Safety of Donated Blood of Malaria Patients Before Diagnosis / 대한수혈학회지

BACKGROUND: As the number of malaria patients has increased in Korea, the number of blood donors who are diagnosed as malaria after donation has also increased. And during 1997~2001, ten cases of transfusion-transmitted malaria were reported. We investigated the transfusion safety of blood that was donated by malaria patients before diagnosis. METHODS: For a total of 2,552 malaria patients diagnosed in 2001, blood donation history of past one year before diagnosis was inquired at the beginning of 2002. Then we inquired informations about recipients of the hospitals through the regional Red Cross blood centers. we also inquired development of malaria after transfusion for the recipients in the August of 2002. Malaria antibody test results of donated blood were also analyzed to determine the status of immunity of donors in Seoul, Gyeonggi and Gangwon area. RESULTS: Among 2,552 malaria patients, 162 (6.3%) patients had donated within one year before diagnosis and they were all man. Their blood was processed into 292 units of blood components and supplied to 90 hospitals, where it was transfused 286 patients. Among these 286 patients, no one was diagnosed as malaria until time of database retrieving. Among 162 malaria patient, enzyme immunoassay malaria antibody test results of 107 (66.0%) patients were available, and all were negative. CONCLUSION: No one has developed malaria among the recipients transfused with blood that was donated by malaria patients before diagnosis. Therefore, the infectivity of blood donated before malaria diagnosis is thought to be very low. As antibody to malaria was not produced in some of malaria patients before diagnosis, this finding could be useful for the study of immunology of malaria infection.

Study on Serologic Test for Syphilis as a Surrogate Marker for Human Immunodeficiency Virus Infection among Korean Blood Donors / 대한수혈학회지

BACKGROUND: Serologic test for syphilis(STS) is an old traditional donor screening test for preventing transfusion-transmitted syphilis. By conducting STS, history taking for donors and refrigeration of blood, transfusion associated syphilis is very rare at present. This study evaluated the usefulness of the STS as a surrogate marker for preventing the transfusion of human immunodeficiency virus(HIV) via the transfusion of infectious window-period blood in Korean blood donors. METHODS: Demographic and laboratory information on blood donations made between January 1997 and December 1998 in 16 Korean Red Cross Blood Centers was analyzed. STS positive rate of 239 HIV-infected people and blood donors in 1999 were investigated. RESULTS: Of 4,808,297 donations over 2-year period, 3,956 (0.08%) were positive in STS and 40 (0.0008%) were anti-HIV confirmed positive. Of those, two were simultaneously positive for STS and anti-HIV. Among donations, Anti-HIV positive donations were 64 times more likely to be STS positive(odds ratio=63.9) and positive predictive value (PPV) of STS for anti-HIV was 0.05%. Fourteen of 239 HIV-infected people were STS positive. CONCLUSION: STS positivity was higher in anti-HIV positive donors, but the PPV of STS for anti-HIV was low. STS as a donor screening test is considered as a poor marker for preventing post-screening HIV infections and the usefulness of STS must be evaluated in its own value.

Confirmation of HCV Positivity for Indeterminate Donors in Anti-HCV Antibody Immunoblot Assay among Blood Donors / 대한수혈학회지

BACKGROUND: In Korean Red Cross, recombinant immunoblot assay (RIBA) has been used for the confirmatory test of HCV positive units since 1995. To certify the HCV infection in blood donors who showed the 'indeterminate result on the RIBA test, this study was performed. METHODS: Three enzyme immunoassay (EIA) kits (LG HCD 3.0, DONG-A HCV 3.0, and ORTHO HCV 3.0)and RNA detection method were employed to evaluate infection state of 135 samples of the 'indeterminate in the RIBA test. RESULTS: The 52.6% of the samples showed the same test results with three EIA kits. Fifteen samples (11.1%) were HCV RNA positive with RT-PCR-hybridization technique. Among 15 samples of HCV RNA positive, 13 (86.7%), 13 (86.7%), and 14(93.3%) of samples were positive in LG HCD 3.0, Ortho HCV 3.0 and Dong-A HCV 3.0 EIA, respectively. In the analysis of RIBA band reaction, HCV RNA positivity were correlated with core14, core518, and 897 antigen. However, among 64 samples which react with core antigen only, five samples (7.8%) were HCV RNA positive. CONCLUSION: Based on the results of the present study, it is recommend that the HCV RNA test be used as a method of confirmatory test in order to notify exact HCV positivity status to blood donor who showed indeterminate RIBA result.

A Preliminary Report of Allogeneic Stem Cell Transplantation for Patients with Acute Leukemia Conditioned by Triple-alkylating Regimen / 대한혈액학회지

BACKGROUND: We assessed the toxicity and feasibility of the three-alkylator combinations as conditioning regimens for allogeneic hemopoietic stem cell transplantation (HSCT) in 23 adult patients with acute leukemia. METHODS: Sixteen patients were transplanted for acute myeloid leukemia, six for acute lymphoblastic leukemia, and one for myelodysplastic syndrome. Group A included thirteen cases of relapsed refractory, 2 relapsed after first HSCT and group B eight patients in first complete remission or two in second complete remission. Eleven cases received G-CSF mobilized CD34+allogeneic peripheral blood stem cells (PBSCs) in addition to bone marrow (BM) and three in vivo expanded BM by G-CSF and eight unmanipulated BM and one from syngeneic BM after conditioned with busulfan, thiotepa and melphalan (n=14) or cyclophosphamide, thiotepa and melphalan (n=6) or TBI, melphalan and thiotepa (n=3). RESULTS: Twelve of thirteen patients in group A patients engrafted successfully and only one patient failed to achieve complete remission (CR). All patients in group B had successful engraftment. The median days reaching absolute neutrophil count (ANC) more than 500/microliter and platelet more than 30,000/microliter in group A and group B were 13.4 days (7-22), 17.9 days (9-40) and 16.3 days (10-21), 22.6 days (13-38), respectively. Acute graft vs host disease (GVHD) developed in both groups with the incidence of seven (78%) for group A and six (60%) for group B. The major regimen-related toxicity was mucositis with incidence of 95.7% (22/23). The disease free survival rate after HSCT with median follow-up of 161 days (31-283 days) and 101 days (22-163 days) in each group were 24% and 62.5%, respectively. CONCLUSION: Although the observation period is limited, this study shows that the combination of triple-alkylating regimens are tolerable as a preparative regimen for allogeneic HSCT for both high-risk and standard-risk leukemic patients. We need to confirm effects of these regimens in prospective randomized-controlled studies in the future. (allo-BMSCT) and 14 cases of autologous peripheral blood stem cell transplantation (aPBSCT) were underwent. With a median follow-up of 293 days (range, 35~510), the relapse rate was 34.1% (14/41 cases) in chemotherapy-only group and 13.5% (5/37 cases) in transplant-group. The probability of disease-free survival (DFS) at 2 years of chemotherapy-only group, aPBSCT group, and allo-BMSCT group were 20.1%, 44.9%, and 90%, respectively. The relapse-probability at 2 years of three groups were 76.1%, 55.1% and 11.1% in order, respectively. Univariate analyses showed that age (P=0.0274) and augmentation with BHAC (p=0.0334) were significant factors for achieving CR.

Effects of Induction Chemotherapy with BHAC Plus Idarubicin on Long-term Survival for Patients with Acute Myelogenous Leukemia according to Different Postremission Strategies / 대한혈액학회지

No abstract available.

Allogeneic Bone Marrow Transplantation for Myelodysplastic Syndromes / 대한혈액학회지

BACKGROUND: The myelodysplastic syndromes (MDS) can be categorized as a group of clonal hematopoietic disorders characterized by ineffective hematopoiesis and peripheral cytopenias. Although the natural history of MDS varies, traditional treatments are not curative and allogeneic marrow transplantation offers potentially curative treatment for MDS. METHODS: In our center, 10 patients underwent allogeneic bone marrow transplantation (BMT) between December 1989 and May 1997. The minimum follow-up of 3 months was possible in 10 patients, for whom treatment-related complications and clinical outcomes were assessed. RESULTS: The median age of the 10 patients was 33 (range 20~40) years. The median time from diagnosis to BMT was 34 (3~116) months. By morphology, 5 patients had advanced MDS (i.e., RAEB, RAEB-t, CMML) and 5 patients had less advanced MDS (RA). By Bournemouth score, 8 patients had a score 2~3 and two patients had a score 4. By IPSS, 5 patients were in intermediate-1 group, 3 patients in intermediate-2 group and 2 patients in high risk group. Patients were prepared for transplant with either a total body irradiation (TBI)+cyclophosphamide (n=7), busulfan+TBI (n=2) and busulfan+cyclophophamide (n=1). All patients received CsA+short course MTX for GVHD prophylaxis. Successful engraftment was confirmed in all patients. The overall incidence of acute GVHD was noted in 70% (7/10 patients) and grade IV acute GVHD developed in 2 patients (20%). Five patients were evaluable for the development of chronic GVHD and 2 patients (40%) developed limited chronic GVHD. The duration of median follow-up was 8.1 months. At present five patients are alive and disease-free 3 to 21 months (median survival duration : 8.2 months) post-transplantation resulting in a 2-year disease-free survival of 44%. 2-year disease free survival was 63% in less advanced MDS and 25% in advanced MDS. CONCLUSION: Allogeneic BMT should be considered when any clinical evidence of disease progression to a more advanced stage becomes apparent. International prognostic scoring system (IPSS) and Bournemouth score can also be used to gauge timing for BMT. For patients were in intermediate-1 or intermediate-2 group by IPSS, BMT can be justified if the patient is young and has an HLA matched sibling donor.

Direct Comparsion of Long-Term Culture-Initiating Cells in Bone Marrow, Umbilical Cord Blood and Peripheral Blood Stem Cells / 대한혈액학회지

BACKGROUND: Classically bone marrow (BM) is the major source of hematopoietic stem cells for the transplantation. Recently, hematopoietic stem cells circulating in peripheral nlood and umbilical cord stem cells have been widely accepted for use in high dose chmotherapy requiring hematopoietic stem cells support. Number if CFU-GM and CD34+ cells are routinely used to assess the engraftment potential of BM aspirates and leukapheresis harvests. However, these parameters predominantly reflect clonogenic cell activity which might only be relevant to short-term hematopoeitic reconstitution, and not necessarily reflect the hematopoeitic stem cell activity capable of sustained engraftment. Long-term culture system is regarded as a quantitative method of estimating hematopoietic stem cell activity in clinical samples. METHODS: We enumerated CFU-GM and CD34+ cells in G-CSF mobilized peripheral blood (MPB), BM and umbilical cord blood (UCB). We obtained the number of LTC-IC from each of these hematopoietic stem cell sources using the long-term culture system. These parameters have compared between the stem cell sources. RESULTS: CD34+ cells were detected in MPB, BM, and UCB at incidences of 2.27+/-1.58%, 0.74+/-0.55%, 1.24+/-0.24% of total mononuclear cells. The highest number of CD34+ cells were seen in UCB. The colony counts higher in UCB than in MPB and BM. Direct comparison of LTC-IC was made between three sources based on CD34+ cell counts. The total numbers of LTC-IC per 105 CD34+ cell were 713 for UCB, 263 for BM, 104 for MPB. These UCB was superior to BM and MPB by cell all three parameters; CFU-GM, CD34+, LTC-IC. CONCLUSION: We speculate that UCB should be better source of hematopoietic stem cell transplantation as well as gene therapy if it could be expanded.

Autologous or Allogeneic Bone Marrow Transplantation Compared with Consolidation Chemotherapy in Acute promyelocytic Leukemia / 대한암학회지

PURPOSE: Acute promyelocytic leukemia (APL) is a distinct subtype of acute myelogenous leukemia characterized by the morphology of blast cells (M3 in FAB classification), the t (15;17) translocation, and a coagulopathy combining disseminated intravascular coagulation and fibrinolysis. It has been considered to have better response to combination chemo- therapy of an anthracycline and cytosine arabinoside and a higher cure rate than other subtypes because of recent approach of differentiating leukemic blasts by all-transretinoic acid (ATRA). The role of stem cell transplantation in APL has to be determined in comparison with that of consolidation chemotherapy. MATERIALS AND METHODS: We compared the leukemia-free survival and overall survival between APL patients receiving the consolidation chemotherapy and those undergoing the allogeneic or autologous stem cell transplantation following the high-dose anticancer therapy. Of the 65 patients achieving the first complete remission from 1992 to 1997, 33 patients were treated with 3 courses of consolidation chemotherapies and 32 with the stem cell transplantation. RESULTS: With a median follow-up of 22 months (8-60), the actuarial leukemia-free survival at 3 years was significantly higher in transplantation group than in chematherapy group (73.8% versus 33.5%; P=0.0087), and the probability of leukemic relapse was considerably lower in transplantation group than in chemotherapy group (6.3% versus 57.5%; P=0.001). The treatment-related mortalities of the groups were 0% in chemotherapy group and 14.3% in transplantation group. The main cause of deaths was relapse in the consolidation chemotherapy group. CONCLUSION: These data demonstrate that the stem cell transplantation results in better leukemia-free survival than the consolidation chemotherapy for patients with APL in the first complete remission because of lower risk of relapse.

A Case of Nocardiosis after Bone Marrow Transplantation / 감염

The nocardiae are gram-positive, aerobic actinomycetes causing opportunistic infections in compromised hosts, such as recipients of solid organ transplants, patients with AIDS, and patients with cancer receiving immunosuppressive therapy, and those with chronic illnesses. Because cellular immunity and neutrophil function are critical for the clearance of Nocardia, frequent infection with the organism would be expected amongmarrow recipients, but reports of nocardiosis are surprisingly rare among these patients. We report a case of nocardiosis sixteen months after an allogenic bone marrow transplantation. The patient was successfully treated with imipenem and amikacin for 4 weeks and then with oral trimethoprim-sulfamethoxazole.

Hepatic Graft-Versus-Host Disease: Three Cases Proven By Laparoscopic Liver Biopsy / 대한내과학회지

Hepatic graft-versus-host disease (GVHD) occurs in nearly one-third of recipients of HLA-identical sibling bone marrow transplantation (BMT), and is a major cause of morbidity and mortality following BMT. Hepatic dysfunction after BMT may result from a number of causes such as pretransplant chemoradiation, drugs for GVHD prophylaxis, venoocclusive disease, various infections, GVHD, and infiltration of recurrent malignancy. The clinical distinction of these causes may be difficult and the treatment of each causes is quite different. Therefore the early diagnosis of GVHD is very important. Hepatic GVHD is recognized to immunologic disorder such as primary biliary cirrhosis, and is characterized by cholestasis due to extensive bile duct damage and mild hepatocellular necrosis. In Korea, the occurrence of GVHD is about 20-45%. We report three cases of severe hepatic GVHD after allogeneic BMT, which were proven by laparoscopic liver biopsy in 1996. There were differences in primary illness, associated condition and disease progression.

Changes in Antibody Titers of Measles, Mumps, Rubella, and Hepatitis B Virus AftEr Bone Marrow Transplantation in Korea: A Preliminary Report / 감염

BACKGROUND: Bone marrow transplantation (BMT) has become a significant treatment modality for hematopoietic and solid organ malignancy. Recipients of BMTs lose immunity to measles-mumps-rubella (MMR) and hepatitis B infections which are preventable with vaccination. There is no consensus regarding a vaccination schedule after BMT and time of vaccination is variable according to each institution. We analyzed sequential changes in antibody titers of MMR and hepatitis B during the first year after BMT in an attempt to identify the time, dose, and needs for revaccination. METHODS: Total 20 patients with hematologic malignancies were studied. Serum levels of IgG antibodies of MMR and hepatitis B virus (HBV) were determined every three months post-BMT by enzyme immunoassay (EIA), chemical luminescence immunoassay (CLIA) and immunofluorescence assay (IFA). RESULTS: IgG antibody levels of measles, rubella, HBV were 1:746, 80 85 IU/mL, 214 343 IU/L before BMT, declined to 1:633, 18 11 IU/mL, 4 6 IU/L one year after BMT, respectively. All the antibody levels were still above cut-off value for positive immunity. Mumps antibody titers were 1:62 before BMT, declined to 1:25 significantly from 6 months after BMT, but the antibody level was still above cut-off value. CONCLUSION: Antibody titers of MMR and hepatitis B decline during the first year after BMT, but the levels are still above cut-off value. Thus, the timing of revaccination should be after the first year post-transplantation. Long-term studies are needed to determine the optimal time for revaccination.

A Case of Treatment of Serum EB Virus Antibody Positive Patient Presented with Evans Syndrome / 대한혈액학회지

Evans syndrome is defined as the simultaneous or sequential occurrence of Coombs- positive hemolytic anemia and idiopathic thrombocytopenia. The clinical course is characterized by periods of remission and exacerbation with variable, and often disappointing responses to therapy. We experienced a case of serum Epstein-Barr virus antibody positive patient presented with Evans syndrome in a 31-year-old woman whose chief complaints were dyspnea and general weakness and whose disease responded to the multimodality therapy including prednisolone, plasmapheresis, intravenous immunoglobulin (IVIG), and alternate-day cyclosporine A and prednisolone. This is the encouraging report of the use of multimodality treatment with prednisolone, plasmapheresis, IVIG, and cyclosporine A and prednisolone in a serum EV virus antibody positive patient presented with Evans syndrome.

A Preliminary Report of Busulfan, Melphalan and Thiotepa or TBI-containing Bi-alkylator Chemotherapy as a Preparative Regimen for Allogeneic Bone Marrow Transplantation in Refractory or Relapsed Acute Leukemias / 대한암학회지

PURPOSE: We assessed the three-alkylator combination of busulfan, melphalan and thiotepa or TBI, melphalan and thiotepa conditioning for allogeneic stem cell transplantation in 7 adult patients with refractory or relapsed acute leukemias. MATERIALS AND METHODS: Six patients were transplanted for acute myeloid leukemia, one for acute lymphoblastic leukemia and included 5 of relapsed refractory, 2 of relapsed after first-BMT. All but 1 cases received G-CSF stimulated CD34+ allogeneic peripheral blood progenitor cells (PBPCs) in addition to stimulated allogeneic marrow. RESULTS: All patients except one engrafted (median time to ANC >0.5 10 (9)/L=11days, to platelets >30 X 10 (9)/L=14 days) successfully and complete remission was obtained in 6 patients. Grade I-II acute GVHD and controllable regimen-related toxicity especially oral mucositis (grade II-III) developed in all cases, but 2 patients including one second- allogeneic BMT patient expired early by transplant-related toxicity of hepatic or multiorgan failure along the course of sepsis. CONCLUSION: Although the observation period on these cases are limited, the data presented show that the combination of busulfan, melphalan and thiotepa is tolerable as a preparative regimen for allogeneic marrow transplantation in high-risk leukemic patients. We think that these encouraging results need to be confirmed in prospective studies in the future.

Effect of All - trans Retinoic Acid ( ATRA ) on the Remission Induction and Coaguloyathy in Acute Promyelocytic Leukemia ( APL ) / 대한내과학회지

OBJECTIVES: APL, which characteristically shows t(15:17), accompanies fatal coagulopathy during remission induction with systemic chemotherapy alone. ATRA, a derivative of vitamin A, can differentiate APL cells as well as HL-60 cells in vitro and induce higher rate of complete remission(CR). Hence, we assessed the effect of ATRA on remission induction and coagulopathy in APL patients. METHODS: (1) 42 patients diagnosed histologically in St. mary's hospital from June 1991 to June 1994 were included. (2) We compared the CR rate, the time required for restoration of derranged coagulation profiles, and the amount of coagulation factors including platelets among the chemotherapy group (control) and ATRA group. RESULTS: 1) There was no difference in CR rate between the control group and ATRA group [84.2%(16 out of 19) vs 87.0%(20 out of 23), p>0.05)] and also no difference between two subgroups of ATRA [ATRA with chemotherapy; 83.3%(10 out of 12) vs ATRA without chemotherapy; 90.9%(10 out of 11), p>0.05] 2) In the ATRA group, the CR rate of newly diagnosed patients was 82.4%(14 out of 17). The first relapsed patients (4) and the second (2) were all achieved CR. 3) The mean duration of coagulopathy, time to normalization of PT, aPTT, FDP, fibrinogen level, was 12.0+/-10.4, 11.1+/-10.2, 16.5+/-9.3, 15.4+/-10.2 days after chemotherapy alone and 4.5+/-4.4, 3.7+/-3.7, 8.9+/-6.1, 8.1+/-6.5 days in the ATRA group(p<0.05). The amount of fresh frozen plasma used in the ATRA group for the purpose of correction of coagulopathy were significantly lower than the control group(p<0.05). The incidence of profound coagulopathy during the remission induction treatment in the ATRA group was significantly lower than the control group[40% (8 out of 20) vs 96.7%(13 out of 15), p

Acute Myeloid Leukemia with Trisomy 9 Following Chemotherapy of Non-Hodgkin's Lymphoma / 대한암학회지

A 56-year-old male patient with non-Hodgkin's lymphoma achieved complete remission in July 1994 after receiving MACOP-B chemotherapy. 29 months after treatment, acute myeloid leukemia (AML, FAB subtypes M4) with trisomy 9 was developed. To our knowledge this is the first report of therapy-related AML with trisomy 9.

1991 cancer incidence in Seoul, Korea: results of the Implementation Study of the Seoul Cancer Registry

This article presents the results of the Implementation Study of the Seoul Cancer Registry, which started in July, 1991 as a population based cancer registry in Seoul, Korea. The completeness and validity of the registered data were evaluated using Mortality/Incidence ratio (M/I ratio), Histologically Verified Cases (HV%), Primary Site Uncertain (PSU%), and Age Unknown (Age UNK%). Owing to the additional active surveillance, the completeness of the data turned out to be fairly acceptable, except for the aged over 75(Mortality/Incidence ratio was over 100%). Eventhough the Seoul cancer registry(SCR) has further way to go in the completeness especially among elderly persons, the validity of SCR data was also acceptable in terms of HV%, PSU%, and Age UNK%. However, PSU% and Age UNK% might need to be further reduced to be comparable with other well established cancer registries. The age standardized incidence rates(ASR) of all cancers between July 1, 1991 and June 30, 1992 were 232.4/100,000 in males and 147.9/100,000 in females. The top five major sites of cancers in Seoul were the stomach, liver, lung, colo-rectum, and bladder in order in males, and the uterine cervix, stomach, breast, colo-rectum, and liver in females. Those 5 cancer sites comprised 68.9% and 64.7% of the total cancer incidence in males and females, respectively.

Pathogenesis of rheumatoid arthritis / 대한류마티스학회지

No abstract available.

Five cases of cytomegalovirus infection detected by in situ hybridization and antigenemia assay

We report five cases of cytomegalovirus infection in immunocompromised patients which were detected by either cytomegalovirus antigenemia assay or in situ hybridization. Four cases had leukemia and the other had chronic renal failure. All the three BMT recipients suffered from GvHD. Interestingly, there was an unique case of CMV disease without a history of BMT, which reminded us that CMV could attack immunocompromised patients who had not undergone transplantation, too. Four out of five cases died. We think that cytomegalovirus infection or disease should not be regarded as a minor problem in post-transplantation infection in Korea.

Total Body Irradiation for Allogeneic Bone Marrow Transplantation in Chronic Myelogenous Leukemia / 대한치료방사선과학회지

Between July 1987 and December 1992, we treated 22 patients with chromic myelogenous leukemia; 14 in the chronic phase and 8 with more advanced disease. All were received with allogeneic bone marrow transplantation from HLA-identical sibling donors after a total body irradiation (TBI) cyclophosphamide conditioning regimen. Patients were non-randomly assigned to either 1200 cGy/6fractions/3days (6 patients) or 1320 cGy/8 fractions/4days (16 patients) by dose of TBI. Of the 22 patients, 8 were prepared with cyclophosphamide alone, 14 were conditioned with additional adriamycin or daunorubicin. To prevent graft versus host disease, cyclosporine was given either alone or in conjunction with methotrexate. The actuarial survival and leukemic-free survival at four years were 58.5% and 41.2%, respectively, and the relapse rate was 36% among 22 patients. There was a statistically significant difference in survival between the patients in chronic phase and more advanced phase (76% vs 33%, p=0.05). The relapse rate of patients receiving splenectomy was higher than that of patients receiving splenic irradiation (50% vs 0%, p=0.04). We conclude that the probability of cure is highest if transplantation is performed while the patient remains in the chronic phase.

A case of thrombotic thrombocytopenia purpura / 대한혈액학회지

No abstract available.