Clinical significance of chromosomal abnormality in multiple myeloma / 대한내과학회지

BACKGROUND: Multiple myeloma is a clonal B-cell malignancy manifested by the accumulation of terminally differentiated plasma cells. The disease is characterized by clinical heterogeneity, with survival ranging from a few months to more than 10 years. The purpose of this study is to evaluate the prognostic value of specific chromosomal abnormality in multiple myeloma. METHODS: We analyzed the clinical records of 40 patients who were diagnosed as multiple myeloma, between April, 1995 and August, 2004. Cytogenetic analysis was conducted by metaphase karyotype analysis. Patients were grouped into normal cytogenetic group (arm A), complete or partial deletion of chromosome 13 and hypodiploidy group (arm B) and other cytogenetic abnormality group (arm C). RESULTS: Median follow up duration was 13.1 months (range 1.5-92.1). Overall response rate to chemotherapy was 58.8% and response rate among arm A, B and C were 56.3%, 33.3% and 75%, respectively (p=0.229). The prognostic factors affecting survival were clinical stage, performance status, serum creatinine level, sex and chromosomal abnormality. The median overall survival was significantly different among arm A, B and C (34.9 months, 8.5 months and 19.8 months, respectively, p=0.0125). CONCLUSION: chromosomal abnormality, especially, complete or partial deletion of chromosome 13 and hypodiploidy at initial diagnosis is significantly associated with survival duration.

Comparison of Tissue Perfusion Measured by ST Segment Resolution between Thrombolysis and Primary Stenting in Acute ST Elevation Myocardial Infarction

BACKGROUND AND OBJECTIVES: The primary objective of reperfusion therapy in the acute ST elevation myocardial infarction (STEMI) is the recovery of myocardial perfusion in infarct tissue, as well as the restoration of epicardial blood flow. ST segment resolution on the ECG is an index, which represents adequate myocardial tissue perfusion following treatment. SUBJECTS AND METHODS: Patients with acute STEMI, arriving within 12 hours of the onset of symptom underwent either thrombolysis (n=40) or primary stenting (n=51) were used for this study. ST segments on the ECG were measured with hand-held electronic callipers and the results were analysed by a single observer. RESULTS: Thrombolysis therapy was started earlier than primary stenting, although this was not statistically significant (311+/-171 minutes vs 399+/-251 minutes, p=0.61). After treatment, thrombolysis achieved a higher rate of complete ST segment resolution (>or=70%) compared to primary stenting (20/40;50.0% vs 13/51;25.4%, p=0.016). However, when the data was corrected for time, the difference between the two modalities was not significant (p=0.119). ST segment resolution varied significantly (p=0.026) according to treatment time, regardless of treatment modality. At the 6 month follow up, patients with complete ST segment resolution had a lower rate of major cardiac event (2.1% vs 13.8% p=0.094). CONCLUSION: In this study, thrombolysis achieved a higher rate of complete ST resolution compared with primary stenting in acute STEMI. By ad hoc analysis, this result was attributed to the difference in treatment time between the two groups, suggesting successful tissue reperfusion in acute STEMI is determined primarily by the rapidity, rather than the type, of treatment.

Salvage Treatment for Advanced Gastric Cancer Using FEP (5-FU, Etoposide, Cisplatin) Combination Chemotherapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: There is no effective treatment for patients with advanced gastric cancer having failed to respond to first line chemotherapy. The aim of this study was to evaluate the therapeutic activity, and safety, of a FEP regimen in patients with a recurrence of, or metastatic, gastric cancer that had been unresponsive to primary chemotherapy. MATERIALS AND METHODS: Recurred or metastatic gastric cancer patients that did not respond to a 5-fluorouracil based regimen were entered into this trial. The patients were treated with FEP (5-FU, etoposide and cisplatin) as salvage chemotherapy. The treatment regimen was 5-FU (900 mg/m2/day) by continuous infusion for 3 days, etoposide (90 mg/m2/day) on days 1, 2 and 3, and cisplatin (60 mg/m2/day) on day 2. This treatment was repeated every 3 weeks. RESULTS: Between December 1997 and October 2001, 28 patients were enrolled to the study. The response rate was 32.1% (95% CI 15.5~57.8%). The median times to progression and survival duration were 23~33 weeks, respectively. Among a total of 187 cycles of chemotherapy, the grade 3 and 4 hematological toxicities were leukopenia (6.4%), thrombocytopenia (1.6%), and grade 3 non-hematological side effects of nausea/vomiting (17.9%). CONCLUSION: FEP combination chemotherapy seems to be an effective treatment regimen for gastric cancer as salvage chemotherapy. To confirm these results, large scale of clinical trials will be required.

A Phase II Study of Oxaliplatin Combined with 5-Fluorouracil and Leucovorin (Mayo Clinic Regimen) in 5-Fluorouracil Refractory Colorectal Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: There are few therapeutic options in patients with colorectal cancer that have progressed or recurred following 5-fluorouracil (5-FU) based therapy. We evaluated the efficacy and toxicity of oxaliplatin, 5-FU, leucovorin (Mayo clinic regimen) in 5-FU pretreated advanced colorectal cancer patients. MATERIALS AND METGODS: Twenty-eight patients were enrolled in this study between January 1999 and May 2001. Patients were treated with oxaliplatin 150 mg/m2 on day 1 as a 2-hr infusion and 5-FU 425 mg/m2, leucovorin 20 mg/m2, bolus for 5 days. Treatment courses were repeated in 4-week intervals. RESULTS: The objective response rate was 25% for 28 assessable patients, all cases registered a partial response. Eleven patients (39%) demonstrated stable disease, and ten (36%) progressed. The median response duration was 5.5 months, and the median time to progression was 6.3 months. The median overall survival time was 13.5 months from the start of the chemotherapy. From the 120 cycles analyzed, grade 3,4 hematologic toxicities included neutropenia: 1.6%, and thrombocytopenia: 1.6%. The frequent grade 3.4 non-hematologic adverse reactions were nausea/vomiting (25.0%), diarrhea (14.3%), stomititis (3.6%), and neuropathy (3.6%). There were no treatment-related deaths. CONCLUSION: This phase II study had relatively higher toxicity than previous studies, and did not show an increased significant response rate. These high levels of toxicity suggest that the study treatment combination of oxaliplatin with a full dose Mayo clinic regimen arm is no feasible. Therefore, this regimen will be discontinued and a safer regimen will be adopted.

Clinical Characteristics and Trends of the Surgical Treatment of Chordae Rupture

BACKGROUND AND OBJECTIVES: The proportion of mitral regurgitation caused by chordae rupture has recently been seen to be increasing, as has the role of mitral valve repair in the treatment of chordae rupture. This study evaluated the clinical characteristics and trends of surgical treatment of chordae rupture. Additionally, we attempted to discern the usefulness of transthoracic echocardiography (TTE) in the preoperative diagnosis of chordae rupture. SUBJECTS AND METHODS: Forty patients (20 men, mean age:49+/-14) presenting with chordae rupture confirmed during surgery between January 1994 and April 2001 were included in this study. Clinical, TTE and surgical data were analyzed retrospectively. RESULTS: The cause of chordae rupture was idiopathic degeneration in 28 cases, rheumatic heart disease in 5, infective endocarditis in 6, and trauma in 1 case. The sites of rupture were the anterior leaflet (14), posterior leaflet (23), and anterior and posterior leaflets (3). Mitral valve repair was performed in 20 cases and mitral valve replacement was performed in 20 cases. Most mitral valve repairs were performed beginning in 1998 (17/20). Chordae rupture diagnosed by TTE numbered 14 cases (35%). CONCLUSION: Regurgitation caused by chordae rupture was primarily associated with idiopathic degenerative change. Posterior leaflet rupture was more frequent than anterior leaflet rupture. The use of mitral valve repair has been increasing since 1998.