1999년 고신의료원에서 시행한 자가 말초혈액 조혈모세포 이식의 결과 분석

황현용,김미향,김양수,어완규,박재선,정석훈,이천수 대한임상검사정도관리학회 2001 臨床檢査와 精度管理 Vol.23 No.1

급성 백혈병에서의 자가 말초혈액 및 자가 골수 조혈모세포 이식

김희제,박수정,서정곤,민창기,엄현석,이종욱,최일봉,민우성,김춘추,김동집 대한조혈모세포이식학회 1998 대한조혈모세포이식학회지 Vol.3 No.1

연구배경 : 가톨릭 조혈모세포 이식센타에서 급성 골수성 백혈병 및 급성 림프구성 백혈병 환자들에서 시행한 자가 말초혈액 조혈모세포 이식 성적을 후향적으로 분석하여 향후 치료과정의 지표로 삼고자 하였다. 방법 : 1995년 1월부터 1997년 2월까지 가톨릭 조혈모세포 이식센터에서 치료한 급성 골수성 백혈병 환자23명과 급성 림프구성 백혈병 환자 8명 등 31명에서 시행한 자가 말초혈액 조혈모세포 이식 치료성적을 분석하였다. 관해유도요법을 시행한 후 완전관해가 확인되면 2-3회의 공고요법을 하고 말초혈액 단핵구분반술을 시행하였고 예비용 자가 골수를 전신마취하에 채취하여 단핵구만 분리 후 냉동보관하였다. 전처치요법이 완료된 후 이틀째에 보관하였던 자가 조혈모세포를 이식하였다. 결과 : 이식 후 축적 관찰기간은 급성 골수성 백혈병군이 중앙값 13.2개월(6-31.5개월+), 급성 림프성구성백혈병군이 15.1개월(5-27.5개월+)이었다, 전체생존율은 급성 골수성 백혈병군이 23명 중 17명으로 73.9%, 급성 림프구성 백혈병군이 8명중 5명으로 62.5%였다. 자가 말초혈액 조혈모세포 및 자가 골수 조혈모세포 이식을 시행한 후 무병생존율은 각군에서 추적기간 중앙값 12.1개월(3-31.5개월+)에 69.6%와 14.3개월(2-27.5개월+)에 50%였다. 재발은 급성 골수성 백혈병군에서 7예(30.4%), 급성 림프구성 백혈병군에서 4예였고 이식된 자가 말초혈액 단핵구 수는 중앙값 9.4×10^(8)/㎏(3.6-19.1×10^(8)/㎏), 자가 골수 단핵구수는 1.18×10^(8)/㎏(0.86-2.16×10^(8)/㎏)였다. 이식 후 과립 백혈구수 500㎣이상까지의 회복기간은 각각중앙값 13.7일(7-50일)과 14.2(9-23일)이었고 혈소판수 20,000/㎣이상까지의 회복기간은 각각 중앙값 14.1일(5-55일), 12.1일(5-23일)이었다. 이식 후 가장 흔한 치료관련 합병증은 점막염 및 폐렴, 패혈증의 순서이며 각각 6/31(19.4%), 6/31(19.4%), 5/31(16.1%)의 빈도를 보였으나 모두 본 센터 지지요법과 치료에 잘 조절되었고 치료 관련 사망은 없었다. 결론 : 비록 이식예수와 이식 후 관찰기간이 짧아 단정하기는 어려우나 급성 백혈병에서의 자가 말초혈액 조혈모세포 이식은 이식 성적이 양호하고 이식관련 합병증이 동종 조혈모세포 이식에 비해 양호하므로 향 후 골수 및 말초 혈액정화문제를 포함한 보다 적극적인 치료시도과 필요할 것으로 생각된다. Background : We retrospectively reviewed the results of autologous stem cell transplantation for acute leukemia. The purposes of this study were to analyse the characteristics of autologous stem cell transplantation and to suggest therapeutic guidelines for acute leukemia. Methods : From January 1995 to February 1997, 31 patients with 23 acute myelogenous leukemias (AML) and 8 acute lymphoblastic leukemias (ALL) were treated with autologous stem cell transplantation. All patients received two or three consolidation chemotherapy after the first remission. At second-day after the completion of conditioning therapy, autologous bone marrow or peripheral blood stem cells were infused. Results : 28 cases were in first complete remission and 2 in second remission and 1 in first relapse. The median age of them was 29.9 (range, 16-46 years). 18 were male and 13 were female. According to FAB classification, M1:3, M2:9, M3:6, M4:2, M5:3, L1:4, L2:4. The median interval between achieving first remission and autografting was 6.6 months (range, 3-11 months). Of the 31 patients, 29 patients received conditioning regimens that included total body inadiation and 2 patients received various combination of cytotoxic drugs. The median cell doses of PBSCs and BM were 9.4×10^(8)/㎏(range, 3.54-2.2×10^(8)/㎏), 1.18×10^(8)/㎏ (range, 0.5-2.37) in order. Median follow up was 13.2 months (range, 6-31.5months) for AML and 15.1 months(range, 5-27.5months) for ALL. THe disease-free survival(DFS) with median follow up 12.1 months (range, 3-31.5+months) was 69.6% for AML and that of ALL with 14.3 months (range, 2-27.5+ months) was 50%. The median number of days, after the first transplant, to achieve a absolute neutrophil count > 0.5×10^(8)/1 and platelet count of > 20×10^(8)/1, were 13.7 days (range, 7-50 days), 14.1 days (range, 5-55 days) for AML and 14.3 days (range, 9-27 days), 12.1 days (range, 5-23 days) for ALL. The most common post-transplant complication was mucositis (>grade Ⅱ) in 6 cases and pneumonia in 6 cases. The transplant-related mortality (TRM) was 3.2% with one case of engeaft failure. The relapse rate were 30.4% for AML and 50% for ALL. The most common cause of deaths was relapse in 8 cases ( 5AML, 3ALL). The median time to post-transplant relapse for AML and ALL were 150 days (range, 96-181 days) and 190 days (range, 63-330 days), respectively. Conclusion : Even though the number of patients and the observation period were short, the autologous peripheral blood stem cell transplantation (APBSCT) seems to be acceptable and very efficient therapy for the patients with acute leukemias.

혈액종양질환 환자에서 자가말초혈액 조혈모세포이식 시 가동화

김민지,김상경,이아진,장해봉,배성화,류헌모 대한진단검사의학회 2014 Laboratory Medicine Online Vol.4 No.1

Background: Autologous peripheral blood-stem cell transplantation (autoPBSCT) is the treatment of choice for hematologic malignancy, because the technique requires neither general anesthesia nor surgical intervention, amongst many other advantages. Despite these benefits, the risk of hematologic malignancy, as well as the effect of patient age and sex on the prediction of successful collection of autoPBSCT are still unclear. The purpose of this study was to examine whether the hematologic diagnosis of the disease, and age or sex affect the mobilization of CD34+ cells and mononuclear cells. Methods: We retrospectively investigated 30 (6 multiple myeloma, 11 diffuse large B-cell lymphoma, 8 acute myeloid leukemia, 2 acute lymphoid leukemia, and 3 T-cell lymphoma) patients who underwent autoPBSCT between 2008 and 2011 at Daegu Catholic University Hospital. Results: Patients with multiple myeloma had the highest average of both mononuclear cell (MNC) (2.07±0.67×108 cells/kg) and CD34+ cell (1.28±0.58×106 cells/kg) counts. Patients with T-cell lymphoma had both the lowest MNC (1.23±0.49×108 cells/kg) and CD34+ cell (0.20±0.6×106 cells/kg) counts. Male patients showed greater collected CD34+ cell counts (0.96±1.38×106 cells/kg) and MNC counts (1.71±0.76×108 cells/kg) than the female patients. Patients under the age of 44 had higher collected CD34+ cell counts (0.96±1.37×106 cells/kg) but lower counts of MNC (1.49±0.74×108 cells/kg). Conclusions: The collected MNC and CD34+ cell counts varied between the types of malignancies, and with respect to sex and age. However, only collected MNC counts were significantly different (P<0.05) among the different types of malignancies. 배경: 자가말초혈액조혈모세포이식은 전신마취, 수술적 접근, 장기기간의 입원 등이 필요하지 않은 많은 장점을 가진 치료방법으로 알려짐에도 불구하고 악성혈액질환 환자들의 상태가 말초조혈모세포 채집산물에 어떠한 영향을 미치는가에 대해서는 아직 논란이 존재한다. 따라서 본 연구를 통하여 저자들은 악성혈액질환 환자들의 진단명, 성별 및 나이가 말초조혈모세포 채집산물에 존재하는 CD34양성세포 수와 단핵세포 수에 어떠한 영향을 미치는가에 대하여 알아보고자 하였다. 방법: 2008년부터 2011년까지 대구가톨릭대학병원에서 자가말초혈액조혈모세포이식술을 시행 받은 30명의 악성혈액질환 환자를 대상으로 연구를 시행하였다. 악성혈액질환에는 급성림프구성백혈병(acute lymphoid leukemia, ALL) 환자 2명, 급성골수구성백혈병(acute myeloid leukemia, AML) 환자 8명, 미만성큰B세포림프종(diffuse large B-cell lymphoma, DLBL) 환자 11명, 다발골수종 (multiple myeloma, MM) 환자 6명과 T세포림프종(T-cell lymphoma) 환자 3명이 포함되었다. 결과: 말초혈액조혈모세포채집술을 시행한 결과 MM 환자들이 가장 높은 평균 단핵세포 수(2.07±0.67×108 cells/kg)와 CD34양성세포 수(1.28±0.58×106 cells/kg)를 나타내었고, T cell lymphoma 환자들이 가장 낮은 평균단핵세포 수(1.23±0.49×108 cells/kg)와 CD34양성세포 수(0.20±0.6×106 cells/kg)를 나타내었다. 남성 환자들이 여성 환자들에 비하여 높은 평균단핵세포 수(1.71±0.76×108 cells/kg)와 CD34양성세포 수(0.96±1.38×106 cells/kg)를 나타내었다. 44세 이하 환자군에서 44세 이상 환자군에 비하여 높은 평균 CD34양성세포 수(0.96±1.37×106 cells/kg)를 나타내었으나 낮은 평균의 단핵세포 수(1.49±0.74×108 cells/kg)를 나타내었다. 결론: 본 연구를 통하여 악성혈액질환 환자들의 진단명, 성별 및 나이별에 따라 말초조혈모세포 채집산물에 존재하는 CD34양성세포 수와 단핵세포 수가 차이가 있음을 확인할 수 있었다. 그러나 통계적으로 유의한 차이를 보이는 유일한 항목은 진단에 따른 단핵세포 수로 분석되었다(P<0.05).

Optimal Time to Start Peripheral Blood Stem Cell Collection in Children with High-Risk Solid Tumors

성기웅,최희원,이나희,김동환,이수현,유건희,구홍회,강은석,김대원 대한의학회 2014 Journal of Korean medical science Vol.29 No.1

In order to clarify the optimal timing for peripheral blood stem cell (PBSC) collection, PBSC collection records of 323 children who were scheduled to undergo autologous stem cell transplantation from two study periods differing in the timing of PBSC collection were analyzed. In the early study period (March 1998 to August 2007, n=198), PBSC collection was initiated when the peripheral WBC count exceeded 1,000/μL during recovery from chemotherapy. Findings in this study period indicated that initiation of PBSC collection at a higher WBC count might result in a greater CD34+ cell yield. Therefore, during the late study period (September 2007 to December 2012, n=125), PBSC collection was initiated when the WBC count exceeded 4,000/μL. Results in the late study period validated our conclusion from the early study period. Collection of a higher number of CD34+ cells was associated with a faster hematologic recovery after transplant in the late study period. Initiation of PBSC collection at WBC count>4,000/μL was an independent factor for a greater CD34+ cell yield. In conclusion, PBSC collection at a higher WBC count is associated with a greater CD34+ cell yield, and consequently a faster hematologic recovery after transplant.

관해유도 항암화학요법에 실패한 호지킨병 환자에서 2회의 자가 말초혈액 조혈모세포이식 후 지연되어 완전 관해된 1예

정성진,김일,박환철,오호석,최정혜,이영열,김인순,최일영,안명주 대한조혈모세포이식학회 2003 대한조혈모세포이식학회지 Vol.8 No.1

관해유도 항암화학요법에 실패한 호지킨병 환자에서 2회의 연속된 자가 조혈모세포이식은 하나의 치료 대안으로서 고려될 수 있다. 저자들은 진행된 호지킨병으로 진단된 뒤 기존 항암화학요법에 저항을 보여 자가 말초혈액 조혈모세포이식을 시행하였으나 여전히 부분 관해를 보였고, 재차 자가 말초혈액 조혈모세포이식을 시행하였으나 영상학적 검사에서 부분 관해에 머물렀던 환자가 조혈모세포 이식 3년 후 추적 검사에서는 완전 관해 소견을 보인 1예를 경험하여 이를 보고하는 바이다. The double autologous stem cell transplantation after high-dose therapy has been considered as a therapeutic chance for patients with refractory or relapsing Hodgkin's disease. We report here a 29-year-old patient with Hodgkin's disease (nodular sclerosis, Stage IVB), who was partially responsive to 6 cycles of conventional chemotherapy, achieved only partial remission despite double autologous peripheral blood stem cell transplantation. However, long- term follow-up with 3 years after second stem cell transplantation, the persistently remained tumors on spleen, left ilium, and right scapular area disappeared spontaneously and now the patient has no evidence of disease. Compared with previously reported cases of long-lasting persistent evidences of unresolved disease after allogeneic bone marrow transplantation with subsequent complete response in other hematologic malignancies, an atypical pattern in this case with delayed complete response after autologous hematopoietic stem cell transplantation has not been reported.

고위험 소아 고형종양에서의 반복적인 고용량 화학요법 및 자가말초혈 조혈모세포이식

유건희,성기웅,구홍회,김대원,김형록 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.2

배경: 고용량 화학요법 및 자가 조혈모세포이식으로 고위험 소아 고형 종양의 치료 성적이 현저히 향상되었으나 아직 다수의 환자에서 종양이 재발한다. 본 연구에서는 1회의 고용량 화학요법으로 완치가 어려울 것으로 판단되는 고위험 고형 종양에서 반복적인 고용량 화학요법을 시행함으로서 치료성적을 극대화하고자 하였다. 방법: 1998년 4월부터 2001년 6월까지 삼성서울병원 소아과에서 반복적인 고용량 화학요법 및 자가 말초혈 조혈모세포이식을 시행한 26명을 대상으로 하였으며 대상질환은 신경모세포종 15례, 수모세포종 3례, 뇌간교종 2례, 원시신경외배엽종양 1례, 교모세포종 1례, 털모양별세포종 1례, 악성섬유성조직세포종 1례, 투명세포종 1례, 횡문근육양종 1례이었다.. 1차 및 2차 조혈모세포이식의 혈액학적 회복과 합병증을 비교하였고 고용량 화학요법 전후의 치료반응, 생존율을 분석하였다. 결과: 진단시 중앙 연령은 3년 3개월(7개월~16년 6개월)이었고, 1차 이식 시 중앙 연령은 4년 2개월(16개월~16년 8개월), 1차 이식 후 2차 이식까지의 간격은 중앙값 76일(46일~329일)이었다. 1차, 2차 이식 후 절대호중구수가 500/μL에 도달하는데 각각 10일과 11일(P=0.06)이 소요되었으며 혈소판수가 50,000/μL에 도달하는데 각각 24일과 36.5일(P=0.0005)이 소요되었다. Grade 3 이상의 합병증은 1차 이식에서 구내염이 더 많았으며 간정맥 폐쇄성 질환, 구토, 황달, 신기능 저하 등은 통계적으로 유의하지는 않았으나 2차 이식에서 빈도가 높은 경향을 보였다. 1차 이식 후 부분 관해였던 21명 중 2차 이식 후 완전 관해가 된 경우가 13명이었다. 대상 환자의 3년 생존율은 62.9%였고, 3년 무병 생존율은 57.7%였다. 사망자 9명의 사인은 질병의 진행 4명, 간정맥 폐쇄성 질환 3명, 폐출혈 1명, RSV 폐렴 1명 순이었다. 결론: 2차 고용량 화학요법 및 자가 조혈모세포이식에서 조혈 기능의 회복이 느리고 합병증의 빈도가 더 높은 경향을 보였지만 부분 관해에서 완전 관해로의 전환이 다수에서 관찰되었다. 따라서, 향후 보다 적극적인 보존적 치료가 병행된다면 고위험 소아 고형 종양에서 반복적인 고용량 화학요법을 통해 치료 성적의 향상을 기대할 수 있을 것으로 사료된다. Background: The survival of the patients with pediatric solid tumors has been improved, but there are still many patients who relapse. In this study, double high dose chemotherapy (HDCT) and autologous peripheral blood stem cell transplantation (PBSCT) was applied to those who seem to have the least chance to be cured with single HDCT, so that maximize the cure rate of patients with high risk childhood cancers. Methods: Twenty six patients received double HDCT and autologous PBSCT from April 1998 to June 2001. Patients' diagnoses were neuroblastoma (15), medulloblastoma (3), brain stem glioma (2), primitive neuroectodermal tumor (1), glioblastoma (1), pilocytic astrocytoma (1), malignant fibrous histiocytoma (1), clear cell sarcoma (1), and rhabdoid tumor (1). We compared the hematologic recovery and the incidence of transplant-related complications after 1st and 2nd HDCT. Results: Median age at diagnosis and at 1st HDCT was 39 mo (7 mo~198 mo) and 50 mo (16 mo~200 mo), respectively. The interval between 1st and 2nd HDCT was median 76 days (46 d~329 d). The neutrophil recovery above ANC 500/μL after 1st and 2nd transplant was attained on day 10 and day 11, respectively (P=0.06). The platelet recovery above 50,000/μL without transfusion dependency was attained on day 24 and day 36.5 after 1st and 2nd transplant, respectively (P=0.0005). Grade 3 or 4 stomatitis was more common during 1st transplant (P=0.045), but other toxicities such as hepatic veno-occlusive disease (VOD), hyperbilirubinemia, and renal insufficiency were more common during 2nd transplant without statistical significances. Of the 21 patients who were in partial remission (PR) after 1st HDCT, 13 patients converted to complete remission (CR) after 2nd HDCT. Patients' 3 year overall survival and disease free survival were 62.9% and 57.7%, respectively. Nine patients died from disease progression (4), VOD (3), pulmonary hemorrhage (1), and RSV pneumonia (1). Conclusion: Delayed platelet recovery and various toxicities were more common after 2nd HDCT. But, many patients achieved CR after 2nd HDCT. Therefore, if delicate supportive cares are provided, double HDCT and autologous PBSCT might increase the cure rate of those patients with high risk pediatric solid tumors.

Autologous Peripheral Blood Stem Cell Transplantation in Rapidly Progressive Systemic Sclerosis : Case Report

Ahn, Myung-Ju,Choi, Jung-Hae,Shim, Sung-Gon,Na, Kyoung-Sun,Kim, Think-You,Bae, Sang-Cheol 대한조혈모세포이식학회 2002 대한조혈모세포이식학회지 Vol.7 No.2

Systemic sclerosis (SSc) is a devastating systemic disease with diffuse scleroderma and visceral organ involvement is associated with high morbidity and mortality. Autologous hematopoietic stem cell transplantation (AHSCT) has been developed as a potential treatment for autoimmune disease based on the animal model and clinical evidence. Here, we report a case of 31-year-old patient with rapidly progressive diffuse scleroderma successfully treated with autologous HSCT. Peripheral blood stem cells were mobilized with cyclophosphamide (CTX, 3 g/㎡), followed by granulocyte-colony stimulating factor (G-CSF, 5μg/kg/day). The CD34 positive selected numbers were 4.33×10^(6) cells/kg. Conditioning regimen was high dose CTX (total dose 200 mg/kg) and antithymocyte globulin (ATG, total dose 90 mg/kg). The patient tolerated this regimen well with manageable toxicity. The neutrophil count (>500μ/L) was recovered by day 9. Only transient thrombocytopenia occurred on day 4. Two months after HSCT, the patient's total skin score was decreased by 55% accessed by the modified Rodnan skin thickness score (from 27 to 12). The health-related quality of life, which was measured by Korean Short Form Health Survey-36 (KSF-36) and EuroQol-5 Dimensions (KEQ-5D), was improved. And the functional disability, which was assessed by the Korean Health Assessment Questionnaire-20 (KHAQ-20), also showed an improvement.

Eruption of lymphocyte recovery after peripheral blood stem cell transplantation

( Jin Hyup Lee ),( Hae Eul Lee ),( Young Lee ),( Young Joon Seo ),( Jeung Hoon Lee ),( Myung Im ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Eruption of lymphocyte recovery creates erythematous macules and papules in patients receiving chemotherapy. The phenomenon usually develops after the chemotherapy-induced nadir of the leukocyte count is attained, and correlates with the time of initial recovery in peripheral lymphocyte numbers. No reported case of eruption of lymphocyte recovery after autologous peripheral blood stem cell transplantation (PBSCT) has been reported in Korea. We treated a 59-year-old patient with a history of acute myeloid leukemia, who developed erythematous macules and patches on his trunk and thigh 1 week after PBSCT. His white cell count was 1.0 x 103/L, his hemoglobin level 11.6 g/dL, and his platelet 26 x 103/L. Histopathologically, apoptotic keratinocytes were evident in the epidermis, and the dermis exhibited perivascular lymphocyte infiltration, without atypia. The skin lesions cleared completely, and spontaneously, within 2 weeks. We thus report an eruption of lymphocyte recovery after PBSCT.

고용량 항암요법후 말초혈액 자가조혈모세포 이식환자에서의 감염 양상

구성현,최소연,조요한,한동석,마경애,김현수,김효철 대한조혈모세포이식학회 1996 대한조혈모세포이식학회지 Vol.1 No.1

목적: 동종골수이식이나 자가골수이식, 말초혈액 자가조혈모세포이식에서 공통적으로 이병률과 사망률에 관여하는 중요한 인자중의 하나가 항암 치료후 발생하는 감염이다. 감염의 발생빈도 및 정도에 대해서 확실히 알수 있고, 위험인자를 감별해 낼수 있다면 고용량 항암요법 후에 발생하는 이병률과 사망률을 줄여 더 나은 결과를 얻을수 있다고 사료되어 저자 등은 고용량 항암요법을 시행한 환자들을 대상으로 후향적인 연구를 통해 감염 및 그로 인한 합병증을 발생빈도, 정도 및 감염과 관련된 위험인자를 규명하려고 하였다. 방법: 1995년 11월부터 96년 8월까지 아주대학교병원에서 고용량 항암요법후에 말초혈액 자가조혈모 세포이식을 시행한 33명의 환자를 대상으로 하여 나이, 성별, 진단명, 조혈모세포이식 날짜, 사용한 항암제의 종류, 방사선 치료 유무 여부, 호중구 감소증 기간, 사망여부, 사망원인을 분석하였다. 결과 33명의환자에서 37회(4명은 2번 항암치료)의 고용량 항암 요법을 시행한 결과를 분석하였다. 1) 기존에 가지고 잇는 질환을 종류별로 보면, non-Hodgkin's lymphoma(n=13), Hodgkin's disease(n=1), breast cancer(n=5), stomach cancer(n=14)이었으며 모든 환자가 기존의 항암 치료에 불응하는 악성 종양이었다. 2) 대상환자의 평균 연령은 42세이었으며 여자가 18명이었고, 평균 호중구 감소기간은 9.62일 이었다. 3) 37회 고용량 항암 요법후 8회를 제외한 29회 (78.3%)에서 열이 있었으며, 29회의 발열 중 8예(21.6%)에서 감염이 균 검출로 증명되었거나 임상적으로 확실히 의심되었다. 8회의 감염중 Staphylococcus epidermidis가 1예, E coli가 2예, Bacteroides fragilis가 1예 있었다. 4) 33명의 환자중 모두 10명이 현재까지 추적관찰중 사망하였는데 이중 2명이 고용량 항암요법후 호중구가 감소되어있는 기간에 발생한 패혈증으로 사망하여 사망원인이 고용량 항암요법에 의한 합병증과 직접적인 연관이 있었다. 5) 감염에 연관되는 위험인자를 알아보기 위하여 나이, 성별, 방사선치료유부, 호중구 감소증 기간, 악성종양 종류 등을 감염군과 비감염군으로 나누어 비교하였는데 모든 항목에서 감염군과 비감염군 사이에 통계적으로 의미있는 차이를 찾을수 없었다. 결론: 고용량 항암요법후 감염이 가장 중요한 이병률 및 사망률의 원인이 되고 있는데 현재 말초혈액 자가조혈모 세포이식후 조혈촉진인자를 사용하여 감염 발생률을 많이 줄이기는 하였으나 앞으로 좀더 많은 환자를 오랜기간 추적 관찰하여 감염으로 인한 문제점을 찾아 개선해 나가야 하겠다. Objectives: Infection is one of the most important factor in the morbidity and mortality of both allogenic and autologous bone marrow transplantation, and peripheral blood stem cell transplant patients. Therefore, an accurate knowledge of the incidence, severity, and risk factors can lead to reduction in the morbidity and mortality. We performed a retrospective analysis in patients with high dose chemotherapy to clarify these infections and also the incidence of complication, severity and associated risk factors. Methods: The subjects of our study were patients who had been admitted at Ajou University Hospital from November 1995 to August 1996 and received autologous peripheral blood stem cell transplantation(PBSCT) after high dose chemotherapy. There were 33 patients in all and the following were analyzed : age, sex, disease diagnosis, date of PBSCT, the duration of neutropenia, and the cause of death. Results: The results of 37 trials (4 patients had two trials) of high dose chemotherapy in 33patients were analyzed. ① The diagnosis included non-Hodgkin's lymphoma(n=13), Hodgkin's disease(n=1), breast cancer(n=5), stomach cancer(n=14). All of the patients were refractory to the conventional chemotherapy. ② The average age was 42years, 18 of the patients were female and the mean duration of netropenia was 9.62days. ③ 29 out of37trials was associated with fever. In 8 out 29case, infection was diagnosed by detection of bacteria or clinically suspicious. Staphylococcus aureus was detected in 4case, Staphylococcus epidermidis in 1 case, E coli in 2 case, and Bacteroides fragilis 1 case. ④10patients died during follow up. 2 case died of sepsis during the period of neurtropenia. Therefore 2 death were directly related to the complications of high dose chemotherapy. ⑤The following factors were analyzed in both infected and non-infected group to determine if there any significant different: age, sex, radiation therapy, duration of neutropenia, disease. There was no significant different between the 2 groups. Conclusion: Infection is the most important cause of morbidity and mortality in high dose chemotherapy. The rate of infection has been largely reduced as a result of rapid marrow engraftment following autologous PBSCT. A longer duration of follow up must be done on more patients to find and improve the problems after autologous PBSCT.

유방암에서 Cyclophosphamide , Thiotepa , Carboplatin ( CTCb ) 고용량 복합항암화학요법 후 자가말초혈액 조혈모세포 이식술

민영주 ( Young Joo Min ),서철원 ( Cheol Won Suh ),이제환 ( Je Hwan Lee ),채영란 ( Young Ran Chae ),김신 ( Shin Kim ),배창황 ( Chang Whang Bae ),박진희 ( Jin Hee Park ),최성준 ( Sung Joon Choi ),김태원 ( Tae Won Kim ),윤환중 ( Wha 대한내과학회 1997 대한내과학회지 Vol.53 No.4

Objectives: Recently high dose chemotherapy with autologous peripheral blood stem cell transplantation (APBSCT) has been investigated with the hope of maximizing tumor response and increasing survival. The purpose of this study is to evaluate the effect, feasibility, and toxicity of high-dose cyclophosphamide, thiotepa, and carboplatin (CTCb) with APBSCT in patients with metastatic or high risk primary breast cancer. Methods: Four cases of high-risk primary breast cancer (with more than 10 involved axillary nodes) and three cases of metastatic disease in complete or partial response were enrolled. Peripheral blood stem cells were mobilized by G-CSF plus chemotherapy, and median number of collected mononuclear cells was 5.44×108/㎏(range, 1.95-7.08×108/㎏). High-dose chemotherapy of cyclophosphamide (1,500㎎/㎡/day), thiotepa (125㎎/㎡/day) and carboplatin (200㎎/㎡/day) was administered for 4 days and peripheral blood stem cells were reinfused to the patients 72 hours after the completion of chemotherapy. Results. The median days of recovery for neutrophil (over 500/㎣) and for platelet (over 50,000/㎣) were 10 (range, 8 to 33) and 30 (range, 10 to 40). One patient suffered from seizure attack and grade 3 hepatotoxicity during high dose chemotherapy, There were no treatment-related death. Four patients with high-risk primary breast cancer remained disease-free at 2, 8, 12 and 19 months post-transplant. In one patient with bone metastasis, complete response was induced following APBSCT. All three patients with metastatic disease remained progression-free at 8, 18 and 19 months post-transplant. Conclusion: High-dose chemotherapy and autologous peripheral blood stem cell transplantation was feasible and would be a potentially effective treatment modality in high risk and metastatic breast cancer.