ABSTRACT
PURPOSE: Given the promising activity of capecitabine and vinorelbine in metastatic breast cancer, this randomized phase II trial evaluated the efficacy and safety of this combination as neoadjuvant chemotherapy in breast cancer. MATERIALS AND METHODS: Patients with operable breast cancer (n=75) were randomly assigned to receive either four cycles of adriamycin 60 mg/m2 plus cyclophosphamide 600 mg/m2 every 3 weeks followed by four cycles of docetaxel 75 mg/m2 every 3 weeks (AC-D) or four cycles of capecitabine 2,000 mg/m2 (day 1-14) plus vinorelbine 25 mg/m2 (days 1 and 8) every 3 weeks followed by four cycles of docetaxel 75 mg/m2 (CV-D). The primary endpoint was pathologic complete response (pCR) in the primary breast (ypT0/is). RESULTS: Most patients (84%) had locally advanced (n=41) or inflammatory breast cancer (n=22). pCR rates in the primary breast were 15% (95% confidence interval [CI], 7% to 30%) and 11% (95% CI, 4% to 26%) in the AC-D and CV-D groups, respectively. The overall response rates and 5-year progression-free survival rates in the AC-D and CV-D groups were 62% and 64%, and 51.3% (95% CI, 34.6% to 68.0%) and 30.2% (95% CI, 13.3% to 47.1%), respectively. Although both regimens were well tolerated, CV-D showed less frequent grade 3-4 neutropenia and vomiting than AC-D, whereas manageable diarrhea and hand-foot syndrome were more common in the CV-D group. CONCLUSION: CV-D is a feasible and active non-anthracycline-based neoadjuvant chemotherapy regimen for breast cancer.
Subject(s)
Humans , Anthracyclines , Breast , Breast Neoplasms , Cyclophosphamide , Diarrhea , Disease-Free Survival , Doxorubicin , Drug Therapy , Hand-Foot Syndrome , Inflammatory Breast Neoplasms , Neoadjuvant Therapy , Neutropenia , Polymerase Chain Reaction , VomitingABSTRACT
Tamoxifen and radiotherapy are used in breast cancer treatment worldwide. Radiation recall dermatitis (RRD), induced by tamoxifen, has been rarely reported. Herein, we report a RRD case induced by tamoxifen. A 47-year-old woman had a right quadrantectomy and an axillary lymph node dissection due to breast cancer. The tumor was staged pT2N0; it was hormone receptor positive, and human epidermal growth factor receptor 2 negative. The patient received adjuvant chemotherapy followed by tamoxifen and radiotherapy. After 22 months of tamoxifen, the patient developed a localized heating sensation, tenderness, edema, and redness at the irradiated area of the right breast. The symptoms improved within 1 week without treatment. Three weeks later, however, the patient developed similar symptoms in the same area of the breast. She continued tamoxifen before and during dermatitis, and symptoms resolved within 1 week.
Subject(s)
Female , Humans , Middle Aged , Breast , Breast Neoplasms , Chemotherapy, Adjuvant , Dermatitis , Edema , Heating , Hot Temperature , Lymph Node Excision , Radiodermatitis , Radiotherapy , ErbB Receptors , Sensation , TamoxifenABSTRACT
Mesenteric venous thrombosis (MVT) is a serious condition due to its potential association with mesenteric ischemia and infarction of the small bowel. Symptoms of MVT are often vague, making accurate diagnosis and sufficient treatment difficult. However, increased awareness and new imaging modalities for this condition have improved outcomes for patients with MVT. Treatment includes anticoagulation, transcatheter therapy, and surgery. In the present report, we describe the case study of a 62-year-old woman with a presenting diagnosis of superior MVT, who was finally diagnosed with myelodysplastic syndrome. The superior MVT spontaneously dissolved after the patient underwent 6 months of systemic anticoagulation therapy. Invasive surgery or bowel resection was not required.
Subject(s)
Female , Humans , Middle Aged , Diagnosis , Infarction , Ischemia , Mesenteric Veins , Myelodysplastic Syndromes , Thrombosis , Venous ThrombosisABSTRACT
BACKGROUND: The objectives of this study were to determine the incidence, outcome and risk factors for HBV reactivation in HBsAg positive breast cancer patients while on anthracycline -based adjuvant chemotherapy. METHDOS: We retrospectively reviewed the records of 2,431 patients with early breast cancer who received adjuvant chemotherapy from March 2001 to December 2005. Among these patients, 111 HBsAg positive women were enrolled in this study. RESULTS: Thirty-seven patients (33.3%) developed acute hepatitis, of which 23 (20.7%) were related to HBV reactivation. Univariate analysis showed that an age > or =47 years (p=0.034) and abnormal sonographic findings such as a fatty liver or cirrhotic changes (p=0.034) were associated with HBV reactivation. However, an HBeAg positive status and the use of corticosteroids were not. Multivariate analysis found that no clinical factors could predict HBV reactivation during chemotherapy. All 23 patients who developed HBV reactivation received lamivudine as a therapeutic measure at the time of HBV reactivation. Despite the use of lamivudine, disruption in the chemotherapy protocol occurred in 18 patients (78.3%) and 14 of these patients had premature termination of their chemotherapy. CONCLUSIONS: HBV reactivation occurred in a significant proportion of HBsAg positive patients during adjuvant anthracycline-based chemotherapy. Once hepatitis developed, most patients could not finish the chemotherapy as planned despite lamivudine treatment. Until the risk factors for reactivation are clearly identified, HbsAg-positive patients should begin prophylactic antiviral treatment before initiating chemotherapy.
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Anthracyclines/adverse effects , Antineoplastic Agents/adverse effects , Antineoplastic Combined Chemotherapy Protocols , Breast Neoplasms/drug therapy , Chemotherapy, Adjuvant/adverse effects , Hepatitis B/epidemiology , Incidence , Korea/epidemiology , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
PURPOSE: To evaluate the efficacy of gemcitabine- based chemotherapy, particularly in patients with anthracycline- and taxane-pretreated 2(nd)-line or greater metastatic breast cancer, and to compare gemcitabine monotherapy (G) with two gemcitabine-based doublets, gemcitabine/ vinorelbine (GV) and gemcitabine/capecitabine (GX). MATERIALS AND METHODS: Of 124 consecutive patients who progressed after anthracycline- and taxane-containing chemotherapy, 58 received G alone, 38 received GV, and 28 received GX; their outcomes were analyzed retrospectively. RESULTS: The median number of prior metastatic chemotherapy regimens was 2 (range 0~4). Visceral metastases were observed in 65 patients (51.4%). The overall response rate was 19.3% (21 partial responses). After a median follow-up period of 21.4 months, the overall survival was 7.6 months (95% CI: 5.5~9.6 months) and the median time to progression was 3.1 months (95% CI: 2.0~4.2 months). Compared with monotherapy (G), combination therapy with vinorelbine or capecitabine (GV/ GX) was associated with a significantly higher response rate (8.2% vs. 28.3%, p=0.008) and a significantly longer median time to progression (2.8 vs. 3.5 months; p=0.028), but overall survival did not differ between the groups (7.4 vs. 8.2 months, respectively; p=0.54). Most of the adverse treatment-related events were mild to moderate in intensity. The most common adverse event was hematologic toxicity. Multivariate analysis showed that poor performance status and a short disease-free interval were independent prognostic factors for impaired overall survival. CONCLUSIONS: The combination of gemcitabine with vinorelbine or capecitabine was an active and well-tolerated treatment option for taxane- and anthracycline-pretreated 2(nd)-line or greater metastatic breast cancer patients, and gemcitabine-based doublets were more beneficial than gemcitabine monotherapy in alleviating symptoms for these patients.
Subject(s)
Humans , Breast Neoplasms , Breast , Drug Therapy , Drug Therapy, Combination , Follow-Up Studies , Multivariate Analysis , Neoplasm Metastasis , Retrospective Studies , CapecitabineABSTRACT
Pleural effusion in chronic myeloid leukemia (CML) is poorly understood and rarely reported in the literature. When the pleural effusion is caused by leukemic pleural infiltration, the differential white blood cell count of the effusion is identical to that of the peripheral blood, and the fluid cytology reveals leukemic blasts. We report here a case of bilateral pleural involvement of atypical CML in an 83-yr old male diagnosed with pancreatic cancer with abdominal wall metastasis and incidental peripheral leukocytosis. Based on bone marrow examination, chromosome analysis and polymerase chain reaction he was diagnosed with Philadelphia chromosome negative, BCR/ABL gene rearrangement negative CML. Following 3 months of treatment with gemcitabine for pancreatic cancer, he developed bilateral pleural effusions. All stages of granulocytes and a few blasts were present in both the pleural fluid and a peripheral blood smear. After treatment with hydroxyurea and pleurodesis, the pleural effusion resolved.
Subject(s)
Male , Humans , Aged, 80 and over , Aged , Pleural Effusion/etiology , Leukemic Infiltration/pathology , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complicationsABSTRACT
The treatment outcomes with conventional second-line chemotherapy or radiotherapy aregenerally very poor for patients with relapsed primary CNS lymphoma (PCNSL). We treated three relapsed PCNSL patients with high-dose cytarabine plus etoposide (CYVE) chemotherapy, and this was followed by autologous stem cell transplantation (ASCT). The salvage CYVE chemotherapy consisted of cytarabine 2g/m2/d on days 2 to 5 in a 3-hour infusion and 50mg/m2/d on days 1 to 5 in a 12-hourinfusion, and etoposide 200mg/m2/d on days 2 to 5 in a 2-hour infusion. After two cycles of CYVE chemotherapy, two patients achieved a complete response (CR), and one patient achieved a partial response (PR). All three patients experienced febrile neutropenia and grade 4 thrombocytopenia with the CYVE chemotherapy. However, the hematologic toxicities were well managed without any complications. The conditioning regimen for ASCT consisted of BCNU 300mg/m2 on day -7, etoposide 100mg/m2 on days -6 to -3, cytarabine 100mg/m2 on days -6 to -3, and cyclophosphamide 35mg/kg on days -6 to -3 (BEAC). After ASCT, the patient who initially showed a PR with CYVE chemotherapy then achieved a CR. At the time of this report, one patient remained alive in CR for 41 months after CYVE chemotherapy. The remaining two patients experienced relapse 5 months and 4 months after ASCT, respectively, and they ultimately died of disease progression 18 months and 8 months after ASCT, respectively. In our cases, the CYVE chemotherapy+ASCT was well tolerated, and this induced the complete disappearance of the tumor, and one patient showed prolonged disease-free survival. CYVE chemotherapy+ASCT could be a treatment option for relapsed PCNSL.
Subject(s)
Humans , Anemia, Hemolytic, Autoimmune , Carmustine , Cyclophosphamide , Cytarabine , Disease Progression , Disease-Free Survival , Drug Therapy , Etoposide , Febrile Neutropenia , Lymphoma , Radiotherapy , Recurrence , Stem Cell Transplantation , Stem Cells , Thrombocytopenia , Waldenstrom MacroglobulinemiaABSTRACT
PURPOSE: The benefit of consolidation high-dose chemotherapy (HDC) for high-risk primary breast cancer is controversial. We evaluated the efficacy and safety of consolidation HDC with cyclophosphamide, thiotepa and carboplatin (CTCb) followed by autologous stem-cell transplantation (ASCT) in resected breast cancer patients with 10 or more positive lymph nodes. MATERIALS AND METHODS: Between December 1994 and April 2000, 22 patients were enrolled. All patients received 2 to 6 cycles of adjuvant chemotherapy after surgery for breast cancer. The HDC regimen consisted of cyclophosphamide 1, 500 mg/m2/day, thiotepa 125 mg/m2/day and carboplatin 200 mg/m2/day intravenous for 4 consecutive days. RESULTS: With a median follow-up of 58 months, 11 patients recurred and died. The median disease-free survival (DFS) and median overall survival (OS) were 49 and 69 months, respectively. The 5-year DFS and OS rates were 50% and 58%, respectively. The 12 patients with 10 to 18 involved nodes had better 5-year DFS (67%) and OS (75%) than 10 patients with more than 18 involved nodes (30% and 38%, respectively). The most common grade 3 or 4 nonhematologic toxicity was diarrhea, which occurred in 5 patients (23%). No treatment-related death was observed. CONCLUSION: Consolidation HDC with CTCb followed by ASCT for resected breast cancer with more than 10 positive nodes had an acceptable toxicity but does not show promising survival.
Subject(s)
Humans , Breast Neoplasms , Breast , Carboplatin , Chemotherapy, Adjuvant , Cyclophosphamide , Diarrhea , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Lymph Nodes , Peripheral Blood Stem Cell Transplantation , ThiotepaABSTRACT
No abstract available.
Subject(s)
Breast Neoplasms , Breast , Drug Therapy , Neoadjuvant TherapyABSTRACT
PURPOSE: The benefit of high-dose chemotherapy (HDC) for metastatic breast cancer (MBC) is controversial. We evaluated the efficacy and safety of HDC with cyclophosphamide, thiotepa, and carboplatin (CTCb) followed by autologous stem-cell transplantation (ASCT) for MBC patients. MATERIALS AND METHODS: From September 1994 to December 1999, 23 MBC patients were enrolled. All the patients received 2 to 10 cycles of induction chemotherapy. Before transplantation, 12 patients were in complete response (CR), nine were in partial response (PR), and two had progressive disease (PD). The HDC regimen consisted of cyclophosphamide 1, 500 mg/m2/day, thiotepa 125 mg/m2/day and carboplatin 200 mg/m2/day intravenously for 4 consecutive days RESULTS: After ASCT, 13 patients (56%) had a CR, five (22%) had a PR, three (13%) had no change, while two (9%) showed a PD. Seventeen patients relapsed or progressed during the median follow-up of 78 months. The median progression-free survival (PFS) time was 11 months and the median overall survival (OS) time was 23 months. The 5-year PFS and OS rates were 22% and 25%, respectively. On the multivariate analyses, less than 4 involved lymph nodes was predictive of a better PFS and OS. CONCLUSION: HDC with CTCb for MBC has acceptable toxicity; however, this treatment does not show a survival benefit.
Subject(s)
Humans , Breast Neoplasms , Breast , Carboplatin , Cyclophosphamide , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Induction Chemotherapy , Lymph Nodes , Multivariate Analysis , ThiotepaABSTRACT
Non-myeloablative allogeneic peripheral stem cell transplantation (NST) is a novel therapeutic strategy for patients with hematologic malignancies. Whether non-myeloablative transplants are associated with increased risk of cytomegalovirus (CMV) infections is unknown. To clarify this issue, we compared the outcome of CMV infection following 24 allogeneic non-myeloablative peripheral blood stem cell transplants and 40 conventional bone marrow transplants (CBT). The NST regimen consisted of busulfan (4mg/kg/day), fludarabine (30mg/m2) and anti-thymocyte globulin (10mg/kg). Twelve patients (50%) in the NST group and 17 (43%) in the CBT group developed positive antigenemia before day 100 (p=0.60). The time to the first appearance of positive antigenemia was not different between these two groups (p=0.40), and two groups showed similar initial and maximal antigenemia values (p=0.56 and p=0.68, respectively). Only one case of CMV colitis developed in the CBT group whereas CMV disease did not develop in the NST group. Although statistically insignificant, the treatment response against CMV antigenemia using ganciclovir was in favor of NST group. In conclusion, there was no difference in the risk of CMV infection between NST group and CBT group. Further prospective and controlled study is needed to clarify the impact of non-myeloablative procedure on the outcome of CMV infection.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Antigens, Viral/blood , Antiviral Agents/therapeutic use , Bone Marrow Transplantation/adverse effects , Comparative Study , Cytomegalovirus Infections/epidemiology , Ganciclovir/therapeutic use , Hematopoietic Stem Cell Transplantation/adverse effects , Incidence , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
PURPOSE: To determine whether COX-2 expression is associated with clinicopathological parameters, including c-erb-B2 overexpression and angiogenesis, and the disease- free survival of patients with operable breast cancer. MATERIALS AND METHODS: Paraffin-embedded tissue samples were selected from 205 patients surgically resected for breast cancer, between 1991 and 1997, and followed- up for at least 4 years. Samples were immunohistochemically stained with antibodies to COX-2, c-erb-B2 and CD34. RESULTS: COX-2 and c-erb-B2 expressions were detected in 118/205 (57.6%) and 58/205 (28.3%) patients, respectively. COX-2 expression was significantly higher in c-erb-B2 positive than c-erb-B2 negative tumors (75.9% vs. 49.7%, p-value 0.001). COX-2 expression was positively correlated with microvessel count (13.3+/-8.0 vs. 6.6+/-7.0, p-value 0.050), but not with other clinicopathological characteristics, including tumor size, involved axil lary lymph nodes and estrogen or progesterone receptor status. Although COX-2 expression itself was not a prognostic marker, breast cancer patients with tumors that co-expressed both COX-2 and c-erb-B2 had a poorer 5-year disease-free survival rate than those that did not (60.2% vs. 78.3%, p-value 0.0527). CONCLUSION: Our data suggest that COX-2 expression occurs frequently in c-erb-B2 positive breast cancer, and co-expression of COX-2 and c-erb-B2 may be a useful prognostic marker in patients with operable breast cancer.
Subject(s)
Humans , Antibodies , Breast Neoplasms , Breast , Cyclooxygenase 2 , Disease-Free Survival , Estrogens , Lymph Nodes , Microvessels , Receptors, ProgesteroneABSTRACT
BACKGROUND: To see whether there has been improvement in the survival of patients with acute leukemia over the last 14 years, a retrospective analysis was performed. METHODS: Clinical and laboratory data were obtained form the medical records. Patient survival data was obtained from the hospital records, national cancer registry or by direct phone contacts. RESULTS: Between June, 1989 and August 2002, 714 adult patients were diagnosed with acute leukemia at Asan Medical Center in Seoul. Fourteen patients were lost to follow-up within 100 days of the diagnosis and excluded. There were 535 patients with acute myelogenous leukemia (AML) and 165 with acute lymphoblastic leukemia (ALL). There were 65 patients with acute promyelocytic leukemia (APL) among 535 patients with AML. Patients with non-APL AML and ALL were divided into 3 cohorts according to the year of the diagnosis: cohort I, 1989~1994; cohort II, 1995~1998; cohort III, 1999~2002. Patients with APL were also divided into 3 cohorts: cohort I, pre-all-transretinoic acid (ATRA) period (1989~1994. 2); cohort II, ATRA with or without chemotherapy (1994. 3~2000. 8); and cohort III, ATRA plus idarubicin (2000. 9~2002). Univariate analysis showed significant improvement in patient survival in non-APL AML (4-year projected survival rates of 10%, 19%, and 33% for cohorts I, II, and III, respectively, P=0.0000), in ALL (27%, 28%, and 52%, P=0.03), and in APL (36%, 56%, and 80%, P=0.04). Multivariate analysis showed that the year of diagnosis was a significant independent variable for patient survival in non-APL AML and ALL. CONCLUSION: Our study showed significant survival improvement in acute leukemia over the last 14 years. This improvement is not likely due to change in patient demographics. Rather, it is likely that introduction of newer methods of treatment of acute leukemia, such as multi-cycle combination chemotherapy for ALL, high dose cytarabine consolidation for AML, ATRA for APL, and wider application of allogeneic hematopoietic cell transplantation, has resulted in a better patient survival.
Subject(s)
Adult , Humans , Cell Transplantation , Cohort Studies , Cytarabine , Demography , Diagnosis , Drug Therapy , Drug Therapy, Combination , Hospital Records , Idarubicin , Leukemia , Leukemia, Myeloid, Acute , Leukemia, Promyelocytic, Acute , Lost to Follow-Up , Medical Records , Multivariate Analysis , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Retrospective Studies , Seoul , Survival Rate , TransplantsABSTRACT
We have evaluated the efficacy and safety of the combination of capecitabine and vinorelbine in metastatic breast cancer (MBC) patients previously treated with anthracycline-and taxane-containing regimens. Between April 2000 and September 2002, 44 female MBC patients received oral capecitabine (1,250 mg/m(2) twice daily on days 114), and intravenous vinorelbine (25 mg/m2 on days 1 and 8) during each 3 weekchemotherapy cycle (median, 5 cycles/patient; total, 235 cycles). One patient achieved a complete response and 21 patients had partial responses, giving an overall response rate of 50% in the intention-to-treat analysis (95% CI, 35.0-65.0%). Median duration of response was 6.0 months (range 1.2-23.0 months). Patients were followed- up for a median of 16 months, with median progression-free survival being 5.3 months, and median overall survival being 17 months. Toxicities included grades III and IV neutropenia in 63 (26.8%) and 4 (1.7%) cycles, respectively, and grades II and III hand-foot syndrome in 12 (5.1%) and 4 (1.7%) cycles, respectively. Other nonhematologic toxicities were minimal and manageable. In conclusion, the combination of capecitabine and vinorelbine was effective and well tolerated in MBC patients even after treatment with anthracyclines and taxanes.
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Anthracyclines/therapeutic use , Antineoplastic Agents/therapeutic use , Breast Neoplasms/drug therapy , Deoxycytidine/analogs & derivatives , Drug Therapy, Combination , Neoplasm Metastasis , Prodrugs , Retrospective Studies , Survival Rate , Taxoids/therapeutic use , Treatment Outcome , Vinblastine/analogs & derivativesABSTRACT
This study was performed to assay the expression of epidermal growth factor receptor (EGFR) in non-small cell lung carcinoma (NSCLC), and to investigate the relationship between EGFR status and various clinicopathologic features of NSCLC, including angiogenesis and proliferative activity. The expression of EGFR, microvessel count (MVC) measured by CD31 monoclonal antibody, and proliferative activity using Ki-67 labeling index were immunohistochemically analyzed in formalin-fixed and paraffin-embedded tissue specimens from 65 patients with completely resected stage II-IIIA NSCLC. Pathologic and clinical records of all patients were retrospectively reviewed. EGFR was expressed in 18 (28%) of 65 NSCLC samples. More squamous tumors (35%) were EGFR-positive than other NSCLCs (23%) (p-value 0.308). There was a statistically significant correlation between EGFR expression and Ki-67 labeling index (p-value 0.042), but no correlation was observed between EGFR expression and tumor histology, stage, or MVC. There were no differences between EGFR positive and negative tumors in 5-yr disease-free survival (60% vs. 52%, p-value 0.5566) and 5-yr overall survival (53% vs. 45%, p-value 0.3382) rates. In conclusion, our findings suggest that NSCLC proliferative activity may be dependent on EGFR expression, but that EGFR expression had no significant impact on survival in curatively resected NSCLC.
Subject(s)
Adult , Aged , Animals , Female , Humans , Male , Middle Aged , Carcinoma, Non-Small-Cell Lung/chemistry , Cell Proliferation , Disease-Free Survival , Follow-Up Studies , Immunohistochemistry , ErbB Receptors/analysis , Retrospective Studies , Survival RateABSTRACT
Although hepatotoxicity has been rarely reported during adjuvant chemotherapy in breast cancer patients, we observed a high frequency in our patients who were also taking alternative agents. We therefore sought to determine the association between hepatotoxicity and alternative agents during adjuvant chemotherapy in breast cancer patients. All breast cancer patients were treated with the same chemotherapeutic regimen and had normal baseline liver function test (LFT). LFT was checked repeatedly during each cycle of chemotherapy. Patients showing LFT abnormalities were asked about use of alternative agents, and, after the end of chemotherapy, a questionnaire was administered to each patient on their use of alternative agents. Of 178 patients, 65 (36.5%) admitted using alternative therapy, and significantly more patients in this group developed LFT abnormalities (37/65, 56.9%) than those who denied taking alternative therapy (25/113, 22.1%, p=0.001). Although LFT abnormalities were mild to moderate and normalized in most patients after cessation of alternative agents, it remained a serious problem in one patient. In conclusion, alternative therapy may be one of the etiologies for abnormal LFT in breast cancer patients receiving adjuvant chemotherapy.
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Breast Neoplasms/drug therapy , Chemotherapy, Adjuvant , Complementary Therapies/methods , Liver/pathology , Liver Function Tests , Time FactorsABSTRACT
Although enumeration of CD34+ cells in the peripheral blood (PB) on the day of apheresis predicts the quantity of those cells collected, the flow cytometric techniques used are complex and expensive, and several hours are required to obtain the result in the clinical practice setting. The Sysmex SE-9000 automated haematology analyzer provides an estimate of immature cells, called hematopoietic progenitor cells (HPC). The aim of this study was to evaluate the clinical usefulness of HPC in predicting the optimal timing of peripheral blood progenitor cells (PBPC) harvest. Studies were performed on 628 aphereses from 160 patients with hematologic or solid malignancies. Spearman's rank statistics was used to assess correlation between HPC, WBC, mononuclear cells (MNC), and CD34+ cells. A receiver operating characteristic (ROC) curve was drawn for cutoff value of HPC, and predictive values of the chosen cutoff value of HPC for different target CD34+ cell collections were calculated. The PB HPC had a stronger correlation (rho=0.592, por=1 x10(6)/kg with sensitivity of 75%. Positive and negative predictive values of HPC >or=50x10(6)/L for CD34+ cells >or=1x10(6)/kg were 59.7% and 81.1%, respectively. In the clinical practice setting, applying variable cutoff values of HPC would be a useful tool to predict the optimal timing of PBPC collection.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Antigens, CD34/analysis , Antineoplastic Combined Chemotherapy Protocols/pharmacology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Blood Cell Count/instrumentation , Combined Modality Therapy , Granulocyte Colony-Stimulating Factor/pharmacology , Hematopoietic Stem Cell Mobilization , Hematopoietic Stem Cells , Leukapheresis , Neoplasms/blood , Neoplasms/drug therapy , Neoplasms/therapy , Peripheral Blood Stem Cell Transplantation , Predictive Value of Tests , Sensitivity and Specificity , Time FactorsABSTRACT
PURPOSE: Mutations in the p53 gene are reported in 50~90% of gallbladder and bile duct cancer, and have been implicated in chemoresistance. We undertook this study to determine whether the introduction of the wild type p53 gene into GBCE (human gallbladder cancer cell line with a heterozygous p53 mutation) by an adenoviral vector could increase the sensitivity of the cell to 5-FU, a commonly used drug in the treatment of gallbladder cancer. MATERIALS AND METHODS: GBCE cells were transfected with either Ad/p53 or Ad/E1 in the presence of 5-FU. Gene expression was confirmed by western blotting. Nude mice were injected subcutaneously with GBCE cells. When tumors formed, intratumoral injection of Ad/p53 was performed. Reduction of tumor size was compared in two weeks of Ad/p53 gene transfection. RESULTS: Ad/53 transfection induced a dose-dependent inhibition of tumor growth. Tumor colony formation was more inhibited with p53 gene transfection than with mock transfection in the presence of 5-FU. The reduction in tumor size was more pronounced with p53 transfection than with mock infection. CONCLUSION: These treatment modalities could be utilized in the treatment of p53 mutant human gallbladder cancers.
Subject(s)
Animals , Humans , Mice , Bile Duct Neoplasms , Blotting, Western , Cell Line , Fluorouracil , Gallbladder Neoplasms , Gallbladder , Gene Expression , Genes, p53 , Mice, Nude , TransfectionABSTRACT
BACKGROUND: We performed this study to compare response rate and survival according to treatment modalities, such as allogeneic bone marrow transplantation (BMT), immunosuppressive therapy (IS) and androgen therapy in patients with aplastic anemia (AA). METHODS: Medical records of one hundred and thirty-seven patients who diagnosed with aplastic anemia at the Asan Medical Center from September 1989 to December 2000 were retrospectively analyzed. RESULTS: Forty-one patients received supportive care only. Ninety-five out of 96 treated patients were evaluable for response. In severe AA group (N=79), the response rate according to treatment modalities was 25.0% in the androgen group (N=4), 30.3% in the ALG or ATG group (N=33), 25.0% in the cyclosporine (CSA) group (N=8), 44.4% in the ATG plus CSA group (N=9), and 73.8% in the BMT group (N=23) (P<0.001). Five- and 10-year survival of overall patients was 67.5% and 50.9%, respectively. Ten-year survival according to disease severity was 42.3% in severe AA group and 75.8% in non-severe AA group (P=0.0043). Five- year survival according to treatment modalities in patients with severe AA was 75.0% in the androgen group, 49.0% in the ALG or ATG group, 75.0% in the CSA group, and 88.9% in the ATG plus CSA group. Five-year survival was 82.6% in the BMT group and 57.7% in the IS group (P=0.0259). CONCLUSION: This study showes that BMT resulted in significantly better response rate and overall survival compared to IS in patients with severe AA.
Subject(s)
Bone Marrow TransplantationABSTRACT
Although high-dose therapy (HDT) with autologous hematopoietic stem cell transplantation (ASCT) is widely accepted as an effective and safe consolidation therapy for multiple myeloma (MM), few reports on its efficacy are available in Korea. We present the results of a prospective phase II study, involving 33 patients with MM treated with HDT with ASCT. The treatment consisted of 4 courses of VAD (vincristine, adriamycin, dexamethasone) induction, peripheral blood stem cell collection, and high-dose melphalan with stem cell infusion. The overall response rate was 93%, with 45% of patients having complete responses. The toxicity was predictable and tolerable. With a median follow-up of 27.6 months, the 2-year event free survival rate was 43%. At the time of writing, the median overall survival duration had not been reached with 2-year survival and projected 3-year survival rates of 81% and 74%, respectively. The overall survival was significantly better than that of the historical control patients (N=82) treated with conventional chemotherapy at our institution. The results suggest that HDT with ASCT is a valuable first or second-line treatment for patients with MM.