The occurrence of multiple myeloma is described in a patient receiving phenytoin (diphenylhydantoin) for 43 years. In this article, five cases of multiple myeloma and one of immunoblastic lymphadenopathy associated with diclonal gammopathy diagnosed after longterm phenytoin therapy are reviewed. These cases are characterized by lymphadenopathy, hepatosplenomegaly, and no or equivocal bone lesions, which are quite unusual in multiple myeloma. Because of the association of lymphomas with phenytoin, the role of the drug in the etiology of multiple myeloma or plasma cell dyscrasias is still in controversy, but highly suspected. It is suggested that a periodic examination of patients receiving phenytoin may be useful in an early detection of M-component. The possibility of reversing multiple myeloma by removal of phenytoin early in the course of the disease should be investigated.
A 79-year-old patient with acute myeloblastic leukemia (M2 type in FAB), who has survived more than 5 years, is reported. She was admitted because of fever and anemia. Her white blood cell count was 6200/mm3 with 58% blasts. Bone marrow aspiration showed a nucleated cell count of 26 X 10(4)/mm with 84% blasts, Complete remission was achieved within one month by DCMP two-step method therapy. She relapsed in the third and fifth years after initial therapy. Because leukemic change is atypical, she was treated with a low dose of Ara-C therapy, resulting in complete remission. In cases of acute myelobastic leukemia in elderly patients, long-term survival is rare. However in this case, follow-up has succeeded for 5 years. This patient is the oldest case of acute myeloblastic leukemia ever reported in Japan.
