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Treatment Outcomes with CHOP Chemotherapy in Adult Patients with Hemophagocytic Lymphohistiocytosis
Shin, Ho-Jin,Chung, Joo Seop,Lee, Je-Jung,Sohn, Sang Kyun,Choi, Young Jin,Kim, Yeo-Kyeoung,Yang, Deok-Hwan,Kim, Hyeoung-Joon,Kim, Jong Gwang,Joo, Young Don,Lee, Won Sik,Sohn, Chang-Hak,Lee, Eun Yup,Ch The Korean Academy of Medical Sciences 2008 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.23 No.3
<P>The objective of the current study was to investigate the treatment outcomes for the use of cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP) chemotherapy in adult patients with hemophagocytic lymphohistiocytosis (HLH). Seventeen HLH patients older than 18 yr of age were treated with CHOP chemotherapy. A response evaluation was conducted for every two cycles of chemotherapy. With CHOP chemotherapy, complete response was achieved for 7/17 patients (41.2%), a partial response for 3/17 patients (17.6%), and the overall response rate was 58.8%. The median response duration (RD) was not reached and the 2-yr RD rate was 68.6%, with a median follow-up of 100 weeks. Median overall survival (OS) was 18 weeks (95% CI, 6-30 weeks) and the 2-yr OS rate was 43.9%. Reported grade 3 or 4 non-hematological toxicities were increased serum liver enzyme levels and stomatitis. Grade 3 or 4 hematological toxicities were leukopenia (50.8%), anemia (20%), and thrombocytopenia (33.9%). Neutropenic fever was observed in 21.6% of patients (14/65 cycles), and most of the cases were resolved with supportive care including treatment with broad-spectrum antibiotics. CHOP chemotherapy seems to be effective in adult HLH patients and the toxicities are manageable.</P>
Lee, Se Ryeon,Yang, Deok Hwan,Ahn, Jae Sook,Kim, Yeo Kyeoung,Lee, Je Jung,Choi, Young Jin,Shin, Ho Jin,Chung, Joo Seop,Cho, Yoon Young,Chae, Yee Soo,Kim, Jong Gwang,Sohn, Sang Kyun,Kim, Hyeoung Joon The Korean Academy of Medical Sciences 2009 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.24 No.3
<P>A refractory and resistant disease to conventional induction chemotherapy and relapsed disease are considered as the most important adverse prognostic factors for acute myeloid leukemia (AML). Sixty-one patients (median age, 33.6 yr) with relapsed or refractory AML were treated with the FLAG regimen that consisted of fludarabine (30 mg/m<SUP>2</SUP>, days 1-5), cytarabine (2.0 g/m<SUP>2</SUP>, days 1-5) and granulocyte colony-stimulating factor. Of the treated patients 29 patients (47.5%) achieved complete remission (CR). Higher CR rates were observed for patients with a first or second relapse as compared to patients with a primary refractory response or relapse after stem cell transplantation (HSCT). There was a significant difference in the response rates according to the duration of leukemia-free survival (pre-LFS) before chemotherapy (<I>P</I>=0.05). The recovery time of both neutrophils (≥500/µL) and platelets (≥20,000/µL) required a median of 21 and 18 days, respectively. Treatment-related mortality (TRM) occurred in seven patients (11.4%), of which 71.4% of TRM was caused by an invasive aspergillosis infection. After achieving CR, 18 patients underwent consolidation chemotherapy and six patients underwent allogeneic HSCT. In conclusion, FLAG chemotherapy without idarubicin is a relatively effective and well-tolerated regimen for relapsed or refractory AML and the use of FLAG chemotherapy has allowed intensive post-remission therapy including HSCT.</P>
Shin, Ho-Jin,Chung, Joo Seop,Lee, Je-Jung,Sohn, Sang Kyun,Choi, Young Jin,Kim, Yeo-Kyeoung,Yang, Deok-Hwan,Kim, Hyeoung-Joon,Back, Jin Ho,Kim, Jong Gwang,Joo, Young Don,Lee, Won Sik,Sohn, Chang Hak,Le 부산대학교 병원 암연구소 2007 부산대병원학술지 Vol.- No.21
목적: 림프종이나 Ebstein Barr 바이러스와 연관된 혈구탐식증후군에서 CHOP 항암화학요법의 치료성적에 관한 보고는 현재까지 거의 보고된 바 없다. 이에 본 연구에서는 성인 혈구탐식증후군 환자에서 CHOP 항암화학요법 뿐만 아니라 etoposide와 corticosteroid 병합요법 그리고 prednisolone 단독 치료의 치료성적을 비교분석하고자 하였다. 대상과 방법: 16세 이상의 46명의 성인환자들이 혈구탐식증후군으로 진단되었다. 이들 중 CHOP 항암화학요법 치료를 시행받은 환자 18명, etoposide와 corticosteroid 병합요법 치료를 시행받았던 6명, 그리고 prednisolone 단독치료를 시 행받았던 6명의 환자들이 분석가능하였다. 결과: CHOP 항암화학요법 치료를 시행받은 환자 중 완전관해 27.8% (5/18), 부분관해 27.8% (5/18) 를 보였으며, 전체생존율은 55.6% 였다. Etoposide 와 corticosteroid 병합요법에서는 50% (3/6)에서 부분관해를 보였으나 완전관해는 한 명도 없었다. Prednisolone 단독치료로는 16.7% (1/6) 에서 완전관해와 부분관해를 보였다. 중앙추적기간은 132주 였으며, CHOP 항암화학요법치료를 시행받은 환자에서 중앙반응기간은 아직 도달하지 않았고, 3년 추정 반응기간은 68.57% 였다. Etoposide 와 corticosteroid 병합요법과 prednisolone 단독치료군에서 중앙 반응기간은 각각 3주와 1주였다. CHOP 항암화학요법 치료를 시행받은 환자군의 중앙생존기간 16주, 3년추정 생존율이 40.63%로 etoposide 와 corticosteroid 병합치료와 prednisolone 단독치료군에 비해 통계학적으로 유의하게 높았다(p = O.OO16). 결론: CHOP 항암화학요법은 성인 혈구탐식증후군 환자에서 유용할 수 있을 것으로 사료된다.