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김우건(Woo Kun Kim),박영환(Young Hwan Park),이규형(Kyoo Hyung Lee),이정신(Jung Shin Lee),박태한(Tae Han Park),안한종(Han Jong Ahn),홍준혁(Jun Hyuk Hong),김청수(Choung Soo Kim) 대한내과학회 1999 대한내과학회지 Vol.57 No.3
N/A Transitional cell carcinoma(TCC) of the bladder is confined to mucosa or submucosa on initial presentation. However, high grade superficial tumors tend to recur and progress to muscle invasive or metastatic diseases. Regardless of radical cystectomy in invasive bladder cancer, a poor prognosis was noted due to local recurrence and distant metastasis in recent studies. In this study, the clinical and pathological factors affecting survival of patients with muscle invasive bladder cancer were analyzed. Methods : A total of 105 patients with histopathologically verified muscle invasive bladder cancer who were admitted to Asan Medical Center between August 1989 and August 1998 were reviewed retrospectively. The clinical manifestations, laboratory findings, and histopathological findings at initial diagnosis were evaluated. Overall survival, disease free survival, and disease specific survival according to many prognostic factors were also analyzed. Results : The factors affecting overall survival of muscle invasive bladder cancer were age, sex, TNM stage, performance status, tumor size, invasion of deep bladder muscle, tumor grade, lymphovascular invasion, and complete resection of tumors. In patients with completely resected bladder cancer by radical cystectomy, tumor size, deep bladder muscle invasion, stage, and lymph node involvement were significant prognostic factors. In patients who had either incomplete resection of bladder cancer or in whom no operation was performed, the survival rate was lower in cases with lymph node involvement or hemoglobin level of less than 10 g/dl. Conclusion : After radical cystectomy, the recurrence rate appeared to be higher in solid tumors with deep bladder muscle invasion and lymphovascular invasion on cystoscopic findings. Overall survival was higher in patients with lower tumor stage, no lymph node involvement, and completely resected bladder cancer. Age and sex had no significant correlation with overall survival. No apparent survival advantage was noted in those patients who received post-operative chemotherapy. However, prospective randomized controlled studies are necessary to evaluate the benefit of adjuvant chemotherapy in muscle invasive bladder cancer. (Korean J Med 57:333-347, 1999)
이제환,김우건,김상위,이정신,이규형,장대영,최종수,김상희,김성배,서철원,지현숙 울산대학교 의과대학 1995 울산의대학술지 Vol.4 No.1
Backgrounds : The expression of the MDR-1(multidrug resistance)encoded P-170 glycoprotein(p-170)and CD34 have been well known to be associated with drug resistance in AML(acute myelogenous leukemia). P-170 and CD34 expression in AML have been reported as unfavorble prognostic parameters separately. Methods : P-170 glycoprotein expression was analyzed in correlation with CD34 expression and clinical response in 15 consecutive patients with de novo acute myelgenous leukemia (AML). They were measured with flow cytometry after direct and indirect immunofluorescence staining simultaneously. Results : 1) The positive rate of P-glycoprotein and CD34 were in two of 15 patients(13%), seven of 15 patients(46%), respectively. 2) One of two P-170 positive patients as compared with 7 of 13 P-170 negative patients achieved a complete remission(CR), which showed no clinical significant difference. 3) There was no significant correlation between P-glycoprotein and CD34 expression(r=0.29, p=0.28). 4) In de novo acute myelogenous leukemia, there was no case which expressed both P-170 and CD34 simultaneously. 5) P-glycoprotein and CD34 were not expressed in acute promyelocytic leukemia group. 6) Cytogenetic abnormalities did not show any significant difference in the rate of P-glycoprotein expression, CD34 expression and complete remission. Conclusion : CD34 and P-glycoprotein in acute myelogenous leukemia were independent parameter in this study. Further investigations are warranted for clinical implication.
비혈연간 조혈모세포이식 후 재발한 만성골수성백혈병에서 Gleevec에 의한 완전관해 및 공여자 조혈 재건 1예
박사라,김우건,이제환,최성준,형철호,손희정,강혜진,지형석,이정신,이규형 대한조혈모세포이식학회 2002 대한조혈모세포이식학회지 Vol.7 No.2
저자들은 만성골수성백혈병으로 동종 골수이식 후 림프구성급성전환으로 재발한 환자에서, Gleevec 투약 후 DLI (donor lymphocyte infusion) 없이 공여자 조혈(donor hematopoiesis)의 재건이 이루어지고, 세포유전학적, 분자생물학적 기준에서 모두 완전관해에 이르고, 12개월째 관해를 유지하고 있는 환자를 경험하였기에 이를 보고하는 바이다. 본례의 환자에서 Gleevec은 동종 골수이식 후 급성전환기로 재발한 환자에서도 매우 효과적인 것으로 나타났다. Gleevec은 동종 골수이식 후 재발한 만성골수성백혈병에서 Interferon-α, DLI, 2차골수이식 등 기존의 치료의 문제점을 보완할 수 있는 유용한 치료방법으로 사용될 수 있을 것으로 생각되며, 이의 장기적 치료효과의 평가와 기존치료와의 병합요법의 유용성 등에 대한 향후 연구가 필요할 것으로 생각된다. We report a 32-year old woman with chronic myelongenous leukemia (CML) in lymphoid blast crisis, who underwent allogenic bone marrow transplantation (BMT) from HLA phenotype full mached unrelated donor. Her disease relapsed into full-blown blast crisis. Upon treatment with gleevec, she achieved immediate remission of leukemia as well as the donor type hematopoiesis without donor lymphocyte infusion (DLI). Our case suggests the high effectiveness of gleevec in CML relapsed after allogeneic BMT. Further studies are needed to define the role of gleevec (with or without DLI) in the management of CML relapsed after allogeneic BMT.