内容紹介
A Case of Acute Myeloid Leukemia in an Obese Patient―Determining the Therapeutic Dose of Anticancer Drugs
Summary
Currently, there is no consensus to determine whether the therapeutic doses of anticancer drugs should be based on the actual or the ideal body weight of obese cancer patients. We performed induction and consolidation chemotherapy at doses calculated by using the actual body weight of an obese patient with acute myeloid leukemia(AML). A 47-year-old Japanese man presented with pancytopenia at our hospital, and he was diagnosed with AML(FAB classification M0). At the initial diagnosis, the patient was 170 cm tall and weighed 132 kg; therefore, his body surface area was 2.37 m2. His performance status and organ functions were quite good. The calculations for determining doses of anticancer drugs required were based on his actual body weight. He received induction chemotherapy and achieved complete remission. Subsequently, he was treated with 4 courses of consolidation chemotherapy. Febrile neutropenia was a complication during each course, and it was relieved via myeloid recovery. Chemotherapy was administered every 4-5 weeks, except for the second course where platelet recovery was prolonged, and the prescribed treatment was completed. The guidelines of the American Society of Clinical Oncology(ASCO)recommend that physicians routinely use an obese patient's actual body weight to calculate the appropriate doses of almost all chemotherapy drugs. Therefore, the ease and compromised usage of under-dosing because of heaviness owing to obesity should be avoided.
要旨
肥満がん患者の抗がん剤投薬量決定に際し,実体重に基づくか標準(理想)体重に基づいて減量するかコンセンサスがない。われわれは,初診時体重132 kgの急性骨髄性白血病患者に対し,実体重に基づき算出した投薬量で寛解導入療法および地固め療法を行った。症例は47歳,男性。汎血球減少症にて当院受診,急性骨髄性白血病(FAB分類M0)と診断した。初診時身長170 cm,体重132 kg,体表面積2.37 m2,PSや臓器機能はよく,実体重に基づき抗がん剤投薬量を決定した。寛解導入療法を開始し,その後完全寛解となった。続いて地固め療法を4コース行った。各コースで発熱性好中球減少症を合併したものの,骨髄の回復とともに軽快した。血小板数回復が遷延した2コース目を除き,4～5週間隔で化学療法を行い,予定した治療を完遂することができた。米国臨床腫瘍学会(ASCO)のガイドラインは,肥満成人がん患者(特に「治癒」をめざす場合)の投薬量は,実体重に基づいて決めることを推奨している。したがって,肥満による高体重のみを根拠とした安易な減量はすべきでないと考える。
目次
Summary
Currently, there is no consensus to determine whether the therapeutic doses of anticancer drugs should be based on the actual or the ideal body weight of obese cancer patients. We performed induction and consolidation chemotherapy at doses calculated by using the actual body weight of an obese patient with acute myeloid leukemia(AML). A 47-year-old Japanese man presented with pancytopenia at our hospital, and he was diagnosed with AML(FAB classification M0). At the initial diagnosis, the patient was 170 cm tall and weighed 132 kg; therefore, his body surface area was 2.37 m2. His performance status and organ functions were quite good. The calculations for determining doses of anticancer drugs required were based on his actual body weight. He received induction chemotherapy and achieved complete remission. Subsequently, he was treated with 4 courses of consolidation chemotherapy. Febrile neutropenia was a complication during each course, and it was relieved via myeloid recovery. Chemotherapy was administered every 4-5 weeks, except for the second course where platelet recovery was prolonged, and the prescribed treatment was completed. The guidelines of the American Society of Clinical Oncology(ASCO)recommend that physicians routinely use an obese patient's actual body weight to calculate the appropriate doses of almost all chemotherapy drugs. Therefore, the ease and compromised usage of under-dosing because of heaviness owing to obesity should be avoided.
要旨
肥満がん患者の抗がん剤投薬量決定に際し,実体重に基づくか標準(理想)体重に基づいて減量するかコンセンサスがない。われわれは,初診時体重132 kgの急性骨髄性白血病患者に対し,実体重に基づき算出した投薬量で寛解導入療法および地固め療法を行った。症例は47歳,男性。汎血球減少症にて当院受診,急性骨髄性白血病(FAB分類M0)と診断した。初診時身長170 cm,体重132 kg,体表面積2.37 m2,PSや臓器機能はよく,実体重に基づき抗がん剤投薬量を決定した。寛解導入療法を開始し,その後完全寛解となった。続いて地固め療法を4コース行った。各コースで発熱性好中球減少症を合併したものの,骨髄の回復とともに軽快した。血小板数回復が遷延した2コース目を除き,4～5週間隔で化学療法を行い,予定した治療を完遂することができた。米国臨床腫瘍学会(ASCO)のガイドラインは,肥満成人がん患者(特に「治癒」をめざす場合)の投薬量は,実体重に基づいて決めることを推奨している。したがって,肥満による高体重のみを根拠とした安易な減量はすべきでないと考える。