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  • American Society of Hematology  (71)
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  • 1
    Online Resource
    Online Resource
    Predictors of General Discomfort, Limitations in Activities of Daily Living, and Intention of a Second Donation in Unrelated Hematopoietic Stem Cell Donation
    American Society of Hematology ; 2016
    In:  Blood Vol. 128, No. 22 ( 2016-12-02), p. 3375-3375
    Details
    In: Blood, American Society of Hematology, Vol. 128, No. 22 ( 2016-12-02), p. 3375-3375
    Abstract: We performed a retrospective study to predict the risk factors related to general discomfort, limitations in activities of daily living (ADLs), and intention of a second donation in hematopoietic stem cell (HSC) donation. The subjects of this study were 1,868 consecutive unrelated volunteer donors who donated HSCs through the Korea Marrow Donor Program between November 2007 and April 2014. Bone marrow (BM) collections were performed without administration of granulocyte-colony stimulating factor (G-CSF) and peripheral blood stem cell (PBSC) collections were performed after mobilization with G-CSF administered subcutaneously for 4 or 5 consecutive days at a daily dose of around 10 mcg/kg of body weight. General discomfort and limitations in ADLs were assessed by numerical measurement (scores of 0 to 10), and donor's intention of a second donation by yes or no reply. The post-donation questionnaires were completed within 48 hours after HSC collection, and at 1 week, 4 weeks, and 4 months thereafter. Pre-donation and post-donation predictors of general discomfort and limitations in ADLs were identified using univariate and multivariate linear regression considering donor demographic and clinical characteristics (age, sex, collection method, collection period) and the intention of a second donation on day 1. Pre-donation and post-donation predictors of the intention of a second donation were identified using univariate and multivariate logistic regression considering donor demographic and clinical characteristics (age, sex, collection method, collection period). Men represented 76.77% of donors. The median age at donation was 28 years (range, 19-51), and about 93.00% of donors were younger than 40 years of age. Among HSC collection, 61.88% were completed in a day. PBSC and BM collections accounted for 94.49% and 5.51% of HSC collections, respectively. Predictors of general discomfort included female sex (P 〈 0.0001), BM collection (P 〈 0.0001) or PBSC collection through a central line (P= 0.0349), 2-day collection (P= 0.0150), and negative or undetermined intention of a second donation on day 1 (P 〈 0.0001). Predictors of limitations in ADLs included age group of 30-39 years (P= 0.0046), female sex (P 〈 0.0001), BM collection (P 〈 0.0001) or PBSC collection through a central line (P 〈 0.0001), and negative or undetermined intention of a second donation on day 1 (P 〈 0.0001). The only predictor of positive intention of a second donation was male sex (P= 0.0007). Age, sex, collection method and period, and intention of a second donation should be considered risk factors when unrelated HSC donation is performed. As a collection method, PBSC collection through a peripheral line is recommended to alleviate physical stress and to improve ADLs. Female donors are more sensitive to HSC collection than male donors, and male sex of the donor is predictive of positive intention of a second donation. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood.V128.22.3375.3375
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2016
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 2
    Online Resource
    Online Resource
    What Can We Do for the Unrelated Donors of Hematopoietic Stem Cell to Lessen Their Agony?
    American Society of Hematology ; 2014
    In:  Blood Vol. 124, No. 21 ( 2014-12-06), p. 5832-5832
    Details
    In: Blood, American Society of Hematology, Vol. 124, No. 21 ( 2014-12-06), p. 5832-5832
    Abstract: Objectives: The study purposes are as follows. What are the incidences of adverse events (AEs) after hematopoietic stem cell donations among the unrelated donors registered in Korea Marrow Donor Program (KMDP)? What donor factors have influence on their general discomfort and the limitation of daily activity at the time of stem cell collection? What prohibits the donors from donating stem cell repetitively as a Good Samaritan? Methods: 1,666 consecutive unrelated donors were registered at KMDP from November 2007 to October 2013. General discomfort and pain were assessed using a visual analog scale (numerical measurement, 0 to 10) and other donor symptoms were assessed by making either yes or no reply to each item. The limitation of daily activity was assessed by numerical measurement (0 to 10 scales), 10 being the worst activity. The donor’s intention of repetitive donation was assessed by yes or no reply. The donor symptoms and the intention of repetitive donation were assessed within 48 hours after stem cell collection, and then at 1 week, 4 weeks, and 4 months thereafter. Results: There were 1,292 males and 374 females. 1,525 donors underwent peripheral blood stem cells (PBSC) collection, 100 bone marrow (BM) harvest and 40 leukapheresis for donor leukocyte infusion (DLI). All of 1,525 PBSC donors received granulocyte-colony stimulating factor (G-CSF). 76 donors underwent central line insertion for PB cells collection. The degree of general discomfort and the limitation of daily activity were analyzed in variables of sex, stem cell source, G-CSF administration, collection method, collection period and the intention of repetitive donation. A multiple linear regression analysis showed that general discomfort at the time of stem cell collection was significantly influenced by sex and collection period (P 〈 0.05). The limitation of daily activity at the time of stem cell collection was significantly influenced by sex, stem cell source, and collection method (P 〈 0.05). A multiple logistic regression analysis showed that the intention of repetitive donation at the time of stem cell collection and thereafter was significantly influenced by sex only. At least 80% of stem cell donors had the intention of repetitive donation. Compared to the donors using peripheral line, the donors using central line for PB cells collection suffered more frequently from various AEs: C-line site discomfort, hands and feet numbness, perioral numbness, dizziness, chills, nausea/vomiting and abdominal pain. Conclusions: Stem cell collection via peripheral line is recommended to alleviate the physical stress and to improve daily activity and to encourage repetitive donation, and female donors are more sensitive to stem cell collection than male donors. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood.V124.21.5832.5832
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2014
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 3
    Online Resource
    Online Resource
    Clinical Outcomes of R-CHOP Chemotherapy Alone Compared with R-CHOP Plus Radiotherapy in Patients with Localized, Non-Bulky Diffuse Large B-Cell Lymphoma
    American Society of Hematology ; 2014
    In:  Blood Vol. 124, No. 21 ( 2014-12-06), p. 4421-4421
    Details
    In: Blood, American Society of Hematology, Vol. 124, No. 21 ( 2014-12-06), p. 4421-4421
    Abstract: Introduction Although several previous studies addressed the role of radiation in treating localized diffuse large B-cell lymphoma (DLBCL), chemotherapy alone has shown promising efficacy with the emergence of Rituximab. Thus, we evaluated the clinical efficacy outcomes and failure patterns of patients with localized DLBCL according to two different treatment strategies, either 6 or more cycles of R-CHOP chemotherapy alone or 3 or 4 cycles of R-CHOP followed by involved field radiotherapy (IFRT). Methods A prospectively collected database from 21 tertiary centers participating the Consortium for Improving Survival of Lymphoma (CISL), built up for PROCESS study (NCT01202448) for secondary central nervous system involvement in DLBCL, was recruited for current study in addition to the Asan Medical Center (AMC) Lymphoma Registry. CISL database and AMC lymphoma registry consisted of data from patients with newly diagnosed DLBCL between August 2010 and August 2012, and between February 2004 and February 2012, respectively. Inclusion criteria were localized (stage I or II), non-bulky ( 〈 10cm in longest diameter) DLBCL treated with R-CHOP as 1st line chemotherapy, and patients either who received 6 or more cycles of R-CHOP chemotherapy only (R-CHOP alone group) or received 3 or 4 cycles of R-CHOP chemotherapy followed by IFRT (R-CHOP plus RT group). Comparisons of clinicopathologic parameters, clinical outcomes and the patterns of relapse were performed between two groups. The types of relapse were classified as either locoregional or distant, according to whether it involves any separate region from primary sites. Efficacy outcomes included complete response (CR) rate, 2-year overall survival (OS) rate, and 2-year event-free survival (EFS) rate. Results A total of 357 patients (CISL prospective cohort: 161 patients, AMC registry: 196 patients) were eligible for the analyses. Two hundred ninety nine patients (83.5%) received 6 or more cycles of R-CHOP chemotherapy alone, and 58 patients (16.2%) underwent 3 or 4 cycles of R-CHOP followed by IFRT. Median age was 54 years (range, 16-87). During the median follow-up of 24 months (range, 4-116 months), 35 patients (9.8%) experienced relapse, and 22 patients (6.1%) died. Two-year OS and EFS rate was 94.7% and 89.9%, respectively, and 345 out of 357 patients (96.6%) achieved CR. Comparing R-CHOP alone to R-CHOP plus RT group, there was no significant difference in clinicopathologic parameters. R-CHOP alone could achieve significantly higher CR rate of 97.7 % than 91.4% of R-CHOP plus RT group (p = 0.030). Two-year OS and EFS were significantly longer in R-CHOP alone group than R-CHOP plus RT group (96.1 vs 89.9 %, p = 0.029 and 91.7% vs 81.8%, p= 0.028) (Figure 1). Relapse rate was significantly lower in R-CHOP alone group compared with R-CHOP plus RT group than group (7.4% vs 22.4%, p=0.001), and distant relapses were also significantly lower (15.5% vs 2.7%, p 〈 0.001). In addition, even only in relapsed patients, R-CHOP alone group showed lower incidence of distant relapses with marginal statistical significance (36.4% vs 69.2 %, p=0.062) (Table 1). Conclusion In our cohort, R-CHOP alone for six to eight cycles without IFRT could achieve significantly higher 2-year OS and EFS rate as well as CR compared with R-CHOP plus RT group. In addition, the rate of relapse and systemic failure were significantly lower in R-CHOP alone group, which altogether warrant further validation in prospective trial. Table 1. Explorative comparison of overall clinical outcomes and patterns of relapse between two subgroups: patients who underwent six or more cycles of R-CHOP chemotherapy alone and who underwent 3 or 4 cycles of R-CHOP followed by IFRT Total (%) R-CHOP alone group (%) R-CHOP plus RT group (%) P -value Number of patients 357 (100) 299 (83.5) 58 (16.2) Treatment response Complete response 345 (96.6) 292 (97.7) 53 (91.4) 0.030 Overall response 351 (98.3) 294 (98.3) 57 (98.3) 1.000 Rate of relapse 35 (9.8%) 14 (7.4) 11 (22.4) 〈 0.001 Median time to relapse (95% CI) 11 (7-15) 11 (8-14) 10 (5-14) 0.346 Pattern of relapse 〈 0.001 (0.062) Locoregional 14 (4.7) (63.6) 4 (6.9) (30.8) Distant 8 (2.7) (36.4) 9 (15.5) (69.2) Figure 1. Comparison of overall survival and event-free survival in two subgroups: patients who underwent six or more cycles of R-CHOP chemotherapy alone and who underwent 3 or 4 cycles of R-CHOP followed by IFRT Figure 1. Comparison of overall survival and event-free survival in two subgroups: patients who underwent six or more cycles of R-CHOP chemotherapy alone and who underwent 3 or 4 cycles of R-CHOP followed by IFRT Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood.V124.21.4421.4421
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2014
    detail.hit.zdb_id: 1468538-3
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  • 4
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    Online Resource
    Development of a New Risk Stratification System for Patients with Newly Diagnosed Multiple Myeloma Using R-ISS and 18F-FDG PET/CT
    American Society of Hematology ; 2021
    In:  Blood Vol. 138, No. Supplement 1 ( 2021-11-05), p. 3757-3757
    Details
    In: Blood, American Society of Hematology, Vol. 138, No. Supplement 1 ( 2021-11-05), p. 3757-3757
    Abstract: Background A high number of focal lesions (FL) detected using PET/CT at diagnosis were found to be associated with adverse prognosis along with Revised International Staging System (R-ISS). In present study, we combined R-ISS with FL using PET/CT to design a reliable and easily applicable risk stratification system in patients with newly diagnosed MM (NDMM). Methods In training cohort, the data of 380 patients with NDMM who underwent 18F-fluorodeoxyglucose (18F-FDG) PET/CT upon diagnosis from 10 hospitals of the Korean Multiple Myeloma Working Party were retrospectively analyzed. All patients were classified by R-ISS and were treated by frontline therapy with proteasome inhibitors (PI) and/or immunomodulatory drugs (IMiD). The K-adaptive partitioning algorithm was adopted to develop the new risk groups with homogeneous survival. Sixty-seven patients in external validation cohort were additionally collected to confirm reproducibility of the new risk groups. Results In the training cohort, 199 patients (52.4%) showed FL & gt; 3 using PET/CT at diagnosis. R-ISS stages I, II, and III were 78 patients (20.5%), 230 (60.5%), and 72 (18.9%), respectively. The combined R-ISS with PET/CT newly allocated NDMM patients into four groups: R-ISS/PET stage I (n=30; R-ISS I with FL≤3), stage II (n=149; R-ISS I with FL & gt;3 and R-ISS II with FL≤3), stage III (n=166; R-ISS II with FL & gt;3 and R-ISS III with FL≤3), and stage IV (n=35; R-ISS III with FL & gt;3). The new R-ISS/PET showed significantly pronounced survival differences according to stages. Two-year overall survival (OS) rates were 96.6%, 89.5%, 75.0%, and 57.9% (p & lt; 0.001), and 2-year progression-free survival (PFS) rates were 86.9%, 65.1%, 41.9%, and 15.2% (p & lt; 0.001) in stages I, II, III, and IV, respectively. The prognostic role of the R-ISS/PET for survival outcomes was also confirmed in different subgroups classified by transplant eligibility and by types of treatments. In the external validation cohort, the new R-ISS/PET was successfully implemented. Two-year OS rates for were 100%, 89.9%, 82.6%, and 42.0% for R-ISS/PET I, II, III, and IV, respectively (p = 0.001). PFS rates at 2 years for each R-ISS/PET were 100%, 74.5%, 57.9%, and 25.6%, respectively (p = 0.004). In the multivariate Cox analysis for survival outcome, R-ISS/PET was a significant factor and could predict long-term outcomes with regard to OS: stage II vs. I (HR 2.50, p = 0.215), (ii) stage III vs. I (HR 5.11, p = 0.025), and (iii) stage IV vs. I (HR 10.3, p = 0.003) and PFS: (i) stage II vs. I (HR 2.21, p = 0.005), (ii) stage III vs. I (HR 4.57, p & lt; 0.001), and (iii) stage IV vs. I (HR 9.48, p & lt; 0.001). Conclusion The new R-ISS/PET had a remarkable prognostic power for estimating the survival outcomes of patients with NDMM. This system helps discriminate patients with a good prognosis from those with a poor prognosis more precisely. Thus, R-ISS/PET is applicable for identifying heterogeneous manifestation of clinical MM. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood-2021-152008
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2021
    detail.hit.zdb_id: 1468538-3
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  • 5
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    Online Resource
    Prospective Cohort Study with Risk-Adapted Central Nervous System (CNS) Evaluation in Diffuse Large B-Cell Lymphoma Patients Treated with Rituximab-CHOP: Analysis of Incidence and Risk Factors for Secondary CNS Involvement.
    American Society of Hematology ; 2012
    In:  Blood Vol. 120, No. 21 ( 2012-11-16), p. 2683-2683
    Details
    In: Blood, American Society of Hematology, Vol. 120, No. 21 ( 2012-11-16), p. 2683-2683
    Abstract: Abstract 2683 Background Secondary central nervous system (CNS) involvement in diffuse large B-cell lymphoma (DLBCL) includes CNS relapse or CNS involvement with systemic disease progression. Although many publications have provided information regarding the incidence and risk factors for CNS involvement in DLBCL, its incidence reported across those studies varies widely. It might be related with that the majority of data were from retrospective analyses. Furthermore, the role of CNS prophylaxis for DLBCL has been challenged, especially in the era of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). As a result, this rare but fatal clinical problem still remains a therapeutic dilemma in the management of DLBCL. In this study, we prospectively explored the risk factors of CNS involvement and the clinical impact of screening evaluation for CNS involvement. Methods We analyzed the incidence of secondary CNS involvement in pathologically confirmed DLBCL patients enrolled in the Prospective Cohort Study with Risk-adapted Central Nervous System Evaluation in Diffuse Large B-cell Lymphoma (PROCESS study, NCT01202448). Patients should be treated with at least one cycle of R-CHOP, and provide written informed consents. We assessed the risk of CNS involvement based on previously reported risk factors: serum LDH elevation, the number of extranodal involvements, serum albumin, bone marrow invasion, HIV positivity, the involvement of testis, breast, paranasal sinus, bone, retroperitoneal lymph nodes, orbit, and epidural space. If patients had any of these risk factors, they underwent CSF study to screen the CNS involvement at diagnosis. If the results were abnormal, additional studies including brain MRI could be done depending on physicians' decision. CNS prophylaxis was done with intrathecal chemotherapy with methotrexate for patients who had positive findings of screening evaluation or were determined to have a risk of CNS involvement based on physicians' decision. Results 564 patients were enrolled between 2010 and 2012 from 26 institutions belonged to the Consortium for Improving Survival of Lymphoma (CISL). They were prospectively monitored with the median follow-up duration of 10.5 months. The median age was 59.5 years old (range 20–89 years), and approximately a half of patients had Ann Arbor stage III/IV (n = 276, 48.9%) and 193 patients involved two or more than two extranodal sites (34.2%). Based on the International Prognostic Index (IPI) risk, 192 patients belonged to high or high-intermediate risk (34%). Among patients (n = 368) who had at least one of risk factors for CNS involvement, 243 patients underwent CNS evaluation, and the evidence of CNS involvement was found in16 patients including positive cytology (n = 11), and brain parenchyma lesion (n = 5). The other 78 patients showed equivocal results of CSF analysis including the presence of atypical cells (n = 17). Intrathecal prophylaxis was done for 51 patients whereas high dose methotrexate chemotherapy was combined with R-CHOP for patients with brain lesion. During follow-up, 14 cases of additional CNS involvement including brain parenchyma (n = 8), leptomeningeal (n = 5), and ocular invasion (n = 1) were observed. The median time to CNS event in these 14 patients was 7.5 months (range 1.2 – 15.9 months). Thus, 30 cases of secondary CNS involvement were documented in our study population at the time of analysis (5.3%) including 16 cases at diagnosis and 14 cases during follow-up. The univariate analysis for evaluation of risk factors demonstrated serum LDH, the number of extranodal involvements, bone marrow invasion, and the involvement of retroperitoneal lymph nodes, breast, paranasal sinus and orbit were significantly associated with CNS involvement. The high/high-intermediate risk of IPI was also predictive of CNS involvement (P 〈 0.05). However, in the multivariate analysis, bone marrow invasion and the involvement of breast, paranasal sinus and orbit were independently predictive for CNS involvement. Conclusions The incidence of secondary CNS involvement in DLBCL patients treated with R-CHOP was around 5%, and a half of cases had the evidence of CNS involvement at diagnosis. Considering a particular risk of CNS involvement of disease-related factors, risk-adapted active screening against CNS involvement may help to improve treatment outcome of patients with DLBCL. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood.V120.21.2683.2683
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2012
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  • 6
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    Online Resource
    Clinical Significance of PML/RAR Isoform in Patients of Acute Promyelocytic Leukemia.
    American Society of Hematology ; 2007
    In:  Blood Vol. 110, No. 11 ( 2007-11-16), p. 4218-4218
    Details
    In: Blood, American Society of Hematology, Vol. 110, No. 11 ( 2007-11-16), p. 4218-4218
    Abstract: Background: Three types of PML-RARα mRNA fusion transcripts in acute promyelocytic leukemia (APL) could be existed: a short (S)-form type, a long (L)-form type or a variable (V)-form type. Whether 3 types of PML-RARα mRNA fusion transcripts associated with different manifestations and outcomes in individual APL cases are unclear. Recently, some studies reported the controversial results for the relationship between the types of PML-RARα mRNA fusion transcripts and clinical outcomes. But, there was no data about the types of PML-RARα mRNA fusion transcripts especially for the APL patients who were received remission induction therapy with AIDA. Methods: We performed a retrospective analysis for the data of 94 patients with APL, whose isoform data was available. We evaluated the differences of therapeutic outcome of remission induction chemotherapy in terms of response rate, relapse-free survival (RFS), overall survival (OS) and the association of pretreatment clinical parameter characteristics according to the PML-RARα isoforms. Results: The median age of the patients was 41 years (15–85). CR rate following remission induction treatment was 84.9% (AIDA 87.0% vs. non-AIDA 80.0%). Among 94 patients, there were 58 L-form cases (62.1%), 32 S-form cases (34.0%), 4 V-form cases (4.3%). There was no significant difference at any patient’s pretreatment characteristic according to PML-RARα isoform type. CR rate was higher in the group of initial WBC 〈 10,000/ul (93.5% vs. 65.4%, p=0.001). But there was no difference within the isoform L/S subgroup (84.2% vs. 87.2%). And OS and RFS were not different between isoform L/S subgroup (5yr 74.3% vs. 83.1%, 84.2% vs. 85.1%). AIDA induction group was better than non-AIDA induction group regarding OS and RFS (5yr 84.4% vs 55.7%, p=0.026, 90.0% vs 65.7%, p=0.007), but not significant in the multivariate analysis. And also, it was not significantly different in the OS and RFS between isoform L/S subgroup of the AIDA induction group (5yr 80.5% vs. 92.0%, 95.7% vs. 97.0%). Conclusion: This study suggests that high initial WBC count is associated with low CR rate, AIDA induction group has a trend of better OS and RFS, treatment outcomes according to PML-RARα isoform type are not different. Prospective study will be needed to confirm the meaningful significance of PML-RARα isoform type.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood.V110.11.4218.4218
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2007
    detail.hit.zdb_id: 1468538-3
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  • 7
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    Pretreatment Serum Level of 15-KDa Granulysin Might Predict Recurrence and Survival of Diffuse Large B Cell Lymphoma Patients Treated by R-CHOP Regimen
    American Society of Hematology ; 2010
    In:  Blood Vol. 116, No. 21 ( 2010-11-19), p. 1993-1993
    Details
    In: Blood, American Society of Hematology, Vol. 116, No. 21 ( 2010-11-19), p. 1993-1993
    Abstract: Abstract 1993 Granulysin, cytolytic molecules of cytotoxic T lymphocytes and NK cells, is synthesized as 9-kDa and 15-kDa molecule. 9-kDa granulysin is located intracellularly, whereas 15-kDa granulysin is continuously secreted. We investigated the association between pretreatment serum level of 15-kDa granulysin and prognosis in 63 patients with diffuse large B cell lymphoma (DLBL), initially treated by R-CHOP regimen. The mean pretreament serum level of 15-kDa granulysin level of DLBL patients was significantly lower than that of healthy subjects (p 〈 0.0001) (Figure 1A). To analyze the difference in pretreatment serum granulysin levels according to the underlying patients’ characteristics, they were dichotomized in a prognostically meaningful way. There were no significant differeces according to gender, age, performance, histology, stage, existence of B symptom, international prognostic index (IPI) risk group 7, LDH level, β2-microglobulin level, and response to R-CHOP treatment. Among the patients who achieved complete remission, however, the mean pretreatment serum 15-kDa granulysin level of the patients who experienced recurrence within three years was significantly lower than that of the patients without recurence (p=0.035) (Figure 1B). When patients were sorted into two groups with the median pretreatment serum granulysin value (380 pg/ml), the high granulysin group showed significantly longer progression-free survival (PFS) and overall survival (OS) (p=0.044 and p=0.019, respectively) (Figure 1C-D). On univariate analysis for PFS of 1st line therapy, high IPI risk group (high/high-intermediate) (p 〈 0.0001), the presence of B symptom (p 〈 0.0001), high β2-microglobulin level (p=0.002), bulky disease (single lesion diameter 〉 = 10cm) (p=0.017), and low pretreatment serum granulysin level (p=0.044) were shown to sinigicantly influence PFS unfavorably. However, multivariate analysis showed only IPI risk group to be the significant factor for PFS [p=0.001, hazard ratio(HR) 0.156, 95% CI, 0.053–0.456]. With regard to overall survival (OS), the high IPI risk group (p 〈 0.0001), the presence of B symptom (p 〈 0.0001), high β2-microglobulin level (p=0.002), bulky disease (p=0.012), and low pretreatment serum granulysin level (p=0.019) were shown to be significantly influential. Multivariate analysis showed that IPI risk group [p 〈 0.0001, HR 0.082, 95% CI, 0.025 to 0.268], bulky disease (p=0.035, HR 0.337, 95% CI, 0.122 to 0.929), and pretreatment serum granulysin level (p=0.019, HR 0.038, 95% CI, 0.169 to 0.949) were found to be the significant risk factors for OS. Therefore, the impact of pretreatment serum 15-kDa granulysin level on OS was independent. In conclusion, pretreatment serum level of 15-kDa granulysin might be a valuable independent marker to predict prognosis such as recurrence after response and overall survival in DLBL patients who received R-CHOP as frontline treatment. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood.V116.21.1993.1993
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2010
    detail.hit.zdb_id: 1468538-3
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  • 8
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    Clinical Features and Treatment Outcomes of Non-Hodgkin's Lymphoma with Breast Involvement; Multi-Institutional Analysis of 98 Patients in Korea.
    American Society of Hematology ; 2009
    In:  Blood Vol. 114, No. 22 ( 2009-11-20), p. 5024-5024
    Details
    In: Blood, American Society of Hematology, Vol. 114, No. 22 ( 2009-11-20), p. 5024-5024
    Abstract: Abstract 5024 Introduction The non-Hodgkin's lymphoma (NHL) with breast involvement is an extremely rare extranodal presentation. The aim of this study is to analyze the clinical features and treatment outcomes of NHL with breast involvement, and to investigate whether the arbitrary classification between primary breast lymphoma (PBL) and secondary breast lymphoma (SBL) has any clinical relevance. Patients and Methods We retrospectively analyzed 98 patients newly diagnosed as NHL with breast involvement from 16 hospitals in Korea between January 1994 and June 2009. The eligibility criteria included: (1) histological confirmation by pathologist should be made, (2) documentation of one or both breasts involvement by histology or imaging modalities was needed. The PBL was defined as disease localized to one or both breasts ± regional lymph nodes (ipsilateral axillary, supraclavicular and internal mammary lymph nodes), and SBL defined as disease with systemic lymph nodes and/or other extranodal organ involvement as well as one or both breasts involvement. Mediastinal and cervical lymph nodes were not regarded as regional lymph nodes. Recurrent lymphomas in the breast following prior treatment were not included in this analysis. Results The median age at diagnosis was 45 (range, 17-83) years, and median follow-up duration was 39.2 (range, 0.5-186.0) months. The two most common histologic subtypes included were diffuse large B-cell (68 patients, 69.4%) and mucosa-associated lymphoid tissue (8 patients, 8.2%) histology. Other 7 histologic subtypes were identified. Among 98 patients, 89 (91%) were treated at least 1 cycles of systemic chemotherapy, 82 (84%) treated with anthracycline-based regimens, 44 (44.9%) treated with combination of chemotherapy and rituximab. Any surgery or any radiotherapy to the breasts was performed in 27 (27.6%) patients, respectively. According to the definition, PBL and SBL group were 58 (59.2%) and 40 (41.8%) patients, respectively. The estimated 5-year progression-free survival (PFS) and overall survival (OS) was 51.2% ± 6.8 and 61.3% ± 6.0, respectively. Overall response rate (ORR) of 93 patients who were evaluable was 91.4% (CR, 76.3%; PR, 15.1%). Compared the baseline characteristics of PBL with those of SBL, PBL group showed more favorable clinical factors as 0 or 1 of Eastern Cooperative Oncology Group performance status (p 〈 0.001), normal LDH level (p=0.003), absence of B symptom (p=0.001) and low or low-intermediate international prognostic index (p 〈 0.001). 14 (24%) of PBL group were treated with abbreviated course (£4 cycles) of systemic chemotherapy and local therapy, 11 (28%) of SBL group were treated 4 or less than 4 cycles of systemic chemotherapy because of mainly disease progression or early death. ORR was significantly higher in PBL group (96.6% vs 72.5%, p=0.005), and estimated 5-year PFS (63.6% ± 8.7 vs 35.2% ± 8.9, p 〈 0.001) and OS (71.8% ± 7.2 vs 45.3% ± 9.9, p=0.004) was also significantly longer in PBL group compared with SBL group. Eight (8.2%) patients had central nervous system (CNS) relapse or progression in the course of disease, and PBL group had a significantly higher rates of CNS relapse or progression compared with SBL group (6 [10.3%] vs 2 [5%] , p=0.046). In multivariate analysis for PFS, 4 or less than 4 cycles of systemic chemotherapy regardless of any local treatments (hazard ratio [HR], 5.14; 95% confidence interval [CI] , 2.18-12.12) and more than 2 of extranodal organ involvement (HR, 10.64; 95% CI, 4.75-23.83) were independent prognostic factors for shorter PFS. And, for OS, 4 or less than 4 cycles of systemic chemotherapy regardless of any local treatments (HR, 4.03; 95% CI, 1.90-8.54) was the only independent prognostic factor for shorter OS. Conclusion Although criteria for PBL and SBL, we traditionally used, did not consider tumor biology and an arbitrary definition, we confirmed that the patients with NHL involved breasts could be classified into two different groups; traditional PBL and SBL according to the clinical characteristics, treatment outcomes and patterns of failure in this analysis. Continuation ( 〉 4 cycles) of active systemic chemotherapy was the only prognostic factor for OS, regardless of any local treatment. Thus, standard systemic chemotherapy should be the mainstay of treatment for NHL involved breasts. And, newer treatment strategy adapted on the poor prognosis should also be warranted. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood.V114.22.5024.5024
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2009
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  • 9
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    The Feasibility of High-Dose Dexamethasone (HD-DEX) in Idiopathic Thrombocytopenic Purpura (ITP) in Adults; a Multi-Center Study in Korea.
    American Society of Hematology ; 2005
    In:  Blood Vol. 106, No. 11 ( 2005-11-16), p. 4009-4009
    Details
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 4009-4009
    Abstract: Short term use of HD-DEX has shown less adverse effects (AEs) than PDS maintenance but its success rates reported differently by several studies. The objective of this study was to determine HD-DEX effectiveness in adult ITP with newly diagnosed (group 1) and relapsed after other treatments(Tx) (group 2). 71 (median age; 45, 20~82) with ITP with a platelet counts (PC) 20,000/uL or less than 50,000/uL and clinically significant bleeding were enrolled. DEX a dose of 40 mg/day for 4 consecutive days was tried. A response was defined as an increase in the PC of at least 30,000/uL, PC of more than 50,000/uL by day 10 (D10) after DEX. A maintenance was defined as a PC of more than 50,000/uL 6 ms after Tx. The number of group 1 and 2 were 54, 17, retrospectively. In group 2, previous regimens included;oral PDS and/or IVIG (16)and splenectomy (4). Median PC before Tx were 8,500(1,000~45,000/uL) and 9,000(100~33,000/uL) in group 1 and 2, retrospectively (p=0.80). 27(50%) and 6(35.3%) in group 1, 2 showed good initial response to 1st course of DEX, retrospectively (p=0.40). After 1st course of DEX, 11(20.3%) in group 1 and 1(5.9%) in group 2 could maintain response for 3 ms (p=0.27). By 6 ms, 8 (14.8%) in group 1 and 1 (5.9%) in group 2 kept first response (p=0.68). Among 33 patients bearing initial response, 12 (44.4%)and 2 (33.3%) in group 1, 2 relapsed (p=1.0). Good correlation revealed between PC (D10) and response rate (RR) (p & lt;0.05). Of 21 with PC (D10) above 100,000/uL, 6(28.6%) experienced relapse. On the other hand, nine of 11 patients (81.8%) in whom PC (D10) were less than 100,000/uL relapsed after all. There was no significant difference in relapse-free survival (RFS) after 1st DEX between 2 groups (p=0.9). 13 of 14 relapsed received 2nd DEX and then maintained PDS without interruption. After several weeks of maintenance, PDS tapered according to the PC. 9(75.0%) in group 1 and 2(100%) in group 2 showed response in 2nd DEX. Of these 11 patients, 2 in group 1 relapsed 10 ms after receiving 2nd DEX. After 1st DEX, 12 (16.9%), 5(7%) and 6 (8.5%) temporarily suffered from vague generalized sx., facial edema, and mild liver function abnormality, retrospectively. During the 2nd DEX and consecutive oral PDS, 4(30.7%), 3(23.1%) and 1(7.7%) experienced same AEs, retrospectively. Additionally, of these 13, overt DM requiring hypoglycemic agents appeared in 2(15.4%) and 1(7.7%) experienced duodenal ulcer bleeding. In conclusion, 1 course of HD-DEX revealed good initial response in group 1 but in group 2, the RR was lower than in historical results of oral PDS. However, it has an advantage for the patients to have a good compliance to the Tx because of few AEs and no need to maintain long-term daily medication. Furthermore, although the 2nd DEX and PDS maintenance showed good response, it revealed no benefit compared as a previously established oral PDS regimen because of frequently occurrence of AEs and poor compliance. Therefore, the proper DEX schedule remained to be determined according to the early achieved platelet counts (eg. D10) with 1st course DEX or to the presence of previous Tx.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood.V106.11.4009.4009
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
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  • 10
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    Prognostic Implication of Inflammatory Factor-Based Staging System in Multiple Myeloma in the New Agent Era
    American Society of Hematology ; 2019
    In:  Blood Vol. 134, No. Supplement_1 ( 2019-11-13), p. 4372-4372
    Details
    In: Blood, American Society of Hematology, Vol. 134, No. Supplement_1 ( 2019-11-13), p. 4372-4372
    Abstract: B ackground The advent of new agents has contributed to the prolonged survival of multiple myeloma (MM) patients. From the Durie-Salmon staging system, international staging system (ISS) and recently, revised ISS (R-ISS) have been developed to better prognosticate the survival of MM. R-ISS includes chromosomal abnormalities (CA) detected by interphase fluorescent in situ hybridization (iFISH) and lactate dehydrogenase (LDH) in addition to the ISS. However, the R-ISS has still some limitations in the real clinical settings, as it has enrolled patients exclusively on clinical trials which includes more young patients (age 〈 65 years old), contains non-standardized iFISH results and has short median follow-up duration. The first-line drugs used in the patients could also affect the prognosis. Therefore, a more detailed and standardized but also convenient prognostic system is needed with clinical findings commonly observed in MM patients treated with new agents in the real clinical world. Patient and Method Adult patients who were confirmed multiple myeloma between January, 2011 to December, 2017 and patients who had received thalidomide and/or bortezomib or lenalidomide-based chemotherapy as a first-line treatment were included for the analysis. A total of 861 patients from 13 centers participating Korean multiple myeloma working party were analyzed. Baseline serum albumin, serum ß2-microglobulin, cytogenetics by iFISH, LDH (lactate dehydrogenase), ALC (absolute lymphocyte count), CRP (C-reactive protein) and ferritin were measured within 4 weeks before beginning the first line of chemotherapy. Each factors of age ≥ 65 years, serum ß2-microglobulin ≥ 5.5 mg/L, LDH 〉 normal, cytogenetic high risk by FISH (del17p, t(4;14), t(14;16)), ALC 〈 1500/mm3, CRP ≥ 1.5 mg/dL, and ferritin ≥ 500 ng/mL were defined as abnormal findings, which were given 1 point (Table 1) and the sum of points were used to discriminate inflammatory factor-based staging system (IFBSS). IFBSS were defined as follows: Stage I (point 0), stage II (point 2-3), stage III (point 4-5), and stage IV (point 5-7). Overall survival (OS) was defined by the date of MM diagnosis to the date of death by any cause or follow-up loss. Results Baseline characteristics of the patients were as listed in Table 2. With a median follow-up duration of 22.70 months (range, 0.20-86.80 months), age ≥ 65 years, serum ß2-microglobulin ≥ 5.5 mg/L, LDH 〉 normal, cytogenetic high risk by FISH (del17p, t(4;14), t(14;16)), ALC 〈 1500/mm3, CRP ≥ 1.5 mg/dL, and ferritin ≥ 500 ng/mL showed significant higher OS by univariate and multivariate analysis. Albumin 〈 3.5 mg/dL were excluded into the staging system due the unpredictability to OS in univariate analysis (Table 3). Study groups of inflammatory factor-based scoring system comprised of 61 patients in stage I, 395 patients in stage II, 189 patients in stage III and 36 patients in stage IV. The median OS were not reached in stage I and II, stage III and IV showed a median OS of 36.57 months (95%CI, 33.96-.39.18) and 17.60 months (95%CI, 9.16-.26.04). The OS according to the IFBSS showed significant differences (P 〈 0.001), which predicted OS better compared with conventional ISS and R-ISS (Table 4). Conclusion In the new agent era, inflammatory factors incorporated into the staging system can better discriminate prognosis of multiple myeloma patients compared to the ISS or R-ISS. Validation of this finding in a larger cohort is needed to expand usage of this new staging system. Disclosures Yoon: Novartis: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Kyowa Hako Kirin: Research Funding; Janssen: Consultancy; Yuhan Pharma: Research Funding; Genentech, Inc.: Research Funding; MSD: Consultancy.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood-2019-127707
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2019
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