Modified MVAC as a Second-Line Treatment for Patients with Metastatic Urothelial Carcinoma after Failure of Gemcitabine and Cisplatin Treatment / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: There is no established standard second-line chemotherapy for patients with advanced or metastatic urothelial carcinoma (UC) who failed gemcitabine and cisplatin (GC) chemotherapy. This study was conducted in order to investigate the efficacy and toxicity of modified methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) in patients with metastatic UC previously treated with GC. MATERIALS AND METHODS: We retrospectively analyzed 28 patients who received modified MVAC between November 2004 and November 2012. All patients failed prior, first-line GC chemotherapy. RESULTS: The median age of patients was 64.0 years (range, 33.0 to 77.0 years), and 23 (82.1%) patients had an Eastern Cooperative Oncology Group performance status of 0 or 1. The overall response rate and the disease control rate were 36.0% and 64.0%, respectively. After a median follow-up period of 38 weeks (range, 5 to 182 weeks), median progression free survival was 21.0 weeks (95% confidence interval [CI], 6.3 to 35.7 weeks) and median overall survival was 49.0 weeks (95% CI, 18.8 to 79.3 weeks). Grade 3 or 4 hematological toxicities included neutropenia (n=21, 75.0%) and anemia (n=9, 32.1%). Grade 3 or 4 non-hematological toxicities did not occur and there was no treatment-related death. CONCLUSION: Modified MVAC appears to be a safe and active chemotherapy regimen in patients with stable physical status and adequate renal function after GC treatment.

Differentiation Culture of Hematopoietic Stem Cells from Embryonic Stem Cells / 대한혈액학회지

BACKGROUND: This study was designed to verify the effective culture condition for the differentiation of human hematopoietic stem cells from SNU-3 embryonic stem cell line. METHODS: Control group was that of which embryonic stem cells were directly cultured to LTC-IC assay. Study group was that of which an embryonic body manufactured from embryonic stem cells was cultured to LTC-IC assay. CD34+ cells were separated by MACS method at 1, 3, 5, 7, 10, 14, 21 days of LTC-IC assay in both groups. Thereafter, CD34+ cell were cultured to semisolid methyl-cellulose media to count CFUs. CD34+CD45- cell percentage was measured with FACS method at 5 days of LTC-IC assay. This study was repeated for 14 times. RESULTS: In control group, CD34+ cells were hardly separated in any period of LTC-IC assay. In study group, the median count of CD34+ cells was 0.7 (0.4-1.2)x10(4), 1.8 (1.4-2.6)x10(4), 0.6 (0.5-0.7)x10(4) and the median count of CFUs was 0.5 (0.2-0.8)x10(2), 1.0 (0.6-1.3)x10(2), 0.2(0.1-0.4)x10(2) at 3, 5, 7 days of LTC-IC assay, respectively. Median CFUs count per CD34+ cell was 0.0071, 0.0056, 0.0033 at 3, 5, 7 days of LTC-IC assay, respectively. In study group, the count of CD34+ cells and CFUs was significantly higher at 5 days of LTC-IC assay than at any other days (P<0.01). CFUs count per CD34+ cell was significantly higher at 3 days of LTC-IC assay than at any other days (P<0.01). CD34+CD45- cells detected by FACS method of study group(1.16%(0.92-1.97) was significantly higher than that of control group (0.09% (0.00-0.23)) (P<0.01). CONCLUSION: The differentiation of hematopoietic stem cells from SNU-3 embryonic stem cell line is effective in the condition of which an embryonic body manufactured from embryonic stem cells is cultured to LTC-IC assay. The period of which embryonic stem cells differentiate to hematopoietic stem cells is between 3 to 7 days of LTC-IC assay.

Phase II Trial of Gemcitabine, UFT-E, Leucovorin Combination Chemotherapy in Advanced Pancreatic Adenocarcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To evaluate the efficacy and toxicity of a Gemcitabine, UFT-E, Leucovorin combination chemotherapy in the treatment of advanced pancreatic adenocarcinoma. PATIENTS AND METHODS: Patients <=70 years, with no prior chemotherapy and with bidimensionally measurable advanced pancreatic adenocarcinoma, ECOG performance status <=2, and adequate bone marrow, kidney, and liver function were eligible for this trial. Eligibility criteria for clinical benefit assessment were pain with at least a daily analgesic consumption of two nonsteroidal anti-inflammatory drugs or a Karnofsky performance status between 50 and 70. Treatment consisted of 1,000 mg/m2 of Gemcitabine on days 1, 8 and 15, repeated every 4 weeks, with UFT-E administered orally 500 mg-700 mg by body surface area (BSA). Leucovorin was administered 45 mg/day orally. Dosages of UFT-E and Leucovorin were divided and administered three times per day from day 1 to day 21. After 7 days of rest, UFT-E and Leucovorin were administered repeatedly. RESULTS: Twenty-three patients were enrolled between April 1999 to April 2000. Eighty two cycles (median, four cycles) were delivered to all patients. The objective response rate was 15.8% in 19 assessable patients and 13.0% in the intent-to-treat population. Twelve patients (57.9%) displayed stable disease. Grade 3 or 4 neutropenia occurred in 30.4% of patients, nausea/vomiting in 8.3%, diarrhea in 4.3%, and mucositis in 4.3%. The median time to progression was 8 months. The median survival was 8 months in the assessable population and 6 months in the intent-to-treat population Clinical benefit was achieved in 11 (57.9%) of 19 assessable patients. CONCLUSION: Gemcitabine, UFT-E, Leucovorin combination chemotherapy is a well-tolerated and safe regimen in cases of advanced pancreatic adenocarcinoma. Although the response rate is low, it shows a survival benefit and clinical benefit and deserves further evaluation in a phase III trial.

A Case of Aplastic Anemia Spontaneously Recovered after Delivery / 대한혈액학회지

A 26-year-old female was admitted for the evaluation of thrombocytopenia, who complained easy bruisy and multiple petechiae at 22 weeks of gestation. Bone marrow examination was recommended, but refused. Steroid therapy was tried under the impression of idiopathic thrombocytopenic purpura. But pancytopenia developed at 37 weeks of gestation. Considering aplastic anemia associated with pregnanacy, Caesarian section with supplementation of platelet rich plasma and packed red blood cells was done in order to terminate pregnancy. Bone marrow findings at 1 week after delivery were compatible with aplastic anemia. At 8 weeks after delivery, recovery of pancytopenia was noticed with normalization of bone marrow cellularity and maturation of hematopoietic cells.

Results of CHOP-Bleo / CMED Alternating Chemotherapy for Aggressive Non - Hodgkin's Lymphoma / 대한암학회지

PURPOSE: To assess the efficacy and toxicity of a new protocol that consists of CHOP- Bleo alternated with a new regimen of Cyclophosphamide, methotrexate, etoposide, and dexamethasone(CMED) for aggressive Non-Hodgkin's Lymphoma(NHL). PATIENTS AND METHODS: Between January 1991 and December 1996, forty-six patients with Ann Arbor stages II-IV aggressive NHL were treated with alternating cycles of CHOP-Bleo and CMED for a total of 12 cycles. All eligible patients were evaluated for response, disease-free survival, and overall survival. RESULTS: Twenty-two patients(47.8%) achieved a complete response and overall response rate was 83.9%. The range of survival duration was 1-68+months and the median survival time was 42 months. Overall 3-year survival rate was 54%. The range of disease-free survival time was 6-63+months and 3-year disease-free survival rate was 61%. The most common hematologic toxicity was leukopenia and the incidence of severe leukopenia(<1,000/mm3) was 11%. And alopecia(84.8%) was the most common non-hematologic toxicity. CONCLUSION: The results of CHOP-Bleo/CMED alternating chemotherapy for patients with aggressive Non-Hodgkin's Lymphoma is not superior to other results of previous studies. Therefore further study will be warranted to determine clinical effectiveness of alternating chemotherapy.

The Evaluation of Auto-Transfusion with Red Blood Cells Thawed after Freezing at -80degrees C / 대한혈액학회지

BACKGROUND: The need for auto-transfusion has been increased because the allo-transfusion has many problems such as infection and allo-immunization. But, the maximal storage period of blood at 4degrees C is 28~35 days. For long-term storage, the cryopreservation of blood is essential. However, the cryopreservation research of blood has been done rarely in Korea. Therefore, we evaluated the effects of auto-transfusion of RBCs thawed after freezing at -80degrees C. METHODS: Twelve healthy donors of allogeneic bone marrow transplantation were participated in this study. Control group was composed with 6 persons auto-transfused with 4degrees C stored blood collected at 3, 2, and 1 week prior to bone marrow harvest. Study group was composed with 6 persons auto-transfused with -80degrees C stored frozen-thawed RBCs, employing a high glycerol technique, collected at 5, 4, and 3 week prior to bone marrow harvest. To evaluate the effects of auto-transfusion at both group, the amount of harvested bone marrow and the changes of hemoglobin (Hb) and hematocrit (Hct) between pre-harvest and post-transfusion 24 hours were compaired. To assess the efficacy of cryopreservation, the studies for RBC recovery rate, the level of K+ and plasma Hb, bacterial culture and complications of transfusion were performed. RESULTS: 1) The amount of harvested bone marrow and the changes of Hb and Hct: The harvested bone marrow (mL) was 1,350+/-87 in control group and 1,300+/-70 in study group. At pre-bone marrow harvest, the Hb (g/dL) and Hct (%) levels were 13.2+/-0.60, 40.1+/-2.7 in control group and 12.8+/-0.50, 38.3+/-1.9 in study group, respectively. After 24 hours of auto-transfusion, the Hb (g/dL) and Hct (%) levels were 12.9+/-0.42, 38.1+/-1.1 in control group and 12.6+/-0.56, 37.3+/-1.2 in study group, respectively. There were no significant differences in Hb and Hct between pre-harvest and post-transfusion of control and study groups. 2) The efficacy of cryopreservation: The RBC recovery rates were 72~80% and the levels of K+ and plasma Hb were 1.5~3.5mEq/L and 251~840mg/dL, respectively. There was no bacterial growth of frozen-thawed blood culture and no complication associated with transfusion of frozen-thawed blood. CONCLUSION: It could be suggested that the method of RBC cryopreservation at -80degrees C with high glycerol technique was practically applicable to auto-transfusion.

A Case of Churg-Strauss Syndrome / 대한류마티스학회지

Churg-Strauss syndrome(CSS) or the syndrome of allergic granulomatosis and angiitis is a kind of rare systemic vasculitis characterized by bronchilal asthma, peripheral eosinophilia, paranasal sinus abnormality, mono or polyneuropathy, pulmonary infiltrates nonfixed and pathological findings such as prominent eosinophilic infiltration, necrotizing angiitis and extravascular granuloma formation. Clinical features of CSS includes asthma, pulmonary infiltrates, cutaneous lesions, neuropathy, cardiac involvement, gastrointeastinal involvement, renal involvement and musculoskeletal involvement. The diagnosis of CSS is made on the basis of both clinical and pathologic features. We experienced a 30-year-old man who presented peripheral eos'lnophilia, asthma of two year's duration, lower extremity weakness and lung infiltrations. His lung and skin biopsy showed eosinophilic infiltrates and eosinophilic vasculitis. He was diagnosed as Churg-Strauss syndrome based on the clinical manifestations and pathologic finding of lung and skin. He was managed with 3 times of plasmapheresis and methylprednisolone 1.0 g/day of 3 days followed by oral prednisolone 50rag/day and cyclophosphamide 2mg/kg. Clinical symptoms, laboratory and X-ray findings of the patient were improved at 7 days after treatment. After discharge, he has been treated with cyclophosphamide and low dose prednisolone. We report a case CSS with review of the literatures.