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Purpose@#To compare the eyelid blink characteristics of patients with ptosis assessed using a cellphone camera before and after levator resection. @*Methods@#In this prospective study, pictures and videos of eyelid blinking were obtained from 40 eyes (20 patients with ptosis) at a margin reflex distance 1 (MRD1) of 3.0 mm or less before and 1 month after levator resection. MRD1, palpebral fissure height (PFH), levator function, inter-blink interval, and blink duration, rate, and velocity were measured. The patients were also divided into those aged < 70 or ≥ 70. @*Results@#MRD1, PFH, and blink velocity increased, and blink duration decreased, after levator resection. In the ptosis group aged less than 70 years, the levator function and blink velocity increased preoperatively, while MRD1, PFH, levator function, and blink velocity increased postoperatively. The blink velocity showed a positive correlation with MRD1 and PFH. @*Conclusions@#Although no significant changes were observed in levator function postoperatively, the blink velocity increased significantly. Blink velocity may be useful for the evaluation of ptosis and as an indirect measure of levator function.
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Schizophyllum commune is a mold in phylum Basidiomycota and is an uncommon human pathogen. Sinusitis and allergic bronchopulmonary mycosis are the two major diseases caused by S. commune. Although there have been several reports of invasive fungal diseases, most of them were invasive sinusitis. We present a case of invasive fungal pneumonia due to S. commune, developed in a patient with acute myeloid leukemia presenting neutropenic fever. The diagnosis was made by characteristic macroscopic and microscopic findings of fungal isolate and was confirmed via sequencing of internal transcribed spacer region. The patient was improved after 8 weeks of antifungal therapy based on the susceptibility result.We propose that S. commune should be considered as an emerging pathogen of invasive fungal pneumonia when a patient is under immunocompromised state. We also reviewed global literatures focused on the invasive fungal diseases caused by S. commune
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Purpose@#Acute asthma exacerbations in children have seasonal variations and occur frequently in fall. Respiratory viral infections and environmental allergens are associated with asthma exacerbation. This study aimed to identify seasonal trends of asthma exacerbation and the effects of respiratory viral infection and allergen sensitization on the seasonality of asthma exacerbation in children. @*Methods@#Children under the age of 18 years who visited to the Emergency Department or hospitalized for acute asthma exacerbations from 2011 to 2019 were included. We reviewed medical records, including demographics, date of asthma exacerbation, results of respiratory virus and allergen sensitization, and they were analyzed to identify the seasonal trends of asthma exacerbation. @*Results@#A total of 320 asthma exacerbations were included, with the highest frequency in fall. Human rhinovirus was positive in 64.7% and 60.0% in fall and spring exacerbations, respectively. House dust mite sensitization was highest in fall at 78.5%, while food sensitization was highest in spring at 76.9%. In patients who were sensitized to house dust mites or food allergens, respiratory viral infections further increased asthma exacerbation in fall and spring, respectively. @*Conclusion@#Respiratory virus may be associated with asthma exacerbation in fall and spring. House dust mite and food sensitizations may be associated with fall and spring asthma exacerbations by worsening the severity of asthma symptoms caused by respiratory viral infections. In childhood asthmatic patients with allergen sensitization, avoidance of sensitized allergens, prevention of viral infection, and more active treatment of viral infection may help prevent acute asthma exacerbations.
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Purpose@#To report a case of bilateral calcific band keratopathy treated with dipotassium edetic acid (EDTA) in a blood collection tube, an approach that has not been used previously in the Republic of Korea.Case summary: A 77-year-old male patient, with a history of diabetes and hypertension, presented with decreased vision in both eyes that had begun 1 year prior. Five years prior, the patient had undergone cataract surgery in the right eye and had received a diagnosis of prostate cancer for which he was currently under observation without surgical treatment. At the initial eye examination, his best-corrected visual acuity was 0.15 in the right eye and 0.1 in the left eye. Calcium deposition was observed in the center of the cornea by slit-lamp examination, resulting in a diagnosis of band keratopathy. We proceeded to dissolve the dipotassium EDTA coated on a blood collection tube with distilled water. Using the dissolved dipotassium EDTA, we peeled off the corneal epithelium under local anesthesia to remove the calcium deposition. One week after surgery, the visual acuity of both eyes improved to 0.6, and no recurrence or complications occurred for 7 months. @*Conclusions@#As a new treatment for band keratopathy, we discovered that dipotassium EDTA is more convenient to obtain than the conventional disodium EDTA. We expect that dipotassium EDTA will be widely used in the treatment of band keratopathy.
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Background@#Allogeneic hematopoietic stem cell transplantation (alloSCT) is a potentially curative treatment option for acute leukemia. We aimed to identify the comorbidity factors affecting survival outcomes after alloSCT and develop a new comorbidity index tool for predicting overall survival (OS). @*Methods@#A Korean nationwide cohort of 3,809 adults with acute leukemia treated with alloSCT between January 2002 and December 2018 was analyzed as the development cohort.A retrospective cohort comprising 313 consecutive adults with acute leukemia who underwent alloSCT between January 2019 and April 2020 was analyzed as the validation cohort. @*Results@#In the development cohort, advanced age, male sex, and comorbidities such as previous non-hematologic malignancy, hypertension, and coronary or cerebral vascular disease were significantly related to poor OS. Subsequently, a new comorbidity scoring system was developed, and risk groups were created, which included the low-risk (score ≤0.17), intermediate-risk (0.17＜ score ≤0.4), high-risk (0.4＜ score ≤0.55), and very high-risk (score ＞0.55) groups. The 1-year OS rates were discriminatively estimated at 73.5%, 66.2%, 61.9%, and 50.9% in the low-risk, intermediate-risk, high-risk, and very high-risk groups in the development cohort, respectively (P ＜0.001). The developed scoring system yielded discriminatively different 1-year OS rates and 1-year incidence of non-relapse mortality according to the risk group (P =0.085 and P =0.018, respectively).Furthermore, the developed model showed an acceptable performance for predicting 1-year non-relapse mortality with an area under the curve of 0.715. @*Conclusion@#The newly developed predictive scoring system could be a simple and reliable tool helping clinicians to assess risk of alloSCT in adults with acute leukemia.
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Background@#To estimate real-world outcomes in East Asian populations, we conducted a nationwide retrospective analysis of the efficacy and safety of lenalidomide for del(5q) myelodysplastic syndrome (MDS) patients with transfusion-dependent anemia in Korea. @*Methods@#Patients aged ≥19 years who had received lenalidomide for the treatment of lower-risk, red blood cell (RBC) transfusion-dependent del(5q) MDS were selected. A filled case report form (CRF) with information from electronic medical records was requested from members of the acute myeloid leukemia (AML)/MDS Working Party of the Korean Society of Hematology. All the CRFs were gathered and analyzed. @*Results@#A total of 31 patients were included in this study. Of 28 evaluable patients, 19 (67.9%) achieved RBC transfusion independence (RBC-TI). Female sex and the development of thrombocytopenia during treatment were associated with achieving RBC-TI. The most common non-hematologic toxicities were pruritus, fatigue, and rashes. All non-hematologic toxicities of grades ≥3 were limited to rash (12.9%) and pruritus (6.5%). Dose reduction was required in 15 of the 19 responders (78.9%). The most common final stable dosing schedule for the responders was 5 mg once every other day (31.6%). @*Conclusion@#Lenalidomide efficacy and tolerability were similar in the Asian del(5q) MDS patients and western patients. Dose reduction during treatment was common, but it was not associated with inferior outcomes.
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Purpose@#To report a case of bilateral calcific band keratopathy treated with dipotassium edetic acid (EDTA) in a blood collection tube, an approach that has not been used previously in the Republic of Korea.Case summary: A 77-year-old male patient, with a history of diabetes and hypertension, presented with decreased vision in both eyes that had begun 1 year prior. Five years prior, the patient had undergone cataract surgery in the right eye and had received a diagnosis of prostate cancer for which he was currently under observation without surgical treatment. At the initial eye examination, his best-corrected visual acuity was 0.15 in the right eye and 0.1 in the left eye. Calcium deposition was observed in the center of the cornea by slit-lamp examination, resulting in a diagnosis of band keratopathy. We proceeded to dissolve the dipotassium EDTA coated on a blood collection tube with distilled water. Using the dissolved dipotassium EDTA, we peeled off the corneal epithelium under local anesthesia to remove the calcium deposition. One week after surgery, the visual acuity of both eyes improved to 0.6, and no recurrence or complications occurred for 7 months. @*Conclusions@#As a new treatment for band keratopathy, we discovered that dipotassium EDTA is more convenient to obtain than the conventional disodium EDTA. We expect that dipotassium EDTA will be widely used in the treatment of band keratopathy.
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Background/Aims@#Idiopathic multicentric Castleman disease (iMCD) comprises approximately 30% of all cases of Castleman disease. It is characterized by constitutional symptoms, enlarged lymph nodes at multiple anatomical sites, and laboratory test abnormalities, which are primarily related to the overproduction of interleukin 6 (IL-6). Siltuximab is a human-mouse chimeric immunoglobulin G1κ monoclonal antibody against human IL-6. In view of the limited treatment options for iMCD, this study aimed to evaluate the efficacy and safety of siltuximab in the management of this condition. @*Methods@#In this real-world retrospective study, we administered siltuximab to 15 patients with iMCD who previously received conventional chemotherapy and/or steroid pulse therapy. The median time to a durable symptomatic response was 22 days (range, 17 to 56). The serum hemoglobin and albumin levels and erythrocyte sedimentation rates significantly normalized after the first 3 months of siltuximab treatment. Lymph node involution, assessed using imaging, was relatively gradual, demonstrating a complete or partial response at 6 months. @*Results@#On an average, the improvements in clinical, laboratory, and radiologic parameters of iMCD in responders were observed after one, three, and eight cycles of siltuximab treatment, respectively. Siltuximab demonstrated a favorable safety profile, and prolonged treatment was well-tolerated. @*Conclusions@#Despite the small sample size of the present study, the results are encouraging and demonstrate the potential of siltuximab as the first-line treatment of iMCD. Further large multicenter studies are needed to evaluate the clinical outcomes and adverse events associated with siltuximab.
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Background@#Allogeneic hematopoietic stem cell transplantation (alloSCT) is a potentially curative treatment option for acute leukemia. We aimed to identify the comorbidity factors affecting survival outcomes after alloSCT and develop a new comorbidity index tool for predicting overall survival (OS). @*Methods@#A Korean nationwide cohort of 3,809 adults with acute leukemia treated with alloSCT between January 2002 and December 2018 was analyzed as the development cohort.A retrospective cohort comprising 313 consecutive adults with acute leukemia who underwent alloSCT between January 2019 and April 2020 was analyzed as the validation cohort. @*Results@#In the development cohort, advanced age, male sex, and comorbidities such as previous non-hematologic malignancy, hypertension, and coronary or cerebral vascular disease were significantly related to poor OS. Subsequently, a new comorbidity scoring system was developed, and risk groups were created, which included the low-risk (score ≤0.17), intermediate-risk (0.17＜ score ≤0.4), high-risk (0.4＜ score ≤0.55), and very high-risk (score ＞0.55) groups. The 1-year OS rates were discriminatively estimated at 73.5%, 66.2%, 61.9%, and 50.9% in the low-risk, intermediate-risk, high-risk, and very high-risk groups in the development cohort, respectively (P ＜0.001). The developed scoring system yielded discriminatively different 1-year OS rates and 1-year incidence of non-relapse mortality according to the risk group (P =0.085 and P =0.018, respectively).Furthermore, the developed model showed an acceptable performance for predicting 1-year non-relapse mortality with an area under the curve of 0.715. @*Conclusion@#The newly developed predictive scoring system could be a simple and reliable tool helping clinicians to assess risk of alloSCT in adults with acute leukemia.
ABSTRACT
Background@#To estimate real-world outcomes in East Asian populations, we conducted a nationwide retrospective analysis of the efficacy and safety of lenalidomide for del(5q) myelodysplastic syndrome (MDS) patients with transfusion-dependent anemia in Korea. @*Methods@#Patients aged ≥19 years who had received lenalidomide for the treatment of lower-risk, red blood cell (RBC) transfusion-dependent del(5q) MDS were selected. A filled case report form (CRF) with information from electronic medical records was requested from members of the acute myeloid leukemia (AML)/MDS Working Party of the Korean Society of Hematology. All the CRFs were gathered and analyzed. @*Results@#A total of 31 patients were included in this study. Of 28 evaluable patients, 19 (67.9%) achieved RBC transfusion independence (RBC-TI). Female sex and the development of thrombocytopenia during treatment were associated with achieving RBC-TI. The most common non-hematologic toxicities were pruritus, fatigue, and rashes. All non-hematologic toxicities of grades ≥3 were limited to rash (12.9%) and pruritus (6.5%). Dose reduction was required in 15 of the 19 responders (78.9%). The most common final stable dosing schedule for the responders was 5 mg once every other day (31.6%). @*Conclusion@#Lenalidomide efficacy and tolerability were similar in the Asian del(5q) MDS patients and western patients. Dose reduction during treatment was common, but it was not associated with inferior outcomes.
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Purpose@#To report a case of acute myopic change and anterior chamber depth decrease induced by zonisamide, which is an antiepileptic drug.Case summary: A 40-year-old male with no ophthalmologic history, who was admitted to the neurology department through the emergency center for evaluation and treatment of frontal lobe epilepsy, was referred to the ophthalmology department due to a visual disturbance that occurred while the patient was being treated with 100 mg of zonisamide during hospitalization. Corrected visual acuities with the patient’s own glasses were 0.3 in both eyes, with intraocular pressure of 16 and 17 mmHg in the right and left eye, respectively. Automated refraction revealed a bilateral myopic change of -1.25 diopters (D) in the right eye and -1.00 D in the left eye, and the anterior chambers in both eyes were shallow under slit-lamp examination. As we assumed these symptoms were related to the intake of zonisamide, we immediately instructed the patient to discontinue the drug. At 3 days after discontinuing the drug, his myopia improved, and corrected visual acuities with the previous glasses increased to 1.0 in both eyes. @*Conclusions@#Zonisamide is a sulfonamide anticonvulsant that may cause acute myopic shift and a reduction in the anterior chamber depth. Therefore, physicians must consider the possibility of these complications occurring, when diagnosing a sudden blurring of vision in patients who are taking sulfonamide medications.
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Purpose@#To report a case of acute myopic change and anterior chamber depth decrease induced by zonisamide, which is an antiepileptic drug.Case summary: A 40-year-old male with no ophthalmologic history, who was admitted to the neurology department through the emergency center for evaluation and treatment of frontal lobe epilepsy, was referred to the ophthalmology department due to a visual disturbance that occurred while the patient was being treated with 100 mg of zonisamide during hospitalization. Corrected visual acuities with the patient’s own glasses were 0.3 in both eyes, with intraocular pressure of 16 and 17 mmHg in the right and left eye, respectively. Automated refraction revealed a bilateral myopic change of -1.25 diopters (D) in the right eye and -1.00 D in the left eye, and the anterior chambers in both eyes were shallow under slit-lamp examination. As we assumed these symptoms were related to the intake of zonisamide, we immediately instructed the patient to discontinue the drug. At 3 days after discontinuing the drug, his myopia improved, and corrected visual acuities with the previous glasses increased to 1.0 in both eyes. @*Conclusions@#Zonisamide is a sulfonamide anticonvulsant that may cause acute myopic shift and a reduction in the anterior chamber depth. Therefore, physicians must consider the possibility of these complications occurring, when diagnosing a sudden blurring of vision in patients who are taking sulfonamide medications.
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BACKGROUND: Cancer is characterized by uncontrolled cellular proliferation, and Polo-like kinase 1 (PLK1), a key regulator of the cell cycle, is overexpressed in many cancers, including acute leukemia and lymphoma. However, the dynamics of PLK1 transcription in myelodysplastic syndromes (MDS) are unknown. This study aimed to investigate the transcript dynamics of PLK1 and determine its role in the pathophysiology of MDS. METHODS: PLK1 mRNA obtained from the bone marrow samples of 67 patients with MDS, 16 patients with secondary acute myeloid leukemia (sAML), and 10 healthy controls were analyzed using quantitative real-time PCR and compared according to various clinical parameters. RESULTS: The median PLK1 expression levels differed slightly, but not significantly, between MDS and sAML patients [661.21 (range, 29.38–8,987.31) vs. 1,462.05 (32.22–5,734.09), respectively], but were significantly higher (P<0.001) than the levels in the healthy controls [19.0 (1.60–49.90)]. Further analyses of PLK1 levels according to the WHO classification of MDS, prognostic risk groups, karyotype risk groups, marrow blast percentage, and depth of cytopenia did not reveal any significant associations. In patients progressing to sAML, PLK1 expression levels differed significantly according to the presence or absence of resistance to hypomethylation treatment (2,470.58 vs. 415.98, P=0.03). CONCLUSION: PLK1 is upregulated in MDS patients; however, its role in the pathophysiology of MDS is unclear. Gene upregulation in cases with pharmacotherapeutic resistance warrants further investigation.
Subject(s)
Humans , Bone Marrow , Cell Cycle , Cell Proliferation , Classification , DNA Methylation , Gene Expression , Karyotype , Leukemia , Leukemia, Myeloid, Acute , Lymphoma , Myelodysplastic Syndromes , Phosphotransferases , Protein Serine-Threonine Kinases , Real-Time Polymerase Chain Reaction , RNA, Messenger , Up-RegulationABSTRACT
PURPOSE: We aimed to investigate the prevalence and allergen sensitization of allergic rhinitis (AR) in preschool children. We assessed the relationship of AR, allergen sensitization, and air pollutants. METHODS: Between 2012 and 2016 in Jincheon, skin prick testing and questionnaire survey were performed on 2,958 children. AR have diagnosed on the basis of current symptoms and sign of AR on the Korean International Study of Asthma and Allergies in Childhood questionnaire and 1 or more proven allergen sensitization. RESULTS: A total of 2,052 children completed survey and skin prick testing, and were included in the analysis. The prevalence of AR symptom within last 12 months and AR were 27.0% and 10.9%, respectively. During study, both prevalences were increased from 20.1% and 8.6%, respectively in 2012 to 29.1% and 12.8%, respectively in 2016. The total inhalant allergen sensitization rate was 32.6%. The most common inhalant allergen was Dermatophagoides farinae (23.1%), followed by Dermatophagoides pteronyssinus (22.5%), tree pollens (5.3%), weed pollens (5.2%), fungi (4.7%), dog hair (4.5%) cat fur (3.6%), grass pollens (1.1%), and cockroach (0.8%). Although there was no difference tree or weed pollen sensitization, pollen seasonal prevalence of current AR symptoms is highest in spring (80%) versus autumn (52.3%). Seasonal PM10 (particulate matter with a median aerodynamic diameter less than or equal to 10 µm in diameter) and SO2 (sulfur dioxide) levels were correlated with the prevalence of seasonal AR symptoms. Pollen seasonal current AR symptoms were significantly related to seasonal pollen sensitization, but not inhalant allergens including dust mites. CONCLUSION: There was a rapid increasing prevalence of AR in preschool children in the areas of urbanization and industrialization. Pollen seasonal current AR symptoms have a close relationship with PM10 and seasonal pollen sensitization.
Subject(s)
Animals , Cats , Child , Child, Preschool , Dogs , Humans , Air Pollutants , Allergens , Asthma , Cockroaches , Dermatophagoides farinae , Dermatophagoides pteronyssinus , Dust , Fungi , Hair , Hypersensitivity , Mites , Poaceae , Pollen , Prevalence , Rhinitis, Allergic , Seasons , Skin , Trees , UrbanizationABSTRACT
Because primary antifungal prophylaxis is widely used for immunocompromised hosts, the incidences of unusual fungal infections have increased. Trichosporon asahii has emerged as an important life-threatening opportunistic systemic pathogen because of the increased use of cytotoxic or immunosuppressant agents, along with high mortality rates. Here, we describe a case of catheter-related T. asahii bloodstream infection with multiple septic skin nodules in both the arms and legs of the patient who was in the neutropenic period after allogeneic stem cell transplantation for myelodysplastic syndrome treated with prophylactic ciprofloxacin and itraconazole. We successfully treated her with intravenous voriconazole for more than a month without any complications. Clinicians should consider breakthrough Trichosporon infections when clinical progress in an immunocompromised patient with unexplained infection signs and symptoms does not improve despite proper treatment with antibiotics or various antifungal agents. In addition, voriconazole can be a good treatment choice for achieving better treatment results and prognosis.
Subject(s)
Humans , Anti-Bacterial Agents , Antifungal Agents , Arm , Catheter-Related Infections , Ciprofloxacin , Fungemia , Immunocompromised Host , Incidence , Itraconazole , Leg , Mortality , Myelodysplastic Syndromes , Prognosis , Skin , Stem Cell Transplantation , Trichosporon , VoriconazoleABSTRACT
Because primary antifungal prophylaxis is widely used for immunocompromised hosts, the incidences of unusual fungal infections have increased. Trichosporon asahii has emerged as an important life-threatening opportunistic systemic pathogen because of the increased use of cytotoxic or immunosuppressant agents, along with high mortality rates. Here, we describe a case of catheter-related T. asahii bloodstream infection with multiple septic skin nodules in both the arms and legs of the patient who was in the neutropenic period after allogeneic stem cell transplantation for myelodysplastic syndrome treated with prophylactic ciprofloxacin and itraconazole. We successfully treated her with intravenous voriconazole for more than a month without any complications. Clinicians should consider breakthrough Trichosporon infections when clinical progress in an immunocompromised patient with unexplained infection signs and symptoms does not improve despite proper treatment with antibiotics or various antifungal agents. In addition, voriconazole can be a good treatment choice for achieving better treatment results and prognosis.
Subject(s)
Humans , Anti-Bacterial Agents , Antifungal Agents , Arm , Catheter-Related Infections , Ciprofloxacin , Fungemia , Immunocompromised Host , Incidence , Itraconazole , Leg , Mortality , Myelodysplastic Syndromes , Prognosis , Skin , Stem Cell Transplantation , Trichosporon , VoriconazoleABSTRACT
BACKGROUND: The aim of this study was to evaluate the effects of darbepoetin alfa (DA) on hemoglobin (Hb) concentration and the need for transfusions in multiple myeloma (MM) patients receiving chemotherapy with novel agents. METHODS: Of 251 patients with MM who received DA therapy for at least 4 weeks, 142 who did not receive RBC transfusion during 4 weeks after DA initiation and started DA therapy at baseline Hb <10.0 g/dL were analyzed. RESULTS: After 4 weeks of DA therapy, 80 (60.6%) of 132 patients with evaluable data had Hb that increased ≥1.0 g/dL from baseline, while 50 (37.9%) had Hb that increased ≥2.0 g/dL from baseline. Pretreatment Hb level did not correlate with the proportion of patients with increased Hb. The median duration of DA therapy was 9.0 weeks. At the end of DA therapy, of 135 patients with evaluable data, 86 (60.6%) had Hb that increased ≥1.0 g/dL from baseline, while 67 (47.2%) had Hb that increased ≥2.0 g/dL from baseline. Stage III disease according to the International Staging System and absence of myeloma bone disease at diagnosis were independent predictors of higher Hb response during early DA therapy. CONCLUSION: We demonstrated the efficacy of DA therapy in a homogeneous group of MM patients receiving chemotherapy. DA therapy significantly increased Hb concentration, regardless of baseline Hb level.
Subject(s)
Humans , Anemia , Bone Diseases , Darbepoetin alfa , Diagnosis , Drug Therapy , Erythropoietin , Multiple MyelomaABSTRACT
BACKGROUND: Mesenchymal stromal cells (MSCs) are useful for cell therapy because of their potential for multilineage differentiation. However, MSCs that are expanded in traditional two-dimensional (2D) culture systems eventually lose their differentiation abilities. Therefore, we investigated whether azacitidine (AZA) supplementation and three-dimensional culture (3D) could improve the differentiation properties of MSCs. METHODS: 2D- or 3D-cultured MSCs which were prepared according to the conventional or hanging-drop culture method respectively, were treated with or without AZA (1 µM for 72 h), and their osteogenic and adipogenic differentiation potential were determined and compared. RESULTS: AZA treatment did not affect the cell apoptosis or viability in both 2D- and 3D-cultured MSCs. However, compared to conventionally cultured 2D-MSCs, AZA-treated 2D-MSCs showed marginally increased differentiation abilities. In contrast, 3D-MSCs showed significantly increased osteogenic and adipogenic differentiation ability. When 3D culture was performed in the presence of AZA, the osteogenic differentiation ability was further increased, whereas adipogenic differentiation was not affected. CONCLUSION: 3D culture efficiently promoted the multilineage differentiation of MSCs, and in combination with AZA, it could help MSCs to acquire greater osteogenic differentiation ability. This optimized culture method can enhance the therapeutic potential of MSCs.
Subject(s)
Adipogenesis , Apoptosis , Azacitidine , Cell- and Tissue-Based Therapy , Mesenchymal Stem Cells , Methods , OsteogenesisABSTRACT
This retrospective study aimed to compare the clinical features of paramedullary lesions (PLs) and extramedullary lesions (ELs) of plasmacytomas at diagnosis, using positron emission tomography integrated with computed tomography, using glucose labeled with the positron-emitting radionuclide ¹⁸F (¹⁸F-FDG-PET/CT) in newly diagnosed multiple myeloma (NDMM), and to address their prognostic impact. Sixty-four patients with NDMM presenting ELs (n=22) and/or PLs (n=42) were included. Patients with ELs at initial presentation had unfavorable laboratory parameters of calcium and lactate dehydrogenase, a higher percentage of bone marrow plasma cells, and showed a trend toward advanced international staging system (ISS), compared to patients with PLs. Using X-ray imaging, high bone disease (HBD) was observed in 50% and 71% of patients with ELs and PLs, respectively. After a median follow-up of 29.2 months (range, 3.4–76.5 months) in survivors, patients with ELs had a significantly lower overall survival (OS) (p=0.033) than patients with PLs did, whereas the progression-free survival (PFS) did not differ significantly (p=0.818). However, the PFS after 1(st) progression was significantly worse in patients with ELs than in those with PLs (p=0.017). In the multivariate analyses, the negative impact of initial ELs on OS (p=0.033) was sustained. Our results demonstrated the different clinical features and outcomes of ELs and PLs in NDMM. Patients with initial ELs showed a shorter PFS after 1(st) progression, which translated into poor OS, providing insight into the different biological effect of ELs.
Subject(s)
Humans , Bone Diseases , Bone Marrow , Calcium , Diagnosis , Disease-Free Survival , Follow-Up Studies , Glucose , L-Lactate Dehydrogenase , Multiple Myeloma , Multivariate Analysis , Plasma Cells , Plasmacytoma , Positron-Emission Tomography , Retrospective Studies , SurvivorsABSTRACT
BACKGROUND: Standard remission induction chemotherapy consisting of anthracycline plus cytarabine (3+7) is administered for adult acute myeloid leukemia (AML). However, the effects of intensified regimen on complete remission (CR), relapse and overall survival (OS) remain unknown. METHODS: We analyzed 1195 patients treated with idarubicin plus cytarabine/BHAC (3+7) from 2002 to 2013. Among them, 731 received early intensification with 3-day cytarabine/BHAC (3+10, N=363) or 2-day idarubicin plus cytarabine/BHAC 3 days (5+10, N=368). The 3+10 and 5+10 strategies were applied to patients with bone marrow blast counts of 5–20% and >20% on day 7 of 3+7, respectively. RESULTS: Early intensification correlated with a younger age (median: 40 vs. 45 yr) and higher t(8;21) frequency (20.4% vs. 7.1%), compared to 3+7. After early intensification, the early death rates were higher among the elderly (3+10 [15.7%], 5+10 [21.7%] vs. 3+7 [6.3%], P=0.038), while the post-induction CR rate was higher in young patients (3+10 [79.8%], 5+10 [75.1%] vs. 3+7 [65.1%], P<0.001). Early relapse rate was also decreased (3+10 [11.8%], 5+10 [11.7%] vs. 3+7 [22.0%], P<0.001). In multivariate analysis, early intensification correlated with an inferior 5-year OS among elderly patients (19.2% vs. 22.8%; hazard ratio [HR]=1.84, 95% confidence interval [CI]; 1.11–3.06, P=0.018) and lower overall relapse rate among young patients (33.0% vs. 41.4%, P=0.023; HR=0.71, 95% CI; 0.55–0.93, P=0.012). CONCLUSION: Early intensification correlated with higher CR and lower relapse rates, but not OS in young AML patients. In elderly patients, early intensification correlated with a higher early death rate and poorer OS.