Journal of Hematology & Thromboembolic Diseases
Open Access

Abstract

A Case of Delayed Sinusoidal Obstruction Syndrome (SOS) Administered with Recombinant Soluble Thrombomodulin (rTM) and Peritoneovenous Shunt

Yutaka Tsutsumi, Reiki Ogasawara, Naohiro Miyashita and Shinichi Ito

The subject is a 45-year old female who visited the hospital due to irregular vaginal bleeding. Her white blood cell count was 170400/ uL and LDH level was 2099 iU/L. The subject was diagnosed with acute myeloid leukemia type M2 by bone marrow examination. The chromosomes were 46, XX, add(3)(p21), add(8)(q22), and add(21)(q22). The PCR (Polymerase Chain Reaction) examination confirmed that the positive AML1/ETO. Although one course of idarubicin hydrochloride (IDR: 12 mg/m2 for three days) plus cytarabine (AraC: 100 mg/m2 for seven days) was conducted as remission induction therapy, remission was not achieved. Since the bone marrow examination also observed meningeal infiltration, a second course of IDR plus AraC was combined with intraspinal administration of antitumor drugs, aiming for reremission induction. Although the meningeal infiltration disappeared, non-remission status remained. We then conducted two courses of FLAG-M (AraC 2 g/m2 twice a day for four days, fludarabine 15 g/m2 twice a day for four days, mitoxantrone 10 mg/ m2 for three days, and granulocyte colony-stimulating factor: G-CSF 75 μg) and one course of MEC (AraC 1 g/m2 for six days, etoposide 80 g/m2 for six days, and mitoxantrone 6 mg/ m2 for six days). These regimens did not lead to a complete remission.