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다발성골수종 환자의 일차 치료제로서 탈리도마이드 병합요법의 임상적 효능
정성훈,이제중,손상균,신호진,양덕환,김여경,김상기,백진호,김동환,김종광,정주섭,조군제,김형준 대한혈액학회 2006 Blood Research Vol.41 No.2
배경: 본 연구에서는 새로이 진단된 다발성골수종 환자를 대상으로 thalidomide를 포함한 복합 항암요법을 시행하여서 그 임상적인 유효성과 안전성, 또한 말초혈액 조혈모세포 채집에 미치는 영향을 알아보고자 하였다. 방법: 새로 진단된 다발성골수종 환자에 TD 요법(thalidomide와 dexamethasone) 또는 TCD 요법(thalidomide, cyclophosphamide, dexamethasone)을 투여한 후 치료에 대한 반응을 평가하였으며, G-CSF±cyclophosphamide로 조혈모세포를 가동화시킨 후 말초혈액 조혈모세포를 채집하였다. 결과: 2003년 6월부터 2005년 12월까지 새로 진단된 다발성골수종 환자 60예를 대상으로 상기 요법이 투여되었으며, 이 중 4주기 이상 투여되어서 평가 가능한 56예를 대상으로 치료에 대한 반응과 독성을 분석하였다. 중앙연령은 65.5세(범위: 39~80세)였다. 치료에 대한 전체반응률은 85.5%를 보였고, TD 요법을 시행받은 12예의 환자 중에서 완전반응은 3예(25%), 부분반응은 6예(50%)를 보였으며, TCD 요법을 시행받은 44예의 환자 중에서 완전반응은 17예(38.6%), 부분반응은 21예(47.7%)를 보였다. NCI-CTC 기준 3도 이상 치료 독성은 호중구감소증 7예(12.5%), 혈소판감소증 4예(7.1%), 감염 6예(10.7%), 신경병증 10예(17.8%)가 발생하였고, 또한 혈전증이 2예(3.6%)에서 발생하였다. 부분반응 이상을 보인 환자 중 13예에서 자가 조혈모세포를 채집하였으며, 채집한 CD34 양성 세포의 중앙치는 3.8×106/kg을 보였다.
강병욱,손상균,문준호,채이수,김종광,이수정,김원석,이제중,이세련,박건욱,이호섭,이원식,원종호,박무림,곽재용,김민경,김효정,오성용,강혜진,서철원 대한혈액학회 2014 Blood Research Vol.49 No.1
BackgroundWe investigated the clinical features and treatment outcomes of patients with mantle cell lymphoma (MCL) in Korea. MethodsWe retrospectively analyzed the clinical characteristics and prognosis of 131 patients di-agnosed with MCL between January 2004 and December 2009 at 15 medical centers in Korea; all patients received at least 1 chemotherapeutic regimen for MCL.ResultsThe median age for the patients was 63 years (range, 26‒78 years), and 77.9% were men. A total of 105 patients (80.1%) had stage III or IV MCL at diagnosis. Fifty-two patients (39.7%) were categorized with high- or high-intermediate risk MCL according to the International Prognostic Index (IPI). Eighteen patients (13.7%) were in the high-risk group according to the simplified MCL-IPI (MIPI). The overall incidence of extranodal involve-ment was 69.5%. The overall incidence of bone marrow and gastrointestinal involvements at diagnosis was 41.2% and 35.1%, respectively. Cyclophosphamide, doxorubicin, vin-cristine, prednisolone, and rituximab were used frequently as the first-line treatment (41.2%). With a median follow-up duration of 20.0 months (range, 0.2‒77.0 months), the overall survival (OS) at 2 years was 64.7%, while the event-free survival (EFS) was 39.7%. Multivariate analysis showed that the simplified MIPI was significantly associated with OS. However, the use of a rituximab-containing regimen was not associated with OS and EFS. ConclusionSimilar to results from Western countries, the current study found that simplified MIPI was an important prognostic factor in Korean patients with MCL.
강병욱,손상균,문준호,채이수,김종광,이수정,김원석,이제중,이세련,박건욱,이호섭,이원식,원종호,박무림,곽재용,김민경,김효정,오성용,강혜진,서철원 대한혈액학회 2014 Blood Research Vol.49 No.1
BackgroundWe investigated the clinical features and treatment outcomes of patients with mantle cell lymphoma (MCL) in Korea. MethodsWe retrospectively analyzed the clinical characteristics and prognosis of 131 patients di-agnosed with MCL between January 2004 and December 2009 at 15 medical centers in Korea; all patients received at least 1 chemotherapeutic regimen for MCL.ResultsThe median age for the patients was 63 years (range, 26‒78 years), and 77.9% were men. A total of 105 patients (80.1%) had stage III or IV MCL at diagnosis. Fifty-two patients (39.7%) were categorized with high- or high-intermediate risk MCL according to the International Prognostic Index (IPI). Eighteen patients (13.7%) were in the high-risk group according to the simplified MCL-IPI (MIPI). The overall incidence of extranodal involve-ment was 69.5%. The overall incidence of bone marrow and gastrointestinal involvements at diagnosis was 41.2% and 35.1%, respectively. Cyclophosphamide, doxorubicin, vin-cristine, prednisolone, and rituximab were used frequently as the first-line treatment (41.2%). With a median follow-up duration of 20.0 months (range, 0.2‒77.0 months), the overall survival (OS) at 2 years was 64.7%, while the event-free survival (EFS) was 39.7%. Multivariate analysis showed that the simplified MIPI was significantly associated with OS. However, the use of a rituximab-containing regimen was not associated with OS and EFS. ConclusionSimilar to results from Western countries, the current study found that simplified MIPI was an important prognostic factor in Korean patients with MCL.
Treatment Outcomes with CHOP Chemotherapy in Adult Patients with Hemophagocytic Lymphohistiocytosis
신호진,정주섭,이제중,손상균,Young Jin Choi,김여경,양덕환,김형준,김종광,주영돈,이원식,Chang Hak Sohn,이은엽,Goon Jae Cho 대한의학회 2008 Journal of Korean medical science Vol.23 No.3
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.
이세련,양덕환,안재숙,김여경,이제중,최영진,신호진,정주섭,조윤영,김종광,손상균,김형준,채이수 대한의학회 2009 Journal of Korean medical science Vol.24 No.3
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 ㎎/㎡, days 1-5), cytarabine (2.0 g/㎡, 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 (P=0.05). The recovery time of both neutrophils (≥500/μL) and platelets (≥20,000/μL) required a median of 21 and 18 days, respectively. Treatmentrelated 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.
조혈모세포이식 환자의 삶의 질에 대한 연구 : 화학요법 환자 및 정상인과의 비교
김병수,서재홍,최철원,김열홍,김준석,김정아,손상균,김재석,이경희,이제중,정익주,곽재용,안진석,이정애,박영석 대한조혈모세포이식학회 1999 대한조혈모세포이식학회지 Vol.4 No.1
연구배경: 조혈모세포이식후 신체 및 정신적 장애의 정도가 얼마나 환자의 '삶의 질(QOL)'에 영향을 미치는지에 대하여 외국에서는 연구들이 활발히 진행되고 있다. 그러나 우리나라에서는 조혈모세포이식이 비교적 활발히 시술되고 있음에도 불구하고 이에 대한 연구가 미미한 실정이었다. 연구자 등은 우리 나라에서 조혈모세포이식을 받은 환자들의 QOL은 어떤지를 알아보고자 하는 목적으로 본 연구를 시행하였다. 방법: 본 연구에 참여한 각 기관에서 조혈모세포이식을 받고 주된 치료가 끝난 후 1999년 2월 시점에서 최소 3개월이 지나고 관해상태에서 일상생활을 영위하고 있는 재생불량성 빈혈과 급성 및 만성 백혈병 환자들을 각각 자가 및 동종 조혈모세포이식을 시행받은 조혈모세포이식군(1군)과 항림프구 글로불린, 공고요법 등으로 치료를 끝낸 화학요법군(2군)으로 분류하고 연구자 병원에 내원한 건강한 환자 보호자들로 이루어진 정상대조군(3군)을 선정하여 각각의 QOL을 비교, 분석하였다. QOL의 측정은 EORTC QLQ-C30 문항을 우리나라의 실정에 맞게 번역하여 사용하였다. 결과: 조혈모세포이식군(1군)은 53명, 화학요법군(2군)은 57명, 정상대조군(3군)은 55명 이었고, 성별, 나이, 질환별 분포, 검사시점 등에서의 유의한 차이는 없었다. 각 군간의 QLQ-C30 평균 점수를 비교한 결과, 전반적인 삶의 질에서는 1군이 73.5, 2군이 51.7, 3군이 79.3으로 2군이 1.3군보다 낮았고 역할 및 사회기능은 각각 1군이 64.3/68.9, 2군이 57.6/70.3, 3군이 85.2/85.5로 1,2군이 3군에 비하여 낮았다.(P<0.01). 또한, 오심/구토가 1군은 8.7, 2군은 4.5, 3군은 3.2로 1군이 2, 3군보다 높았으며 통증은 1군은 17.0, 2군은 19.2, 3군은 9.6으로 1,2군이 3군에 비하여 높았다(p〈0.01). 기타 신체, 감정, 인식기능 및 피로에서는 각군간에 유의한 차이를 발견할 수 없었다. 결론: 본 연구에 참여한 조혈모세포이식환자들의 전반적인 삶의 질은 화학요법을 받은 환자들보다 우월하면서 정상인들과 유사하였으나 역할기능 및 사회기증, 통증에서는 화학요법 환자들처럼 정상인들에 비하여 열악하였고 오심/구토는 화학요법 환자들 및 정상인에 비하여 심한 양상을 보였다. 그러므로 본 연구를 바탕으로 하여 국내 실정에 맞는 QOL 측정 방법을 개발하고 조혈모세포이식을 시행받는 환자들의 삶의 질에 관한 연구들이 향후 계속 진행되어야 하리라고 생각된다. Background: It is very important to endow patient with satisactory quality of life (QOL). However, little is known about QOL after hematopoietic stem cell transplantation (HSCT) in Korea. In this study we tried to measure QOL in the patients treated with HSCT and compare QOL scores with those of patients treated with usual chemotherapy and normal populations. Methods: The QOL evaluation was performed with EORTC QLQ-C30 questionnaires interpreted to Korean language. The study populations were consisted with 53 patients treated with HSCT (Group 1), 55 patients treated with usual chemotherapy (Group 2), and 55 normal populations (Group 3). The QLQ-30 scores of each group were evaluated and compaired with x² test. Results: Global quality of in group 1, 3 (score: 73.5, 79.3, respectively) were higher than that (score: 51.7) of group 2. Role and social function were lower in group 1, 2 (score: 64.3/68.9, 57.6/70.3, respectively) than those (score: 85.2/85.5) of group 3. The degree of nausea and vomiting was more severe in group 1 (score: 8.7) than those of group 2, 3 (score: 4.5, 3.2 respectively). Pain scores of group 1, 2 (score: 17.0, 19.2, respectively) were more higher than that of group 3 (score: 9.6) In other parameters of QLQ-C30, there was no significant difference between each groups. Conclusion: Our perliminary result may suggest that HSCT is not necessarily associated with deterioration of QOL. This underlines the necessity of undertaking perospective studies using reliable and well-validate methods for measuring QOL