPCLBCL, leg type 13 —á‚ɑ΂ľŒoĂ–Ź“I‚ɃŠƒcƒLƒVƒ}ƒu‚đ’PÜ“Š—^‚ľC5 —á‚ÉCR ‚đ“ž‚˝‚Ć•ń‚ľ‚Ä‚˘‚é12jB‚—î”­Ç‚Ş‘˝‚­‡•šÇ‚âADL ‚É–â‘č‚Ş‚ ‚čC‘˝Ü•š—p‰ťŠw—Ă–@‚ލ˘“ď‚Čę‡‚ɂ̓ŠƒcƒLƒVƒ}ƒu’PÜ“Š—^‚஡—Ă–@‚Ć‚ľ‚Đ„§‚ł‚ę‚éB

•śŒŁ

12j Sneff NJ, Noordijk EM, Kim YH, et al: European Organization for Research and Treatment of Cancer and International. Society for Cutaneous Lymphoma consensus recommendations for the management of cutaneous Bcell lymphomas, Blood, 2008; 112: 1600-1609.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹ Ⅰj


CQ35

‚Ń‚Ü‚ńŤ‘ĺ×–EŒ^B ×–EƒŠƒ“ƒpŽî‚ɑ΂ľ‚ÄŠO‰Č“IŘœ‚â•úŽËüĆŽË‚ÍŠŠ‚ß‚ç‚ę‚é‚Š

„§“x

C1

ƒŠƒcƒLƒVƒ}ƒu•š—p‰ťŠw—Ă–@‚ލs‚Ś‚Č‚˘‚悤‚ȍ‚—ŽŇ‚⍇•šÇ‚Ě‘˝‚˘ŠłŽŇ‚ɑ΂ľ‚ẮCŠO‰Č“IŘœ‚â•úŽËüĆŽË‚ĚŽŔŽ{‚đl—ś‚ľ‚Ä‚ŕ‚悢B

ƒAƒ‹ƒSƒŠƒYƒ€‚Ö


Ą‰đŕ

‚Ń‚Ü‚ńŤ‘ĺ×–EŒ^B ×–EƒŠƒ“ƒpŽî‚ɑ΂ˇ‚éŠO‰Č“IŘœ‚â•úŽËüĆŽË‚ĚŒř‰Ę‚ÉŠÖ‚ˇ‚郉ƒ“ƒ_ƒ€‰ť‹y‚Ń”ńƒ‰ƒ“ƒ_ƒ€‰ť”äŠrŽŽŒą‚Í‘śÝ‚ľ‚Č‚˘B1 •Ň‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚Í‰ŠúŽĄ—Ă‚Ć‚ľ‚ÄPCLBCL, leg type 3 —á‚ɑ΂ľ‚ÄŠO‰Č“IŘœ‚đC28 —á‚ɑ΂ľ‚Ä•úŽËüĆŽË‚đŽ{s‚ľC‚ť‚ę‚ź‚ę3 —Ⴈ‚ć‚Ń23 —á‚ĹCR ‚đ“ž‚˝‚Ć•ń‚ľ‚Ä‚˘‚éCQ29-1jB‚ŕ‚¤1 •Ň‚ĚÇ—áWĎŒ¤‹†‚Ĺ‚Í21 —á‚ĚPCLBCL, leg type ‚ÉŠÖ‚ľ‚āC•úŽËüŽĄ—Ă‚đ9 —áCŠO‰Č“IŘœ‚đ9 —á‚ÉŽ{s‚ľC‚ť‚ę‚ź‚ę3 —áC6 —á‚Ş—LŒř‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚é13jBCQ34 ‚ɉđŕ‚ľ‚˝‚悤‚ɁCƒŠƒcƒLƒVƒ}ƒu‚đ•š—p‚ľ‚˝‘˝Ü•š—p‰ťŠw—Ă–@‚Ş‘ćˆę‘I‘đ‚Ć‚ľ‚Đ„§‚ł‚ę‚é‚ŞC‘˝Ü•š—p‰ťŠw—Ă–@‚ލs‚Ś‚Č‚˘‚悤‚ȍ‚—ŽŇ‚⍇•šÇ‚Ě‘˝‚˘ŠłŽŇ‚ɑ΂ľ‚āCÇóŠÉ˜a‚ŕ‚ľ‚­‚ÍˆęŽž“I‚Č•a•ĎkŹ‚đ–Ú“I‚ɁCŠO‰Č“IŘœ‚â•úŽËüĆŽË‚஡—Ă–@‚Ě‘I‘đŽˆ‚Ć‚Č‚č‚¤‚éB

•śŒŁ

13j Hallermann C, Niermann C, Fischer RJ, et al: New prognostic relevant factors in primary cutaneous diffuse large B-cell lymphomas, J Am Acad Dermatol, 2007; 56: 588-597.iƒGƒrƒfƒ“ƒXƒŒƒxƒ‹Ⅳj