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변자민,이자윤,신상진,강민주,윤성수,고영일 대한혈액학회 2018 Blood Research Vol.53 No.2
Background High-dose melphalan (HDMEL) represents the standard conditioning regimen before autologous stem cell transplant (ASCT) in multiple myeloma (MM), but recent updates have suggested combination of melphalan with bulsulfan (BUMEL) is also associated with favorable outcomes. We performed the current study to address the lack of comparative studies between the two conditioning regimens in Asian populations. Methods Using the Korean National Health Insurance and Korean Health Insurance Review and Assessment Service databases, 1,304 patients newly diagnosed with MM undergoing ASCT between January 2010 and December 2014 were identified. Patients were divided according to conditioning regimen (HDMEL vs. BUMEL), and after case matching, 428 patients undergoing HDMEL conditioning were compared to 107 patients undergoing BUMEL conditioning with respect to clinical course and treatment outcomes. Results The 3-year progression-free survival (PFS) was 52.5% for the HDMEL conditioning group versus 70.3% for the BUMEL conditioning group (P=0.043). The 3-year overall survival (OS) was 82.0% versus 83.5% (P=0.525), respectively. Although not statistically significant, BUMEL conditioning was associated with more platelet transfusion, while HDMEL was associated with more granulocyte colony stimulating factor support. In multivariate analysis, BUMEL conditioning was not inferior to HDMEL conditioning in regard to both PFS and OS. Conclusion Our study confirmed that BUMEL is an effective and well-tolerated alternative to HDMEL conditioning, with better PFS.
변자민,윤성수 대한내과학회 2022 대한내과학회지 Vol.97 No.4
Chimeric antigen receptor (CAR) T-cell therapy constitutes a revolutionary advancement in personalized cancer treatment. During this treatment, a patient's own T cells are genetically engineered to express a synthetic receptor that binds a tumor antigen. CAR-T cells are then expanded for clinical use and infused back into the patient's body to attack cancer. CAR-T cells have produced remarkable clinical responses with B-cell malignancies. However, CAR-T cells therapy is not without problems. Barriers to effective CAR-T cells therapy include severe life-threatening toxicities and modest anti-tumor activity. In this review, we introduce the concept of CAR-T cells therapy, currently available CAR-T cells therapy options, and how to deal with adverse events.
변자민,이창균,이상열,김효종,김정욱,심재준,장재영 대한의학회 2015 Journal of Korean medical science Vol.30 No.2
The aims of this study were to assess the risk of tuberculosis (TB) and the status of latenttuberculosis infection (LTBI) in Korean patients with inflammatory bowel disease (IBD)receiving tumor necrosis factor (TNF)-α blockers. We reviewed medical records of 525Korean IBD patients (365 TNF-α blocker naïve and 160 TNF-α blocker exposed) betweenJanuary 2001 and December 2013. The crude incidence of TB was significantly higher inIBD patients receiving TNF-α blockers compared to TNF-α-blocker-naïve patients (3.1% vs. 0.3%, P = 0.011). The mean incidence of TB per 1,000 patient-years was 1.84 for theoverall IBD population, 4.89 for TNF-α blocker users, and 0.45 for TNF-α-blocker-naïvepatients. The adjusted risk ratio of TB in IBD patients receiving TNF-α blocker was 11.7 (95%confidence interval, 1.36-101.3). Pulmonary TB was prevalent in patients treated withTNF-α blockers (80.0%, 4/5). LTBI was diagnosed in 17 (10.6%) patients, and none of the17 LTBI patients experienced reactivation of TB during treatment with TNF-α blockers. Treatment with TNF-α blockers significantly increased the risk of TB in IBD patients inKorea. De novo pulmonary TB infection was more prevalent than reactivation of LTBI,suggesting an urgent need for specific recommendations regarding TB monitoring duringTNF-α blocker therapy.
변자민,신정훈,김상아,박현경,이지윤,신동엽,홍준식,이정옥,방수미,김인호,윤성순,고영일 대한암학회 2024 Cancer Research and Treatment Vol.56 No.2
Purpose Despite the recent success of Bruton’s tyrosine kinase (BTK) inhibitors for the treatment of Waldenstrom macroglobulinemia (WM), their indefinite treatment duration ultimately tantamount to substantial financial and emotional burden. On the other hand, fixed duration of proteasome inhibitors (PI) have shown rapid and reasonable response in WM treatment. Despite the well-known synergism between PI and immunomodulatory drugs (IMiD), there is no trials evaluating such combination in WM.Materials and Methods Based on above, we designed this phase II study to investigate the efficacy and safety of 6 cycles of 28-day bortezomib-thalidomide-dexamethasone (VTD) regimen for treatment-naïve WM.Results A total of 15 patients were enrolled: major response rate was 64.3%, and overall response rate was 78.6%. During the median follow-up of 41 months, median progression-free survival (PFS) was 13 months and overall survival 40 months. For responders, median duration of response was 13 months and median PFS 19 months. The most common adverse event (AE) of any grade was constipation (57.1%). The most common grade ≥ 3 AE was anemia (21.4%).Conclusion All in all, we hereby provide proof-of-concept that PI + IMiD may be an attractive backbone for fixed duration treatment. It should be noted that granting the same level of access to newer drugs globally is virtually impossible. Thus efforts to develop regimens using readily available drugs to yield similar or adequate treatment outcomes should not be disregarded. In this sense, we believe our study holds its place for its novelty and eloquently addresses achieving the daunting societal quest of health equity.