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혈액종양 : 원발성 식도 미만성 거대 B세포 림프종 2예: 치료와 문헌적 고찰
김지혜 ( Ji Hye Kim ),정윤화 ( Yun Hwa Jung ),우인숙 ( In Sook Woo ),한치화 ( Chi Wha Han ),서민우 ( Min Woo Seo ),유상훈 ( Sang Hoon Yoo ),하소영 ( So Young Ha ) 대한내과학회 2015 대한내과학회지 Vol.88 No.2
Primary esophageal lymphoma is very rare, and most reported cases are histologically mucosa-associated lymphoid tissue lymphoma. Therefore, the principle treatment strategy for primary esophageal lymphoma focuses on local treatments, such as endoscopic mucosal resection or radiation therapy, but systemic chemotherapy plays the central role in the treatment of diffuse large B cell lymphoma (DLBCL). Generally, standard treatment for DLBCL is six or three cycles of R-CHOP chemotherapy followed by involved field radiation therapy according to stage. However, the optimal treatment strategy for primary esophageal DLBCL, and the role of additional radiation is not settled, due to a paucity of cases. Moreover, the clinical characteristics related to the etiology and natural course are also unknown. Here, we present two cases of primary esophageal DLBCL with a literature review. (Korean J Med 2015;88:224-230)
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급성 골수성 백혈병에서 busulfan, thiotepa, 그리고 melphalan 3제 알킬화제제 전처치를 이용한 동종 골수이식
박수정(Soo Jeong Park),민우성(Woo Sung Min),김희제(Hee Je Kim),박은정(Eun Joung Park),엄기성(Ki Seong Eum),엄현석(Hyeon Seok Eum),민창기(Chang Ki Min),김동욱(Dong Wook Kim),이종욱(Jong Wook Lee),진종률(Jong Yul Jin),한치화(Chi Wha Ha 대한내과학회 2001 대한내과학회지 Vol.60 No.2
N/A Background : The purpose of this study was to evaluate the toxicity and efficacy of high-dose chemotherapy with busulfan, thiotepa and melphalan (BTM) as a myeloablative regimen in allogeneic bone marrow transplantation (allo-BMT) for patients with acute myelogenous leukemia (AML). Methods : Twenty-seven patients with AML were enrolled; Sixteen patients had standard risk (SR) diseases (first complete remission (CR1) and de novo AML) and eleven patients had high risk (HR) diseases (second, or subsequent remission, secondary AML, relapsed, or refractory AML, CR marrow with persisting extramedullary manifestation (chloroma), or hypoplastic acute leukemia). The conditioning regimen included busulfan 4 mg/kg/day for a total dose of 12 mg/kg; thiotepa 250 mg/m2/day for a total dose of 500 mg/m2; and melphalan 50 mg/m2/day for a total dose of 100 mg/m2. Cyclosporine A and short-course methotrexate were used for graft-versus-host disease (GVHD) prophylaxis. Results : The median time to recovery a granulocyte count of 0.5 x 109/L was 14 days (range 10∼25 days) and platelet transfusion independence was 30 days (range 12∼49 days). The major regimen-related toxicities were gastrointestinal-related symptoms including oral mucositis, nausea, vomiting, and diarrhea. All patients experienced oral mucositis (≥ grade 1) and the patients with oral mucositis of equal and greater than grade 3 were 44% in SR and 45% in HR. The toxicities associated with lung, skin, heart and brain were minimal. Three (11%) patients had severe or fatal veno-occlusive disease (VOD). There were five treatment-related death (19%) (hepatic VOD with multiorgan failure (n=3), pneumonia and ARDS (n=2)) within the first 100 days after allo-BMT. There was not a significant difference between SR and HR group (p=0.167). The incidence of acute GVHD equal or greater than grade II was less than 10%. The actual survival at 2 year was 70.4%(95% confidence interval (CI), 54.7%∼86.1%)(SR; 81.3% (95% CI; 63.4∼99.1%) vs HR; 54.6% (95% CI; 28.7∼80.4%), p=0.154). After a median follow-up of 630 days, 18 of 27 (67%, 355∼1062 days) patients are alive without evidence of disease. Three of the 27 patients relapsed (SR; 0% vs HR; 55.6% (95% CI; 19.6∼71.3%), p=0.004). Conclusion : The BTM regimen followed by allo-BMT is associated with acceptable toxicity and appears to have significant activity in patients with AML. It should be used with caution in patients with prior hepatopathy or refractory state who have an increased risk of severe VOD. Busulfan, thiotepa, and melphalan is an effective and alternative myeloablative regimen for patients with AML.(Korean J Med 60:156-166, 2001)
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