구미에 맞추기 보다는 구미를 깨는 게 낫다

김종광,Kim, Jong-Gwang 대한출판문화협회 2007 출판저널 Vol.374 No.-

혈액종양 ; 미만성 거대 B세포 림프종 환자 치료 후 절대림프구수 감소율의 예후적 가치

김시내 ( Shi Nae Kim ),채의수 ( Yee Soo Chae ),김종광 ( Jong Gwang Kim ),문준호 ( Joon Ho Moon ),이수정 ( Soo Jung Lee ),김윤정 ( Yun Jeong Kim ),이유진 ( Yoo Jin Lee ),손상균 ( Sang Kyun Sohn ) 대한내과학회 2009 대한내과학회지 Vol.76 No.1

목적: 미만성 거대 B 세포 림프종에서 IPI와 절대림프구수는 예후인자로 알려져 있다. 그러나 리툭시맙을 이용한 치료에 있어 리툭시맙과 관련하여 새로운 예후인자가 필요할 것으로 생각된다. 이에 저자는 초기 병기의 미만성 거대 B 세포 림프종 환자에서 R-CHOP 요법의 생존율 관련 예후인자를 평가하였다. 방법: 2003년 8월부터 2007년 11월까지 내원한 초기병기의 미만성 거대 B 세포 림프종 환자로 계획된 R-CHOP 요법을 시행받은 마친 78명을 후향적으로 조사하였다. 생존율분석을 위해 연령, 임상수행능력, LDH, 림프절외 침범, 병기, 절대림프구수, 백혈구 감소율 및 절대림프구수 감소율에 대해 평가하였다. 결과: 초기병기의 미만성 거대 B 세포 림프종 환자 78명 중 26명(33.3%)은 병기 1기였고, 73명의 환자들은 좋은 임상수행능력을 보였으며 20명의 환자에서 LDH 증가를 보였다. IPI 분류시 저위험군은 67명(85.9%)이고, 저중등군은 8명(10.3%), 고중등군은 3명(3.8%)이었다. 전체 반응율은 100%로서 완전관해율이 94.8%였다. 생존율 분석시 전체 생존율에서는 연령이 가장 중요한 예후인자였고(p=0.006), 무진행 생존율에 있어서는 첫 R-CHOP 요법 후 절대림프구수 감소율이 유일한 예후인자였다(p=0.037). 결론: 본 연구에서 초기 병기의 미만성 거대 B 세포 림프종 환자에서 R-CHOP 요법시 나이, IPI와 함께 절대림프구수 감소율이 의미있는 예후인자임을 알 수 있었다. Background/Aims: The International Prognostic Index (IPI) and absolute lymphocyte count (ALC) are prognostic factors in diffuse large B cell lymphoma (DLBCL). Nevertheless, in the Rituximab era, a new predictive marker related to Rituximab might be needed. We evaluated prognostic factors for survival in patients with early stage DLBCL after R-CHOP (Rituximab, cyclophosphamide, adriamycin, vincristine, prednisolone) treatment. Methods: From Aug 2003 to Nov 2007, 78 patients with early stage DLBCL, who finished R-CHOP as scheduled, were reviewed retrospectively. Survival analyses were performed according to clinical parameters (age, performance status, lactate dehydrogenase (LDH), extra-nodal involvement, stage, ALC, and the rates of reduction of the white blood count (WBC) and ALC). Results: Of the 78 patients with early stage DLBCL, 26 (33.3%) were classified as stage I. Seventy-three patients (93.6%) presented with a good performance status, while LDH was elevated in 20 patients (25.6%). According to the IPI, 67 (85.9%), 8 (10.3%), and 3 (3.8%) patients were classified in the low, low-intermediate, and high-intermediate risk groups, respectively. The overall response rate was 100%, including a 94.8% complete response. Survival analysis demonstrated that the rate of reduction of ALC following the first cycle of the R-CHOP regimen was the only factor associated with time-to-progression (p=0.037), whereas age was the single most important prognostic factor for overall survival (p=0.006). Conclusions: In our study, the rate of reduction of ALC in addition to age and IPI was found to be a significant prognostic factor in patients with early stage DLBCL treated with the R-CHOP regimen. (Korean J Med 76:52-59, 2009)

급성전골수성백혈병에서 All-trans retinoic acid 또는 Arsenic trioxide를 사용한 치료 결과

조윤영 ( Yoon Young Cho ),김종광 ( Jong Gwang Kim ),채의수 ( Yee Soo Chae ),문준호 ( Joon Ho Moon ),안병민 ( Byung Min Ahn ),손상균 ( Sang Kyun Sohn ) 대한내과학회 2008 대한내과학회지 Vol.74 No.6

목적: 본 기관에서 진단된 APL 증례를 분석하여 치료방법, 결과, 관해율과 생존율을 알아보고 아울러 이차적 치료약제로서 ATO의 효용성에 대해 알아보고자 하였다. 방법: 1999년 2월부터 2006년 9월까지 경북대학교병원에서 APL로 진단된 26명의 환자들에서 37차례의 항암치료를 시행한 결과를 후향적으로 분석했다. 새로 진단된 환자는 첫 치료로 ATRA (45 mg/m2 daily)를 복용했으며 만약 ATRA에 반응하지 않거나 부작용으로 복용할 수 없는 경우 ATO [10 mg (0.13-0.15 mg/kg) daily]를 투여받거나 또는 anthracyclin을 기초로 한 항암화학요법을 시행받았다. 결과: 첫 진단된 또는 재발된 APL 환자를 대상으로 총 37 치료증례를 분석하였다. ATRA 및 항암화학치료 또는 ATO 치료 후 총 29예(78.4%)가 완전관해에 도달했다. 일년 생존율은 74.3%였으며 일년무사고생존율은 66.3%였다. 그 중 총 16예가 ATO로 치료받았으며 그 중 3예는 ATRA에 불응성이었고, 2예는 부작용으로 인해 ATRA 사용을 할 수 없는 환자였으며 11예는 재발된 환자였다. ATO만을 사용했을 때 16예 중 7예(43.8%)가 완전관해에 도달했고 이후 약제를 바꾸거나 다른 약제와 병합했을 때 총 14예(78.4%)가 재관해에 성공했다. 일년생존율은 78.4%였고, 일년무사 고생존율을 69.6%였다. 결론: ATRA를 이용한 일차치료에 불응성이거나 재발한 APL 환자에서 ATO 사용은 완전관해율도 높고 부작용도 심하지 않아 구제요법으로 적절할 것으로 생각된다. Background/Aims: Acute promyelocytic leukemia is a distinct subtype of acute myeloid leukemia with a specific clinical and molecular presentation. Treatment of acute promyelocytic leukemia with all-trans retinoic acid or arsenic trioxide in association with anthracyclin has improved outcomes in this disease. We report the results of all-trans retinoic acid and arsenic trioxide-based treatment regimens in acute promyelocytic leukemia patients diagnosed in a single center. Methods: Thirty-seven treatment events in 26 patients with acute promyelocytic leukemia were retrospectively reviewed. Results: Complete remission was achieved in 29 (78.4%) of 37 treatment events. One-year overall survival rate and 1-year event-free survival rate were 74.3% and 66.3%, respectively. Among 16 patients treated with an arsenic trioxide-based regimen, 14 patients (87.5%) achieved complete remission. The 1-year overall survival rate and 1-year event-free survival rate were 78.4% and 69.6%, respectively. Conclusions: The short-term use of arsenic trioxide for salvage treatment of acute promyelocytic leukemia seems to be efficacious and could be a bridge to intensive chemotherapy or stem cell transplantation in terms of minimizing the risk of severe disseminated intravascular coagulation.(Korean J Med 74:596-604, 2008)

원발성 중추신경계 림프종의 치료 성적에 대한 다기관 후향적 분석

문준호 ( Joon Ho Moon ),김동환 ( Dong hwan Kim ),안병민 ( Byung Min Ahn ),김시내 ( Shi Nae Kim ),전석봉 ( Seok Bong Jeon ),백진호 ( Jin Ho Baek ),김종광 ( Jong Gwang Kim ),손상균 ( Sang Kyun Sohn ),이규보 ( Kyu Bo Lee ),황정현 ( J 대한내과학회 2006 대한내과학회지 Vol.71 No.6

Background: A primary central nervous system lymphoma (PCNSL) is a rare neoplasm with a poor prognosis. The treatment of PCNSL involves a combination of chemotherapy, intrathecal chemotherapy and radiotherapy. This study retrospectively evaluated the treatment outcomes and prognostic factors of Korean patients with PCNSL. Methods: Between 1995 and 2003, 58 patients diagnosed with PCNSL from the multi-center hospitals were enrol1ed in this study. Among 56 patients who had received treatment, 16 patients were treated with radiotherapy alone, while 40 patients were treated with combined chemotherapy (CHOP; 9 cases, high-dose methotrexate; 31 cases) and radiotherapy. Results: The median age of the patients was 58 years (range, 19-76). A diffuse large B-cell lymphoma was diagnosed in 56 cases (96.6%), while a peripheral T-cell lymphoma was diagnosed in 2 cases. Of the 47 patients who could be assessed for their response after treatment, a CR and PR was observed in 32 (68%) and 11 patients (23%), respectively, giving an overall response rate of 91% (95% CI, 82~100%). The estimated 3-year overall survival rate for all the patients was 67±7.9% and the 3-year disease free survival rate was 53±8.3%. The overall survival of the high-dose methotrexate group was superior to that of the CHOP group (77±10%) versus 47±19%, p=0.05). Leukoencephalopathy was observed as a late complication in 9 patients (21%). No significant prognostic factors affecting survival were found by univariate analysis. Conclusions: Approximately half of the patients could have long-term survival after treatment in this study. High-dose methotrexate containing chemotherapy followed by radiotherapy was found to be an effective treatment. (Korean J Med 71:65i4-661, 2000)

진행성 위암 환자에서 docetaxel과 cisplation 복합항암화학요법의 치료 효과

전석봉 ( Seok Bong Jeon ),안병민 ( Byung Min Ahn ),문준호 ( Jun Ho Mun ),성우진 ( Woo Jin Sung ),김동환 ( Dong Hwan Kim ),김종광 ( Jong Gwang Kim ),김태봉 ( Tae Bong Kim ),정호영 ( Ho Young Jung ),유완식 ( Wan Sik Yu ),손상균 ( Sa 대한내과학회 2005 대한내과학회지 Vol.68 No.6

동종 말초혈액 조혈모세포이식 후의 거대세포바이러스 감염에 대한 Ganciclovir의 정주 후 경구용 선제치료 효과

김종광,성우진,채의수,서광운,박성원,정진태,손상균,서장수,이규보 大韓血液學會 2002 大韓血液學會誌 Vol.37 No.1

진행성 위암 환자에서 발생한 Cisplatin에 의한 말초신경병증

김창민,박연희,김유철,유성재,김태유,한철주,김종광,이진오,류백렬,김봉석,최성준,정숙향,강윤구 대한소화기학회 2000 대한소화기학회지 Vol.36 No.5

Background/Aims: Since cisplatin was widely used for the treatment of advanced gastric cancer, prevention and management of its side effects have become an important issue. Among the various side effects, neurotoxicity still remains as the major dose-limiting side effect of cisplatin. To investigate the frequency and the prognostic factors of neurotoxicity associated with cisplatin- containing chemotherapy, we performed this retrospective analysis. Methods: We analyzed clinical data of 317 patients with advanced gastric cancer treated with cisplatin-containing (20 mg/m2/day, D1-5 per cycle) chemotherapy in Korea Cancer Center Hospital from 1992 to 1996. Results: Peripheral neuropathy was developed in 44 patients(13.9%; 95% C.I, 10-17.8%): 28 patients in who grade I and 16 patients in who grade II. The incidence of peripheral neuropathy was increased as the cumulative dose of cisplatin increased. Age(p=0.0458) and cumulative dose of cisplatin(p 0.0001) were significant prognostic factors for the development of peripheral neuropathy in multivariate analysis. Conclusions: Peripheral neuropathy was a side effect of cisplatin-containing chemotherapy observed frequently in patients with advanced gastric cancer. Its development was closely related with cumulative cisplatin dose and patient's age. Once peripheral neuropathy developed clinically, it did not improve in most patients even after the administration cisplatin was discontinued.

만성 간질환과 간세포암종 환자에서 Basic Fibroblast Growth Factor와 Vascular Endothelial Growth Factor의 혈청 농도

김창민,홍석일,이진옥,유성재,정성문,정숙향,이진오,한철주,김종광,송용환,홍영준,김유철 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.1

Background/Aims: Angiogenesis occurs in response to tissue damage, and is of vital importance for tumor growth and metastasis. Basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) are potent angiogenic factors, and have been suggested to be useful diagnostic markers in certain hypervascular tumors. However, little is known of serum bFGF and VEGF in patients with hepatocellular carcinoma (HCC). We attempted to measure serum bFGF and VEGF in patients with chronic liver diseases (CLD) and HCC to assess their pathogenetic role and usability as tumor markers. Methods: Serum bFGF and VEGF were measured in 8 patients with chronic hepatitis (CH), 15 patients with liver cirrhosis (LC), and 49 patients with HCC. bFGF was measured in 33, and VEGF was measured in 50, healthy blood donors. Results: Serum bFGF was 3.8±1.9, 2.0±1.4, 4.2±6.0, 17.4±30.0 pg/mL in normal control, CH, LC, HCC, respectively. The serum bFGF level was significantly increased in patients with HCC when compared withmal control or patients with CLD. No difference, however, was observed in serum VEGF levels among the four groups. The serum levels of bFGF and VEGF were not significantly different in patients with HCC according to tumor type, size and stage. Serum bFGF showed good sensitivity (90%), specificity (87%), and positive predictive value (94%) in differentiating patients with HCC from those with CLD at the cut-off value of 4.6 pg/mL. Conclusions: bFGF might play a role in the growth of HCC and its serum level might be used as a tumor marker. On the other hand, serum VEGF does not seem to be an adequate tumor marker.(Korean J Hepatol 2001;7:47-54)

간세포암 환자에서 TACE 후에 발생한 상복부 피부발진 2 례

이병희,김창민,정숙향,임경진,정진행,이승숙,이진오,김유철,한철주,김종광,김연경,서요안,송용환 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.3

$quot;Transcatheter arterial chemoembolization (TACE) is a therapeutic option for unresectable hepatocellular carcinoma. Supraumbilical skin rash is a rare complication of TACE caused by patent hepatic falciform artery. We report herein two cases of supraumbilical skin rash developed after TACE for hepatocellular carcinoma, with discussion on the pathogenesis, prophylaxis, and treatment$quot;.

동종 말초혈액 조혈모세포이식에서 광범위 만성 이식편대숙주질환의 발생에 따른 임상적 결과

성우진,전석봉,김동환,김종광,손상균,서장수,이규보 대한조혈모세포이식학회 2003 대한조혈모세포이식학회지 Vol.8 No.1

연구배경: 최근 수년간 악성 혈액질환에서 동종 말초혈액 조혈모세포 이식이 많이 이용되고 있으나 아직까지는 이식편대숙주질환의 발생률 및 생존율 등의 이식결과에 대해서는 논란이 있다. 이에 본 연구에서는 T-림프구가 많이 포함되는 동종 말초혈액 조혈모세포 이식에서 광범위 만성 이식편대숙주질환의 유무에 따르는 이식성적을 분석하였다. 방법: 동종 말초혈액 조혈모세포 이식 후 만성 이식편대숙주질환의 유무를 확인할 수 있었던 34명의 환자를 대상으로 하였다. 주요조직적합성이 일치하는 가족공여자로부터 G-CSF 또는 GM-CSF로 가동화한 후 백혈구분반술로 채집하여 이식하였다. 광범위 만성 이식편대숙주질환이 있었던 군과 없었던 군으로 나누어 이들 군간의 재발률과 생존율 등을 비교분석하였다. 결과: 광범위 만성 이식편대숙주질환이 있었던 환자는 16명(47.0%)이었다. 이들의 생존기간의 중앙값은 251일(범위, 120~1263일)이었고, 추적관찰기간의 중앙값은 572일이었다. 광범위 만성 이식편대숙주질환이 있었던 군과 없었던 군에서 백혈구 및 혈소판 생착일, 발열기간은 통계학적 차이가 없었다. 그러나 급성 이식편대숙주질환은 광범위 만성 이식편대숙주질환이 있었던 군에서 15명(93.7%), 없었던 군은 11명(61.1%)로 의미있게 차이가 있었고(P=0.043) 재발률에서도 광범위 만성 이식편대숙주질환이 있었던 군은 재발이 2명(12.5%), 없었던 군은 8명(44.4%)로 의미있게 차이가 있었다(P=0.013). 그러나 사망률은 광범위 만성 이식편대숙주질환이 있었던 군은 5명(31.2%), 없었던 군은 7명(38.8%)으로 통계적 차이는 없었다. 결론: 동종 말초혈액 조혈모세포 이식에서 광범위 만성 이식편대숙주질환의 유무에 따르는 생존율 등의 이식성적에는 차이가 없었다. 하지만 재발 가능성이 높은 고위험군의 악성 혈액질환에서는 만성 이식편대숙주질환의 발현으로 인한 이식편대종양효과로 생존율 향상을 가져올 가능성이 있음으로 만성 이식편대숙주질환에 대한 다각적인 치료 접근이 필요할 것으로 생각된다. Background: In recent years, allogeneic peripheral blood stem cell transplantation (PBSCT) has been widely used for patients with hematologic malignancies, but the issue of chronic graft-versus-host disease (cGVHD) are under debate. We have analyzed the impact of cGVHD on clinical outcomes in unmanipulated allogeneic PBSCT from HLA identical siblings for patients with hematologic malignancies. Methods: Thirty-four consecutive adult patients with hematologic diseases, who survived at least over day 90 after allogeneic PBSCT and were evaluable for cGVHD, were included in this study. Peripheral blood stem cells were collected from HLA-matched sibling donors mobilized with G-CSF and/or GM-CSF. The patients were classified into groups with or without extensive cGVHD. Results: Extensive cGVHD developed in 16 patients (47.0%). Median survival duration for patients with extensive cGVHD was 251 days (range, 120~1263 days) with median follow-up duration of 572 days. There was no significant difference in engraftment days of WBC and platelet, febrile duration, and the incidence of CMV antigenemia between two groups. The incidence of acute GVHD was significantly different between two groups (cGVHD+ vs. cGVHD- group, 93.7% vs. 61.1%, P=0.043). There was a significant difference in relapse rate (cGVHD+ vs. cGVHD- group, 12.5% vs. 44.4%, P=0.013), but there was no significant difference in mortality rate (cGVHD+ vs. cGVHD- group 31.2% vs. 38.8%). Conclusion: There was no difference in the overall survival between groups with and without extensive cGVHD, although a significant difference in relapse rate. The role of cGVHD should be issued especially in patients with advanced hematologic malignancies.