Outcomes of a Modified CALGB 19802 Regimen in Adult Acute Lymphoblastic Leukemia

We analyzed the efficacy and toxicity of a modified Cancer and Leukemia Group B (CALGB) 19802 regimen in adult acute lymphoblastic leukemia (ALL). From February 2002 to August 2005, 25 adults with untreated ALL were enrolled in the study. Compared to the original regimen, the modified CALGB 19802 regimen consisted of a 4-drug induction (cyclophosphamide, daunorubicin, vincristine, and prednisone) instead of a 5-drug induction (L-asparaginase was added to the previous regimen). This was followed by high-dose methotrexate (1,000 mg/m(2)X3 days) and cytarabine (2,000 mg/m(2)X4 days) for the consolidation cycles. High-dose systemic and intrathecal methotrexate was given for central nervous system prophylaxis. Twentythree patients (92%) achieved a complete remission (CR), and two patients (8%) had refractory disease. With a median follow-up of 21.5 months, 10 patients (40%) were alive and continued to be in CR. The 3-yr probability of an event-free survival and the overall survival were 39.0% and 47.4%, respectively. Treatment related mortality and major grade 3 to 4 neurotoxicity occurred in 1 patient and 3 patients, respectively. The modified CALGB 19802 regimen demonstrated a high remission rate and a favorable survival rate.

Three Cases of Synchronous Solid Tumor and Multiple Myeloma / Journal of the Korean Cancer Association, 대한암학회지

The association between a multiple myeloma and a secondary solid tumor is not well established. Some reports showed an increased risk of secondary solid neoplasms in multiple myeloma patients, but others have not. Three cases of the synchronous occurrence of multiple myelomas and solid tumors, namely, a small cell carcinoma of the lung, an adenocarcinoma of the colon and a squamous carcinoma of the pyriform sinus were experienced at our hospital. Therefore, herein is reported the clinical courses and treatment results. The stage of multiple myeloma was Durie-Salmon stage I in all of three cases; therefore, the solid tumors were treated as a primary target because the prognosis of early stage multiple myeloma is generally better than that of advanced solid tumor, while a smoldering or stage I myeloma do not need primary therapy until progression of the multiple myeloma. Two patients died of their solid tumors, but one patient is alive.

Significance of Multidrug Resistance (MDR) Activity in Remission Induction & Survival of Acute Myeloid Leukemia / 대한혈액학회지

BACKGROUND: The significant improvement in the treatment of adults with acute myeloid leukemia (AML) has been achieved in recent years. However, many patients still fail to achieve a complete remission and long term survival because of either toxic death during aplasia periods of induction chemotherapy or resistance to induction chemotherapy. The P-glycoprotein (Pgp) associated with Multidrug Resisitance (MDR) gene is the best characterized mechanism of resistance to induction chemotherapy. In this study, the authors effort to examine the functional activity of Pgp using the rhodamine123 functional efflux assay and discuss for the predictive value of MDR functional assay for treatment outcomes of AML. METHODS: Between January 1996 and June 2003, 45 patients with AML were enrolled in this study. For evaluation of functional MDR activity using the rhodamine123 functional efflux assay, mononuclear cells isolated from bone marrow aspirates of 45 patients were used. All patients were received induction chemotherapy and consolidation therapy with high dose chemotherapy or stem cell transplantation. RESULTS: Among the 45 AML patients, 30 (66.7%) patients showed positive functional MDR activity and 15 (33.3%) patients negative functional MDR activity. Complete remission rate was lower in the group with positive functional MDR activity than negative, but no statistical significance was observed (P=0.453). Survival time in both groups was investigated. Leukemia free survival was 40.9 months in negative group and 18.7 months in positive group (P=0.336). Overall survival was 48.5 months and 26.6 months respectively (P=0.513). CONCLUSION: The functional MDR activity using the rhodamine123 functional efflux assay does not significantly affect induction rate and survival rate of AML patients.

Esophageal Squamous Cell Carcinoma Recurring as a Solitary Renal Mass / Journal of the Korean Cancer Association, 대한암학회지

Herein, a case of solitary, unilateral renal metastasis in a patient with curatively resected thoracic esophageal carcinoma, who achieved a pathological complete remission after neoadjuvant concurrent chemoradiotherapy, is reported. The kidney is the 4th or 5th most common visceral metastasis site of a primary esophageal carcinoma. More than 50% of renal metastases typically show bilateral involvement. Solitary, unilateral renal metastasis is extremely rare. Renal metastases from a primary esophageal carcinoma are usually latent and its diagnosis is very unusual in a live patient. The solitary renal metastasis in this case was not accompanied by metastases to other sites. The value of a nephrectomy in solitary renal metastasis of esophageal cancer is not known due to the rarity of such cases. A nephrectomy could be justified in limited situations, such as with uncertainty of histological diagnosis, severe life-threatening hematuria, which cannot be controlled by embolization, or solitary renal metastasis with a long disease-free interval.

Use of GCDFP-15 (BRST-2) as a Specific Immunocytochemical Marker for Diagnosis of Gastric Metastasis of Breast Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

Metastasis of breast cancer to the stomach is relatively uncommon and typically occurs in patients with disseminated diseases. This may cause difficulty in differentiating it from primary gastric carcinoma. The correct diagnosis of the primary source is important, since the treatment and prognosis of metastatic breast cancer is quite different from those of metastatic gastric cancer. Immunohistochemical staining with GCDFP-15 (gross cystic disease fluid protein-15) can be used to differentiate primary gastric carcinoma and gastric metastasis from breast cancer. We report two cases of gastric metastasis of breast cancer by describing their clinical course, illustrating the histologic findings, and showing the results of immunohistochemical staining with GCDFP-15.