This study was performed to validate the effectiveness and safety of concurrent chemoradiotherapy and adjuvant therapy with temozolomide for newly diagnosed glioblastoma multiforme as a standard treatment protocol. Between 2004 and 2011, patients newly diagnosed with glioblastoma who were treated with temozolomide during concurrent chemoradiotherapy and adjuvant chemotherapy were included from a single institution and analyzed retrospectively. The primary endpoint was overall survival, and the secondary endpoints were progression-free survival, response, and safety. A total of 71 patients were enrolled in this study. The response rate was 41% (29/71), and the tumor control rate was 80% (57/71). In the 67 patients who completed the concurrent chemoradiotherapy with temozolomide, the median overall survival was 19 months and the 1- and 2-yr overall survival rates were 78.3% and 41.7%, respectively. The median progression free survival was 9 months, and the 1- and 2-yr progression free survival rates were 33.8% and 14.3%, respectively. The mean duration of survival after progression of disease in salvage treatment group was 11.9 (1.3-53.2) months. Concurrent chemoradiotherapy with temozolomide resulted in grade 3 or 4 hematologic toxic effects in 2.8% of the patients. The current protocol of temozolomide during and after radiation therapy is both effective and safe and is still appropriate as the standard protocol for treatment of glioblastoma. An active salvage treatment might be required for a better prognosis.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents, Alkylating/administration & dosage ; Brain Neoplasms/diagnosis/*mortality/*therapy ; Chemoradiotherapy, Adjuvant/methods/mortality ; Comorbidity ; Dacarbazine/administration & dosage/*analogs & derivatives ; Female ; Glioblastoma/diagnosis/*mortality/*therapy ; Hematologic Diseases/*mortality ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Prevalence ; Radiotherapy, Conformal/mortality ; Republic of Korea/epidemiology ; Risk Factors ; Survival Rate ; Treatment Outcome ; Young Adult

BACKGROUND/AIMS: The clinical outcomes of patients with hematologic malignancies who were treated with extracorporeal membrane oxygenation (ECMO) after the failu re of optimal conventional therapy were determined. METHODS: The medical records of all patients administered ECMO during their stay in a medical intensive care unit of Seoul St. Mary's Hospital between February 2010 and July 2013 were reviewed retrospectively. RESULTS: In total, 15 patients with hematologic malignancies were compared to 33 immunocompetent patients with documented cardiorespiratory failure. Underlying hematologic malignancies were significantly associated with lower overall survival (0.0% vs. 24.2%, p = 0.044). Mortality was significantly associated with a higher 24 hours ECMO inspired fraction of oxygen (0.71 +/- 0.24 vs. 0.47 +/- 0.13, p = 0.015), the development of infection after ECMO (87.5% vs. 25.0%, p = 0.001), and the presence of hyperbilirubinemia (70.0% vs. 0.0%, p < 0.001). Matching of the patients based on their Acute Physiology and Chronic Health Evaluation II scores confirmed the greater risk of mortality in patients with hematologic malignancies (survival: 0.0% vs. 40.0%, p = 0.017). The mean difference in inotropic-equivalent scores after ECMO was significantly lower in the immunocompetent patients than in those with hematologic malignancies (-59.22 +/- 97.83 vs. 53.87 +/- 164.46, p = 0.026). CONCLUSIONS: Patients with hematologic malignancies who require ECMO for respiratory support have poor outcomes. The incidence of complications in these patients did not significantly differ from that in immunocompetent patients.
APACHE ; Adult ; Aged ; *Extracorporeal Membrane Oxygenation/adverse effects/mortality ; Female ; Hematologic Neoplasms/diagnosis/mortality/*therapy ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Medical Records ; Middle Aged ; Predictive Value of Tests ; Republic of Korea ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome

Invasive pulmonary aspergillosis (IPA) is the most frequent form of invasive fungal diseases in immunocompromised patients. However, there are only a few studies on IPA in immunocompromised children in Korea. This study was designed to characterize IPA in Korean children with hematologic/oncologic diseases. Medical records of children with hematologic/oncologic diseases receiving antifungal therapy were reviewed. The enrolled children were divided into the IPA group (proven and probable IPA) and non-IPA group, and the clinical characteristics and prognosis were compared between the two groups. During the study period, 265 courses of antifungal therapy were administered to 166 children. Among them, two (0.8%) episodes of proven IPA, 35 (13.2%) of probable IPA, and 52 (19.6%) of possible IPA were diagnosed. More children in the IPA group suffered from neutropenia lasting for more than two weeks (51.4% vs. 21.9%, P<0.001) and showed halo signs on the chest computed tomography (78.4% vs. 40.7%, P<0.001) than in the non-IPA group. No other clinical factors showed significant differences between the two groups. Amphotericin B deoxycholate was administered as a first line antifungal agent in 33 (89.2%) IPA group episodes, and eventually voriconazole was administered in 27 (73.0%) episodes. Ten (27.0%) children in the IPA group died within 12 weeks of antifungal therapy. In conclusion, early use of chest computed tomography to identify halo signs in immunocompromised children who are expected to have prolonged neutropenia can be helpful for early diagnosis of IPA and improving prognosis of children with IPA.
Antifungal Agents/*therapeutic use ; Child ; Child Health/statistics & numerical data ; Comorbidity ; Female ; Hematologic Diseases/*mortality ; Humans ; Incidence ; Invasive Pulmonary Aspergillosis/*diagnosis/drug therapy/*mortality ; Male ; Neoplasms/*mortality ; Prognosis ; Republic of Korea/epidemiology ; Risk Factors ; Survival Rate ; Tomography, X-Ray Computed/statistics & numerical data ; Treatment Outcome

Although Aspergillus endocarditis has rarely been reported, it can cause fatal complications in hematologic malignancy patients and allogeneic stem cell transplant recipients. We experienced two cases of aspergillus endocarditis developed in acute lymphoblastic leukemia patients. Case; A 19-year-old patient developed Aspergillus endocarditis after allogenic hemopoietic stem cell transplantation. He was treated with surgical intervention and liposomal amphotericin B. He died of recurred Aspergillus endocarditis and cerebral hemorrhage probably related with aspergillosis of central nervous system. Case 2; A 23-year-old patient developed invasive Aspergillus endocarditis after induction chemotherapy. Aspergillus endocarditis was successfully treated by surgical intervention and amphotericin B. He died of refractory neutropenic fever and sepsis after the third relapse of leukemia and repetitive chemotherapy. He probably had invasive pulmonary aspergillosis without evidence of endocarditis recurrence. Because the mortality of Aspergillus endocarditis is very high, early diagnosis and surgical intervention are very important for better outcome.
Amphotericin B ; Aspergillosis ; Aspergillus* ; Central Nervous System ; Cerebral Hemorrhage ; Drug Therapy ; Early Diagnosis ; Endocarditis* ; Fever ; Hematologic Neoplasms ; Humans ; Induction Chemotherapy ; Invasive Pulmonary Aspergillosis ; Leukemia ; Mortality ; Osteomyelitis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Recurrence ; Sepsis ; Stem Cell Transplantation ; Stem Cells ; Transplantation ; Young Adult

Although Aspergillus endocarditis has rarely been reported, it can cause fatal complications in hematologic malignancy patients and allogeneic stem cell transplant recipients. We experienced two cases of aspergillus endocarditis developed in acute lymphoblastic leukemia patients. Case; A 19-year-old patient developed Aspergillus endocarditis after allogenic hemopoietic stem cell transplantation. He was treated with surgical intervention and liposomal amphotericin B. He died of recurred Aspergillus endocarditis and cerebral hemorrhage probably related with aspergillosis of central nervous system. Case 2; A 23-year-old patient developed invasive Aspergillus endocarditis after induction chemotherapy. Aspergillus endocarditis was successfully treated by surgical intervention and amphotericin B. He died of refractory neutropenic fever and sepsis after the third relapse of leukemia and repetitive chemotherapy. He probably had invasive pulmonary aspergillosis without evidence of endocarditis recurrence. Because the mortality of Aspergillus endocarditis is very high, early diagnosis and surgical intervention are very important for better outcome.
Amphotericin B ; Aspergillosis ; Aspergillus* ; Central Nervous System ; Cerebral Hemorrhage ; Drug Therapy ; Early Diagnosis ; Endocarditis* ; Fever ; Hematologic Neoplasms ; Humans ; Induction Chemotherapy ; Invasive Pulmonary Aspergillosis ; Leukemia ; Mortality ; Osteomyelitis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Recurrence ; Sepsis ; Stem Cell Transplantation ; Stem Cells ; Transplantation ; Young Adult