title: [Bestatin-induced intravascular hemolysis in a patient with acute myelocytic leukemia].
abstract: We encountered a patient who developed intravascular hemolysis while being treated with immunotherapy of bestatin. A 18-year-old female, diagnosed as having acute myelocytic leukemia and remained in complete remission for about 18 months by repeated consolidation therapy, was admitted to our hospital because of sudden fall of Hb concentration. Nine days prior to admission, bestatin, 30 mg daily, was resumed following a rest period of 2 weeks. Bestatin was started after the first complete remission had been achieved, Urine was dark brown with positive occult blood, but no red cells were observed. Hb was 7.9 g/dl, the number of reticulocytes 14.1%, WBC 3100/microliters with a normal classification, and platelets 6.1 x 10(4)/microliters. The serum total bilirubin was 2.3 mg/dl with a direct component of 0.8 mg/dl. Serum LDH was markedly elevated. Serum Hb was 0.12 g/dl and haptoglobin was less than 10 mg/dl. Direct and indirect Coombs' tests were both negative. Lymphocyte stimulation test by bestatin was positive. Full recovery followed the cessation of bestatin therapy and the initiation of corticosteroid therapy. It may be speculated from our case that discontinuous administration of bestatin may have been an opportune setting for developing a side effect of severe intravascular hemolysis.
authors.affiliation: Department of Internal Medicine, Kobe City General Hospital.
authors.forename: S
authors.initials: S
authors.lastname: Nakayama
authors.forename: H
authors.initials: H
authors.lastname: Yabe
authors.forename: T
authors.initials: T
authors.lastname: Ishikawa
authors.forename: K
authors.initials: K
authors.lastname: Nagai
mesh_terms: D000208:Acute Disease; D000276:Adjuvants, Immunologic / Q000009:adverse effects*; D000293:Adolescent; D000743:Anemia, Hemolytic / Q000139:chemically induced; D005260:Female; D006461:Hemolysis / Q000187:drug effects*; D006801:Humans; D007930:Leucine / Q000009:adverse effects / Q000031:analogs & derivatives*; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000276:immunology
chemical_list: D000276:Adjuvants, Immunologic; D007930:Leucine; C012211:ubenimex