Emergency Cranial Irradiation Effects in Adult Leukemia with Extremely High Leukocytosis

박승호(Seoung Ho Park),조문준(Moon June Cho),김삼용(Samyong Kim) 대한방사선종양학회 1992 Radiation Oncology Journal Vol.10 No.2

성인의 급성 백혈병 환자 64예를 1990년 1월부터 1991년 10월 사이에 충남대학교 병원에서 치료하였다. 극심한 백혈구 증다증이 동반된 20예를 선별하여 네가지 각기 다른 방법으로 치료하였으며 이 치료양상에 따른 급성 사망률과 완해율에 관하여 조사하여 보았다. 응급 두 개부 방사선 조사 단독 또는 항암제 약물용법을 병행한 경우에 있어서 단지 보조적 요법만을 시행한 경우나 항암제 약물요법만을 시행한 경우에 비하여 초기 급성 사망률이 낮았다. 또 완해율에 있어서도 응급 두 개부 방사선 조사 및 항암제 약물요법을 병행한 경우에 높았다. 따라서 우리는 성인의 급성 백혈병에서 극심한 백혈구 증다증이 동반된 경우 조기 두 개부 방사선 조사가 초기 급성 사망률을 낮추고 후에 완해율을 높이는 데에도 효과가 있을 것이라고 추정해보았다. We have treated adult acute leukemia 64 patients between January 1990 and October 1991 at the Chungnam National University Hospital. They were examined for the impact of presenting WBC count on the initial course and form them we have chosen twenty patients whose leukocyte count is over one hundred thousands per cubic milimeter. We divided the twenty patients into 4 groups on the base of treatment modalities: conservative therapy only, chemotherapy only, cranial irradiation only, and chemotherapy with cranial irradiation. Early sudden death rate is lower in cranial irradiation with without chemotherapy groups than the conservative only or chemotherapy only patients. Also the remission rate is high in cranial irradiation with chemotherapy patients. Therefore we suggest that the rapid intervention of cranial irradiation in adult acute leukemia could be helpful in reducing the early sudden death rate and perhaps in increasing the remission rate.

소화기종양환자에서 CA19 - 9 과 TPA 의 진단적 의의

이복희(Bok Hee Lee),윤세진(Sei Jin Youn),윤오주(Oh Ju Youn),송민호(Min Ho Song),이헌영(Heon Young Lee),김삼용(Samyong Kim) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.2

To evaluate the diagnostic significance of serum CA 19-9 and tissue polypeptide antigen (TPA) in patients with gastrointestinal tumors, serum CA 19-9 levels were measured by radioimmunoassay with monoclonal antibody. Serum levels of CEA, TPA and AFP were measured in 10 patients each of stomach cancer, colorectal cancer, pancreatic cancer, bile duct cancer and hepatoma and in 10 normal control subjects and 10 patients with benign gastric ulcer. The results were as follows: 1) Serum CA 19-9 and TPA levels in normal controls were 16+-5.0 u/ml(M+-SD) and 96+-38 u/1 respectively. Serum CA 19-9 and TPA levels in patients with benign gasric ulcer were 11.9+-7.4 u/ml and 113+-43 u/1 respectively and there were no significant difference between them. 2) Serum CA 19-9 and TPA levels were elevated 60% (30/50) and 54% (27/50) of all gasrointestinal tumors respectively. According to tumor types, serum CA 19-9 and TPA levels were elevated 50% and 60% of stomach caner, 50% and 40% of colorectal cancer respectively. Serum CA 19-9 levels were elevated 70% of pancreatic cancer, 80% of bile duct cancer, most prominently, Serum TPA levels were elevated 70% of hepatoma, and serum AFP were elevated 60% of hepatoma (Cut-off value was 26 u/ml in CA 19-9, 172 u/l in TPA, 4.3 ng/ml in CEA, 100 ng/ml in AFP) 3) Serum CA 19-9 and TPA levels in patients with metastasis (128+-82 u/ml, 430+-326 u/1) were significantly different from that in patients without metastasis (47+-54 u/ml, 190+-470 u/1) 4) There were no correlation between CA 19-9 and CEA, between TPA and CEA as well as AFP in patients with hepatoma and other gastrointestinal disease. 5) The sensitivities of combinations of CA 19-9 and CEA, TPA and CEA were 70% and 90% respectivelty in stomach cancer, and the sensitivities of both combinations in colorectal cancer were 70% and 60% respectively. 6) The sensitivities of combinations of Ca 19-9 and CEA, TPA and CEA were 90% and 60% respectively in pancreatic cancer, In bile duct cancer, the sensitivities of CA 19-9 alone (80%) was equal to the combinations of CEA and TPA, or CA 19-9 and CEA. 7) The sensitivities of combinations of CA 19-9 and AFP, TPA and AFP were 80% and 90% respectively in hepatoma. Thus. It is concluded that CA 19-9 and TPA are useful tumor markers in above mentioned gastrointestinal tumors, especially when used in combination it will increase sensitivity. Assays of serum CA 19-9 and TPA in gastrointestinal tumors may be useful as tumor markers.

진행성 미분화 림프구성 림프종(DPDL) 및 미만성 조직구성 림프종(DHL)에 대한 복합화학요법

김삼용,송민호,신영태,김영건 충남대학교 의과대학 지역사회의학연구소 1988 충남의대잡지 Vol.15 No.2

Fifteen patients with stage Ⅲ or Ⅳ diffuse histiocytic lymphoma(DHL) and diffuse poorly differentiated lymphocytic lymphoma(DPDL) were treated with cyclophosphamide, doxorubicin, vincristine and prednisolone(CHOP) and other combination chemotherapy regimen, such as IMVP, C-MOPP and CVP regimen. Seven patients (47%) achieved complete remission and and three patients (20%) obtained partial remission. The overall response rate was 67%(10/15). Among eleven patients treated with CHOP regimen, six patients (54.5%) achieved complete remission. In eight patients with DHL three patients (37.5%) obtained complete remission and in seven patients with DPDL, four patients (57.1%) achieved complete remission. The median duration of remission was 9+ months (range; 2+ - 34+ months). The median duration of survival was 13+ months (range; 6+ - 36+ months). The incidence of hematologic toxicities following the chemotherapy were evaluated by ECOG toxicity criteria. The severe heamtologic toxicities(grade Ⅲ or Ⅳ) after the 133 cycles of treatment were as followings, anemia 13%, leukopenia 13% and thrombocytopenia 7%. The therapeutic effects of involving CHOP regimen as the mainstay for therapy of the advanced DHL and DPDL including CHOP and other regimen was substantial. The further elucidation of therapeutic uses of such first or second line regimen, we need more patient accrual and further prognostic stratification of subjects.

항암제 처리한 백혈병 세포주에서의 Apoptosis 발현

김삼용,윤소현,김현수,김종숙,윤환중,김진경,조덕연 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

The bcl-2 proto-oncogene encodes a 26 kD protein that promotes cell survival by blocking apoptosis. The bax protein is a member of the bcl-2 familly, now known to form heterodimers with the bcl-2 protein. The ratio of bax to bcl-2 is be critical in determining the fate of the cell in response to stimuli that can induce apoptosis. Extract of Pulsatilla Koreana (SB-31) showed promising antitumor activity in vitro with Topo I inhibitory action. In the present study, the relationship between apoptosis and the apoptosis related proteins, bcl-2 and bax were investigated in human leukemic cell lines HL-60, U-937 and CEM-CM3. All anticancer drugs(adriamycin, etoposide, camptothecin, SB-31) induced extensive apoptosis in HL-60, U-937 cells and CEM-CM3 cells. The expression of bcl-2 and bax protein were determined in cell lines by western blotting before and after incubation with anticancer drugs at different time points. 1) In HL-60 or U-937 cell lines, down regulation of bcl-2 and up-regulation of bax were found after incubation with ADR, VP-16 or camptothecin. 2) In HL-60 or U-937 cell lines, no significant change in bcl-2 or bax protein expression resulted after incubation with SB-31. 3) In CEM-CM3 cells, virtually no change was noted in bcl-2/bax expression after incubation with ADR, VP-16, camptothecin or SB-31. It is suggested that different leukemic cell lines use different pathways of apoptosis activation and a given cell may utilize different pathways of apoptosis activation in response to different cytotoxic agents.

냉동 제대혈 세포의 체외 증폭

김삼용,김철희,배광봉,김현수,박상준,김종숙,윤환중,조덕연 大韓血液學會 1997 大韓血液學會誌 Vol.32 No.3

만성 골수성 백혈병에서 Interferon-alpha 2a와 Hydroxyurea 병합 요법

김삼용,장준,성기양,길준영,윤일국,이경숙,김종완,서종진 大韓血液學會 1990 大韓血液學會誌 Vol.25 No.2

Cisplatin 병용화학요법으로 인한 오심, 구토의 예방을 위한 Granisetron(Kytril^ⓡ)과 MDL(Meroclopramide, Dexamethasone, Lorazepam) 병용요법의 비교

김삼용,김철희,배광봉,김현수,박상준,김종숙,최지영,윤환중,조덕연 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.1

Granisetron is known as the most selective 5-HT3 receptor antagonist and is reported to be effective in the prevention of acute emesis induced by cisplatin based chemotherapy. From June 1885 to December 1995, 32 solid tumor patients who were scheduled to receive cisplatin based combination chemotherapy were randomized either to granisetron or MDL(Metoclopramide, Dexamethasone, Lorazepam) prophylaxis. We evaluated 32 patients; 17 patients received granisetron 3mg, while 15 patients received MDL. The male to female ration was 12:5(Granisetron group) versus 12:3(MDL group), and moan age was 44.6 yrs(Granisetron group) versus 46.5 yrs(MDL group). Of 17 granisetron treated patients, 76.5%(13/17) obtained complete or major response in prevention of acute emesis, while 73.4%(11/15) of patients receiving MDL on first 24 hours of chemotherapy(P>0.05). No severe side effects were recorded in both groups. In granisetron group, mild headache and constipation were noted. In MDL group, the most common side effect was sedation(4/15, 26.7%), but extrapyramidal reaction was not noted in our patients. These results show that granisetron is an effective antiemetic in the control of cisplatin induced nausea and vomiting, and can be administered safely with minimal side effects.

급성 및 만성 간질환에서 C형 간염바이러스 항체(anti-HCV)양성률

김삼용,성자원,김병호,이기천,허승식,길준영,정현용,이헌영,김영건 충남대학교 의과대학 지역사회의학연구소 1992 충남의대잡지 Vol.19 No.2

The prevalence of antibody against hepatitis C virus (anti-HCV) was investigated in 331 patients with various liver diseases from April 1992 to September 1992. The presence of anti-HCV was detected by Lucky HCD EIA test in 331 cases and by (Ortho HCV Antibody ELISA test 148 patients) The results are summarized as follows: 1. Overall, antibody to HCV(anti-HCV) was positive in 37(11%) of 331 patients with various liver diseases. 2. 16(11%) of 144 patients with chronic hepatitis, 2(5%) of 37 patients with alcoholic liver disease, 17(22%) of 76 patients with liver cirrhosis and 2(5%) of 38 HBsAg carriers were positive for anti-HCV.None of 12 patients with acute hepatitis, 11 patients with drug induced hepatitis and 13 patients with hepatocellular carcinoma was anti-HCV positive. 3. HBsAg positivity in patients who had anti-HCV was 24%(9/37). 4. A positive correlation was found between Lucky HCD and Ortho HCV test. Of 128 Lucky HCD negative cases, 124 cases were negative for Ortho HCV ELISA and 4 cases were positive for Ortho HCV ELISA Of 20 Lucky HCD positive cases, 11 cases were positive for Ortho HCV ELISA and 9 cases were negative for Ortho HCV ELISA. These results suggest that hepatitis C virus has an important etiologic role in HBsAg negative chronic hepatitis and liver cirrhosis in Korea. The diagnostic value of Lucky HCD EIA test may be slightly better or equivalent to Ortho HCV ELISA test in the diagnosis of Hepatitis C virus infection.

급성골수성백혈병 환자에서 DAV 병용화학요법 후의 장기생존율

김삼용,최지영,윤환중,전의건,길준영,조덕연 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Background : Despite substantial progress, the treatment of acute myeloid leukemia(AML) has produced complete remission in 60-80% of patients receiving induction chemotherapy, and median remission duration is about 12 months and only 20% to 35% of patients undergoing consolidation chemotherapy achieve long-term disease-free survival(DFS). We evaluated the long-term outcome of AML patients treated with doxorubicin/Ara-C/VP-16(DAV) induction chemotherapy and consolidation/intensification therapy. Method : Induction therapy : From January 1986 to December 1991, twenty three patients with previously untreated acute myelogenous leukemia received a course of 45mg/㎡ doxorubicin daily intravenously for three consecutive days with Ara-C at 100mg/㎡ by continuous intravenous infusion for eight consecutive days and VP-16 at 100mg/㎡ daily intravenously for three consecutive days. A second course of treatment was started if leukemia persisted on 22 days after treatment. Post-remission therapy : Three to six cycles were given at three or four months interval with Ara-C/doxorubicin/VP-16 regimen or other therapy. Results : Twenty two pateints were evaluable and complete remission was achieved in 16 of 22(73%). Median duration of complete remission was 8 months. The relapse rate was 81% and 63% relapsed in first year. 4-year survival rate of patients entering complete remission(n=16) was 19% and median survival duration was 14.5 months. The postremission chemotherapy was the only significant prognostic factor influencing long term disease free survival. No significant correlation was observed between the probability of survival and age (40< or >40), sex, FAR subgroup, and leukocyte count at diagnosis. The median survival duration were 21 months and 12.5 months for patients who received, or not received postremission chemotherapy respectively(P=0.035). Conclusion : Our results show that DAV combination chemotherapy is a useful therapeutic regimen in remission induction and postremission chemotherapy offering survival advantage in patients with AML entering complete remission.

재생불량성 빈혈의 임상적 고찰

김삼용,길준영,전의건 충남대학교 의과대학 지역사회의학연구소 1991 충남의대잡지 Vol.18 No.2

A retrospective analysis of clinical data of 32 cases of aplastic anemia diagnosed at Chungnam National University Hospital from August 1985 to July 1991 was done. 1) The highest incidence of aplastic anemia was seen in the third decade and 25 cases of patients (78.2%) were below 40 years of age. The incidence decreased in older age groups. 2) Exposure to possible toxic agents were seen in 6 cases(18.8%), among which benzene was related in 2 cases(6.3 % ), herb drug in 2 cases(6.3 % ), acute viral hepatitis(type B) in 1 case(3.1 % ), antifungal agent in 1 case(3.1 % ). 3) Initially all patients were treated with oxymetholone with or without prednisolone and supportive care. Eleven(37.9 %) out of twenty-nine patients showed responses(CR: 17.2%, PR: 20.6%). Nine out of the eighteen patiens who did not respond to androgen therapy were treated with antilymphocyte globulin (ALG) plus methylprednisolone. Two patients(22.2 %) out of 9 showed complete responses. 4) Overall responses of present series of patients was 44.8 % (androgen± prenisolone therapy: 37.9%, ALG+ methylprednisolone: 6.9%). The actuarial survival of all patients at 72 months was 83.4%. The median survical rate of severe aplastic anemia(32 months) was similiar to that of moderate aplastic anemia(37 months). 5) Factors associated with favourable survival were male sex and presence of etiological factor. Since the prognosis of aplastic anemia in Korea is quite favorable, randomized controlled study would be needed to define the therapeutic roles of bone marrow transplantation of immunosuppressive therapy in patients with severe aplastic anemia in Korea.