제대혈 조혈모세포의 생리

안명주 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.2

Umbilical cord blood (UCB) is another source of hematopoietic stem/progenitor cells (HSPC) including bone marrow and peripheral blood, and UCB is increasingly used for hematopoietic cell transplantation for the treatment of various genetic disease and hematologic disease/malignancies. Over the last ten years, many researches have focused on the purification, biological characterization, proliferation and expansion of UCB HPSC. Many studies have shown that HPSC from UCB is functionally different from that of bone marrow or peripheral blood, which has higher proliferation and expansion potential and contains more primitive progenitor cells. But, until now many unsolved problems about the biology of UCB stem cells remain. This review will describe and discuss briefly about the biology of UCB stem cells.

고형암에서 자가조혈모세포이식술의 전처치요법

안명주 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.2

암은 과연 정복될 수 있는가?

안명주 한양대학교 의과대학 1998 한양의대 학술지 Vol.18 No.2

Cancer is one of the major causes of death in the world. Cancer begins when a cell breaks free from the normal restraints on uncontrolled growth and spread. Over the past 25 years, scientists have uncovered a set of basic principles that govern the development of cancer. The cells in a tumor descend from a common ancestral cell that at one point initiated a program of inappropriate reproduction. Furthermore, the malignant transformation of a cell comes about through the accumulation of mutations in specific classes of the genes within it. Among them, two gene classes, oncogenes and tumor suppressor genes, account for much of the uncontrolled cell proliferation seen in human cancers. More than half the cancer death can be attributed to tobacco smoke and diet in worldwide. Therefore, a cancer death can be avoided through prevention strategies, including never smoking and eating certain vegetables and other foods that counteract the activity of cancer-causing agents (carcinogens) in the body. Improvements in medical imaging technology and the power of the new molecular diagnostic tools will be able to diagnose the cancer in early stage. Although the mainstays of cancer treatment - surgery, radiation and chemotherapy- are being refined and combined in ways that can help patients enjoy longer and more fulfilling lives, the new approaches to cancer treatment such as immunotherapy and the molecularly targeted approach (gene therapy to restore normal suppressor gene, antisense inhibitors for oncogene, angiogenesis inhibitors, etc.) would combat cancers without the devastating side effects of many current therapies in the near future.

신증후군, 단클론성 감마병증 및 다발성 골용해 병변으로 발현한 소형 림프구성 림프종 1예

유준호,안명주,김호중,이웅수,박용욱,박문향 한양대학교 의과대학 1999 한양의대 학술지 Vol.19 No.2

We reported here a 70-year-old woman with small lymphocytic lymphoma who was initially presented with recurrent nephrotic syndrome and later developed multiple bone lytic lesions and monoclonal gammopathy, mimicking plasma cell dyscrasia and only involving bone marrow without lymphadenopathy or hepatosplenomegaly. She responded to combination chemotherapy, including cyclophosphamide and prednisone with proteinuria disappearing. The unusual features of this case includes : (1) nephrotic syndrome of minimal change lesion as the initial manifestion in lymphocytic lymphoma, (2) only bone marrow involvement of lymphoma without organomegaly or lymphadenopathy, (3) the presence of multiple bone lytic lesions in conjunction with monoclonal gammopathy in a patient with lymphoma rather than multiple myeloma.

자가 말초혈액 조혈모세포 이식술의 임상적용

김혁,안명주,오석중,이영열,김인순,정태준,최일영,오미란,임호준,이항,김신규 한양대학교 의과대학 1999 한양의대 학술지 Vol.19 No.1

Responses to chemotherapy correlate with the increased dose of chemotherapeutic agents in some cancers, e.g. breast cancer, Ewing's sarcoma, Hodgkin's disease(HD) and non-Hodgkin's lymphoma(NHL), then for the improvement of the chemotherapy responsiveness, high-dose chemotherapy(HDCT) was proposed. But, it's application was limited due to complications, especially bone marrow suppression. HDCT and succeeding autologous peripheral blood stem cell transplantation(APBSCT) was introduced to overcome this problem. This study was designed to determine the clinical pictures including clinical parameters and the responsiveness of HDCT followed by APBSCT in Hanyang University Hospital. Ten patients were enrolled. They were 8 adults (3 breast cancers, 3 multiple myelomas, 1 HD, 1 NHL) and 2 children (1 acute myelogenous leukemia (AML), 1 neuroblastoma). Mobilization chemocherapy(MCT) followed by Granulocyte Colony Stimulating Factor(G-CSF) was administered to mobilize stem cells from bone marrow to peripheral blood. The stem cells were collected by using CS-3000 and cryopreserved at -196℃ with programmed controlled rate freezer as the mixture with 10% dimethyl sulfoxide(DMSO). HDCT was administered and cryopreserved peripheral stem cells were infused on day 0 as planned. Patients' mean age was 41 years old. After induction chemotherapy three patients achieved complete response and 5 partial response. The median time for bone marrow recovery after MCT was 11.5 days for neutrophil(〉500/㎣) and 4.8 days for platelet(〉20,000/㎣). There were three cases of neutropenic fever and one case of gingivitis. After HDCT with APBSCT, one patient was converted partial response to complete response, and one patient achieved complete response after HDCT without induction chemotherapy. The median time for bone marrow recovery was 12.7 days for neutrophil(〉500/㎣) and 14.7 days for platelet(〉20,000/㎣). Eight patients developed neutropenic fever and required systemic antibiotics. Transfusion was required 1.6 pints for packed red cell and 23.4 pints for platelet concentrates. Toxicity consisted mainly of vomiting, diarrhea, and mucositis which were mild. HDCT with APBSCT can be performed safely with minimal complications. For the evaluation of the exact role of HDCT with APBSCT in malignant diseases, further studies are required as a large scale of patients and lung-term follow up.

하시모토 병과 동반된 악성 빈혈 1 예

한 호,안명주,최정혜,이창범,이영열,최일영,김인순,이웅수 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.2

Pernicious anemia is the most common cause of vitamin B12 deficiency and is caused by autoimmune destruction of parietal cell containing gastric mucosa region. This disease is significantly associated with autoimmune endocrinopathies and anti-receptor autoimmune disease. We report here a case of 26-year old man who was diagnosed pernicious anemia with high level of autoantibody titer (antithyroglobulin antibody 1:25,600 and antimicromosomal antibody 1:6,400) indicating subclinical Hashimoto's thyroiditis. Since other autoimmune diseases are frequently associated with pernicious anemia even without evidence of clinical symptoms, screening test for the presence of autoimmune disease should be evaluated in these patients.

예방적 lamivudine 투여로 성공적인 동종골수이식술을 시행한 HBV 양성 중증 재생불량빈혈 환자 1예

성윤경,안명주,오호석,최정혜,이영열,김인순,최일영 대한내과학회 2004 대한내과학회지 Vol.66 No.1

저자들은 만성 B형 감염을 동반한 중증 재생불량빈혈 환자에게 lamivudine을 예방적으로 투여하여 HBV의 재활성 없이 성공적으로 동종골수이식술을 시행하였기에 문헌고찰과 함께 보고하는 바이다. Reactivation of hepatitis B virus (HBV) infection has been known to be a serious complication of immunosuppressive or cytotoxic chemotherapy in HBV carriers or chronic hepatitis B patients. We report here a 25-year-old woman who has severe aplastic anemia and chronic hepatitis B underwent successful allogeneic bone marrow transplantation (BMT) with prophylactic lamivudine treatment and showed no evidence of reactivation of hepatitis B, HBV DNA elevation, or liver dysfunction. This result suggests that prophylactic administration of lamivudine to a BMT recipient of chronic hepatitis B might be a safe and promising measure to prevent fatal liver dysfunction.

비호지킨 림프종환자에서 proMACE-cytaBOM 복합항암화학요법의 유효성에 대한 제 2상 임상시험

김성우,안명주,박석규,이영렬,정태준,최일영,김인순 한양대학교 의과대학 2000 한양의대 학술지 Vol.20 No.1

Aggressive non-Hodgkin's lymphoma by REAL classification is a heterogenous group of disease. With recent advances in combination chemotherapy, the long-term survival is improved to 40-65%. We investigated twenty-one aggressive non-Hodgkin's lymphoma patients treated with pro-MACE-cytaBOM (prednisone, adriamycin, cyclophosphamide, etoposide, cytosine arabinoside, bleomycin, vincristine and methotrexated) to determine the efficacy and toxicites. There were seven patients older than 60 years. Histologic types by REAL classification were as follows : diffuse large B cell (12/21), peripheral T cell (6/21), anaplastic large cell (2/21) and angiocentric T cell (1/21). Most of patients were classified in Stage Ⅱ-Ⅳ (20/21). According to IPI (international prognostic index) score, seven patients were included in low risk, five were low-intermediate risk, three were high-intermediated risk and six were high risk group. seventeen complete responses (85%) and two partial responses (10%) were achieved. The overall response rate was 95%. The mena disease free survival was 30 months, the mean overall survival was 29 months (range:21-36), and the median overall survival was not reached. WHO grade Ⅲ/Ⅳ neutropenia or thrombocytopenia was observed in 16.7% and 2.8%, respectively. There was no treatment-related death. These results suggest that proMACE-cytaBOM combination chemotherapy is very effective and has low toxicity in the treatment of aggressive non-Hodgkin's lymphoma even treated in elderly patients.

근치적 위절제술을 시행한 위암 환자에서 보조요법으로서 5-Fluorouracil, Epirubicin과 5-Epirubicil,Cisplatin의 복합화학요법의 효과 비교

최정혜,안명주,한동수,손주현,전용철,박훤겸,백홍규,이홍기,남영수 한양대학교 의과대학 2000 한양의대 학술지 Vol.20 No.2

To compare 5-fluorouracil plus epirubicin (FE) to 5-fluorouracil plus cisplatin (FP) chemotherapy as adjuvant therapy for patients with resected gastric cancer. Between August 1995 and March 2000, 46 patients with completely resected gastric cancer received six courses of FE (5-fluorouracil 1000mg/m2/day, D2-D5, epirubicin 70mg/m2, D1) or FP (5-fluorouracil 1000mg/m2/day, D2-D5, cisplatin 70mg/m2, D1) chemotherapy. The 23 patients were assigned to each treatment group. A total of 127 courses of treatment were given both FE and FP group. The FP group tended to show more risk of overall death rate. But there were no differences between FE and FP groups in terms of overall survival or disease-free survival. Both treatment arms were generally well tolerated to chemotherapy. We concluded to be no significant differences between FE and FP groups in terms of overall survival or disease-free survival. To define the efficacy of adjuvant chemotherapy for gastric adenocarcinoma, further prospective randomized trials with large number of patients should be warranted.

유방암의 뇌하수체 전이에 의한 양안 시력소실 1 예

최낙원,안명주,김재민,박동우,박용욱 한양대학교 의과대학 2000 한양의대 학술지 Vol.20 No.1

Pituitary gland metastasis is a rare clinical diagnosis, usually made in the setting of known primary systemic cancer with widespread metastasis to other organs. But visual loss as a presenting symptom of metastasis to the pituitary gland is unusal. We report here a case of 45-year-old woman who had been diagnosed as having metastatic breast cancer involving bone and liver 2 years ago, and received high dose chemotherapy with peripheral blood stem cell transplantation, developed sudden bilateral complete visual loss. At initial presentation, the patient had no light perception and no pupillary response to light in both eyes, but without evidence of panhypopituitarism, or diabetes insipidus. Brain MRI showed a large enhanced mass invasion to the cavernous sinus and extension to the suprasella portion without dura or base-of-skull metastasis. Pathologic examination showed metastatic breast cancer. Despite the transsphenoidal decompression surgery of metastatic tumor, the visual loss was not improved.