• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.8855-8859
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• 2014

Purpose: To investigate the impact of hyperglycemia during inductive treatment on the prognosis of acute lymphocytic leukemia (ALL) in children. Materials and Methods: Clinical data of 159 ALL childhood cases were reviewed. The patients were divided into the hyperglycemia group (fasting $glucose{\geq}126mg/dl$ and/or random blood $glucose{\geq}200mg/dl$) and the euglycemia group according to the blood glucose values. The X2 test was performed to compare the complete remission rates of the two groups, and Kaplan-Meier and log-rank tests were performed to compare the 5-year overall and relapse-free survival. Results: The incidence of hyperglycemia in the $age{\geq}10-year-old$ group was higher than the younger-age group (P=0.009). Values in the interim- and high-risk groups were higher than the standard-risk group (P=0.028), while there was no significant difference between genders (P=0.056). The complete remission rates of the 2 groups demonstrated no significant difference (P=0.134), while the 5-year OS of the hyperglycemia group was lower than in the euglycemia group ($83.8{\pm}6.0%$ vs $94.9{\pm}2.4%$, P=0.014). The 5 -year RFS was significantly lower than the euglycemia group ($62.9{\pm}8.7%$) vs $80.2{\pm}9.1%$, P<0.001). Conclusions: Children with $age{\geq}10year$ old, and in the middle- and high-risk groups appear prone to complicating hyperglycemia during inductive chemotherapy, associated with lower 5-year OS and RFS.

• 대한예방한의학회지
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• 제24권2호
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• pp.17-30
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• 2020

Objectives : To find treatment techniques and design clinical studies, this study reviewed controlled clinical studies on traditional Asian medicine treatment for childhood cancer. Methods : Literature searches were performed on four databases, such as NDSL, OASIS, PubMed, and CNKI. Studies were categorized and analyzed according to the treatment goal and we also assessed the quality of the randomized controlled trials (RCT) using Van Tulder Scale. Results : Twenty-seven studies met our inclusion criteria: 21 RCTs, 4 controlled trials, 2 Cohort studies, however only 6 among the 21 RCTs got the scores of high quality. Various interventions were used, such as herbal medicine, acupuncture, acupressure, and chuna. 7 studies were focused on cure of leukemia or solid cancer. 11 studies were performed to alleviate chemotherapy induced nausea and vomiting. 9 studies were focused on other complications of chemotherapy. Conclusions : Most of the studies reported significant effectiveness of traditional medicine treatment compared to controlled group. However we could not made a definite conclusion because of the low quality and heterogeneity of the studies included. More studies should be performed to introduce traditional Asian medicine to childhood cancer treatment.

• Clinical and Experimental Pediatrics
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• 제55권3호
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• pp.100-106
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• 2012

Purpose: The survival rate for childhood acute lymphoblastic leukemia (ALL) has improved significantly. However, overall prognosis for the 20 to 25% of patients who relapse is poor, and allogeneic hematopoietic stem cell transplantation (HSCT) offers the best chance for cure. In this study, we identified significant prognostic variables by analyzing the outcomes of allogeneic HSCT in ALL patients in second complete remission (CR). Methods: Fifty-three ALL patients (42 men, 79%) who received HSCT in second CR from August 1991 to February 2009 were included (26 sibling donor HSCTs, 49%; 42 bone marrow transplantations, 79%). Study endpoints included cumulative incidence of acute and chronic graft-versus-host disease (GVHD), relapse, 1-year transplant-related mortality (TRM), disease-free survival (DFS), and overall survival (OS). Results: Cumulative incidences of acute GVHD (grade 2 or above) and chronic GVHD were 45.3% and 28.5%, respectively. The estimated 5-year DFS and OS for the cohort was $45.2{\pm}6.8%$ and $48.3{\pm}7%$, respectively. Only donor type, i.e., sibling versus unrelated, showed significant correlation with DFS in multivariate analysis ($p$=0.010). The rates of relapse and 1 year TRM were $28.9{\pm}6.4%$ and $26.4{\pm}6.1%$, respectively, and unrelated donor HSCT ($p$=0.002) and HLA mismatch ($p$=0.022) were significantly correlated with increased TRM in univariate analysis. Conclusion: In this single institution study spanning more than 17 years, sibling donor HSCT was the only factor predicting a favorable result in multivariate analysis, possibly due to increased TRM resulting from unrelated donor HSCT.

• 한국방사선학회논문지
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• 제7권4호
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• pp.259-264
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• 2013

전신방사선조사는 소아백혈병의 치료 방법 중 하나인 조혈모세포이식의 전처치로 이용되고 있으며, 현재 조직보상체를 사용하여 치료를 시행하고 있다. 그러나 조직보상체의 조건에 따라 인체 내부 장기에 미치는 영향을 직접 평가하는 것은 어려움이 있다. 이에 본 연구는 수학적 모의피폭체를 사용하여 방사선의 에너지와 선원과 환자와의 거리(source surface distance, SSD), 조직보상체와 환자와의 거리 변화에 따라 인체 장기의 선량을 평가하였다. 그 결과, 표면선량은 에너지 4 MV, SSD 280 cm, 조직보상체와 환자와의 거리 30 cm일 때 5.84 G/min 으로 가장 높은 수치를 나타내었다. 또한 조직보상체와 환자와의 거리가 30 cm 이하였을 때 TBI에서 가장 이상적인 선량분포를 나타냄을 알 수 있었다.

• 한국콘텐츠학회논문지
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• 제14권4호
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• pp.249-255
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• 2014

전신방사선조사(Total Body Irradiation; TBI)는 백혈병의 치료방법 중의 하나인 조혈모세포 이식법의 전처치로 쓰인다. 2013년 장기이식관리센터 자료에 의하면 조혈모세포이식법의 건수는 계속 늘어나고 있다고 보고되었다. 하지만 현재 TBI 시행하기에 앞서 선량에 대한 평가는 미미한 실정이다. 특히 소아의 경우 방사선감수성이 민감하기 때문에 TBI 시행 전 정확한 선량평가가 시행되어야 할 것으로 판단된다. 이에 본 연구는 TBI 시행 시 사용되는 조직보상체의 두께의 변화에 따라 표면선량과 심부장기선량에 대하여 선량평가를 한 후 가장 이상적인 조건을 찾고자 하였다. 그 결과, 표면선량은 에너지 4 MV, SSD 280 cm, 조직보상체의 두께가 0.5 cm일 때 5.84 mGy/min 으로 가장 높은 수치를 나타내었다. 또한 조직보상체의 두께가 1 cm 이하였을 때 TBI에서 가장 이상적인 선량분포를 나타냄을 알 수 있었다.

• 대한방사선기술학회지:방사선기술과학
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• 제38권1호
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• pp.17-21
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• 2015

소아백혈병의 치료방법 인 조혈모세포이식법의 전처치 방법으로서 항암제와 함께 대표적으로 사용되고 있는 전신방사선조사에 대하여 치료를 시행하기 전 정량적인 인체장기에 대한 선량을 평가하고자 하였다. 모의실험 프로그램 MCNPX를 사용하여 가상의 공간에서 소아용 모의피폭체를 대상으로 조직보상체의 재질을 변화시켜 실험을 진행하였다. 그 결과 첫째, 평균피부선량은 조직보상체의 재질에 따라 Plexiglass는 74.60 mGy/min, Al은 73.96 mGy/min, Cu는 72.26 mGy/min, Pb의 경우 67.90 mGy/min을 보였다. 둘째, 심부선량은 조직보상체 재질에 상관없이 갑상선, 생식선, 소화기계, 머리, 폐, 신장의 순으로 높게 나타났다. 끝으로 조직보상체와 환자와의 거리는 50 cm 이격시켰을 때가 이상적인 것으로 분석되었다. 본 연구결과를 토대로 할 때, 조직보상체 Al, Cu, Pb은 현재 사용되고 있는 Plexiglass 재질을 대체할 수 있을 것으로 판단된다.

• Childhood Kidney Diseases
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• 제21권1호
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• pp.21-25
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• 2017

Severe hypercalcemia is rarely encountered in children, even though serum calcium concentrations above 15-16 mg/dL could be life-threatening. We present a patient having severe hypercalcemia and azotemia. A 14-year-old boy with no significant past medical history was referred to our hospital with hypercalcemia and azotemia. Laboratory and imaging studies excluded hyperparathyroidism and solid tumor. Other laboratory findings including a peripheral blood profile were unremarkable. His hypercalcemia was not improved with massive hydration, diuretics, or even hemodialysis, but noticeably reversed with administration of calcitonin. A bone marrow biopsy performed to rule out the possibility of hematological malignancy revealed acute lymphoblastic leukemia. His hypercalcemia and azotemia resolved shortly after initiation of induction chemotherapy. Results in this patient indicate that a hematological malignancy could present with severe hypercalcemia even though blast cells have not appeared in the peripheral blood. Therefore, extensive evaluation to determine the cause of hypercalcemia is necessary. Additionally, appropriate treatment, viz., hydration or administration of calcitonin is important to prevent complications of severe hypercalcemia, including renal failure and nephrocalcinosis.

• Clinical and Experimental Pediatrics
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• 제56권3호
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• pp.130-134
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• 2013

Purpose: Anthracyclines have been utilized in the treatment of children with acute lymphoblastic leukemia (ALL). Recent studies have shown that anthracyclines may induce toxicity in the vascular endothelium. This study was performed using brachial artery reactivity (BAR) to evaluate vascular endothelial function in ALL patients who were treated with anthracycline chemotherapy. Methods: We included 21 children with ALL who received anthracycline chemotherapy and 20 healthy children. The cumulative dose of anthracyclines in the ALL patients was $142.5{\pm}18.2/m^2$. The last anthracycline dose was administered to the patients 2 to 85 months prior to their examination using BAR. The diameter of the brachial artery was measured in both groups using echocardiography, and BAR was calculated as the percentage change in the arterial diameter after release of the cuff relative to the baseline vessel diameter. Results: In the anthracycline-treated group, BAR was observed to be $3.4%{\pm}3.9%$, which was significantly lower than that observed in the control group ($12.1%{\pm}8.0%$, P<0.05). The time elapsed after the last anthracycline treatment and the age at the time of treatment did not affect the change in BAR (P =0.06 and P =0.13, respectively). Conclusion: These results provided evidence that treatment of ALL patients with anthracycline results in endothelial dysfunction. A larger cohort study and a longer follow-up period will be required to clarify the relationship between endothelial dysfunction resulting from anthracycline treatment for childhood ALL and occurrence of cardiovascular diseases later in life.

• Clinical and Experimental Pediatrics
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• 제56권8호
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• pp.343-350
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• 2013

Purpose: Despite the established role of imatinib (IM) in chronic myelogenous leukemia (CML) in adults, there are few reports on its efficacy in children. In this study, we compared the outcomes of children with CML before and after the advent of IM-based treatment. Methods: The study cohort consisted of 52 patients treated for CML at the Department of Pediatrics, The Catholic University of Korea from January 1995 to October 2010. Patients were divided and analyzed according to the preImatinib group (pre-IMG) and imatinib group (IMG). Results: Median age at diagnosis for the overall cohort (pre-IMG, n=27; IMG, n=25) was 9 years, with a median follow-up duration of survivors of 84 months. Except for 5 patients in the IMG, all were diagnosed in chronic phase (CP). The overall survival (OS) of patients diagnosed in CP was 45.7% and 89.7% for pre-IMG and IMG, respectively (P=0.025). The OS of hematopoietic stem cell transplantation (HSCT) recipients in the 2 groups was similar, but the OS of patients diagnosed in CP who did not receive HSCT was superior in IMG (91.7% vs. 16.7%, P=0.014). Of the 12 patients in IMG who remained on IM without HSCT, 2 showed disease progression, compared to 11 of 12 in pre-IMG. No difference was observed in the progression free survival (PFS) of matched donor HSCT recipients and IM-based treatment recipients. Conclusion: Similar PFS of patients treated with IM and those who received matched donor HSCT underscore the potential of IM as effective first-line treatment in childhood CML.

• Asian Pacific Journal of Cancer Prevention
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• 제15권12호
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• pp.4843-4846
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• 2014

Background: Acute lymphoblastic leukemia (ALL) is most common in childhood. Inhibin (a non-steroidal glycoprotein hormone of gonadal origin) can be used as marker of fertility. The current study was conducted to evaluate inhibin levels in ALL patients and to estimate its correlation with some antioxidants in these in comparison with control subjects. Materials and Methods: This study was conducted on sixty patients with ALL and thirty children as controls. Fasting blood samples were taken from each subject and analyzed for haemoglobin, serum protein, vitamin E and C, in addition to glutathione and inhibin. Results: The results of the study showed highly significant decreases (p<0.001) in haemoglobin, glutathione and inhibin levels with significant decreases (p<0.05) in serum protein and vitamin E levels for patients group in comparison with controls while there was no significant differences in vitamin C. Moreover, there were significant correlations between inhibin levels and serum protein, glutathione and both vitamins (E and C) in the ALL patient group (r= 0.81, 0.80, 0.77 and 0.69, respectively). Conclusions: The present results indicated infertility in patients with ALL demonstrated by low inhibin level as a consequence of abnormality in anti-oxidative metabolism due to the cancer process. So, it can be suggested the need for routine measurement of inhibin for leukemic patients to estimate the action of hormones of gonadal origin.