Purpose: We conducted a nationwide, multicenter, prospective registry study for newly diagnosed patients with peripheral T-cell lymphoma (PTCL) to better define the clinical characteristics, treatment patterns, survival outcomes, and the role of upfront autologous stem cell transplantation (ASCT) in these patients. Materials and Methods: Patients with PTCL receiving chemotherapy with curative intent were registered and prospectively monitored. All patients were pathologically diagnosed with PTCL. Results: A total of 191 patients with PTCL were enrolled in this prospective registry study. PTCL, not otherwise specified (PTCL-NOS) was the most common pathologic subtype (n=80, 41.9%), followed by angioimmunoblastic T-cell lymphoma (AITL) (n=60, 31.4%). With a median follow-up duration of 3.9 years, the 3-year progression-free survival (PFS) and overall survival (OS) rates were 39.5% and 60.4%, respectively. The role of upfront ASCT was evaluated in patients who were considered transplant-eligible (n=59). ASCT was performed as an upfront consolidative treatment in 32 (54.2%) of these patients. There were no significant differences in PFS and OS between the ASCT and non-ASCT groups for all patients (n=59) and for patients with PTCL-NOS (n=26). However, in patients with AITL, the ASCT group was associated with significantly better PFS than the non-ASCT group, although there was no significant difference in OS. Conclusion The current study demonstrated that the survival outcomes with the current treatment options remain poor for patients with PTCL-NOS. Upfront ASCT may provide a survival benefit for patients with AITL, but not PTCL-NOS.

Purpose: Diffuse large B-cell lymphoma (DLBCL) is the most common hematologic malignancy worldwide. Although substantial improvement has been achieved by the frontline rituximab-based chemoimmunotherapy, up to 40%-50% of patients will eventually have relapsed or refractory disease, whose prognosis is extremely dismal. Materials and Methods: We have carried out two prospective cohort studies that include over 1,500 DLBCL patients treated with rituximab plus CHOP (#NCT01202448 and #NCT02474550). In the current report, we describe the outcomes of refractory DLBCL patients. Patients were defined to have refractory DLBCL if they met one of the followings, not achieving at least partial response after 4 or more cycles of R-CHOP; not achieving at least partial response after 2 or more cycles of salvage therapy; progressive disease within 12 months after autologous stem cell transplantation. Results: Among 1,581 patients, a total of 260 patients met the criteria for the refractory disease after a median time to progression of 9.1 months. The objective response rate of salvage treatment was 26.4%, and the complete response rate was 9.6%. The median overall survival (OS) was 7.5 months (95% confidence interval, 6.4 to 8.6), and the 2-year survival rate was 22.1%±2.8%. The median OS for each refractory category was not significantly different (p=0.529). Conclusion In line with the previous studies, the outcomes of refractory DLBCL patients were extremely poor, which necessitates novel approaches for this population.

Purpose: Febrile neutropenia (FN) can cause suboptimal treatment and treatment-related mortality (TRM) in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). Materials and methods: We conducted a prospective cohort study to evaluate the effectiveness of pegfilgrastim prophylaxis in DLBCL patients receiving R-CHOP, and we compared them with the PROCESS cohort (n=485). Results: Since January 2015, 986 patients with DLBCL were enrolled. Pegfilgrastim was administered at least once in 930 patients (94.3%), covering 90.3% of all cycles. FN developed in 137 patients (13.9%) in this cohort (23.7% in the PROCESS cohort, p<0.001), and 4.2% of all cycles (10.2% in the PROCESS cohort, p<0.001). Dose delay was less common (≥3 days: 18.1% vs. 23.7%, p=0.015; ≥5 days: 12.0% vs. 18.3%, p=0.023) in this cohort than in the PROCESS cohort. The incidence of TRM (3.2% vs. 5.6%, p=0.047) and infection-related death (1.8% vs. 4.5%, p=0.004) was lower in this cohort than in the PROCESS cohort. The 4-year overall survival (OS) and progression-free survival (PFS) rates of the two cohorts were not different (OS: 73.0% vs. 71.9%, p=0.545; PFS: 69.5% vs. 68.8%, p=0.616). However, in patients aged ≥75 years, the 4-year OS and PFS rates were higher in this cohort than in the PROCESS cohort (OS: 49.6% vs. 33.7%, p=0.032; PFS: 44.2% vs. 30.3% p=0.047). Conclusion Pegfilgrastim prophylaxis is effective in the prevention of FN and infection-related death in DLBCL patients receiving R-CHOP, and it also improves OS in patients aged ≥75 years.

BACKGROUND/AIMS: To identify the risk factors for metachronous gastric neoplasms in patients who underwent an endoscopic resection of a gastric neoplasm. METHODS: We prospectively collected clinicopathologic data and measured the methylation levels of HAND1, THBD, APC, and MOS in the gastric mucosa by methylation-specific real-time polymerase chain reaction in patients who underwent endoscopic resection of gastric neoplasms. RESULTS: A total of 257 patients with gastric neoplasms (113 low-grade dysplasias, 25 high-grade dysplasias, and 119 early gastric cancers) were enrolled. Metachronous gastric neoplasm developed in 7.4% of patients during a mean follow-up of 52 months. The 5-year cumulative incidence of metachronous gastric neoplasm was 4.8%. Multivariate analysis showed that moderate/severe corpus intestinal metaplasia and family history of gastric cancer were independent risk factors for metachronous gastric neoplasm development; the hazard ratios were 4.12 (95% confidence interval [CI], 1.23 to 13.87; p=0.022) and 3.52 (95% CI, 1.09 to 11.40; p=0.036), respectively. The methylation level of MOS was significantly elevated in patients with metachronous gastric neoplasms compared age- and sex-matched patients without metachronous gastric neoplasms (p=0.020). CONCLUSIONS: In patients who underwent endoscopic resection of gastric neoplasms, moderate/severe corpus intestinal metaplasia and a family history of gastric cancer were independent risk factors for metachronous gastric neoplasm, and MOS was significantly hypermethylated in patients with metachronous gastric neoplasms.
Aged ; Basic Helix-Loop-Helix Transcription Factors/genetics ; DNA Methylation ; Female ; Gastrectomy/methods ; Genes, APC/physiology ; Genes, mos/genetics ; Humans ; Incidence ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasms, Second Primary/epidemiology/*genetics/pathology ; Proportional Hazards Models ; Risk Factors ; Stomach Neoplasms/genetics/*pathology/surgery ; Thrombomodulin/genetics

PURPOSE: Pneumonia is the most common cause of death among infectious diseases. Community-acquired pneumonia is the sixth leading cause of death in Korea. This study was designed to analyze the relationship of risk factors and mortality, especially the pneumonia severity index (PSI) in patients with community-acquired pneumonia diagnosed in the emergency department of a referral hospital. METHODS: The medical records of patients admitted to the Yeungnam University Hospital between March 2006 and March 2008 for community-acquired pneumonia were reviewed retrospectively. The demographic data, comorbidity, laboratory results, PSI score and class of PSI, all of which might influence the prognosis of pneumonia, were analyzed. RESULTS: Among 123 patients admitted for community-acquired pneumonia, 18 died (mortality rate of 15%). Laboratory data showed that sodium, glucose, blood urea nitrogen, albumin, platelets, hematocrit and arterial pH were related to the prognosis. For the pneumonia severity index, the mortality rate increased in a step-wise manner from class I through class V. Comorbidities such as neoplasms (p=0.000), cerebrovascular accidents (p=0.005) and liver disease (p=0.003), as well as systolic blood pressure (p=0.003), respiratory rate (p=0.024), sodium (p=0.000), glucose (p=0.000), blood urea nitrogen (p=0.000), albumin (p=0.003), hematocrit (p=0.000) and arterial pH (p=0.042) were the important risk factors for mortality in patients with community-acquired pneumonia. CONCLUSION: The pneumonia severity index could be used as a valuable index for predicting mortality of patients and the prognosis of community-acquired pneumonia in the emergency department.
Blood Glucose ; Blood Platelets ; Blood Pressure ; Blood Urea Nitrogen ; Cause of Death ; Communicable Diseases ; Comorbidity ; Emergencies ; Glucose ; Hematocrit ; Humans ; Hydrogen-Ion Concentration ; Korea ; Liver Diseases ; Medical Records ; Nitrogen ; Pneumonia ; Prognosis ; Referral and Consultation ; Respiratory Rate ; Retrospective Studies ; Risk Factors ; Sodium ; Stroke ; Urea

PURPOSE: The probiotic effects of lactic acid bacteria have widely been researched in diverse human pathogens, but only a few effects are reported against oral pathogens. The antimicrobial effects of the Enterococcus faecium 7413 isolated from Korean infants on the 9 pathogen including 6 oral streptococci were investigated the clinical use of the antimicrobial peptide for oral microflora control. MATERIALS AND METHODS: E. faecium 7413 was identified by morphological, biochemical tests and 16S rDNA sequence analysis. Inhibitory effects of culture supernatants were determined for their ability to grow on agar plate containing pathogenic bacteria. RESULT: The culture supernatant of Enterococcus faecium 7413 showed inhibitory effects on oral pathogens, namely Streptococcus pyogenes KCTC 3556, S. pneumoniae KCTC 5080, S. mutans ATCC 25175, S. anginosus ATCC 33397, S. constellatus KCTC 3268, S. intermedius ATCC 27823 and Shigella flexneri KCTC 2008. Whereas it did not affect the multiplication of E. coli strains, KCTC 1041 and ATCC 43894. CONCLUSION: The data obtained in this study could be useful for future development of effective probiotics allowing prevention for oral pathogens.
Agar ; Bacteria ; DNA, Ribosomal ; Enterococcus ; Enterococcus faecium ; Humans ; Infant ; Lactic Acid ; Pneumonia ; Probiotics ; Sequence Analysis ; Shigella flexneri ; Streptococcus pyogenes

A seventyone-year-old male presented with sudden epigastric pain followed by jaundice and intermittent right upper abdominal pain. He was diagnosed as hepatocellular carcinoma 7 years ago, and has been treated with transarterial chemoembolization, percuaneous ethanol injection and segmentectomy. On admission, the level of serum bilirubin, amylase and lipase were 8.7 mg/dL, 560 IU/L, and 13,297 IU/L, respectively. Stool occult blood test was positive. Abdominal computed tomography revealed newly-appeared intraductal soft tissue mass with ductal dilatation. Endoscopic retrograde cholangiography demonstrated filling defects in the common hepatic and distal common bile duct (CBD). Endoscopic sphincterotomy was performed and the clots in the distal CBD were removed. An intraductal stent was inserted at the common hepatic duct. The obstructive jaundice and pancreatitis were resolved. Our case suggests that intraductal hepatocellular carcinoma may induce hemobilia as a possible cause of acute pancreatitis.
Abdominal Pain ; Amylases ; Bilirubin ; Carcinoma, Hepatocellular* ; Cholangiography ; Common Bile Duct ; Dilatation ; Ethanol ; Hemobilia* ; Hepatic Duct, Common ; Humans ; Jaundice ; Jaundice, Obstructive ; Lipase ; Male ; Mastectomy, Segmental ; Occult Blood ; Pancreatitis ; Sphincterotomy, Endoscopic ; Stents

BACKGROUND: The combination chemotherapy of gemcitabine and cisplatin has been proven effective in the treatment of advanced non-small cell lung cancer (NSCLC). However, the optimal schedule for administration of the two drugs has not yet been determined. We therefore started a phase II trial to evaluate efficacy, toxicity and dose intensity (DI) as three-week scheduled chemotherapy of gemcitabine and cisplatin. METHODS: Between October 2000 and March 2003, a total of 56 patients with stage IIIB and IV NSCLC were enrolled in this study. Treatment schedule consisted of gemcitabine 1200 mg/m2 i.v. on days 1 and 8, and cisplatin 80 mg/m2 i.v. on day 1 of each chemotherapy cycle followed by two weeks of rest. RESULTS: Forty-eight patients were evaluable in response and adverse effects in this study. The median DI was 529 mg/m2/week for gemcitabine (66%) and 22 mg/m2/week for cisplatin (83%). Partial response was observed in 23 patients. The overall response rate was 47.8% (95% confidence interval [CI], range from 33.6% to 61.9%). Anemia and thrombocytopenia were the main hematologic adverse effects, with 8.3% and 8.3% of patients experiencing grade III to IV toxicity, respectively. The median survival time was 11.78 months (95% CI, range from 8.59 to 14.97months). No significant differences in response rate were observed according to sex, age, histology and DI of gemcitabine and cisplatin. CONCLUSION: The 3-week-scheduled combination chemotherapy of gemcitabine and cisplatin has feasibility to treat advanced stage IIIB and IV NSCLC with modest adverse effects. The regimen deserves further evaluaton in a phase III prospective randomized trial.
Anemia ; Appointments and Schedules ; Carcinoma, Non-Small-Cell Lung ; Cisplatin* ; Drug Therapy ; Drug Therapy, Combination* ; Humans ; Thrombocytopenia

Although high-dose therapy (HDT) with autologous hematopoietic stem cell transplantation (ASCT) is widely accepted as an effective and safe consolidation therapy for multiple myeloma (MM), few reports on its efficacy are available in Korea. We present the results of a prospective phase II study, involving 33 patients with MM treated with HDT with ASCT. The treatment consisted of 4 courses of VAD (vincristine, adriamycin, dexamethasone) induction, peripheral blood stem cell collection, and high-dose melphalan with stem cell infusion. The overall response rate was 93%, with 45% of patients having complete responses. The toxicity was predictable and tolerable. With a median follow-up of 27.6 months, the 2-year event free survival rate was 43%. At the time of writing, the median overall survival duration had not been reached with 2-year survival and projected 3-year survival rates of 81% and 74%, respectively. The overall survival was significantly better than that of the historical control patients (N=82) treated with conventional chemotherapy at our institution. The results suggest that HDT with ASCT is a valuable first or second-line treatment for patients with MM.
Adult ; Aged ; Female ; Human ; Male ; Melphalan/*therapeutic use ; Middle Aged ; Multiple Myeloma/mortality/pathology/*therapy ; Neoplasm Staging ; *Peripheral Blood Stem Cell Transplantation ; Prognosis ; Prospective Studies ; Survival Rate ; Transplantation, Autologous

BACKGROUND: The paradoxical response refers to an enlargement of old lesions or unexpected new ones during apparently adequate antituberculous therapy. This response has been reported in cases of intracranial tuberculoma, tuberculous lymphadenopathy, tuberculous pleurisy and pulmonary tuberculosis. However, there are few reports on its frequency and clinical characteristics. METHOD: This study enrolled 205 patients who were treated with first line antituberculous agents for more than 6 months. We retrospectively studied 155 patients with pulmonary tuberculosis and 57 patients with pleural tuberculosis (7 patients had both) from July 1998 to March 2000. The patients were divided into the paradoxical response group and the non-paradoxical group. The clinical characteristics of the paradoxical group were investigated. Statistical analysis was done with an independent sample T-test and Chi-squared test. RESULT: 29 of the 205 patients(14.1%) had paradoxical response. Among the 29 patients, there were 19 pulmonary tuberculosis, 8 tuberculous pleurisy(2 patients had both). Paradoxical response appeared 32 days (mean 35 days in pulmonary tuberculosis, mean 25 days in tuberculous pleurisy) after the beginning of chemotherapy. The duration to regress less than half of initial chest lesion was 114 days in pulmonary tuberculosis and 124 days in tuberculous pleurisy, respectively. Most common clinical manifestation of paradoxical response patients was coughing in both pulmonary tuberculosis and tuberculous pleurisy. Male sex, high blood WBC count and high level of pleural fluid LDH were related with paradoxical response. CONCLUSION: These findings suggest that presponse usually appears 1 month and disappears within 4 months after the beginning of anti-tuberculous chemotherapy. Paradoxical response was relatively correlated with male sex, high blood WBC count and high level of pleural fluid LDH.
Male ; Humans