High Dose Therapy Followed by Autologous Peripheral Blood Stem Cell Transplantation as a First Line Treatment for Multiple Myeloma: a Korean Multicenter Study

We conducted a phase II multicenter trial to estimate the response and survival of patients with newly diagnosed multiple myeloma to high dose melphalan therapy followed by autologous peripheral blood stem cell transplantation. Eligible patients who had undergone induction with vincristine, adriamycin and dexamethasone (VAD) should have adequate cardiac, pulmonary and renal function (creatinine <2 mg/dL). Melphalan at 200 mg/m2 was used as a conditioning regimen. Eighty patients were enrolled from 13 centers. The median age of the patients was 53 yr (range; 20 to 68 yr). The initial stage was IA/IIA/IIB/IIIA/IIIB in 3/8/1/54/14 patients, respectively. Beta2-microglobulin, CRP and LDH were increased in 74, 42 and 34% of the patients examined. Cytogenetic data were available in 30 patients, and 6 patients showed numeric or structural abnormalities. Two therapy-related mortalities occurred from infection. Among the 78 evaluable patients, CR/PR/MR/NC/PD were achieved in 48/26/2/1/1patients, respectively. After a median follow-up of 30 months, the median overall and event-free survivals were 66 months (95% CI: 20-112) and 24 months (95% CI: 18-29), respectively. This study verifies the efficacy and feasibility of high dose melphalan therapy with autologous stem cell transplantation in newly diagnosed multiple myeloma.

Development and Test of an Information Needs Scale for Outpatients Undergoing Chemotherapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to develop and test an Information Needs Scale for Korean outpatients undergoing chemotherapy (INS-C). MATERIALS AND METHODS: Thirty-three items of the INS-C had content validity based upon findings in the literature and the experiences of expert oncology physicians and nurses. Each item consisted of a five-point Likert scale from 1 (don't want to know) to 5 (want to know very much). The items were administered to 175 Korean outpatients undergoing chemotherapy. The data obtained was analysed using a factor analysis for construct validity and Cronabch's alpha for internal consistent reliability. RESULTS: From the factor analysis, six subscales were derived significantly. The six subscales explained 64.62% of the variance. The subscales were named Side-Effects/Investigative Tests (9 items), Spread of Disease (4 items), Financial Cost (2 items), Treatment (7 items), Activities/ Eating (6 items), and Interrelationships/Support (5 items). The Cronbach's alpha of the total INS-C was .95, and the alpha of the subscales ranged from .77 to .91. CONCLUSION: The present study suggests that the INS-C is a reliable and valid instrument to measure the information needs of outpatients undergoing chemotherapy. Health professionals caring for patients with cancer should assess the informational needs of their patients using a reliable and valid instrument and be prepared to provide accurate information.

Pathogenesis of Thrombocytopenia / 대한혈액학회지

Thrombocytopenia may be due to 1) a decrease in production, as seen in patients with marrow aplasia or when the marrow is infiltrated by tumor, 2) disorders in which platelet destruction exceeds production, or 3) splenomegaly, in which the distribution of platelets is abnormal. In evaluating the patient with thrombocytopenia, one should look for splenomegaly on physical examination, which would suggest a syndrome characterized by platelet sequestration. Second, one should examine a bone marrow sample to detect aplasia, fibrosis, or infiltration. In patients with a normal spleen and normal bone marrow function, the underlying disorder must by excess destruction. This can be due to nonimmune disorders, such as disseminated intravascular coagulation, or prosthetic cardiac valves, or thrombotic thrombocytopenic purpura, or to the presence of either immune complexes or specific antiplatelet antibodies. Immune thrombocytopenia can be induced by a wide range of common drugs, including quinidine, penicillin, gold, and sulfonamides. Heparin is perhaps the most common drugs in inducing thrombocytopenia in 1~10% of patients who receive this anticoagulant. Acute immune thrombocytopenia seen primarily in children often occurs following a viral infection. About 90% of these patients recover within 4 to 6 weeks without therapy. In contrast a chronic form of immune thrombocytopenia is much more common in adults. Antibodies against specific target antigens, usually against GP IIb/IIIa or GP Ib/IX/V. Cognizant of pathogenesis of these various forms of thrombocytopenia will allow the diagnosis much easier and practical.