難治性後天性再生不良性貧血に対するリチウム療法の臨床的研究

Abstract

Lithium carbonate has been shown to cause neutrophilia in patients with manic and depressive disorders, and is recognized as a stimulator of granulocytosis both in vivo and in vitro. The possibility that this medicine may cause pluripotent stem cells to proliferate and differentiate has also been suggested by a few reports of remissions in aplastic anemia (AA) coinciding with lithium therapy and some findings in vitro. But now lithium therapy is not recognized as a treatment for AA ; its usefulness for AA is unclear. Directing special attention to this point, I administered lithium carbonate to patients with intractable acquired aplastic anemia (AA) -7 men and 7 women from 16 to 74 years of age (average : 49.9 years). They included 9 subjects with severe AA and 5 with moderate AA in whom previous therapy had been ineffective. They were given initial doses of lithium carbonate ranging from 400 to 600 mg/day ; in some cases dosage was increased to 1,200 mg/day based on drug effects and serum levels. The patients showing improvement during the 16-week treatment were regarded as having effective results, i. e., 7 of 14. Laboratory results for these 7 showed improvement statistically in red blood cells and hemoglobin at the 4-week treatment, and 3 blood components at the 8-week treatment. After 16-week treatment, 10 patients continued lithium therapy and 9 of 10 showed improvement in 3 blood components. Thereafter 2 patients in whom serum lithium level was over 2mEq/l showed toxic effects but recovered quickly when lithium was discontinued. The others controlled under 1mEq/l showed no severe adverse reactions. The author concludes that lithium therapy was remarkably useful for patients with intractable acquired aplastic anemia.