• Asian Pacific Journal of Cancer Prevention
• /
• 제17권12호
• /
• pp.5251-5256
• /
• 2016

Background: Diagnostic karyotyping analysis is routinely used in acute myeloid leukemia (AML) clinics. Categorization of patients into risk stratified groups (favorable, intermediate and adverse) according to cytogenetic findings can serve as a valuable independent prognostic factor. Method and Material: A retrospective descriptive study was conducted based on the patient records of newly diagnosed non-M3 AML young adult cases undergoing standard 3+7 i.e, Daunorubicin and Ara-C (DA) as remission induction chemotherapy. Diagnostic cytogenetic analysis reports were analyzed to classify the patients into risk stratified groups according to South West Oncology Group criteria and prognostic significance was measured with reference to achievement of haematological remission after 1st induction chemotherapy. Results:A normal karyotype was commonly expressed, found in 47.2% of patients, while 65% (n=39) appeared to have intermediate risk cytogenetics, and 13.3% (n=8) adverse or unclassified findings. Favourable cytogenetics was least frequent in the patient cohort, accounting for only 8.3 % (n=5).The impact of cytogenetic risk groups on achievement of haematological remission was evaluated by applying Pearson Chi-square, and was found to be non-significant (df=12, p=0.256) but when the outcomes of favourable risk groups with intermediate, adverse and unclassified findings compared, results were highly significant (df=6, p=0.000) for each comparison. In patients of the favourable cytogenetic risk group, HR?? was reported in 40% (n=2/5), as compared to 62.2% (n=23/37) in the intermediate cytogenetic risk group, 57.1% (n=4/7) in the adverse cytogenetic risk group and 28.6% (n=2/7) in hte unclassified cytogenetic risk group. Conclusion: Cytogenetic risk stratification for AML cases following criteria provided by international guidelines did not produce conclusive results in our Pakistani patients. However, we cannot preclude an importance as the literature clearly supports the use of pretreatment karyotyping analysis as a significant predictive marker for clinical outcomes. The apparent differences between Pakistani and Western studies indicate an urgent need to develop risk stratification guidelines according to the specific cytogenetic makeup of South Asian populations.

• Journal of Oral Medicine and Pain
• /
• 제18권1호
• /
• pp.73-82
• /
• 1993

To investigate the changes in aerobic and facultative anaerobic oral microflora during remission-induction chemotherapy in patients with acute myeloid leukemia, 10 consecutive patients were studied during a period of 28 days. One day before, during and after the induction therapy, patients were given 10% Betadine solution for mouthrinses after breakfast and kept from eating and drinking. After 3 hours, paraffin-stimulated whole saliva was obtained for 2 minutes and transported to the laboratory. The samples were dispersed and homogenized by use of vortex mixer for 20 seconds. From these samples 10-fold serial dilutions (from 10-1 through 10-3) were prepared. Each dilution of 0.1 ml was plated on duplicate set of one nonselective medium (Blood agar) and four selective media (Sabourauds dextrose agar, Mannitol salt agar, Mac-Conkey agar, SF medium ) using applicator woods. All agar plate were incubated at 37$^{\circ}C$ for 48 hours. The total number of microorganisms was calculated and the percentage distribution of the various microorganisms from each specimen was drawn. 1. The salivary flow rate decreased by 66%, going from 5.38 ml/2min to 1.81 ml/2min over two days during the chemotherapy. 2. The total number of microorganisms in saliva increased by 22%, going from 4.88$\times$105/ml to 6.00$\times$105/ml over two days during the chemotherapy. 3. The salivary flow rate and the total number of microorganisms in saliva were recovered within 28 days after the chemotherapy. 4. The quantitative alteration in oral Enterobacteria, Enterococci, Staphylococci, Cndida during the chemotherapy had no statistical significance. 5. In saliva of the patients with acute myeloid leukemia who ahd intraoral ulcer, Enterobacteria was quantitatively predominent. Our study suggests that chemotherapy-induced transient xerostomia may induce acute oral infection. Consequently, the use of saliva substitute, the removal of intraoral infection source and the consistent oral hygiene care seem to be required to avoid the transmission of potential pathogenes in this group of patients.

• 대한두경부종양학회지
• /
• 제20권2호
• /
• pp.172-176
• /
• 2004

Background and Objectives: Standard treatment of locally advanced laryngeal, hypopharyngeal, and some oropharyngeal cancers includes total laryngectomy. In an attempt to preserve the larynx through induction chemotherapy, we designed induction chemotherapy followed by definitive radiation in patients with potentially respectable head and neck cancer to determine whether organ preservation is feasible without apparent compromise of survival. Materials and Methods: The twenty-six patients diagnosed advanced head and neck squamous cell carcinoma, Stage III or IV (AJCC 2002) and performed organ preservation protocols in Ajou university hospital from 1994 to 2001 were included in this study. Results: Neoadjuvant chemotherapy showed an overall response rate of 84.6% and a complete remission (CR) rate was 59.1% following neoadjuvant chemotherapy and radiation. Seven of thirteen patients were able to preserve their larynges for more than two years by chemotherapy and radiation. There were no treatment related mortality after 2 cycles of induction chemotherapy. Conclusion: Although Organ preservation protocol through neoadjuvant chemotherapy and radiation need more controlled randomized study, it was considered alternative treatment modality in advanced head and neck cancer.

• Asian Pacific Journal of Cancer Prevention
• /
• 제16권12호
• /
• pp.5059-5062
• /
• 2015

Background: ALL is an irredeemable disease due to the resistance to treatment. There are several influences which are involved in such resistance to chemotherapy, including oxidative stress as a result of the generation of reactive oxygen species (ROS) and presence of hypodiploid cells. Cluster of differentiation 26 (CD26), also known as dipeptidyl peptidase-4, is a 110 kDa, multifunctional, membrane-bound glycoprotein. Aim and objectives: The aim of this study was to evaluate the clinical significance of serum CD26 in patients with acute lymphoblastic leukaemia patients in the post remission induction phase, as well as the relationship between CD26 activity and the oxidative stress status. Materials and Methods: CD26, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI), in addition to activity of related enzymes myeloperoxidase, glutathione-s-transferase and xanthine oxidase, were analysed in sixty children with acute lymphoblastic leukaemia in the post remission induction phase. Results: The study showed significant elevation in CD26, TOS and OSI levels in patients with acute lymphoblastic leukaemia in the post remission induction phase in comparison to healthy control samples. In contrast, myeloperoxidase, glutathione-s-transferase and xanthine oxidase activities were decreased significantly. A significant correlation between CD26 concentration and some oxidative stress parameters was evident in ALL patients. Conclusions: Serum levels of CD26 appear to be useful as a new biomarker of oxidative stress in children with acute lymphoblastic leukaemia in the post remission induction phase, and levels of antioxidants must be regularly estimated during the treatment of children with ALL.

• Journal of Yeungnam Medical Science
• /
• 제27권2호
• /
• pp.113-121
• /
• 2010

급성 백혈병 환자들은 병 자체로 인해 또는 치료로 인해 장기간의 호중구 감소 기간을 경험하게 되며 이로 인한 심각한 감염을 경험하게 된다. 비록 LAFR과 같은 보호된 환경의 개발로 인해 환자들이 병원의 환경과 주위 사람들의 감염으로부터 보호 받을 수 있게 되었으나 경제적 문제로 모든 급성 골수성 백혈병 환자에서 보호된 환경에서 항암치료를 시행하고 있지 못한 실정이다. 따라서 본 연구는 처음 진단되어 관해 유도 항암치료를 시행한 급성 백혈병 환자를 대상으로 보호된 환경과 일반 병실에서의 완전 관해율과 감염률 그리고 항생제 사용 비율을 비교하였다. 결과적으로 두 군 간의 완전 관해율과 호중구 감소 기간에는 차이가 없었으나 관해 유도 기간 중 현성감염률과 vancomycin, Imipenem 그리고 amphotericin-B 사용률에 있어서 유의한 차이를 보였다. 이는 급성 골수성 백혈병의 관해 유도 치료에서 보호된 환경에서 관해 유도 치료를 시행하는 것이 감염률과 이로 인한 항생제 사용률을 낮출 수 있음을 보여주고 있으며 LAFR과 같은 설비를 갖추는 것의 필요성을 나타내고 있다.

• 대한기관식도과학회지
• /
• 제11권1호
• /
• pp.21-24
• /
• 2005

Acute lymphocytic leukemia(ALL) is a malignant disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. Currently, only $20-30\%$ of adults with ALL are cured with standard chemotherapy regimens. It is very important risk factor whether to failure to achieve complete remission within 4 weeks or not. The relapse of leukemia is usually classified as hematologic and extramedullary relapse, and extramedullary leukemic infiltration is rarely observed in patients with ALL. In October 2004, a 23-year-old man presented with painless enlargement of both parotid glands. He was diagnosed as ALL(L2 subtype) one month ago, and he gained complete remission with induction chemotherapy. Fine needle aspiration cytology and bone marrow biopsy revealed extramedullary and hemtologic remission. To our knowledge this is the first report of extramedullary relapse in the parotid in ALL.

• Radiation Oncology Journal
• /
• 제11권2호
• /
• pp.295-301
• /
• 1993

절제 불가능한 제 3기 비소세포 폐암에서의 MVP(Mitomycin C 6 $mg/m^2$, Vinblastine 6 $mg/m^2$, Cisplatin 60 $mg/m^2$) 복합 항암요법과 다분할 방사선 치료의 효과를 판정하기 위하여 1991년 1월부터 전향성 임의 선택연구(prospective randomized study)를 시작하였다. 본 연구는 제 III기의 비소세포 폐암중 절제가 불가능한 환자를 대상으로 하여 MVP 항암요법을 3 회 시행한 후 다분할 방사선 치료 (120 cGy/fx, BID)를 6480 cGy까지 시행하였다. 방사선 치료가 끝난 1개월 후 유도 항암요법에 부분 관해 이상의 반응을 보였던 환자를 대상으로 추가 항암요법을 시행하는 군과 계속 관찰하는 군으로 임의 분류하였다. 1992년 12월까지 48명의 환자가 등록되었으며, 이중 3명은 항암요법후 치료를 중단하였으며, 6명은 방사선 치료중 치료를 중단하거나, 개인적 사정으로 다분할 방사선 치료를 시행받지 못하여 39명의 환자에 대한분석을 시행하였다. 유도 항암요법을 마친 환자중 2명은 완전 관해를 보였으며, 21명은 부분 관해를 보여 MVP 유도항암요법에 대한 관해율은 $58\%$ (23/39)이었다. 항암요법에 부분관해를 보인 21명중 1명은 방사선 치료후 완전관해를 보였으며, 10명은 부분관해를 보였으나, 나머지 10명은 방사선 치료에 반응을 보이지 않았다. 항암요법에 반응을 보이지 않았던 16명의 환자중 9명은 방사선 치료에도 전혀 반응을 보이지 않았다. 유도항암 요법과 다분할 방사선 치료후의 관해율은 $64\%$이었다. 방사선 치료후 19명의 환자에 대하여 추가 항암요법에 대한 임의 선택을 시행하여 이중 9명은 추가 항암요법 군으로 분류되어, 3회의 추가 항암요법을 시행하였다. 아직까지는 추가 항암요법군과 관찰군 사이에 원격전이나 생존율의 차이가 관찰되지 않았다. 전체 환자의 중앙 생존은 13개월이었고, 6개월과 12개월의 생존율은 각각 $84.6\%$와 $53.7\%,\;40.3\%$이었다. 특히 유도항암요법에 부분관해 이상의 반응을 보였던 환자들은 무반응환자에 비하여 통계적으로 유의하게 증가된 생존율을 보였다(p=0.0287). 아직까지 추적 관찰기간이 짧으나, $64\%$의 높은 치료 관해율과 증가된 생존율, 그리고 합병증의 증가가 관찰되지 않는 점으로 보아 본 연구를 계속 진행함으로써 더 좋은 결과를 얻을 수 있을 것으로 기대된다.

• Tuberculosis and Respiratory Diseases
• /
• 제72권4호
• /
• pp.381-385
• /
• 2012

Non-small cell lung cancer (NSCLC) is the leading cause of cancer related deaths. Most patients were presented with advanced disease at the time of diagnosis. In advanced NSCLC, it is almost impossible to anticipate complete remission by using only cytotoxic chemotherapy or molecularly targeted agents. In our case, two patients were diagnosed as advanced NSCLC and received chemotherapy. They achieved complete response (CR). After finishing treatment, disease recurred. They were retreated with the same regimens and achieved second CR. Until now, they have received each regimen, continuously, and the CR state has been maintained.

• 대한두경부종양학회지
• /
• 제10권1호
• /
• pp.13-24
• /
• 1994

Despite optimal local therapy such as surgery and/or radiotherapy, the long term outcome is poor for patients with advanced squamous cell carcinomma of head and neck, due to frequent loco-regional recurrence and distant metastases. We studied to determine whether the combination chemotherapy, especially as an adjuvant chemotherapy, would improve the survival of these patients. Between January, 1986 and December, 1992, 57 patients with previously untreated, locally advanced squamous cell arcinoma of head and neck were assigned to receive 2-3 cycles of induction chemotherapy consisting of 5-fluorouracil(F) and cisplatin(P) every 3 weeks and standard local therapy such as surgery and/or radiotherapy followed by adjuvant chemotherapy with the same FP regimens. Of the 57 enroled patients, 45 patients were evaluable. The obtained results were as following: 1) Among 45 evaluable patients, 18 patients finished all treatment protocol including adjuvant chemotherapy and 27 patients had no adjuvant chemotherapy. The difference of age, sex, performance status, disease stage, and tumor differentiation was not significant statistically between adjuvant chemotherapy group and no-adjuvant chemotherapy group. 2) After induction chemotherapy, 7/45(15.4%), 30/45(67%) achieved complete remission and partial remission respectively with 82.4% overall response rates in entire patients. 3) The 4year progression free survival was 43.3% in adjuvant chemotherapy group and 24.1% in no-adjuvant chemotherapy group(p>0.05). The 4year overall survival was 56.9% and 25.5% respectively(p>0.05). There was no significant different in the patterns of local recurrence and distant metastasis between the two groups. 4) Adverse reactions from combination chemotherapy included nausea, vomiting, mucositis, diarrhea and hematologic bone marrow depression. These were mild and tolerated by patients, and these was no episode of any life threatening toxicities. In conclusion, adjuvant chemotherapy after induction chemotherapy and local therapy did not show statistically significant survival improvement, but there was trend of prolongation of survival when compared to no adjuvant chemotherapy. Thus, large scale phase III randomized controlled studies are strongly recommended.

• Asian Pacific Journal of Cancer Prevention
• /
• 제14권2호
• /
• pp.1089-1092
• /
• 2013

Background: Elderly patients with acute myeloid leukemia (AML) have a poor outcome because of co-morbidities, poor tolerance to intensive chemotherapy and inherently more resistant disease. Clofarabine is a second generation nucleoside analogue which has shown promising activity in elderly patients with AML. This study was conducted to review the outcome of treatment with clofarabine in a group of such patients. Methods: The records of 5 elderly patients who were diagnosed to have AML and treated with clofarabine over a 12 month period were reviewed retrospectively. Results: There were 2 female and 3 male patients with a median age of 68 years (range 65-82). At the time of treatment, 2 patients had newly diagnosed AML not considered suitable for intensive therapy, while 3 patients had partial or no response to conventional chemotherapy. The overall response rate was 100%, all patients achieving a complete remission. Induction and consolidation were well tolerated. All patients developed neutropenia with a median duration of 20 days (range 17-42). One patient developed hand and foot syndrome and a generalized rash but recovered. There was no mortality and all patients remained in remission after a median follow-up of 5.2 months (Range 3-10). Conclusion: Clofarabine (alone or in combination) is active in elderly AML patients with an acceptable safety profile and should be considered a potential option in this group.