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Littoral Cell Angioma에 동반된 Bicytopenia 1예
송무곤,설영미,박영은,안성규,최영진,신호진,정주섭,조군제 대한혈액학회 2007 Blood Research Vol.42 No.2
LCA는 양성의 경과를 취하는 비장의 원발성 혈관 종양의 일종으로, 복부종괴와 빈혈, 혈소판감소증, 불명열 등으로 발견되고 비장절제술을 시행하여 최종적으로 진단되어 치료될 수 있는 것으로 알려져 있다. 그러나 비록 드문 예이기는 하나 비장절제술 이후에도 증상이 호전되지 않거나 재발하는 경우가 있는데, 이는 비장에서 원격전이된 LCA의 존재에 대한 가능성과 동시에 알려지지 않은 이차적인 혈소판감소증의 원인이 될만한 자가면역성 질환의 존재를 시사하는 것이라 하겠다.1,10-12) 본원에서는 빈혈과 혈소판감소증으로 내원하여 비장절제술 이후 LCA로 진단되었으나 적혈구와 혈소판 수치가 회복되지 않은 1예를 경험하였기에 증례보고를 하는 바이다.
국소 진행성 두경부암의 S-1과 Cisplatin의 유도 화학요법
정주섭,최영진,설영미,송무곤,신호진,조군제 부산대학교 병원 암연구소 2008 부산대병원학술지 Vol.- No.23
Objective: This study was performed to assess the efficacy and safety profiles of the combination treatment with S-1 and Cisplatin in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). Design: Eligibility criteria consisted of histologically confirmed SCCHN, stage III or IV with no evidence of distant metastasis, evaluable lesions, adequate organ function, age of 20-80 years, and a performance status of 2 or less. Cisplatin was infused over 1 hour on day 1 (75 mg/m²) and S-1 was administered orally for 14 consecutive days (days 2-15). The dosages of S-1 were assigned according to the patients' body surface area (BSA): 50 mg twice a day (B5A<1.5m²),or 60 mg twice a day (B5A>1.5m²). Each course was repeated every 3 weeks. After 2 courses, tumor response was evaluated by CT scan and laryngoscopy. If the patients achieved a response (complete response: CR, or partial response: PR), they received one more course of chemotherapy before undergoing radical treatment such as radiotherapy or operation. Results: All 30 patients were assessable for toxicity, and 29 patients for response. Theoverall response was 89.7 % (CR:9, PR:17). 2 year estimated overall survival rate was 79.2 %. Adverse reactions occurred 128 times during 81 courses in the 30 cases. The most common grade 3/4 adverse event was neutropenia, which occurred in 8 patients. Non-hematological grade 3 or 4 toxicity included nausea and vomiting in 4 patients, stomatitis in 2 patients, and diarrhea in 1 patient. Conclusion: S-1 plus cisplatin combination chemotherapy is effective against locally advanced SCCHN with mild toxicity.
송무곤,정주섭,설영미,권보란,신호진,최영진,조군제 대한의학회 2009 Journal of Korean medical science Vol.24 No.4
Previous reports have suggested that a high serum cyclosporine A (CsA) level could result in a lower incidence of acute-graft-versus-host disease (aGVHD). An elevated serum lactate dehydrogenase (LDH) level has been reported to be an adverse predictor of outcome in stem cell transplantation (SCT) for acute myeloid leukemia. In this study, we retrospectively analyzed the records of 24 patients who received allogeneic SCT from an HLA-matched sibling donor for acute and chronic myelogenous leukemia. Univariate analysis showed that two factors (the serum CsA level at the third week after SCT and the LDH level at the third week after SCT) were significantly associated with the incidence of aGVHD among several variables (age, sex, stem cell source, cell dose, C-reactive protein, absolute lymphocyte count, conditioning regimens, and time to engraftment). A higher serum level of CsA and lower serum LDH level at the third week after SCT were associated with a lower incidence of aGVHD (P=0.015, 0.030). In multivariate analysis, the serum CsA level (hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.022-0.652, P=0.0014) and serum LDH level (HR, 6.59; 95% CI, 1.197-36.316, P=0.030) at the third week after SCT were found to be independent factors that were significantly associated with the development of aGVHD. We conclude that a high CsA level and low LDH level might predict a low cumulative incidence of aGVHD after allogeneic transplantation from a matched sibling donor.
송과체에 발생한 Pineal Parenchymal Tumor의 1예
오민영,정주섭,신호진,최영진,송무곤,설영미,김효정 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1
서론: 송과체 부위에 발생할 수 있는 종양은 크게 4가지로 나눌 수 있으며 germ cell tumor, pineal parenchymal cell tumo(PPT), glial celltumor, other miscellaneous tumor and cyst로 분류한다. 이 중 PPT는 매우 드물어 그 빈도가 서양에서는 원발성 뇌종양의 1% 미만, 북아시아에서는 2.2-8%로 보고되고 있으며 송과체에 발생할 수 있는 원발성 뇌종양으로서는 germinoma 다음으로 흔하고 30%의 빈도를 차지하고있다. PPT는 2007년 WHO 분류에 따르면 pineocytoma WHO grade I, PPT within termediate differentiation WHO grade IIIII, pineoblastoma WHO grade IV로 분류할 수 있으며 이중 PPT with intermediate differentiation이 그 빈도가 가장 낮다. PPT로 진단된 환자는 종양이 주로대뇌수도관을 폐쇄하여 폐쇄성 수두증을 유발하기 때문에 이와 관련된 증상을 주소로 병원을 방문한다. 치료는 아직 명확히 확립되어있지 않아 병기와 무관하게 수술 또는 방사선치료 단독 요법이나 이 두 가지를 병합하거나 수술과 항암요법을 병합하는 방법들이 제시되고 있다. 자들은 조직학적으로 pineal parenchymal tumor가 증명되었으며 수술적 제거 및 방사선 병합요법에도 반응을 보이지 않아 항암치료를 병합한 증례1예를 경험하였기에 보고하는 바이다. 증례: 37세 남자로 기립성저혈압을 주소로 내원하였다. 병력 및 신체검사, 혈액검사상 특이견 없었으며 기립경 검사 및 비디오 안구검사상 특이소견 없었다. CT brain 상 중뇌 후상부에 위치한 2.5cm가량의 석회화를 동반한 조영 강되는 덩어리가 보였으며 이는 송과체에 생긴 것으로 추정되었다. 종자세포종의 가능성이 높아 보였으나 송과체암 또는 신경 교암의 가능성 어수술적 제거를 시행하였고 조직 검사 상 pineal parenchymal tumor of intermediate differentiation WHO grade Ⅲ로 진단되었다. 술 후 잔존암에 대하여 총 27회의 방사선치료를 시행하였으며 반응평가를 위해 시행한 MRI brain 상 잔존 암의 크기 증가소견이 있었다. 고식적항 암치료로 환자는 첫번째 PCV (Procarbazine, Lomustine, Vincristine) 항암치료 시행하였으며 2번째 항암치료를 계획 중이다.
김효정,설영미,송무곤,최영진,신호진,박상혁,이은엽,정주섭 대한혈액학회 2016 Blood Research Vol.51 No.3
BackgroundIt is widely known that the prognosis of acute myeloid leukemia (AML) depends on chro-mosomal abnormalities. The majority of AML patients relapse and experience a dismal disease course despite initial remission.MethodsWe reviewed the medical records and laboratory findings of 55 AML patients who had relapsed between 2004 and 2013 and who had been treated at the Division of Hematology of the Pusan National University Hospital. ResultsThe event-free survival (EFS) was related to prognostic karyotype classification at the time of diagnosis and relapse (unfavorable vs. favorable or intermediate karyotypes at diag-nosis, 8.2 vs. 11.9 mo, P=0.003; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.2 vs. 11.9 mo, P=0.009). The overall survival (OS) was significantly corre-lated with karyotype classification only at diagnosis (unfavorable vs. favorable or inter-mediate vs. karyotypes at diagnosis, 8.5 vs. 21.8 mo, P=0.001; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.5 vs. 21.2 mo, P=0.136). A change in karyotype between diagnosis and relapse, which is regarded as a factor of resistance against treat-ment, was not a significant prognostic factor for OS, EFS, and post-relapse survival (PRS). A Cox proportional hazards model showed that the combined use of fludarabine, cytosine arabinoside, and granulocyte colony-stimulating factor (FLAG) as a salvage regimen, was a significant prognostic factor for OS (hazard ratio=0.399, P=0.010) and the PRS (hazard ratio=0.447, P=0.031).ConclusionThe karyotype classification at diagnosis predicts survival including PRS in relapsed AML patients as well as in treatment-naïve patients. We suggest that presently, administration of salvage FLAG could be a better treatment option.
김효정,설영미,송무곤,최영진,신호진,박상혁,이은엽,정주섭 대한혈액학회 2016 Blood Research Vol.51 No.3
BackgroundIt is widely known that the prognosis of acute myeloid leukemia (AML) depends on chro-mosomal abnormalities. The majority of AML patients relapse and experience a dismal disease course despite initial remission.MethodsWe reviewed the medical records and laboratory findings of 55 AML patients who had relapsed between 2004 and 2013 and who had been treated at the Division of Hematology of the Pusan National University Hospital. ResultsThe event-free survival (EFS) was related to prognostic karyotype classification at the time of diagnosis and relapse (unfavorable vs. favorable or intermediate karyotypes at diag-nosis, 8.2 vs. 11.9 mo, P=0.003; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.2 vs. 11.9 mo, P=0.009). The overall survival (OS) was significantly corre-lated with karyotype classification only at diagnosis (unfavorable vs. favorable or inter-mediate vs. karyotypes at diagnosis, 8.5 vs. 21.8 mo, P=0.001; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.5 vs. 21.2 mo, P=0.136). A change in karyotype between diagnosis and relapse, which is regarded as a factor of resistance against treat-ment, was not a significant prognostic factor for OS, EFS, and post-relapse survival (PRS). A Cox proportional hazards model showed that the combined use of fludarabine, cytosine arabinoside, and granulocyte colony-stimulating factor (FLAG) as a salvage regimen, was a significant prognostic factor for OS (hazard ratio=0.399, P=0.010) and the PRS (hazard ratio=0.447, P=0.031).ConclusionThe karyotype classification at diagnosis predicts survival including PRS in relapsed AML patients as well as in treatment-naïve patients. We suggest that presently, administration of salvage FLAG could be a better treatment option.