Addition of rituximab to the CHOP regimen has no benefit in patients with primary extranodal diffuse large B-cell lymphoma

장근두,Dok Hyun Yoon,Shin Kim,이대호,이상욱,허주령,서철원 대한혈액학회 2011 Blood Research Vol.46 No.2

Background :The addition of rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy (R-CHOP) has significantly improved clinical outcomes for patients with diffuse large B-cell lymphoma (DLBCL). However, new predictors of patient response to R-CHOP have not been established. We aimed to evaluate the impact of R-CHOP compared with CHOP in patients with DLBCL and to establish clinical predictors of better outcomes in these patients. Methods :We retrospectively identified 177 patients diagnosed with CD20-positive DLBCL and treated with CHOP (N=82) or R-CHOP (N=95). The response rate, event-free survival (EFS), and overall survival (OS) rates were compared between the 2 treatment groups. All patients were classified into primary extranodal lymphoma (PENL) or nodal lymphoma (NL) subgroups, and the clinical parameters of each subgroup were analyzed. Results :The overall response rate was higher in R-CHOP group (95% vs. 84%, P=0.07). The 3-year EFS rate was significantly higher in R-CHOP group (71% vs. 52%, P=0.013), but the OS rate was comparable between the 2 groups (79% vs. 69%, P=0.23). A significant survival benefit was seen with R-CHOP compared to CHOP therapy in NL patients (P=0.002 for EFS and 0.04 for OS). Multivariate analyses confirmed that R-CHOP therapy is an independent prognostic factor for EFS (hazard ratio of 0.32 [0.17-0.62], P=0.001) and OS (hazard ratio of 0.4 [0.18-0.87], P=0.02) in NL patients. Conclusion :Patients in the PENL group did not benefit from R-CHOP chemotherapy.

A Phase II Study to Evaluate the Efficacy of Ramosetron, Aprepitant, and Dexamethasone in Preventing Cisplatin-Induced Nausea and Vomiting in Chemotherapy-Naïve Cancer Patients

장근두,송헌호,박건욱,김형수,최대로,권정혜,김호영,한보람,김정한,정주영,김효정,장대영 대한암학회 2013 Cancer Research and Treatment Vol.45 No.3

Purpose Combination therapy with aprepitant, serotonin receptor antagonist, and steroids improves the complete response rate of both acute and delayed chemotherapyinduced nausea and vomiting (CINV). However, it is not known whether ramosetron is suitable for administration in combination with aprepitant. Therefore, we conducted a multicenter, open-label, prospective, phase II study in order to assess the efficacy and tolerability of combination therapy with ramosetron, aprepitant, and dexamethasone (RAD) for prevention of cisplatin-based CINV in chemotherapy-naïve patients with solid cancers. Materials and Methods Forty-one patients with various solid cancers (31 male and 10 female; median age,59 years) who received treatment with highly emetogenic chemotherapy (median cisplatin dose, 70 mg/m²; range 50 to 75 mg/m²) were enrolled in this study. Oral aprepitant (125 mg on day 1; 80 mg on days 2 and 3), intravenous ramosetron (0.6mg on day 1), and oral dexamethasone (12 mg on day 1; 8 mg on days 2-4) were administered for prevention of CINV. Results The complete response (no emesisand retching and no rescue medication) rate was 94.9% in the acute period (24 hours post-chemotherapy), 92.3% in the delayed period (24-120 hours post-chemotherapy), and 92.3% in the overall period (0-120 hours). The absolute complete response (complete response plus no nausea) rate was 74.4%in the acute period, 51.3% in the delayed period, and 46.2% in the overall period. There were no grade 3 or 4 toxicities related to these antiemetic combinations. Conclusion RAD regimen is a safe and effective antiemetic treatment for prevention of CINV in patients receiving highly emetogenic chemotherapy.

재생불량성빈혈 환자 137례의 치료 방법에 따른 생존율

손희정,장근두,신영록,강혜진,박사라,김은경,이경원,이재련,류민희,최성준,이제환,김성배,김상위,이규형,이정신,김우건,서철원 대한혈액학회 2003 Blood Research Vol.38 No.1

Primary leiomyosarcoma of bone: A case report

정은주,장근두,조성진,송헌호 대한내과학회 2012 대한내과학회 추계학술대회 Vol.2012 No.1

성인 암환자의 삶의 질에 대한 단면조사연구 -EORTC QLQ-C30을 중심으로

최대로,권정혜,김형수,장근두,김호영,김정한,정주영,김효정,송헌호,장대영 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

서론: 성인 암 환자의 삶의 질에 대한 연구는 주로 특정 질환이나 특정병기에 국한되어 이루어졌다. 저자들은 다양한 종류와 병기의성인암환자에 대한 삶의 질을 평가하여 암환자의 삶의 질에 대한 전반적인 현황을 파악하고자 하였다. 방법: 2011년 1월부터 3월까지 서, 경기도, 강원도의 대학병원에서 성인 암환자를 대상으로 1회의 설문조사를 시행하였고, 삶의 질은 EORTC QLQ-C30을 사용하였다. 결과: 구에 등록된 환자는 총 553명이었다. 60세 이상의 노인은 277명 있었고, 제4병기인 환자는 165명이었다. 대장암(18.1%), 위암(15.6%), 유암(13.7%), 폐암(10.5%)을 포함한 다양한 종류의 암환자에게 설문을 하였다. 진단 후 3년 이상 경과한 환자는 137명 (24.8%)이었다. 자의 암의 원발 부위 또는 과거에 받은 치료방법에 의해서 삶의 질이 차이를 나타내지는 않았다. 진단 당시의 나이, 병기, 설문시점의 전신행능력이 환자의 삶의 질에 있어서 유의한 차이를 보였다(표1). 진단 이후 36개월 이상 생존한 환자들에 있어서는 인지기능 만이 통계적으로 유의한 차이를 보였다. (p=0.035) 결론: 암환자의 삶의 질은 과거에 시행한 치료나 암의 원발 부위 보다는 진단 당시의 병기, 나이, 전수행능력에 의해 영향을 받는다. 특별히 암이 완치된 cancer survivor의 삶의 질에 대해서는 일회성의 단면조사연구보다는 장기간의 종단연가 필요할 것으로 판단된다.

성인 암환자의 삶의 질에 대한 단면조사연구 - EORTC QLQ-C30을 중심으로

최대로,권정혜,김형수,장근두,김호영,김정한,정주영,김효정,송헌호,장대영 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

The Clinical Utility of FDG PET-CT in Evaluation of Bone Marrow Involvement by Lymphoma

김호영,김주석,최대로,김형수,권정혜,장근두,김정한,정주영,송헌호,이영경,민수기,황희성,김화정,장대영,김효정 대한암학회 2015 Cancer Research and Treatment Vol.47 No.3

Purpose Bone marrow biopsy is a standard method for the evaluation of bone marrow infiltration by lymphoma; however, it is an invasive and painful procedure. Fluorodeoxyglucose positron emission tomography–computed tomography (FDG PET-CT) is a noninvasive imaging technique with the potential to detect bone marrow involvement by lymphoma. Materials and Methods We retrospectively reviewed medical records of lymphoma patients. All patients were examined by FDG PET-CT and iliac crest bone marrow biopsy for initial staging work-up. Results The study population comprised 94 patients (median age, 60 years; 56 males) with Hodgkin’s lymphoma (n=8) or non-Hodgkin’s lymphoma (n=86). Maximum standardized uptake values on the iliac crest of patients with lymphoma infiltrated bone marrow were significantly higher than those of patients with intact bone marrow (2.2±1.2 g/mL vs. 1.3±0.4 g/mL; p=0.001). The calculated values for FDG PET-CT during evaluation of bone marrow involvement were as follows: sensitivity 50%, specificity 96%, positive predictive value 80%, negative predictive value 85%, and positive likelihood ratio (LR+) 11.7. The value of LR+ was 16.0 in patients with aggressive subtypes of non-Hodgkin’s lymphoma (NHL). Conclusion FDG PET-CT could not replace bone marrow biopsy due to the low sensitivity of FDG PET-CT for detection of bone marrow infiltration in lymphoma patients. Conversely, FDG PET-CT had high specificity and LR+; therefore, it could be a useful tool for image-guided biopsy for lymphoma staging, especially for aggressive subtypes of NHL. In addition, unilateral bone marrow biopsy could be substituted for bilateral bone marrow biopsy in lymphoma patients with increased FDG uptake on any iliac crest.

성인 T세포림프구성림프종에 시행한 VPDL 항암화학요법: 단일기관에서 시행한 자가조혈모세포이식과의 비교

윤덕현,손병석,이욱진,임성남,김은경,박인근,김경민,장근두,김신,이대호,허주령,서철원 대한혈액학회 2008 Blood Research Vol.43 No.3

Background: Treatment of T-cell lymphoblastic lymphoma (T-LBL) with CHOP or CHOP-like chemotherapy has resulted in poor long-term outcomes. High-dose chemotherapy followed by ASCT has been applied for this dreaded disease. However, the efficacy is still controversial. T-LBL is considered the nodal/extranodal presentation of acute lymphoblastic leukemia. Favorable results with VPDL chemotherapy have been reported in the setting of adult lymphoblastic leukemia. We, therefore, treated T-LBL patients with modified VPDL chemotherapy and compared the outcomes with those achieved using upfront ASCT. Methods: We retrospectively reviewed the outcomes of 24 T-LBL patients treated either with upfront ASCT (n=11) or VPDL chemotherapy without ASCT (n=13) between January 1996 and October 2005. Results: The median follow-up duration for surviving patients was 17 months (range, 5∼109 months). The two-year event-free survival (EFS) rates were 83.1% in the VPDL group and 27.3% in the upfront ASCT group (P=0.008). The two-year overall survival (OS) rates were 83.9% in the VPDL group and 27.3% in the upfront ASCT group (P=0.006). Conclusion: This study suggests that VPDL chemotherapy is very effective and may be superior to upfront ASCT in the treatment of T-LBL patients.

A phase I/II study of bortezomib plus CHOP every 2 weeks (CHOP-14) in patients with advanced-stage diffuse large B-cell lymphomas

Jeong Eun Kim,Dok Hyun Yoon,장근두,이대호,Shin Kim,박찬식,허주령,Won Seog Kim,박진희,이재훈,이순일,서철원 대한혈액학회 2012 Blood Research Vol.47 No.1

Background Bortezomib targets molecular dysregulation of nuclear factor-kB activation and cell cycle control, which are characteristic features of diffuse large B-cell lymphoma (DLBCL). We evaluated the safety and efficacy of bortezomib treatment with dose-dense cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) every 2 weeks (CHOP-14). Methods Untreated DLBCL patients were enrolled. A phase I dose-escalation study with 1.0, 1.3, and 1.6 mg/m2 bortezomib administration on day 1 and 4 in addition to the CHOP-14 regimen was performed to determine the maximum tolerated dose (MTD) and the dose-limiting toxicity (DLT). Lenograstim 5 mg/kg/d was administered on day 4-13. The bortezomib dose from the phase I study was used in the phase II study. Results Nine and 37 patients were enrolled in the phase I and phase II studies, respectively. The analysis of the phase II results (40 patients) included data of the 3 patients in the last MTD dose cohort of the phase I trial. During the phase I trial, no DLT was observed at any bortezomib dose; therefore, the recommended dose was 1.6 mg/m2. In phase II, the overall response rate was 95% (complete response: 80%; partial response: 15%). Nine out of the 40 patients showed grade 3 sensory neuropathy, and 22 required at least 1 dose reduction. Three patients could not complete the intended 6 cycles of treatment because of severe neuropathy. Conclusion Bortezomib plus CHOP-14 was highly effective for the treatment of untreated DLBCL patients, but in many cases, dose or schedule modification was required to reduce neurotoxicity.

Pilot study for the Psychometric Validation of the Sheffield Profile for Assessment and Referral to Care (SPARC) in Korean Cancer Patients

권정혜,백선경,김도연,김유정,이명아,최혜진,변자민,정진영,Sam H Ahmedzai,장근두 대한암학회 2021 Cancer Research and Treatment Vol.53 No.1

Purpose This study aimed to validate the Sheffield Profile for Assessment and Referral to Care (SPARC) as an effective tool for screening palliative care needs among Korean cancer patients. Materials and Methods The English version of the SPARC was translated by four Korean oncologists and reconciled by a Korean language specialist and a medical oncologist fluent in English. After the first version of the Korean SPARC (K-SPARC) was developed, back-translation into English was performed by a professional translator and bilingual oncologist. The back-translated version was reviewed by the original author (S.H.A.), and modifications were made (ver. 2). The second version of the K-SPARC was tested against other questionnaires, including the Functional Assessment of Cancer Therapy-General (FACT-G) and the Edmonton Symptom Assessment System (ESAS). Results Thirty patients were enrolled in the pilot trial. Fifteen were male, and the median age was 64.5 years. Six patients had an Eastern Cooperative Oncology Group performance status of 2 or more. All patients except one were receiving chemotherapy. Regarding internal consistency, the Cronbach’s α scores for physical symptoms, psychological issues, religious and spiritual issues, independency and activity, family and social issues, and treatment issues were 0.812, 0.804, 0.589, 0.843, 0.754, and 0.822, respectively. The correlation coefficients between the SPARC and FACT-G were 0.479 (p=0.007) for the physical domain and –0.130 (p=0.493) for the social domain. Conclusion This pilot study indicates that the K-SPARC could be a reliable tool to screen for palliative care needs among Korean cancer patients. A further study to validate our findings is ongoing.