Showing papers by "Soo Hyun Lee published in 2010"

Double umbilical cord blood transplantation for children and adolescents

Abstract: Umbilical cord blood transplantation (UCBT) with two units has been conducted with promising results in adults to overcome the limitation of low cell numbers. In an attempt to improve the outcomes, double UCBT was performed in children and adolescents. Sixty-one patients, including 44 acute leukemia, and 17 other hematologic diseases, received double UCBT. Donor-type engraftment achieved in 82% of patients. Except one patient with persistent mixed chimerism of two units, other 49 patients showed dominancy of one unit and only the CFU-GM was significant factor influencing dominancy. The event-free survival (EFS) of leukemia and other hematologic disease were 59% and 53%, respectively, and the EFS of acute leukemia patients who received transplant in first or second CR (68.6%) was significantly better than in those with advanced disease (22.2%) (P = 0.007). Among the factors influencing outcomes, low cell dose difference between two units (TNC difference/TNC of large unit <15%) were associated with higher TRM, relapse, and lower EFS. Double UCBT was a promising modality of transplant in children and adolescence. However, engraftment and other results were not so satisfactory yet. To improve the outcomes, development of new selection guideline, probably including cell dose difference between two units and technology to enhance engraftment and reduce transplantation-related mortality are warranted.

Improved Outcome of Central Nervous System Germ Cell Tumors: Implications for the Role of Risk-adapted Intensive Chemotherapy

Abstract: To determine the impact of treatment protocols on the outcome of central nervous system germ cell tumors (CNS-GCTs), we reviewed the medical records of 53 patients who received front-line chemotherapy from September 1997 to September 2006. Pure germinoma, normal alpha-fetoprotein level and beta-human chorionic gonadotropin level <50 mIU/mL were regarded as low-risk features and the others as high-risk. Patients from different time periods were divided into 3 groups according to the chemotherapy protocols. Group 1 (n=19) received 4 cycles of chemotherapy comprising cisplatin, etoposide and bleomycin. Group 2 (n=16) and group 3 (n=18) received 4 cycles of chemotherapy with cisplatin, etoposide, cyclophosphamide and vincristine in the former and with carboplatin, etoposide, cyclophosphamide and bleomycin in the latter. In group 2 and group 3, high-risk patients received double doses of cisplatin, carboplatin and cyclophosphamide. Radiotherapy was given after chemotherapy according to the clinical requirements. The event-free survivals of groups 1, 2, and 3 were 67.0%, 93.8%, and 100%, respectively (group 1 vs. 2, P=0.06; group 2 vs. 3, P=0.29; group 1 vs. 3, P=0.02). Our data suggest that risk-adapted intensive chemotherapy may improve the outcome of patients with malignant CNS-GCTs.

Measurement of tyrosine hydroxylase transcripts in bone marrow using biopsied tissue instead of aspirates for neuroblastoma.

Abstract: Background Molecular detection of tyrosine hydroxylase (TH) transcripts by quantitative RT-PCR (qRT-PCR) is a sensitive method to detect neuroblastoma (NB) cells in the bone marrow (BM). However, its clinical utility following chemotherapy has not been thoroughly investigated. Procedures TH transcripts in the BM were measured by qRT-PCR both at diagnosis and during the course of chemotherapy. The results were analyzed with respect to assay timing, tumor volume and histological findings. Results TH transcripts were detected in 100% of BM aspirates at diagnosis in cases with concurrent tumor involvement in the BM section; however, the proportion of TH transcript positive BM aspirates in cases with concurrent tumor involvement in the BM section gradually decreased following chemotherapy (55.5% after three cycles, 28.6% after six cycles and 0% after nine or more cycles of chemotherapy). Decreased proportion of TH transcript positive BM aspirates was associated with reduced tumor volume in the BM and differentiation of tumors into mature forms during chemotherapy. When qRT-PCR was performed with both aspirated and biopsied tissue during chemotherapy, TH transcripts were detected in BM tissue not only in all of the histology-positive cases but also in some of the histology-negative cases, while the proportion of TH transcript positive BM aspirates was low, even in histology-positive cases. Conclusions Measurement of TH transcripts in BM aspirates does not appear to be clinically useful during or after chemotherapy. Therefore, molecular monitoring of NB cells during or after chemotherapy using BM tissue is more optimal than testing on BM aspirates. Pediatr Blood Cancer. 2010;55:273–278. © 2010 Wiley–Liss, Inc.

Clinical Characteristic of High-risk Neuroblastoma Patients with Respect to Age at Diagnosis

Abstract: Purpose: The purpose of this study was to evaluate the clinical characteristics and outcome of patients with high-risk neuroblastoma with respect to age at diagnosis. Methods: From January 1997 to December 2008, 76 patients were newly diagnosed with stage 4 neuroblastoma over 1 year of age at diagnosis. Patients were divided into two groups according to age at diagnosis; less than 18 months vs. over 18 months, less than 24 months vs. over 24 months and less than 36 months over 36 months. The clinical characteristics and outcome of patients were investigated with respect to the age. Results: Difference in the 5-year relapse-free survival rate was biggest when the patients were divided into less than 24 month group (n=17) and over 24 month group (n=59) (91.7±15.6% vs. 61.3±14.5%, P=0.049). While there was no difference in the toxic death rate between the two groups (11.8% vs. 11.9%), relapse was more frequent in over 24 month group (5.9% vs. 23.7%, P<0.001). There were no differences in sex, stage, histology, lactate dehydrogenase, ferritin, and neuron-specific enolase between the two groups. However, N-myc amplified tumor (≥3 copies) was more frequent in less than 24 month group (75.0% vs. 39.7%, P=0.012). In the multivariate analysis, age less than 24 months was a favorable factor for relapse-free survival with borderline significance (HR 0.16, 95% CI 0.02∼1.35 P=0.078). Conclusion: Relapse-free survival rate was higher in less than 24 month group than in over 24 month group despite a higher frequency of N-myc amplified tumor in less than 24 month group. Therefore, revision of treatment protocol might be needed to reduce treatment-related toxicity without jeopardizing survival rate in high-risk neuroblastoma patients less than 24 months of age at diagnosis. (Clin Pediatr Hematol Oncol 2010;17:36∼42) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Efficacy of Cefepime Prophylaxis for Autologous Stem Cell Transplantation in Children with High-risk Solid Tumor

Abstract: Purpose: Infection is one of the most important complications associated with hematopoietic stem cell transplantation (HSCT) in children with high-risk solid tumor. The study was designed to determine the efficacy of cefepime prophylaxis to prevent infection in autologous HSCT. Methods: From October 2008 to April 2009, 50 children with high-risk solid tumor who received autologous HSCT were enrolled in this study. They were divided to two groups, prophylaxis vs. empirical treatment. In the prophylaxis group, cefepime was given intravenously once the absolute neutrophil count (ANC) fell below 200/μL, after initiation of HDCT, even in the absence of a high fever. In the empirical group, cefepime was given at onset of fever and neutropenia (ANC <500/μL). Results: The two groups had similar clinical characteristics in age at HSCT, conditioning regimens, frequency of HSCT, number of CD34 cells. There were no significant differences in duration of fever, duration of antibacterial agents and cost of total antibacterial agents. However, when the analysis were confined to only patient without grade ≥3 mucositis, duration of fever (P=0.027) and number of patients who needed second-line antibiotic treatment (P=0.009) were lesser in the prophylactic group than in the empirical group. In addition the number of patients without neutropenic fever were more in the prophylactic group than in the empirical group (P=0.010). There was no difference in the development of high grade toxicities (NCI grade ≥3) between two groups. Conclusion: Although there were no significant differences in efficacy and cost effectiveness between prophylactic group and empirical group. Some beneficial effects were observed, when the analysis were confined to only patient without significant mucositis. Further investigation with larger randomized selected patents is needed. (Clin Pediatr Hematol Oncol 2010;17:19∼27) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏