[急性白血病の治療を受けている小児の多発性子宮出血の予防と管理: SFCE白血病委員会のガイドライン]

Audrey Grain¹, Céline Falaise², Virginie Gandemer³

¹Oncologie et hématologie pédiatrique, CHU de Nantes, Nantes, France.

Bulletin du cancer

|September 6, 2025

まとめ

化学療法を受けている若年白血病患者の激しい子宮出血 (HUB) は一般的です. 組織的な予防は推奨されません. 証明されたHUBでは,二次予防のためのホルモンによるオプションと,緊急の非ホルモンまたはホルモンによる治療が推奨されます.

科学分野:

小児腫瘍学
血液学
婦人科

背景:

濃度の化学療法を受けている白血病の青春期および若い成人女性では,激しい子宮出血 (HUB) が起こる可能性があります.
HUBの管理戦略 (予防と治療) はフランス各センターで大きく異なる.
既存の文献は,化学療法中の自発的なアメノレアを強調し,定期的なHUB予防の必要性を疑問視しています.

研究の目的:

若い女性白血病患者の多発性子宮出血の管理のための実践的な勧告を確立する.
フランス児童がん協会 (SFCE) 内のHUB予防と治療のアプローチを調和させる.
決定的なデータがない場合,証拠に基づいたコンセンサス主導のガイドラインを提供すること.

主な方法:

SFCE白血病委員会が参加した調和ワークショップ
既存の文献と国際的勧告のレビュー
HUBの管理方法に関するフランスの25のセンターからのデータ収集.

主要な成果:

白血病患者におけるHUBのシステマティックな予防には,自発的なアメノレアの発生率による指示はありません.
確立されたHUBでは,非ホルモンまたはホルモンによる治療の緊急開始が推奨されます.
二次予防のために,アメノレアを誘発するホルモン治療を考慮することができます.

結論:

この患者集団におけるHUBの定期的な予防措置は,現在の証拠では支持されていません.
管理は,出血のエピソードを迅速かつ緊急に治療することに焦点を当てるべきです.
二次予防戦略については,さらなる議論と合意が必要である.

キーワード:

急性白血病ガイドライン激しい子宮出血急性白血病マネジメント予防する推奨事項胎盤の出血が多くなるトリートメント

さらに関連する動画

10:49

Pre-clinical Evaluation of Tyrosine Kinase Inhibitors for Treatment of Acute Leukemia

Published on: September 18, 2013

18.2K

09:01

Flow Cytometry to Estimate Leukemia Stem Cells in Primary Acute Myeloid Leukemia and in Patient-derived-xenografts, at Diagnosis and Follow Up

Published on: March 26, 2018

14.1K

関連する概念動画

01:30

Venous Thrombosis IV: Nursing Management

Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...

01:28

Esophageal Varices-II: Clinical Features and Management

133

Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...

133

01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...

01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...

01:22

Bone Marrow Sampling and Transplants

491

Bone marrow transplant is a potential cure for several diseases, including cancer and specific genetic disorders. Notably, this procedure is applicable for patients suffering from aplastic anemia, certain types of leukemia, severe combined immunodeficiency disease (SCID), Hodgkin's disease, non-Hodgkin's lymphoma, multiple myeloma, thalassemia, sickle-cell disease, and certain cancers.
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy...

491

02:50

Combination Therapies and Personalized Medicine

5.1K

Combining two or more treatment methods increases the life span of cancer patients while reducing damage to vital organs or tissue from the overuse of a single treatment. Combination therapy also targets different cancer-inducing pathways, thus reducing the chances of developing resistance to treatment.
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...