Therapeutic Effect and Prognostic Analysis of Induction Chemotherapy with Idarubicin/BH-AC in Acute Myelogenous Leukemia / 대한혈액학회지

BACKGROUND: We have analyzed the outcome and prognostic factors for 61 patients with acute myelogenous leukemia (AML) who were treated with idarubicin(IDA)/N 4-behenoyl- 1-beta-D-arabinofuranosylcytosine(BH-AC) regimen at Chonnam National University Hospital between April 1994 and December 1998. METHODS: Fifty-six patients with newly diagnosed AML and 5 patients failed by IDA/ara- C were eligible to analysis. Remission induction chemotherapy consisted of IDA (12 mg/m2/day IV over 30 minutes on days 1~3) and BH-AC (age 40 years: 200 mg/m2/day). After achievement of a complete remission (CR), four polychemotherapy cycles, allogeneic BMT or autologous PBSCT were given as consolidation. RESULTS: Median age was 38 years (range, 17 to 65). Of 61 patients, 43 (70.5%) achi-eved CR and 6 (9.8%) died of early complications. The Kaplan-Meier estimated overall survival rate was 51.8+/-7.7%, 43.1+/-8.5% and 29.6+/-8.8% at 1 year, 2 year and 3 year respectively, and the disease free survival rate was 58.4+/-9.7%, 43.3+/-10.4% and 24.0+/-12.2 % at 1 year, 2 year and 3 year, respectively. Unfavorable prognostic variables for achieving CR were age >55 years (P =0.006), FAB subtypes (P=0.005) and poor risk cytogenetic abnormalities (P=0.021), and FAB subtypes for overall survival (P=0.0064). CONCLUSION: IDA/BH-AC combination chemotherapy is an effective and well-tolerated regimen for induction treatment of AML.

Acquired hemophilia successfully treated with oral immunosuppressive therapy

Acquired hemophilia is a rare disorder associated with serious bleeding in nonhemophilic patients. We had a 40-year-old woman who was diagnosed as acquired hemophilia with a factor VIII inhibitor level of 27.5 BU/mL. She was presented with gross hematuria and severe right shoulder pain, and was successfully treated with daily oral cyclophosphamide and prednisone for 2 weeks. After the remission, the doses of prednisone and cyclophosphamide were slowly decreased and she remained in complete remission without further bleeding episodes.

Clinical Effect of Granulocyte Transfusion Therapy in Neutropenia-Related Infection / 대한혈액학회지

BACKGROUND: After a zealous advocates of granulocyte transfusion therapy (GTX) in the 1970s and early 1980s, the use of GTX has diminished strikingly because of the several problems of GTX and the introduction of new antimicrobial agents and recombinant hematopoietic growth factors. Recently, GTX offers renewed interest because several investigators reported the transfusion efficacy of granulocytes collected by stimulating normal donors with recombinant human granulocyte-colony stimulating factor (G-CSF). METHODS: To evaluate the safety and efficacy of GTX, thirteen patients with neutropenia- related infections at Chonnam University Hospital from March 1997 to February 1998 were treated with dexamethasone- or G-CSF-stimulated granulocyte transfusions apheresed from normal donor. RESULTS: Patients received a mean number of 2.4 transfusions (range, 1-7) and a mean dose of 5.5x1010 granulocytes (range, 0.2-19.6). Six patients (46.2%) had favorable responses. Favorable responses occurred among patients with more fungal infection than bacterial infection (71.4 vs 28.6%, P<0.05) and more increment of absolute neutrophil count at 1 hour after transfusion (P<0.05). Adverse reactions of GTX were pulmonary edema in 2 patient (15.4%) and transient hypoxia in 1 patient (7.7%). One patient (7.7%) with pulmonary edema died of severe pulmonary reaction. Two of 20 donors received by G-CSF complained of mild myalgia and bone pain. CONCLUSION: G-CSF- or dexamethasone-stimulated GTXs were well tolerated and may be clinically beneficial for neutropenia-related infection, particularly in fungal infection, that is refractory to antimicrobial therapy.