Prognostic Role of Serum Vitamin B₁₂ in Solid Tumor Patients

BACKGROUND: Serum vitamin B₁₂ has been suggested as one of the cancer diagnostic markers and predictors for survival in cancer patients. In this study, we investigated the relationship between vitamin B₁₂ and tumor progression. METHODS: Solid tumor patients who had serum vitamin B₁₂ levels and radiologic test follow-up were included in the study. A total of 55 patients were included. Receiver operating characteristic analysis was performed to determine the cut-off value of vitamin B₁₂ for tumor progression. Kaplan-Meier method and Cox proportional hazard model for time to progression (TTP) were performed. Subgroup analysis was performed on patients with or without liver lesion (hepatocellular carcinoma and liver metastasis). RESULTS: The cut-off value of vitamin B₁₂ for tumor progression prediction was 691.4 pg/mL, the sensitivity was 57.1% and the specificity was 59.3%. Patients with vitamin B₁₂≥691.4 pg/mL had shorter median TTP (2.1 months vs. 3.4 months, P=0.011). In subgroup analysis of patients without liver lesion, median TTP was significantly shorter in patients with vitamin B₁₂≥691.4 pg/mL (1.6 months vs. 6.3 months, P=0.021), while there was no significant difference in TTP among the patients with liver lesion. Higher vitamin B₁₂ level (≥691.4 pg/mL) was an independent prognostic factor for tumor progression (adjusted hazard ratio 2.4, 95% confidence interval 1.2–4.8, P=0.019). CONCLUSIONS: Serum vitamin B₁₂ level can be used as a predictor of tumor progression in patients with solid tumors especially in patients without liver lesion. Additional large scale prospective studies are required to confirm this.

Imatinib Mesylate is Effective for Patients Not Only with Chronic Myeloid Leukemia, but Also Rheumatoid Arthritis / 대한내과학회지

Synovial tissue proliferation and inflammation are regarded as possible causes of rheumatoid arthritis. Activation of tyrosine kinase by numerous cytokines and BCR-ABL translocation contribute to synovial tissue inflammation and the development of rheumatoid arthritis, respectively. Imatinib is a tyrosine kinase-blocking agent that is widely used for treating chronic myeloid leukemia. We found several interesting case reports of patients with refractory rheumatoid arthritis who entered remission after initiating imatinib therapy. However, only one case report on treating rheumatoid arthritis with imatinib was found in Korea. Here, we describe the case of a 50-year-old man who showed clinical remission of rheumatoid arthritis and chronic myeloid leukemia after receiving 3 months of imatinib therapy.

Necrotizing Fasciitis versus Pyomyositis: Discrimination with Using MR Imaging

OBJECTIVE: We wanted to evaluate the MR findings for differentiating between necrotizing fasciitis (NF) and pyomyositis (PM). MATERIALS AND METHODS: The MR images of 19 patients with surgically confirmed NF (n = 11) and pathologically confirmed PM (n = 8) were retrospectively reviewed with regard to the presence or absence of any MRI finding criteria that could differentiate between them. RESULTS: The patients with NF had a significantly greater prevalence of the following MR findings (p < 0.05): a peripheral band-like hyperintense signal in muscles on fat-suppressed T2-weighted images (73% of the patients with NF vs. 0% of the patients with PM), peripheral band-like contrast enhancement (CE) of muscles (82% vs. 0%, respectively) and thin smooth enhancement of the deep fascia (82% vs. 13%, respectively). The patients with PM had a significantly greater prevalence of the following MRI findings (p < 0.05): a diffuse hyperintense signal in muscles on fat-suppressed T2-weighted images (27% of the patients with NF vs. 100% in the patients with PM), diffuse CE of muscles (18% vs. 100%, respectively), thick irregular enhancement of the deep fascia (0% vs. 75%, respectively) and intramuscular abscess (0% vs. 88%, respectively). For all patients with NF and PM, the superficial fascia and muscle showed hyperintense signals on T2-weighted images and CE was seen on fat-suppressed CE T1-weighted images. The subcutaneous tissue and deep fascia showed hyperintense signals on T2-weighted images and CE was seen in all the patients with NF and in seven (88%) of the eight patients with PM, respectively. CONCLUSION: MR imaging is helpful for differentiating between NF and PM.

Metachronous Mantle Cell Lymphoma with Leukemic Presentation in a Patient with Early Gastric Cancer: A Case Report

We report here on a case of metachronous second primary non-Hodgkin's lymphoma (NHL) that was diagnosed 6 years after performing subtotal gastrectomy for treating early gastric cancer (EGC). The subtype analysis revealed mantle cell lymphoma (MCL) of the blastic variant with a leukemic presentation, which was composed of mixed small and medium-sized cells. The immunohistochemical staining for cyclin-D1 was positive. The cytogenetic study revealed t(4;6). In Korea, the risk of developing a second primary cancer following gastric cancer was reported to be less than 3.4%, and NHL comprised less than 6.3% of this second primary cancer. Furthermore, MCL represents about 2% of all lymphomas in Korea. To the best of our knowledge, this is the first report of metachronous primary MCL with a leukemic presentation following curative resection of EGC.

A Case of Multiple Intussusceptions in the Small Intestine Caused by Metastatic Renal Cell Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

Renal cell carcinoma (RCC) may metastasize to almost any organ, but metastasis to the small bowel is rare. Small bowel metastasis from RCC can induce obstruction or bleeding, and perforation can also be induced in rare case. Yet RCC metastasis to the small bowel is unlikely to be a direct cause of intussusceptions. A few cases of intussusceptions caused by small intestinal metastasis of RCC have been reported, but multiple small intestinal intussusceptions are extremely rare. We report here on a 47-year-old male patient who presented to the emergency room with acute abdominal pain. He had undergone radical nephrectomy 2 years previously due to left RCC. The abdominal CT scan revealed enhanced masses with the "target" sign that suggested enteric intussusceptions in the jejunum. Eight pedunculated masses within the small intestinal lumen led to intussusceptions at 30 and 150 cm distal to Treitz ligament. Three segmental resections of the small intestine and functional end to end anastomosis were done. The patient recovered uneventfully from this operation. To the best of our knowledge, this is the 1st report of metastases from RCC that presented as synchronous intraluminal polypoid tumors, and these tumors served as the lead points for two intussusceptions in the jejunum.

Breast Cancer Metastasis to the Stomach Resembling Early Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

Breast cancer metastases to the stomach are infrequent, with an estimated incidence rate of approximately 0.3%. Gastric metastases usually are derived from lobular rather than from ductal breast cancer. The most frequent type of a breast cancer metastasis as seen on endoscopy to the stomach is linitis plastica; features of a metastatic lesion that resemble early gastric cancer (EGC) are extremely rare. In this report, we present a case of a breast cancer metastasis to the stomach from an infiltrating ductal carcinoma (IDC) of the breast in a 48-year-old woman. The patient had undergone a left modified radical mastectomy with axillary dissection nine years prior. A gastric endoscopy performed for evaluation of nausea and anorexia showed the presence of a slightly elevated mucosal lesion in the cardia, suggestive of a type IIa EGC. A histological examination revealed nests of a carcinoma in the subepithelial lymphatics, and immunohistochemical staining for estrogen receptor was positive. This is an extremely rare case with features of type IIa EGC, but the lesion was finally identified as a cancer metastasis to the cardia of the stomach from an IDC of the breast.

The Effects of Combined Estrogen and Fluocalcic Effervescent Therapy on the Bone Metabolism in Surgically Menopausal Women with Osteopenia / 대한산부인과학회지

OBJECTIVE: To evaluate the effects of combined estrogen and fluocalcic therapy on the bone metabolism in the surgicalyl menopausal women with osteopenia. METHODS: This prospective randomized clinical trial examined the effects of conjugated equine estrogen and fluocalcic in combination and separately, on BMD in 200 women with low bone mass. Treatment included 0.3 mg conjugated equine estrogen (CEE) (Group I), 0.625 mg CEE (Group II), 0.3 mg CEE plus fluocalcic (Group III), and 0.625 mg CEE plus fluocalcic (Group IV) for 12 months. Biochemical markers of bone turnover were also measured every six months. RESULTS: Urinary deoxypyridinoline in Group III and Group IV decreased signifiantly at 12 months of treatment (p<0.005). Serum osteocalcin and total alkaline phosphatase decreased slightly during the treatment in all groups but statistical significance was not foundsignificantly. CONCLUSION: The combined treatment with conjugated equine estrogen and fluocalcic is more effective in surgically menopausal women with osteopenia by decreasing bone biochemical marker.

Uterine Sarcoma: Analysis of Prognostic variables in 40 cases / 대한산부인과학회지

OBJECTIVE: Uterine sarcomas are rare tumors of mesodermal origin and constitute 2-6% of uterine malignancies. They are the most malignant group of uterine tumors and present difficult problems with regard to diagnosis and treatment. The aim of this study is to investigate the clinicopathologic finding and outcome of patients with uterine sarcoma. METHODS: From Jan. 1996 to Dec. 2004, 40 patients with histologically proven uterine sarcomas at Gospel Hospital were evaluated for their clinical profile and survival retrospectively. RESULTS: The age of patients with uterine sarcoma ranged 28 to 71 years, and the mean age was 48.0 years. The common presenting symptoms were abnormal uterine bleeding, abdominal pain and lower abdominal palpable mass. The overall 5-year survival rate of uterine sarcoma was 48.9% and the mean survival time was 73.6 months. The overall 5-year survival rate of 24 patients less than 50 years was significantly better than that of 16 patients more than 50 years, 69.1% vs 24.6% (P=0.0139). When classified according to histologic type, there were 21 cases (52.5%) of leiomyosarcoma (LMS), 8 cases (20.0%) of endometrial stromal sarcoma (ESS), 10 cases (25.0%) of malignant mixed mullerian tumors (MMMT) and 1 case (2.5%) of liposarcoma. The overall 5-year survival rate of MMMT was significantly worse than that of LMS and ESS, 26.7% vs 49.0% and 100.0%, respectively (P=0.0423). Classifying according to the FIGO surgical staging criteria, we found the following distribution; stage I of 26 cases (66.7%), stage II of 4 cases (10.3%), stage III of 5 cases (12.8%) and stage IV of 4 cases (10.3%). The overall 5-year survival rate of stage I and II was significantly better than stage III and IV, 61.8% vs 11.1% (P=0.0011). The overall 5-year survival rate of 14 patients less than 10 mitotic figures per 10 high-power microscopic fields had a tendency to good prognosis than that of 13 patients more than 10 mitotic figures per 10 high-power microscopic fields, 83.9% vs 38.5% (P=0.0568). The overall 5-year survival rate of 6 patients less than 35 U/mL of CA-125 had a tendency to good prognosis than that of 12 patients more than 35 U/mL of CA-125, 83.3% vs 20.8% (P=0.0580). However, menstrual status and treatment modality were not significant prognostic factors. CONCLUSIONS: Uterine sarcoma are aggressive tumors with a poor prognosis. Age, histologic type, and stage were statistically significant prognostic factors for overall survival in uterine sarcomas.

The Effects of Hormone Therapy and Alen- dronate on Bone Mineral Densities and Bone Metabolism of Postmenopausal Osteopenia

BACKGROUND: There have been bone mass studies for the treatment of osteoporosis, nonetheless, little attention has been paid to the management of osteopenia. This study was to evaluate the effects of estrogen, alendronate and their combination on bone mineral density and bone metabolism in the postmenopausal women with osteopenia. METHODS: A total of 150 healthy regional patients with osteopenia from Busan were enrolled in prospective randomized clinical trial and randomly assigned to receive conjugated equine estrogen (group I), alendronate (group II), or combination of the two (group III). Assessments included BMD of L2-4 spines and femur neck by DEXA and markers of bone turnover including serum osteocalcin, total alkaline phosphatase and urine deoxydyridinoline (Dpd). BMD and markers of bone turnover were re-evaluated at 6 and 12 months after the treatment. RESULTS: BMD of the lumbar spines increased significantly at 12 months after treatment in the three groups (P<0.05). BMD of the femur neck increased at 12 months after treatment in the three groups, but significantly in group III (P<0.05). Serum osteocalcin decreased at 12 months after treatment in the three groups, but only significantly in group III. Urine Dpd decreased at 12 months after treatment in three groups, but significantly in group, II and III (P<0.05). Serum total alkaline phosphatase decreased at 12 months after treatment in only group III (P<0.05). There was more favorable benefit for group III in BMD of the lumbar spines and serum osteocalcin and urine Dpd at 12 months after treatment compared to group, II and III (P<0.05). CONCLUSION: These results indicated a favorable benefit of conjugated equine estrogen, alendronate, or combination of the two in BMD and important markers of bone turnover. The combined treatment with conjugated equine estrogen and alendronate was more effective in postmenopausal women with osteopenia. Long-term studies are required to confirm these results.

A Case of Mesangial Proliferative Glomerulonephritis Presented with Acute Renal Failure in Patients with lambda Light Chain Type-Multiple Myeloma / 대한신장학회잡지

A 44-year-old male was admitted because of nausea and fatigue. At admission, renal insufficiency was disclosed (serum BUN 94 mg/dL, Cr 8.4 mg/ dL). Serum protein electrophoresis was normal. Urine electrophoresis showed non-selective proteinuria with M component in gamma globulin fraction. Serum immunoelectrophoresis disclosed a predominance of free lambda chain protein. Bone marrow aspiration showed a heavy infiltration of immature plasma cells. Percutaneous renal biopsy showed 9 of 10 glomeruli were slightly increased in size. Cellularity and area of mesangium were also increased. Immunohistochemical staining of kappa and lambda light chain was negative. Electron microscopy showed sparse electron dense deposits with no deposition of amyloid-like fibrils in mesangial area. In summary, these finding were compatible with those of mesangial proliferative glomerulonephritis with acute renal failure associated with multiple myeloma (lambda light chain type). There was no published report like this case. Although serum creatinine decreased to 2.1 mg/dL following steroid-pulse therapy, renal function came to deteriorate again after a month of discharge. Permanent hemodialysis was applied.

A case of relapsed renal plasmacytoma after complete remission of multiple myeloma / 대한내과학회지

Extramedullary plasmacytoma is a rare presentation of plasma cell dyscrasia. Most such tumors arise on the upper aerodigestive tract and renal plasmacytoma is very rare. The patient was 44 years old female presented with a 3 month-history of palpable mass in the right flank. There was a past history of complete remission after a chemotherapy for multiple myeloma (6 cycles of VAD chemotherapy) for the two years following the first diagnosis. After surgical resection, histologic and immunofluorescence studies of resected specimens revealed that the renal parenchyma was destroyed by sheets of mature plasma cells producing monoclonal protein (IgG-lambda) and by deposits of amorphous eosinophilic substance stained with anti-lambda antisera. Treatment with chemotherapy of Hyper-CVAD and local irradiation was done. The patient has been disease-free for 3 months after treatment. We report a case of relapsed renal plasmacytoma after complete remission of multiple myeloma.

MINE (mesna, ifosfamide, mitoxantrone, etoposide) Chemotherapy as a Treatment of Relapsed or Refractory Aggressive Non-Hodgkin's Lymphoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The prognosis of non-Hodgkin's lymphoma (NHL) is disappointing for patients who experience primary treatment failure or relapse after an initial response. Patients in relapse may respond again to chemotherapy, however the time to disease progression becomes shorter and eventually the disease becomes resistant. The aim of this study was to evaluate the efficacy and safety of the MINE regimen in the treatment of patients with relapsed or refractory NHL. Material and Methods: Forty-three pretreated patients with a median age of 56 years were enrolled into the study between October 1995 and June 2000. Most patients (60.5%) had a performance status of 0 to 1, and a diffuse large cell subtype (55.8%). Seventy-four percent of patients had stage III or IV disease at the start of MINE treatment. Eighteen (41.9%) patients had complete response, 5 (11.6%) had partial response, and 20 (46.5%) had failed to respond to prior therapy. Ifosfamide 4 g/m2 was divided over 3 days and administered IV over a 1 hour period. Mitoxantrone 8 mg/m2 was administered as a short IV infusion on day 1. Etoposide (65 mg/m2/day) was infused over 1 hour on days 1 to 3. A total of 144 cycles was administered, with a mean of 3.34 cycles per patient (range, 1-8). The mean relative dose intensity was 87.4%. RESULTS: 1) Nine patients achieved a complete response and nine patients achieved a partial response, resulting in an overall response rate of 43.8% of the 41 assessable patients. 2) The median survival time was 6 months (95% CI, 4 to 8 months), and the median time to failure was 5 months (95% CI, 3 to 7 months). 3) A statistically significant association with complete response rates was found for complete response to prior therapy (p=0.049). The significant factors for overall survival were a complete response after MINE chemotherapy and serum 2-microglobulin (p=0.003, p=0.012, respectively). The significant factors for time to treatment failure were a complete response after MINE chemotherapy and serum 2-microglobulin (p=0.003, p=0.044, respectively). 4) The main result of toxicity of MINE was bone marrow suppression. CONCLUSION: The response to MINE chemotherapy and serum 2-microglobulin were both independent prognostic factors for overall survival and time to treatment failure. As the median time to treatment failure for complete responses was 14 months, the best use of this regimen could be in a strategy that includes prompt consolidation of a complete response with intense chemotherapy, with or without hematopoietic stem cell rescue.

A Case of Ig A Nephropathy Associated with Polycythemia Vera / 대한신장학회잡지

Secondary polycythemia is occasionally associated with renal diseases such as renal tumors, cysts, hydronephrosis, renal transplantation, renal artery stenosis and Bartter's syndrome and is rarely associated with nephrotic syndrome, nephrosclerosis, pyelonephritis, chronic gromerulonephritis and membranous nephropathy. The association of polycythemia vera and Immunoglobulin A nephropathy (IgAN) is well not known, and there are only a few isolated reports presenting the concomitance of polycythemia vera and IgAN. We report one patient with concomitant polycythemia vera and Ig A nephropathy. A 53 year-old male visited our hospital because of elevated hemoglobin level. Blood value of hemoglobin was 22.1 g/dL. Isotopic blood studies with radioactive chromium (51Cr)-labelled red blood cells revealed a total blood volume of 90 mL/kg and total red cell volume of 61.8 mL/kg. The concentration of serum erythropoietin measured by radioimmunoassay was 14.29 mIU/mL (normal 10.2-25.2 mIU/mL). Bone marrow aspirate revealed hypercellularity and panmyelosis, characteristically. Renal biopsy specimens showed moderate mesangioproliferative lesions with mesangial IgA and C3 deposition. Treatment with phlebotomy, hydroxyurea and oral prednisolone (1 mg/kg/day) was done. There was no decrease of urinary protein following treatment of phlebotomy and hydroxyurea. But urinary protein decreased and hemoglobin level normalized following combination treatment of phlebotomy, hydroxyurea and oral prednisolone.

The Effects of Low Dose Estrogen Replacement Therapy on the Lipid Profile of Postmenopausal Women / 대한산부인과학회잡지

OBJECTIVE: To evaluate the effects of low dose estrogen replacement therapy on the lipid profile in the postmenopausal women. METHODS: This prospective randomized clinical trial examined the effects of low dose conjugated equine estrogen on lipid profile in 140 postmenopausal women. Treatment included 0.625 mg conjugated equine estrogen (group I, n=75), or 0.31mg conjugated equine estrogen (group II, n=55) for 12 months. Lipid profile were performed at months 6 and 12 months. RESULTS: HDL cholesterol increased significantly during the treatment in Group I and Group II. LDL cholesterol decreased significantly during the treatment in Group I and Group II. Total cholesterol in Group I and Group II decreased during treatment, but not significantly. As triglyceride increased slightly during the treatment in Group I and Group II but not significantly. CONCLUSION: The low dose conjugated equine estrogen is also positive changes on lipid profile.

The Effects of Low Dose Estrogen Replacement Therapy on the Lipid Profile of Postmenopausal Women / 대한산부인과학회잡지

OBJECTIVE: To evaluate the effects of low dose estrogen replacement therapy on the lipid profile in the postmenopausal women. METHODS: This prospective randomized clinical trial examined the effects of low dose conjugated equine estrogen on lipid profile in 140 postmenopausal women. Treatment included 0.625 mg conjugated equine estrogen (group I, n=75), or 0.31mg conjugated equine estrogen (group II, n=55) for 12 months. Lipid profile were performed at months 6 and 12 months. RESULTS: HDL cholesterol increased significantly during the treatment in Group I and Group II. LDL cholesterol decreased significantly during the treatment in Group I and Group II. Total cholesterol in Group I and Group II decreased during treatment, but not significantly. As triglyceride increased slightly during the treatment in Group I and Group II but not significantly. CONCLUSION: The low dose conjugated equine estrogen is also positive changes on lipid profile.

Differentiation induction of dendritic cell phenotypes from human leukemic cell lines

Recent clinical studies have shown that a high proportion of patients with acute promyelocytic leukemia (APL) achieve complete remission after treatment with all-trans retinoic acid (ATRA). However, most patients who receive continuous treatment with ATRA relapse and develop ATRA-resistant leukemia. Dendritic cells (DCs) are important antigen-presenting cells in the development of antileukemic T-cell responses. In this study, we investigated the strategies to overcome ATRA resistance of APL cells by inducing the differentiation of DCs from human leukemic cell lines for the developtment of adoptive immunotherapy. CD83 was used as a mature DC marker in this study and the expression of CD83 mRNA was determined by RT-PCR method. The promyelocytic leukemic cell line HL-60, B lymphoblast cell lines RPMI 7666 and NC-37 could be induced to dendritic cells in vitro. Treatment of HL-60 with phorbol 12-myristate 13-acetate (PMA) resulted in the expression of myeloid-related DC phenotypes, while treatment of RPMI 7666 with fms-like tyrosine kinase 3 ligand (Flt3-ligand, FL) and treatment of NC-37 with PMA and FL led to the expression of lymphoid-related DC phenotypes. In conclusion, myeloid-related DC phenotypes and lymphoid-related DC phenotypes could be generated from HL-60, NC-37 and RPMI 7666 cell lines, respectively. These DC phenotypes can potentially be used to generate antileukemic T cells in vitro for adoptive immunotherapy.

Detection of p53 Mutant and isochromosome 17q in Myelodysplastic Syndromes and Leukemias / 대한임상병리학회지

BACKGROUND: The p53 gene is a tumor suppressor gene situated in the short arm of chromosome 17(in 17p13 band). The p53 mutation is often correlated with the worsening or relapsing of the hematologic malignancies, and the loss of the short arm of chromosme 17 is associated with a p53 mutation on the remaining allele in several hematologic malignancies. In this study, we investigated correlations between cytogenetic rearrangements leading to 17p deletion, the presence of mutant p53 protein and single strand conformational polymorphism analysis of the p53 gene in myelodysplastic syndromes and leukemias. METHODS: In this study, we analyzed 60 patients with different hematologic malignancies, including 26 acute myelogenous leukemia, 16 acute lymphoblastic leukemia, 7 myelodysplastic syndrome, and 11 chronic myelogenous leukemia. Cytogenetic analysis of the bone marrow was performed by using the G-banding method. Mutant p53 protein was detected using a mouse monoclonal antibody, which reacts with mutant p53. The Polymerase chain reaction and the single strand conformational polymorphism analysis(PCR-SSCP) of exons 5 to 8 of the p53 gene were performed on only 20 patients with acute myelogenous leukemia. RESULTS: Only 1(1.7%) out of 61 patients showed a deletion of the short arm of chromosome 17 through isochromosome 17q and mutant p53 protein. This patient with chronic myelogenous leukemia underwent a clinical transition from chronic to blastic phase. But, PCR-SSCP of the p53 gene was not performed on this patient with isochromosome 17q and mutant p53 protein. CONCLUSIONS: Even though analysis of the p53 gene by PCR-SSCP was not fully performed, this report suggests that the frequency of p53 mutant may be rare in Korean patients with myelodysplastic syndromes and leukemias. In addition, further investigation is required for the correlation between immunofluorescence and PCR-SSCP to detect p53 mutations.

Results of Treatment with ProMACE - CytaBOM Regimen for Aggressive Non - Hodgkins Lymphoma / 대한암학회지

PURPOSE: Despite intensive search for the optimal combination chemotherapy for aggres- sive non-Hodgkins lymphoma (NHL), the CHOP regimen is still the standard therapy. We investigated the clinical efficacy of ProMACE-CytaBOM, a third generation regimen, in patients with advanced aggressive NHL. MATERIALS AND METHODS: We prospectively analyzed the therapeutic approach and the outcome in 33 patients with previously untreated aggressive NHL enrolled into the protocol from June 1994 to June 1997. RESULTS: Objective response was achieved in 93.9% of the patients. Complete response (CR) and partial response were 54.5% and 39.4%, respectively. The mean time to CR was 75.4 days. CR rate was significantly lower in patients aged 50 years or more (31.3% vs 76.5%, p=0.009). Five year overall (OS) and failure-free survival (FFS) rate were 56.1% and 47.2%, respectively. The age, attainment of CR, and mean relative dose intensity influenced OS significantly (p=0.002, p=0.005 and p=0.039, respectively). The age and attainment of CR influenced FFS significantly (p=0.001 and p=0.003, respec- tively). In patients aged 50 or more, mean relative dose intensity of less than 72% was more frequent than younger age group (73.3% vs 33.3%, p=0.003). There was one toxic death (3.0%). CONCLUSION: The survival rate of present study was similar to that of previously report concerning ProMACE-CytaBOM. The outcome of elderly NHL patients was poor, and dose intensity may be correlated with the outcome.

Microbial Contamination of Autologous Peripheral Blood Stem Cell / 대한수혈학회지

BACKGROUND: The incidence and clinical consequences of microbiological contamination of autologous peripheral blood stem cells are not well documented. Therefore, we retrospectively analysed our experience with microbial contamination of autologous peripheral blood stem cell concentrates. METHOD: We have determined the incidence and clinical significance of positive microbiologic cultures in series of 52 peripheral blood stem cell concentrates in 14 patients undergoing multiple apheresis procedures for autologous stem cell rescue. Specimens for bacterial cultures were obtained after processing of the autografts just prior to freezing. RESLUTS: The incidence of microbial contamination was 7.7%. The microorganism cultured was coagulase negative Staphylococcus. The patient with contaminated leukapheresis products received two culture-positive stem cell concentrates and three culture-negative stem cell concentrates without adverse clinical sequelae. No microorganism present in the stem cell autograft was recovered in vivo in the posttransplantation period, although fever as a sign of infection occurred in this patient. CONCLUSIONS: Although microbial contamination may occur during autologous peripheral blood stem cell collection and cryopreservation, this report suggests that peripheral blood stem cell contamination may not play a significant role in the infectious complications of autologous peripheral blood stem cell transplantation.

Phase II Multicenter Trial of THP-COP Combination Chemotherapy in Stage II/III/IV Intermediate- and High-Grade Non-Hodgkin's Lymphoma: Korean Malignant Lymphoma Study Group / 대한혈액학회지

BACKGROUND: THP-adriamycin ia a tetrahydropyranyl derivative of adriamycin with compatible anti-lymphoma effect but fewer side effects, especially cardiac, nausea/vomiting and alopecia. So we performed a multicenter study of 4-drug combination chemotherapy, THP-COP regimen for patients with non-Hodgkin's lymphoma to evaluate the response rate, survival time and toxicity by Malignant Lymphoma Study Group in Korea. METHODS: Between June 1996 and Feb. 1997, previously untreated stage II/III/IV intermediate and high-grade non-Hodgkin's lymphoma patients were treated with a THP-COP regimen including THP-adriamycin 40 mg/m2 on day 1, cyclophosphamide 750 mg/m2 on day 1, oncovin 1.4 mg/m2 on day 1, and prednisolone 100 mg PO on day 1-5 with 3 weeks interval. RESULTS: Twenty six patients (89.7%) were evaluable. Patient characteritics include: median age 54.8 years (16-76) and 13 patients were 60 years or old; clinical stage II in 9 patients (34.6%), stage III in 7 patients (26.9%), and stage IV in 10 patients (38.5%). Objective response were 13 CR, 7 PR, 6 PD with 76.9% response rate. Six months and 1 year survival rates and progression-free survival rates were 87.8%, 70.4%, and 85.0%, 60.5% respectively. Grade 3/4 toxicities were anemia in 7.7%, neutropenia in 53.8%, thrombocytopenia in 3.8%, vomiting in 7.7%, alopecia in 7.7% and increased SGOT in 3.8%. Prognostic significance of age and International Prognostic Index were not demonstrated. CONCLUSION: THP-COP combination chemotherapy is active in advanced stage, non-Hodgkin's lymphoma with low incidence of vomiting and alopecia.