혈액종양을 동반한 다발성 원발성 악성종양에 관한 고찰

한지숙,이종인,민유홍,고윤웅 大韓血液學會 1995 大韓血液學會誌 Vol.30 No.1

Statistics of hematologic malignancies in Korea: incidence, prevalence and survival rates from 1999 to 2008

Hyeon Jin Park,Eun-Hye Park,Kyu-Won Jung,Hyun-Joo Kong,Young-Joo Won,Joo Young Lee,Joo Young Lee,Byung-Kiu Park,Hyewon Lee,Hyeon-Seok Eom,Sohee Park 대한혈액학회 2012 Blood Research Vol.47 No.1

Background The nationwide statistical analysis of hematologic malignancies in Korea has not been reported yet. Methods The Korea Central Cancer Registry and the Korean Society of Hematology jointly investigated domestic incidence rates and prevalence of hematologic malignancies occurred between 1999 and 2008, and analyzed survival rates of patients who were diagnosed between 1993 and 2008. Data of hematologic malignancies from 1993 to 2008 were obtained from the Korean National Cancer Incidence Data base. The crude incidence rates, age-specific incidence rates, age-standardized incidence rates, annual percentage change of incidence, and prevalence from 1999-2008 were calculated. Survival rates for patients diagnosed in 1993-2008 were estimated. Results In 2008, a total of 8,006 cases of hematologic malignancies were occurred, which comprised 4.5% of all malignancies. In all genders, non-Hodgkin lymphoma, myeloid leukemia, and multiple myeloma were most frequent diseases. In terms of age, ages between 60 and 69 were most prevalent. From 1999 to 2008, the age-standardized incidence rates increased from 10.2 to 13.7, and the annual percentage change was 3.9%. The 5-year survival rate increased from 38.2% during 1993-1995 to 55.2% during 2004-2008. As of January 2009, number of patients with 10-year prevalence was 33,130, and with 5- to 10-year prevalence was 10,515. Conclusion This is the first nationwide statistical report of hematologic malignancies in Korea. It could be used as the basic information to help investigate epidemiologic characteristics, evaluate progress during the past years, and establish future strategies for hematologic malignancies. Periodic statistical analysis of hematologic malignancies in Korea should be continued.

Prognostic factors in critically ill patients with hematologic malignancies admitted to the intensive care unit

Yeo, C.D.,Kim, J.W.,Kim, S.C.,Kim, Y.K.,Kim, K.H.,Kim, H.J.,Lee, S.,Rhee, C.K. Grune Stratton 2012 Journal of critical care Vol.27 No.6

Objective: Despite an improvement in the prognosis of patients with hematologic malignancies, the mortality of such patients transferred to the intensive care unit (ICU) is high. This study determined the predictors of mortality in a cohort of critically ill patients with hematologic malignancies admitted to the ICU. Methods: We studied 227 critically ill patients with hematologic malignancies who were admitted to the ICU between April 2009 and December 2011. A cohort of consecutive patients with hematologic malignancies was reviewed retrospectively to identify clinically useful prognostic factors. Results: The ICU mortality rate was 84.1%, and the in-hospital mortality rate was 89.9%. The ICU mortality was significantly higher in patients with acute leukemia than in those with other malignancies. A significant difference between survivors and nonsurvivors was found in neutropenia and its recovery during the ICU stay, presence of cardiac dysfunction, the need for an invasive mechanical ventilator, use of inotropic/vasopressor agents, platelet count, aspartate transaminase level, pH, and Acute Physiology And Chronic Health Evaluation II score. In the multivariate analysis, acute leukemia, need for invasive mechanical ventilator, use of inotropic/vasopressor agents, and Acute Physiology And Chronic Health Evaluation II scores were independently associated with a worse outcome in patients with hematologic malignancies admitted to the ICU. Conclusion: Higher mortality in patients with hematologic malignancies admitted to the ICU is associated with more severe illness, as reflected by higher organ failure scores or respiratory or hemodynamic instability. Mortality is higher in patients with acute leukemia as compared with other hematologic malignancies.

Fertility preservation for patients with hematologic malignancies: The Korean Society for Fertility Preservation clinical guidelines

Lee, Dong-Yun,Kim, Seul Ki,Kim, Miran,Hwang, Kyung Joo,Kim, Seok Hyun The Korean Society for Reproductive Medicine 2017 Clinical and Experimental Reproductive Medicine Vol.44 No.4

Although the survival rate of hematologic malignancies in young patients is very high, cytotoxic therapies such as chemotherapy and total body irradiation therapy can significantly reduce a patient's reproductive capacity and cause irreversible infertility. Early ovarian failure also commonly occurs following additional cancer treatment, bone marrow transplantation, or autologous transplantation. Because the risk of early ovarian failure depends on the patient's circumstances, patients with a hematologic malignancy must consult health professionals regarding fertility preservation before undergoing treatments that can potentially damage their ovaries. While it is widely known that early menopause commonly occurs following breast cancer treatment, there is a lack of reliable study results regarding fertility preservation during hematologic malignancy treatment. Therefore, an in-depth discussion between patients and health professionals about the pros and cons of the various options for fertility preservation is necessary. In this study, we review germ cell toxicity, which occurs during the treatment of hematologic malignancies, and propose guidelines for fertility preservation in younger patients with hematologic malignancies.

혈액암 환자의 aminoglycoside의 약물동태

이내영,김호순,박경호,조남춘 한국병원약사회 1998 병원약사회지 Vol.15 No.1

A major determinant of serum aminoglycoside concentration is the volume of distribution (Vd), which has been reported to be larger than normal in patients with hematologic malignancies. But, the cause of the large Vd seen in these patients is not known. In this study we would like to confirm that the Vds of korean patients with hematologic malignancies are larger than population value, and reveal the effect of hydration and malignancy itself on Vds. We conducted a retrospective study with 15∼70 year old patients receiving TDM, who hospitalized at our hospital between 1994 and 1997. Forty patients with a malignancy were hydrated(1st group). In the patients without a malignancy, 34 patients were hydrated(2nd group) and 32 patients were not hydrated(3rd group). Pharmacokinetic parameters were determined by the method of Sawchuk et al. Student t-test was used to determined statistical differences between group means. Vd of aminoglycosides of 1st group was significantly greater than that of 3rd group (p<0.05). Vd of aminoglycosides of 2nd group was greater than that of 3rd group(p<0.05). However, there is no significant differences in Vd of aminoglycosides between group 1 and group 2. We conclude the korean patients with hematologic malignancy also have the increased Vd, which is affected by hydration associated with the chemotherapy.

P-9 Safety of percutaneous dilatational tracheostomy in patients with hematologic malignancy

이종민,김석찬,이종욱,이진국 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Purpose: In patients with hematologic malignancies, acute respiratory failure requiring mechanical ventilation is a severe and frequent complication. Recent have shown that the outcome of mechanically ventilated patients with hematologic malignancies over the last decade. This study conducted to clarify if percutaneous dilatational tracheostomy (PDT) is safe in this group of patients and to report the outcome of patients with hematologic malignancies requiring long-term mechanical ventilation. Methods: To evaluate the safety of PDT in patients with hematologic malignancies, we retrospectively analyzed the clinical characteristics of patients who underwent PDT in medical ICU from January 2012 to January 2017. Results: PDT was safely performed in all 55 patients. Although 5 (9.1 %) patients developed major bleeding that required electric coagulation, fatal complications were not observed. Of the 55 patients in this study, 21 (38.2 %) could be weaned from ventilator, and 19 (34.6%) survived the intensive care unit stay. There were no differences in the demographics, laboratory findings between patients with bleeding complication and those with none. Bleeding complications were significantly fewer in patients with history of hematopoietic stem cell transplantation (p = 0.032). Conclusion: PDT can be safely performed on patients with hematologic malignancies. The procedure did not result fatal complications in this study.

Variable Natural Killer Cell Activity in Hematological Malignancies at Diagnosis

박설희,문영철,성주명,허희진,허정원 대한진단검사의학회 2018 Laboratory Medicine Online Vol.8 No.2

Background: Natural killer (NK) cells play a key role in innate immune responses and are an important component of anti-cancer defenses. This study aimed to investigate the clinicopathological characteristics of NK cell activity (NKA) among various hematological malignancies at diagnosis and to evaluate their clinical value as a monitoring marker. Methods: A total of 111 patients that were newly diagnosed with hematological malignancies were recruited, comprising 18 acute myeloid leukemia (AML), 31 multiple myeloma (MM), and 62 lymphoma. Twenty-three normal control subjects from our health examination center were recruited. NKA was measured using a commercially available enzyme-linked immunosorbent assay kit, which measures interferon-gamma secreted by ex vivo-stimulated NK cells in whole blood. Results: The 111 patients had a median NKA of 202.80 pg/mL (range 40–2,000). NKA was significantly decreased in patients with AML (median 47.05 pg/mL, 40–2,000, P <0.0001), MM (275.00, 40–2,000, P <0.0001), and lymphoma (289.49, 40–2,000, P <0.0001) compared with that in normal controls (1,891, 412–2,000). There was a difference in NKA between AML and lymphoma (P =0.0499). Serial changes in NKA correlated with disease progression. NKA did not correlate with the NK cell count in any group of hematological malignancies. Conclusions: The measurement of NKA could be useful to evaluate the immunological status in hematological malignancies at diagnosis and during follow-up.

혈액종양환자의 타액과 치아우식활성도 평가

김형준 ( Hyeoung Joon Kim ),정경이 ( Kyung Yi Jeong ),박지일 ( Ji Il Park ) 한국치위생학회(구 한국치위생교육학회) 2013 한국치위생학회지 Vol.13 No.3

Objectives : This study was performed to evaluate the salivary secretion, salivary pH and cariogenic activity using unstimulated whole saliva in patients with hematologic malignancy. Methods : Nineteen patients (9 male, 10 female) who had hematologic malignancy and were treated with chemotherapy or bone marrow transplantation, and nineteen normal volunteers (7 male, 12 female) as control group were included. The mean age of patients group and control group was 45.1 and 46.7 years, respectively. Patients group was examined salivary secretion, salivary pH, and cariogenic activity using unstimulated whole saliva and was compared with control group. Results : In comparison with control group, salivary secretion, salivary pH and salivary buffer capacity were significantly lower in patients with hematologic malignancy (p<0.01). Both cariogenic activity(p<0.01) and the number of Lactobacilli(p<0.05) are higher in patients group than control group. Conclusions : These results suggest that the unstimulated whole salivary secretion, pH and buffer capacity were lower in patients with hematologic malignancy than control group. Cariogenic activity is higher in patients with hematologic malignancy than control group. Such salivary factor and cariogenic activity can increase the possibility of induction of dental caries.

혈액종양질환 환자에서 자가말초혈액 조혈모세포이식 시 가동화

김민지,김상경,이아진,장해봉,배성화,류헌모 대한진단검사의학회 2014 Laboratory Medicine Online Vol.4 No.1

Background: Autologous peripheral blood-stem cell transplantation (autoPBSCT) is the treatment of choice for hematologic malignancy, because the technique requires neither general anesthesia nor surgical intervention, amongst many other advantages. Despite these benefits, the risk of hematologic malignancy, as well as the effect of patient age and sex on the prediction of successful collection of autoPBSCT are still unclear. The purpose of this study was to examine whether the hematologic diagnosis of the disease, and age or sex affect the mobilization of CD34+ cells and mononuclear cells. Methods: We retrospectively investigated 30 (6 multiple myeloma, 11 diffuse large B-cell lymphoma, 8 acute myeloid leukemia, 2 acute lymphoid leukemia, and 3 T-cell lymphoma) patients who underwent autoPBSCT between 2008 and 2011 at Daegu Catholic University Hospital. Results: Patients with multiple myeloma had the highest average of both mononuclear cell (MNC) (2.07±0.67×108 cells/kg) and CD34+ cell (1.28±0.58×106 cells/kg) counts. Patients with T-cell lymphoma had both the lowest MNC (1.23±0.49×108 cells/kg) and CD34+ cell (0.20±0.6×106 cells/kg) counts. Male patients showed greater collected CD34+ cell counts (0.96±1.38×106 cells/kg) and MNC counts (1.71±0.76×108 cells/kg) than the female patients. Patients under the age of 44 had higher collected CD34+ cell counts (0.96±1.37×106 cells/kg) but lower counts of MNC (1.49±0.74×108 cells/kg). Conclusions: The collected MNC and CD34+ cell counts varied between the types of malignancies, and with respect to sex and age. However, only collected MNC counts were significantly different (P<0.05) among the different types of malignancies. 배경: 자가말초혈액조혈모세포이식은 전신마취, 수술적 접근, 장기기간의 입원 등이 필요하지 않은 많은 장점을 가진 치료방법으로 알려짐에도 불구하고 악성혈액질환 환자들의 상태가 말초조혈모세포 채집산물에 어떠한 영향을 미치는가에 대해서는 아직 논란이 존재한다. 따라서 본 연구를 통하여 저자들은 악성혈액질환 환자들의 진단명, 성별 및 나이가 말초조혈모세포 채집산물에 존재하는 CD34양성세포 수와 단핵세포 수에 어떠한 영향을 미치는가에 대하여 알아보고자 하였다. 방법: 2008년부터 2011년까지 대구가톨릭대학병원에서 자가말초혈액조혈모세포이식술을 시행 받은 30명의 악성혈액질환 환자를 대상으로 연구를 시행하였다. 악성혈액질환에는 급성림프구성백혈병(acute lymphoid leukemia, ALL) 환자 2명, 급성골수구성백혈병(acute myeloid leukemia, AML) 환자 8명, 미만성큰B세포림프종(diffuse large B-cell lymphoma, DLBL) 환자 11명, 다발골수종 (multiple myeloma, MM) 환자 6명과 T세포림프종(T-cell lymphoma) 환자 3명이 포함되었다. 결과: 말초혈액조혈모세포채집술을 시행한 결과 MM 환자들이 가장 높은 평균 단핵세포 수(2.07±0.67×108 cells/kg)와 CD34양성세포 수(1.28±0.58×106 cells/kg)를 나타내었고, T cell lymphoma 환자들이 가장 낮은 평균단핵세포 수(1.23±0.49×108 cells/kg)와 CD34양성세포 수(0.20±0.6×106 cells/kg)를 나타내었다. 남성 환자들이 여성 환자들에 비하여 높은 평균단핵세포 수(1.71±0.76×108 cells/kg)와 CD34양성세포 수(0.96±1.38×106 cells/kg)를 나타내었다. 44세 이하 환자군에서 44세 이상 환자군에 비하여 높은 평균 CD34양성세포 수(0.96±1.37×106 cells/kg)를 나타내었으나 낮은 평균의 단핵세포 수(1.49±0.74×108 cells/kg)를 나타내었다. 결론: 본 연구를 통하여 악성혈액질환 환자들의 진단명, 성별 및 나이별에 따라 말초조혈모세포 채집산물에 존재하는 CD34양성세포 수와 단핵세포 수가 차이가 있음을 확인할 수 있었다. 그러나 통계적으로 유의한 차이를 보이는 유일한 항목은 진단에 따른 단핵세포 수로 분석되었다(P<0.05).

Success Rate and Risk Factors for Failure of Empirical Antifungal Therapy with Itraconazole in Patients with Hematological Malignancies: A Multicenter, Prospective, Open-Label, Observational Study in Korea

김수정,정준원,민유홍,최영진,이동건,이제환,양덕환,김양수,곽재용,박진희,김진영,김훈구,김병수,류헌모,장준호,김민경,강혜진,조인성,문영철,조덕연,김호영,박병배,김진석,이상민,김성현 대한의학회 2014 Journal of Korean medical science Vol.29 No.1

We assessed the success rate of empirical antifungal therapy with itraconazole and evaluated risk factors for predicting the failure of empirical antifungal therapy. A multicenter, prospective, observational study was performed in patients with hematological malignancies who had neutropenic fever and received empirical antifungal therapy with itraconazole at 22 centers. A total of 391 patients who had abnormal findings on chest imaging tests (31.0%) or a positive result of enzyme immunoassay for serum galactomannan (17.6%) showed a 56.5% overall success rate. Positive galactomannan tests before the initiation of the empirical antifungal therapy (P=0.026, hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.10-4.69) and abnormal findings on the chest imaging tests before initiation of the empirical antifungal therapy (P=0.022, HR, 2.03; 95% CI, 1.11-3.71) were significantly associated with poor outcomes for the empirical antifungal therapy. Eight patients (2.0%) had premature discontinuation of itraconazole therapy due to toxicity. It is suggested that positive galactomannan tests and abnormal findings on the chest imaging tests at the time of initiation of the empirical antifungal therapy are risk factors for predicting the failure of the empirical antifungal therapy with itraconazole. (Clinical Trial Registration on National Cancer Institute website, NCT01060462)