Neonatal Risk Factors for Growth Retardation in Infants With Congenital Heart Disease

Background@#While the association of congenital heart disease (CHD) and growth retardation (GR) is known, data remain limited. This study investigated the incidence of GR and its neonatal risk factors in patients with CHD using nationwide population-based claims data.Method: The study population was extracted from Korean National Health Insurance Service claims data from January 2002 to December 2020. We included patients diagnosed with CHD under one year of age. GR was defined as an idiopathic growth hormone deficiency or short stature on the claims data. We investigated the neonatal risk factors for GR. @*Results@#The number of patients diagnosed with CHD within the first year of birth was 133,739. Of these, 2,921 newborns were diagnosed with GR. The cumulative incidence of GR was 4.8% at 19 years of age for individuals diagnosed with CHD at infancy. In the multivariable analysis, the significant risk factors for GR were preterm birth, small for gestational age, low birth weight, respiratory distress, bronchopulmonary dysplasia, bacterial sepsis, necrotizing enterocolitis, feeding problems and cardiac procedure. @*Conclusion@#Several neonatal conditions were significant risk factors for GR in CHD patients, and appropriate monitoring and treatment programs are required in CHD neonates with these factors. Considering this study is limited to claims data, further studies are warranted, including genetic and environmental factors affecting GR in CHD patients.

The efficacy of EGFR-tyrosine kinase inhibitor in non-small cell lung cancer patients with synchronous brain metastasis: a real-world study

Background/Aims@#The optimal treatment (Tx) for epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients with brain metastasis (BM) remains to be determined. @*Methods@#A retrospective review was conducted on 77 NSCLC patients with synchronous BM who underwent first-line EGFR-tyrosine kinase inhibitor (TKI) Tx. The outcomes of patients were analyzed according to the clinicopathological characteristics including local Tx modalities. @*Results@#Fifty-nine patients underwent local Tx for BM (gamma knife surgery [GKS], 37; whole brain radiotherapy [WBRT], 18; others, four) concurrently or sequentially with EGFR-TKI. Patients treated with TKI alone showed significantly lower incidence of central nervous system (CNS) symptoms. The median progression-free survival (PFS) and overall survival (OS) after the initiation of EGFR-TKI for all patients were 9 and 19 months, respectively. In 60 patients with follow-up brain imaging, the median time to CNS progression was 15 months. Patients with EGFR exon 19 deletion had a significantly longer median OS than those with other mutations including L858R (23 months vs. 17 months). Other clinical characteristics, including CNS symptoms, number of BM, and the use of local Tx were not associated with OS, as well as PFS. In terms of the local optimal Tx modality, no difference was found between GKS and WBRT in the OS and PFS. @*Conclusions@#This study suggests that EGFR-TKI may result in a favorable outcome in NSCLC patients with synchronous BM, especially in deletion 19 mutant, regardless of the extent of BM lesions or local Tx modalities. Patients with asymptomatic BM can be treated with EGFR-TKI and careful surveillance.

Metabolic comorbidities and medical institution utilization among breast cancer survivors: a national population-based study

Background/Aims@#We investigated metabolic comorbidity status and patterns of medical institution utilization among breast cancer survivors using medical claims data from the Health Insurance Review and Assessment Service (HIRA). @*Methods@#Using claims data obtained from the HIRA, we selected breast cancer survivors between 2010 and 2015. Descriptive statistics were calculated to determine the frequency of metabolic comorbidities, as well as to analyze patterns of medical institution utilization in accordance with disease status. @*Results@#A total of 89,953 breast cancer survivors were identified. Among these, 12,364 (13.7%) had hypercholesterolemia, 20,754 (23.1%) had hypertension (HTN), and 11,102 (12.3%) had diabetes mellitus (DM). In particular, more than half of breast cancer survivors older than 60 years had HTN, and other diseases sharply increased beginning at age 50 years. For HTN, a total of 531,292 claims were submitted; more than 80% (n = 473,737) were from primary medical institutions, whereas only 2.4% (n = 12,551) were from tertiary medical institutions. The number of claims submitted for DM was 231,526; those from primary medical institutions accounted for 68.5% (n = 158,566), whereas claims from tertiary medical institutions accounted for 12.0% (n = 27,693). In subgroup analyses, the utilization of secondary and tertiary medical institutions was higher among patients with severe diseases and those diagnosed following their breast cancer diagnosis. @*Conclusions@#More than 10% of breast cancer survivors were diagnosed with a metabolic comorbidity. Through analysis of medical institution utilization patterns, we ascertained that a communication system linking secondary and tertiary medical institutions with primary medical institutions is needed.

Loss of Heterozygosity at Chromosome 16q Is a Negative Prognostic Factorin Korean Pediatric Patients with Favorable Histology Wilms Tumor:A Report of the Korean Pediatric Hematology Oncology Group (K-PHOG) / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Loss of heterozygosity (LOH) at chromosomes 1p and 16q is a poor prognostic factor infavorable histology Wilms tumor (FHWT). This study investigated the prevalence of LOH at1p and 16q and evaluated its prognostic value in Korean children with FHWT. @*Materials and Methods@#We analyzed 101 FHWT patients who were diagnosed between 1996 and 2016 in KoreanSociety of Pediatric Hematology Oncology Group hospitals. Using paraffin-embedded kidneytissue samples sent from each center, we reviewed LOH at 1p and 16q in each patient andassessed the prognostic value of LOH status for clinical parameters affecting event-freesurvival (EFS). @*Results@#Of the 101 patients, 12 (11.9%) experienced recurrence; the 3-year EFS was 87.6%. LOHat 1p or 16q was detected in 19 patients (18.8%), with five having LOH at both 1q and 16q.The frequency of LOH at 1p was higher among younger patients (p=0.049), but there wasno difference in LOH prevalence according to tumor stage. In the multivariate analysis, LOHat 16q was a significant negative prognostic factor affecting EFS (3-year EFS, 73.7% vs.91.1%; hazard ratio, 3.95; p=0.037), whereas LOH at 1p was not (p=0.786). @*Conclusion@#LOH at 16q was a significant negative prognostic factor affecting outcome in Korean pediatricFHWT patients. Due to the small sample size of this study, large-scale multicenter trialsare warranted to investigate the prognostic value of LOH at 1p and 16q in Korean childrenwith FHWT.

Adverse Events and Risk Factors Associated with Chloral Hydrate Sedation for Brain Magnetic Resonance Imaging in the Neonatal Intensive Care Unit

PURPOSE: This study investigated the incidence of adverse events (AEs) and risk factors associated with sedation using chloral hydrate (CH) for brain magnetic resonance imaging (MRI) in the neonatal intensive care unit (NICU). METHODS: This was a retrospective study of infants who received CH for brain MRI in the NICU. Among the enrolled infants (n=143), 12.6% (n=18) were included in the AE group and 87.4% (n=125) were in the non-adverse event group (NAE). RESULTS: Gestational age (GA) at birth and corrected GA at sedation were 35+0±7+2 and 39+5±3+1 respectively. The rate of AEs was 12.6%, included oxygen desaturation (5.6%), aspiration (4.9%), paradoxical agitation (0.7%), tachycardia or bradycardia (0.7%), and arrest (0.7%). In univariate analysis, the AE group was younger in corrected GA at sedation than the NAE group (37+2 [range, 36+0 to 40+0] vs. 40+1 [range, 38+2 to 41+4], P=0.015). There was no significant difference in CH dosage (50.0 [range, 50.0 to 50.0] vs. 50.0 [range, 50.0 to 50.0], P=0.092), cardiopulmonary (33.3% [n=6] vs. 17.6% [n= 22], P=0.209) and central nervous system (61.1% [n=11] vs. 65.6% [n=82], P=0.054) morbidity. In multivariate analysis, CH dosage was the only significant risk factor for AEs associated with sedation (odds ratio, 1.04; 95% confidence interval, 1.01 to 1.07; P=0.0186). CONCLUSION: AEs associated with sedation using CH are not uncommon and should be considered when using high dose CH for diagnostic testing in the NICU.

Neonatal Outcomes of Very Low Birth Weight Infants in Korean Neonatal Network from 2013 to 2016

BACKGROUND: This study was performed to determine survival and morbidity rates in very low birth weight infants (VLBWIs) in the Korean Neonatal Network (KNN), and to compare neonatal outcomes with those in other countries. METHODS: Data were collected for 8,269 VLBWIs with gestational age (GA) ≥ 22 weeks who were born between January 1, 2013 and December 31, 2016, and admitted to the neonatal intensive care units of the KNN. RESULTS: The survival rate of all VLBWIs and of infants with GA 22–23, 24–25, 26–27, 28–29, 30–32, and > 32 weeks were 86% (total), 33%, 65%, 84%, 94%, 97%, and 98%, respectively. The bronchopulmonary dysplasia (BPD) rates of all VLBWIs and of infants with GA 22–23, 24–25, 26–27, 28–29, 30–32, and > 32 weeks were 30% (total), 88%, 64%, 47%, 26%, 14%, and 5%, respectively. The intraventricular hemorrhage rates (≥ grade III) of all VLBWIs and of infants with GA 22–23, 24–25, 26–27, 28–29, 30–32, and > 32 weeks were 10% (total), 45%, 27%, 12%, 5%, 2%, and 1%, respectively. In an international comparison, the survival rate of VLBWIs with GA 24–27 weeks in KNN was lower, and the BPD rate of VLBWIs in the KNN was higher than that of the neonatal networks of other countries. CONCLUSION: Despite overall improvements in neonatal outcomes, the survival and morbidity rates of more immature infants with GA 22–27 weeks need further improvement. Therefore, it would be necessary to develop more optimal treatment strategies and perform more active quality improvement to further improve neonatal outcomes of VLBWIs in Korea.

Dummy Run of Quality Assurance Program before Prospective Study of Hippocampus-Sparing Whole-Brain Radiotherapy and Simultaneous Integrated Boost for Multiple Brain Metastases from Non-small Cell Lung Cancer: Korean Radiation Oncology Group (KROG) 17-06 Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Lung Cancer Subcommittee of Korean Radiation Oncology Group (KROG) has recently launched a prospective clinical trial (KROG 17-06) of hippocampus-sparing whole brain radiotherapy (HS-WBRT) with simultaneous integrated boost (SIB) in treating multiple brain metastases from non-small cell lung cancer. In order to improve trial quality, dummy run studies among the participating institutions were designed. This work reported the results of two-step dummy run procedures of the KROG 17-06 study. MATERIALS AND METHODS: Two steps tested hippocampus contouring variability and radiation therapy planning compliance. In the first step, the variation of the hippocampus delineation was investigated for two representative cases using the Dice similarity coefficients. In the second step, the participating institutions were requested to generate a HS-WBRT with SIB treatment plan for another representative case. The compliance of the treatment plans to the planning protocol was evaluated. RESULTS: In the first step, the median Dice similarity coefficients of the hippocampus contours for two other dummy run cases changed from 0.669 (range, 0.073 to 0.712) to 0.690 (range, 0.522 to 0.750) and from 0.291 (range, 0.219 to 0.522) to 0.412 (range, 0.264 to 0.598) after providing the hippocampus contouring feedback. In the second step, with providing additional plan priority and extended dose constraints to the target volumes and normal structures, we observed the improved compliance of the treatment plans to the planning protocol. CONCLUSION: The dummy run studies demonstrated the notable inter-institutional variability in delineating the hippocampus and treatment plan generation, which could be decreased through feedback from the trial center.

Comparison of concurrent chemoradiotherapy versus sequential radiochemotherapy in patients with completely resected non-small cell lung cancer

PURPOSE: Our institution has implemented two different adjuvant protocols in treating patients with non-small cell lung cancer (NSCLC): chemotherapy followed by concurrent chemoradiotherapy (CT-CCRT) and sequential postoperative radiotherapy (PORT) followed by postoperative chemotherapy (POCT). We aimed to compare the clinical outcomes between the two adjuvant protocols. MATERIALS AND METHODS: From March 1997 to October 2012, 68 patients were treated with CT-CCRT (n = 25) and sequential PORT followed by POCT (RT-CT; n = 43). The CT-CCRT protocol consisted of 2 cycles of cisplatin-based POCT followed by PORT concurrently with 2 cycles of POCT. The RT-CT protocol consisted of PORT followed by 4 cycles of cisplatin-based POCT. PORT was administered using conventional fractionation with a dose of 50.4–60 Gy. We compared the outcomes between the two adjuvant protocols and analyzed the clinical factors affecting survivals. RESULTS: Median follow-up time was 43.9 months (range, 3.2 to 74.0 months), and the 5-year overall survival (OS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were 53.9%, 68.2%, and 51.0%, respectively. There were no significant differences in OS (p = 0.074), LRFS (p = 0.094), and DMFS (p = 0.490) between the two protocols. In multivariable analyses, adjuvant protocol remained as a significant prognostic factor for LRFS, favouring CT-CCRT (hazard ratio [HR] = 3.506, p = 0.046) over RT-CT, not for OS (HR = 0.647, p = 0.229). CONCLUSION: CT-CCRT protocol increased LRFS more than RT-CT protocol in patients with completely resected NSCLC, but not in OS. Further studies are warranted to evaluate the benefit of CCRT strategy compared with sequential strategy.

Nodal tumor response according to the count of peripheral blood lymphocyte subpopulations during preoperative chemoradiotherapy in locally advanced rectal cancer

PURPOSE: The objective of this prospective study was to evaluate the relationship between the circulating lymphocyte subpopulation counts during preoperative chemoradiotherapy (CRT) and tumor response in locally advanced rectal cancer. MATERIALS AND METHODS: From August 2015 to June 2016, 10 patients treated with preoperative CRT followed by surgery were enrolled. Patients received conventional fractionated radiotherapy (50.4 Gy) with fluorouracil-based chemotherapy. Surgical resection was performed at 4 to 8 weeks after the completion of preoperative CRT. The absolute blood lymphocyte subpopulation was obtained prior to and after 4 weeks of CRT. We analyzed the association between a tumor response and change in the lymphocyte subpopulation during CRT. RESULTS: Among 10 patients, 2 (20%) had evidence of pathologic complete response. In 8 patients with clinically node positive, 4 (50%) had nodal tumor response. All lymphocyte subpopulation counts at 4 weeks after CRT were significantly lower than those observed during pretreatment (p < 0.01). A high decrease in natural killer (NK) cell, count during CRT (baseline cell count − cell count at 4 weeks) was associated with node down staging (p = 0.034). CONCLUSION: Our results suggest that the change of lymphocyte subset to preoperative CRT may be a predictive factor for tumor response in rectal cancer.

Gene mutation discovery research of non-smoking lung cancer patients due to indoor radon exposure

Although the incidence and mortality for most cancers such as lung and colon are decreasing in several countries, they are increasing in several developed countries because of an unhealthy western lifestyles including smoking, physical inactivity and consumption of calorie-dense food. The incidences for lung and colon cancers in a few of these countries have already exceeded those in the United States and other western countries. Among them, lung cancer is the main cause of cancer death in worldwide. The cumulative survival rate at five years differs between 13 and 21 % in several countries. Although the most important risk factors are smoking for lung cancer, however, the increased incidence of lung cancer in never smokers(LCINS) is necessary to improve knowledge concerning other risk factors. Environmental factors and genetic susceptibility are also thought to contribute to lung cancer risk. Patients with lung adenocarcinoma who have never smoking frequently contain mutation within tyrosine kinase domain of the epidermal growth factor receptor(EGFR) gene. Also, K-ras mutations are more common in individuals with a history of smoking use and are related with resistance to EFGR-tyrosine kinase inhibitors. Recently, radon(Rn), natural and noble gas, has been recognized as second common reason of lung cancer. In this review, we aim to know whether residential radon is associated with an increased risk for developing lung cancer and regulated by several genetic polymorphisms.

Sustaining Blood Lymphocyte Count during Preoperative Chemoradiotherapy as a Predictive Marker for Pathologic Complete Response in Locally Advanced Rectal Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The objective of this study was to explore the relationship between the circulating lymphocyte level during preoperative chemoradiotherapy (CRT) and pathologic complete response (pCR) in locally advanced rectal cancer. MATERIALS AND METHODS: From May 2010 to May 2013, 52 patients treated with preoperative CRT followed by surgery, were analysed. Patients received conventional fractionated radiotherapy (50-54 Gy) with fluorouracil-based chemotherapy. Surgical resection was performed at 4 to 8 weeks after the completion of preoperative CRT. Absolute blood lymphocyte counts and their relative percentage in total white blood cell counts were obtained from complete blood count tests performed prior to and after 4, 8, and 12 weeks of CRT. We analysed the association between achieving pCR and change in blood lymphocyte level during CRT, as well as clinical parameters. RESULTS: Among 52 patients, 14 (26.9%) had evidence of pCR. Sustaining the blood lymphocyte count during CRT (lymphocyte count at 4 weeks/baseline lymphocyte count > 0.35; odds ratio, 8.33; p=0.02) and initial carcinoembryonic antigen < 4.4 ng/mL (odds ratio, 6.71; p=0.03) were significantly associated with pCR in multivariate analyses. CONCLUSION: Sustaining blood lymphocyte count during preoperative CRT was predictive for pCR in rectal cancer. Further studies are warranted to investigate the association between pathologic responses and circulating lymphocyte count with its subpopulation during preoperative CRT.

A Case Report of Solitary Fibrous Tumor in the Axilla of a 4-year-old Girl with Additional Marker Chromosome / 임상소아혈액종양

Solitary fibrous tumor (SFT) is uncommon and known to affect in middle-aged adults, with rare reports of occurrences in children. Although frequently involving the pleura, recent reports show that SFT may also involve extrapleural sites. SFT is known as a benign tumor, but in some cases SFT recurs, invades locally, or shows malignant transformation. We experienced a case of SFT that developed in the axilla of a 4-year-old girl with multiple congenital anomalies with constitutional chromosomal abnormality of 46,XX[44]/47,XX,+mar[11]. Her tumor could not be surgically resected due to the patient's multiple anomalies including congenital heart disease, chronic lung problem and seizure disorder. She died of congestive heart failure with respiratory failure due to tumor growth. This report is meaningful not only because SFT affected a pediatric patient with a constitutional chromosomal abnormality, but also because the tumor originated from the axillary area, a site of origin rarely reported for SFTs.

A Case Report of Solitary Fibrous Tumor in the Axilla of a 4-year-old Girl with Additional Marker Chromosome / 임상소아혈액종양

Solitary fibrous tumor (SFT) is uncommon and known to affect in middle-aged adults, with rare reports of occurrences in children. Although frequently involving the pleura, recent reports show that SFT may also involve extrapleural sites. SFT is known as a benign tumor, but in some cases SFT recurs, invades locally, or shows malignant transformation. We experienced a case of SFT that developed in the axilla of a 4-year-old girl with multiple congenital anomalies with constitutional chromosomal abnormality of 46,XX[44]/47,XX,+mar[11]. Her tumor could not be surgically resected due to the patient's multiple anomalies including congenital heart disease, chronic lung problem and seizure disorder. She died of congestive heart failure with respiratory failure due to tumor growth. This report is meaningful not only because SFT affected a pediatric patient with a constitutional chromosomal abnormality, but also because the tumor originated from the axillary area, a site of origin rarely reported for SFTs.

CT-based quantitative evaluation of radiation-induced lung fibrosis: a study of interobserver and intraobserver variations

PURPOSE: The degree of radiation-induced lung fibrosis (RILF) can be measured quantitatively by fibrosis volume (VF) on chest computed tomography (CT) scan. The purpose of this study was to investigate the interobserver and intraobserver variability in CT-based measurement of VF. MATERIALS AND METHODS: We selected 10 non-small cell lung cancer patients developed with RILF after postoperative radiation therapy (PORT) and delineated VF on the follow-up chest CT scanned at more than 6 months after radiotherapy. Three radiation oncologists independently delineated VF to investigate the interobserver variability. Three times of delineation of VF was performed by two radiation oncologists for the analysis of intraobserver variability. We analysed the concordance index (CI) and inter/intraclass correlation coefficient (ICC). RESULTS: The median CI was 0.61 (range, 0.44 to 0.68) for interobserver variability and the median CIs for intraobserver variability were 0.69 (range, 0.65 to 0.79) and 0.61(range, 0.55 to 0.65) by two observers. The ICC for interobserver variability was 0.974 (p < 0.001) and ICCs for intraobserver variability were 0.996 (p < 0.001) and 0.991 (p < 0.001), respectively. CONCLUSION: CT-based measurement of VF with patients who received PORT was a highly consistent and reproducible quantitative method between and within observers.

Parotid gland sparing effect by computed tomography-based modified lower field margin in whole brain radiotherapy

PURPOSE: Parotid gland can be considered as a risk organ in whole brain radiotherapy (WBRT). The purpose of this study is to evaluate the parotid gland sparing effect of computed tomography (CT)-based WBRT compared to 2-dimensional plan with conventional field margin. MATERIALS AND METHODS: From January 2008 to April 2011, 53 patients underwent WBRT using CT-based simulation. Bilateral two-field arrangement was used and the prescribed dose was 30 Gy in 10 fractions. We compared the parotid dose between 2 radiotherapy plans using different lower field margins: conventional field to the lower level of the atlas (CF) and modified field fitted to the brain tissue (MF). RESULTS: Averages of mean parotid dose of the 2 protocols with CF and MF were 17.4 Gy and 8.7 Gy, respectively (p or =20 Gy were observed in 15 (28.3%) for CF and in 0 (0.0%) for MF. The whole brain percentage volumes receiving >98% of prescribed dose were 99.7% for CF and 99.5% for MF. CONCLUSION: Compared to WBRT with CF, CT-based lower field margin modification is a simple and effective technique for sparing the parotid gland, while providing similar dose coverage of the whole brain.

Cases report of unicentric Castleman's disease: revisit of radiotherapy role

Castleman's disease or angiofollicular lymph node hyperplasia is a rare lymphoproliferative disorder. Complete surgical resection was recommended in unicentric Castleman's disease. Radiotherapy was considered alternative therapeutic option. However, there have been consistent favorable responses to radiotherapy. We also experienced two cases of uncentric Castleman's disease salvaged successfully with radiotherapy. This paper described these cases and reviewed the literature about Castleman's disease treated with radiotherapy. Reviewed cases showed that radiotherapy is a successful treatment option in unicentric Castleman's disease. Furthermore, our report confirms the radiotherapy role in uncentric Castleman's disease.

Effects of a Smartphone Application on Breast Self-Examination: A Feasibility Study / 대한의료정보학회지

OBJECTIVES: The aims of this study were to develop a smartphone application to encourage breast self-examination (BSE), and to evaluate the effects of this application in terms of modifying BSE behavior. METHODS: A smartphone application, based on the Android OS, was developed with functions including a BSE date alarm, a reminder to encourage mother and daughter to practice BSE together, record keeping, and educational content with video clips. Females aged 19 and over were enrolled to evaluate the effectiveness of the application. Two series of questionnaires were carried out (before and after use of the application) by e-mail, telephone, and face-to-face interviews between July and September 2012. RESULTS: Forty-five subjects were enrolled in the study (age 29.5-5.9 years). Of the participants, only 28 (62.2%) had ever practiced BSE and only one of these (2.2%) was carried out at the appropriate time, based on the results of the baseline survey. After using the application, the number of participants practicing BSE increased from 28 to 32 (62.2% to 71.1%, p = 0.503). In subgroup analysis (age < 30 years), the number of participants using BSE increased from 8 to 18 (36.4% to 81.8%, p = 0.002), and the number of those using it at the appropriate time rose from 1 to 15 (2.2% to 33.3%, p < 0.001). CONCLUSIONS: The use of the developed smartphone application increased BSE in females younger than 30 years. To confirm the long-term benefits of the mobile application, additional studies must be carried out.

Polyomavirus Activation in Pediatric Patients with Hemorrhagic Cystitis Following Hematopoietic Stem Cell Transplantation / 임상소아혈액종양

BACKGROUND: Reactivation of the polyomavirus and the use of conditioning regimen may be the causes of hemorrhagic cystitis (HC) following hematopoietic stem cell transplantation (HSCT). However, there are only a few reports on the clinical characteristics of viral reactivation in HC following HSCT in Korea, especially in pediatric population.METHODS: 51 patients who received HSCT in Ajou University Hospital from January 2006 to June 2012 were investigated retrospectively. 16 patients were diagnosed with HC following HSCT and were enrolled in this study. Confirmation of polyomavirus was done by polymerase chain reaction (PCR) method.RESULTS: Out of the 16 patients diagnosed with HC following HSCT, there were 5 early type HC patients and 11 late type HC patients. Positive PCR results for the BK virus (BKV) and the JC virus were found on 13 and 5 patients, respectively. 4 patients showed positive results for both viruses. For the late type HC, there were 10 patients with positive PCR results for the BKV. Cyclophosphamide was used in 33 patients, and 13 patients eventually developed HC. There was no statistical significance between the incidence of hematuria and the reactivation of the BKV or the conditioning regimens. Most patients were treated conservatively but 4 patients who showed severe hematuria or poor general condition received intravenous cidofovir. After the infusion of cidofovir, hematuria disappeared on average of 65 days and the BKV was undetectable on average of 53 days.CONCLUSION: In our study, activation of the BKV was common in patients who were diagnosed with HC following HSCT. All patients recovered from HC with conservative management and the BKV became undetectable in the majority of patients who were treated with intravenous cidofovir.

Polyomavirus Activation in Pediatric Patients with Hemorrhagic Cystitis Following Hematopoietic Stem Cell Transplantation / 임상소아혈액종양

BACKGROUND: Reactivation of the polyomavirus and the use of conditioning regimen may be the causes of hemorrhagic cystitis (HC) following hematopoietic stem cell transplantation (HSCT). However, there are only a few reports on the clinical characteristics of viral reactivation in HC following HSCT in Korea, especially in pediatric population. METHODS: 51 patients who received HSCT in Ajou University Hospital from January 2006 to June 2012 were investigated retrospectively. 16 patients were diagnosed with HC following HSCT and were enrolled in this study. Confirmation of polyomavirus was done by polymerase chain reaction (PCR) method. RESULTS: Out of the 16 patients diagnosed with HC following HSCT, there were 5 early type HC patients and 11 late type HC patients. Positive PCR results for the BK virus (BKV) and the JC virus were found on 13 and 5 patients, respectively. 4 patients showed positive results for both viruses. For the late type HC, there were 10 patients with positive PCR results for the BKV. Cyclophosphamide was used in 33 patients, and 13 patients eventually developed HC. There was no statistical significance between the incidence of hematuria and the reactivation of the BKV or the conditioning regimens. Most patients were treated conservatively but 4 patients who showed severe hematuria or poor general condition received intravenous cidofovir. After the infusion of cidofovir, hematuria disappeared on average of 65 days and the BKV was undetectable on average of 53 days. CONCLUSION: In our study, activation of the BKV was common in patients who were diagnosed with HC following HSCT. All patients recovered from HC with conservative management and the BKV became undetectable in the majority of patients who were treated with intravenous cidofovir.

Diagnosis and Clinical Presentation of Invasive Aspergillosis in Pediatric Hematology-Oncology Patients / 임상소아혈액종양

BACKGROUND: The useful tools for early diagnosis and diagnostic criteria need to be developed for controlling invasive aspergillosis (IA) which causes life-threatening conditions in high risk group such as immunocompromised hematology-oncology patients.METHODS: 103 cases of suspected IA on the ground of pathologic or Aspergillus Galactomannan (AG) test from March 2006 to March 2011 were reviewed. The patients with IA was classified into 4 groups 'Proven', 'Probable', ('Probable-1'), 'Possible' and 'Non' based on the criteria of European Organization for Research and Treatment of Cancer/Mycoses study Group (EORT/MSG) 2008 (and 2002).RESULTS: Of the 103 patients who underwent AG test, 16 cases were diagnosed as IA; 2 'Proven', 9 'Probable', 5 'Probable-1' and 4 'non' (false-positive). Underlying diseases were acute lymphoblastic leukemia (N=8), acute myeloid leukemia (N=5), severe aplastic anemia (N=4), neuroblastoma (N=2) and non-Hodgkin lymphoma (N=1). Risk factors were severe neutropenia for 10 days (80%), prolonged use of steroid (70%), receipt of an allogeneic stem cell transplant (45%) and treatment with immunosuppressants (40%). Major involved organs of IA were lung (N=15) and sinus (N=1). Overall sensitivity, specificity, positive predictive value and negative predictive value of the AG test were 94%, 95%, 79% and 99%, respectively. The mortality of 16 patients with IA was 50%.CONCLUSION: A combined use of the AG test and modified criteria of EORT/MSG 2008 allows not only early diagnosis but also prompt classifying risk groups of IA so that proper antifungal agents were used in pediatric hematology-oncology patients.