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급성전골수구성백혈병에서 PML/RARα 유전자 이형의 임상적 의의
이원식 ( Won Sik Lee ),이상민 ( Sang Min Lee ),이규형 ( Kyoo Hyung Lee ),이제환 ( Je Hwan Lee ),최성준 ( Seong Joon Choi ),이정희 ( Jung Hee Lee ),김대영 ( Dae Young Kim ),임성남 ( Sung Nam Lim ),박재후 ( Jae Hoo Park ),민영주 ( Y 대한내과학회 2008 대한내과학회지 Vol.75 No.4
Background/Aims: There are three types of PML-RARα mRNA fusion transcripts associated with acute promyelocytic leukemia (APL): the short (S)-form, the long (L)-form and the variable (V)-form. No study on the Korean population has addressed the clinical significance of the specific types of PML-RARα mRNA fusion transcripts for APL patients who receive the combination therapy of all-trans-retinoic-acid and idarubicin (AIDA regimen). Methods: We performed a retrospective analysis on 94 patients with APL to evaluate differences in the therapeutic outcomes, such as the response rate, an event-free survival (EFS), and overall survival (OS), after remission following the induction of chemotherapy. We also analyzed whether differences in the pretreatment clinical characteristics depend on the PML-RARα isoform. Results: The median age of the patients was 41 years (range 15-85). Among the 94 patients, there were 58 L-form cases (62.1%), 32 S-form cases (34.0%), and 4 V-form cases (4.3%). The CR rate following remission induction treatment was 84.9%. The CR rate was higher in patients with an initial WBC<10.0×109/L, as compared to patients with an initial WBC higher than 10.0×109/L (93.5% vs. 65.4%, p=0.001). The AIDA induction regimen was associated with a better EFS than non-AIDA induction regimens (81.9% vs. 49.6%, p=0.006). The induction group was also a significant prognostic factor for EFS in the multivariate analysis (p=0.020). There were no differences in OS and EFS in patients with either isoform L or isoform S in the AIDA induction group. Conclusions: This retrospective study demonstrated that pretreatment clinical characteristics and treatment outcomes were not significantly different among patients with varying PML-RARα isoform types in the AIDA induction group. (Korean J Med 75:412-419, 2008)
최은경,장혜숙,서철원,이규형,이정신,김상희,최철준,고윤석,김우성,김원동,김삼현,손광현,Choi, Euk-Kyung,Chang, Hye-Sook,Suh, Cheol-Won,Lee, Kyoo-Hyung,Lee, Jung-Shin,Kim, Sang-Hee,Choi, Chul-Joon,Koh, Youn-Suck,Kim, Woo-Sung,Kim, Won-Dong,K The Korean Society for Radiation Oncology 1991 Radiation Oncology Journal Vol.9 No.2
제3기의 진행성 비소세포 폐암에서의 MVP항암 요법과 다분할 방사선 치료의 효과를 판정하기 위하여 1991년 1월부터 전향성 임의선택 연구(prospective randomized study)를 시작하였다. 본 연구는 제III기의 비소세포 폐암중 절제가 불가능한 환자를 대상으로 하여 MVP 항암요법(Mitomycin C 6mg/$m^2$, Vinblastine 6 mg/$m^2$, Cisplatin 60 mg/$m^2$)을 3회 시행한 후 다분할 방사선치료 (120 cGy/ft BID)를 6500 cGy까지 조사하였다. 방사선치료가 끝난 1개월 후 관해정도를 확인하여 추가 항암요법을 시행하는 군과 계속 관찰하는 군으로 임의 분류하였다. 1991년 8월까지 18명의 환자가 등록 되었으며 이중 2명은 2cycle의 항암요법 후 치료를 포기하여 16명의 환자에 대한 분석을 시행하였다. MVP항암요법에 대한 관해율은 $62.5\%$로 $50\%$에서는 부분관해 $12.5\%$에서는 minimal response를 보였다. 항암요법에 부분관해를 보인 3명중 1명에서는 방사선 치료후 완전관해를 보였으며 항암요법으로 병이 진행된 6명의 환자중 4명에서는 방사선 치료후에도 역시 병이 진행되는 것을 알 수 있었다. 모든 환자는 다분할 방사선 치료를 잘 견뎠으나 한 환자가 방사선 치료 한달 후 항암요법과 관련된 부작용으로 사망하였다. 아직 추적관찰 기간이 짧고 대상 환자가 많지 않다는 문제점은 있으나 본 연구를 계속 진행함으로써 유의한 결과를 얻을 수 있을 것으로 기대된다. To evaluate the effect of MVP chemotherapy and hyperfractionated radiotherapy in Stage III unresectable non small cell lung cancer (NSCLC), authors have conducted a prospective randomized study since January 1991, Stage IIIa or IIIb unresectable NSCLC patients were treated with hyperfractionated radiotherapy (120 cGy/fx BID) up to 6500 cGy following 3 cycles of induction MVP (Mitomycin C 6 mg/$m^2$, Vinblastine 6 mg/$m^2$, Cisplatin 60 mg/$m^2$) and randomized for either observation or 3 cycles of maintenance MVP chemotherapy. Until August 1991, 18 patients were registered to this study. 4 cases were stage IIIa and 14 were stage IIIb. Among 18 cases 2 were lost after 2 cycles of chemotherapy, and 46 were analyzed for this preliminary report. The response rate of induction chemotherapy was $62.5\%$ : partial response, $50\%$ and minimal response, $12.5\%$. Residual tumor of the one partial responder was completely disappeared after radiotherapy. Among 6 cases who were progressed during induction chemotherapy, 4 of them were also progressed after radiotherapy. All patients were tolerated BID radiotherapy without definite increase of acute complications, compared with conventional radiotherapy group. But at the time of this report, one patient expired in two month after the completion of the radiotherapy because of treatment related complication. Although the longer follow up is needed, authors are encouraged with higher response rate and acceptable toxicity of this treatment. Authors believe that this study is worthwhile to continue.
성인 급성 림프구성 백혈병의 예후 : - 33 예의 환자들을 대상으로 한 분석 -
조유숙(You Sook Cho),이규형(Kyoo Hyung Lee),이제환(Je Hwan Lee),김성배(Sung Bae Kim),김상위(Sang We Kim),서철원(Cheol Won Suh),이정신(Jung Shin Lee),김우건(Woo Kun Kim),김상희(Sang Hee Kim),지현숙(Hyun Sook Chi),박찬정(Chan Jung Park 대한내과학회 1997 대한내과학회지 Vol.52 No.3
N/A Objectives: Rate of complete remission and long-term survival in adult acute lymphoblastic leukemia group has not been as satisfactory as that in childhood ALL. Recently introduction of induction chemotherapy of more intensive combination and various trials of postremission therapy are making improved results better looked forward to. And subtypes of ALL according to the degree of differentiation into T and B cells are identified by using immunologic markers hopefully to work out proper treatment for each subtype. Methods: We analited results of treatment and differences of complete remission rate, remission duration and overall survival as to various immunologic markers and clinicopathologic characteristics in 33adult ALL patients. Results: Eighty five percents of the 27cases that had VPDL chemotherapy achieved complete remission and both overall median survival and mediom duration of remission were 52weeks. No definite prognostic factors were detected influencing complete remission rate, remission duration and overall survival except that patients with serum albumin level higher than 4.0mg/dL showed highter complete remission rate. Although mature B-ALL showed the shortest overall median survival, degree of differenciation of B-cell and other immunologic markers did not influence on complete remission rate, remission duration or overall survival. Conclusion: Further studies are needed to delire the prognostic factors in adult ALL