Myelodysplastic syndrome (MDS) refers to a group of clonal disorders affect both hematopoietic stem cells and progenitor cells within the erythrocytic, granulocytic, and megakaryocytic lineages. Ineffective hematopoiesis, the major manifestation of MDS, arises from a complex interaction between hematopoietic progenitors and the microenvironment, resulting in premature apoptotic death of progenitors and their maturing progeny. Development and progression of MDS is suggested to be a multistep alteration to hematopoietic stem cells. Although the molecular pathogenesis of MDS has not been clearly elucidated, a model of MDS pathogenesis has been proposed whereby a normal hematopoietic stem cell acquires successive genetic abnormalities that ultimately lead to malignant transformation and clonal expansion. Early mutations in stem cells may cause differentiation arrest and apoptosis leading to dysplasia and cytopenia, wherease subsequent defects affecting myeloid cell proliferation may cause the clonal expansion of aberrant cells and leukemic transformation. The heterogeneity in the clinical and morphologic features in MDS reflects the diversity and complexity of the underlying genetic defects. Some of these different molecular alterations have been described. However, since the developing targeted therapeutic advances in MDS will likely depend on a full comprehension of underlying molecular mechanisms, it may be required to make further progress in understanding the exact pathomechanisms of this disease.
Apoptosis ; Comprehension ; Diagnosis, Differential ; Hematopoiesis ; Hematopoietic Stem Cells ; Myelodysplastic Syndromes ; Myeloid Cells ; Population Characteristics ; Stem Cells

Adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) constitute a distinct population from children and older adults. However, AYA represent a minority of patients enrolled onto either adult or pediatric clinical trials. As a result, little information is available regarding complete remission (CR), event-free survival (EFS) and overall survival (OS) rates for this age group, and the appropriate treatment regimen for this group of patients remains elusive. A systematic review of all published clinical trials, which provide data on treatment and outcome of AYA with ALL, has been summarized in an effort to determine whether they should be treated on pediatric or adult protocols. AYA with ALL have far superior outcomes when treated on more intensive pediatric regimens and are required specific collaborative trials in order to optimize and improved outcomes.
Adolescent* ; Adult ; Child ; Disease-Free Survival ; Humans ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Young Adult*

We report a 58-year-old man who developed synchronous gastric non-Hodgkin`s lymphoma (NHL) and renal cell carcinoma. He presented with epigastric discomfort for 2 months. Endoscopic finding of the stomach disclosed a large inegular ulceration with nodular margin on the upper body. Constrast enhanced CT scan of the abdomen showed an ulceration and focal wall thickening in the greater curvature side of stomach, and an enhanced bulging mass in the left kidney incidentally. The tissue obtained by radical proximal gastrectomy and nephrectomy showed diffuse large B-cell lymphoma on stomach and chromophobic type of renal cell carcinoma on kidney. To our knowledge, this is the first report of synchronous gastric NHL and renal cell carcinoma in Korea.
Abdomen ; Carcinoma, Renal Cell* ; Gastrectomy ; Hodgkin Disease* ; Humans ; Kidney ; Korea ; Lymphoma ; Lymphoma, B-Cell ; Middle Aged ; Nephrectomy ; Stomach ; Tomography, X-Ray Computed ; Ulcer

No abstract available.
Trichosporon*

BACKGROUND: Policy-makers are required to know the current patterns of resource use and the costs of stroke. However, the scientific evidence, on which health policy-making can be based, is not sufficient. Our study aimed to investigate resource utilization and costs during the one year after stroke. METHODS: Among patients with acute ischemic stroke (7 days from onset) who were admitted from July of 2001 to July of 2002, 223 were interviewed one year after the onset of stroke through a home visit by an experienced research nurse. Resource utilization and related costs were investigated. RESULTS: The average length of stay was 25 days. The average first inpatients costs was won 2, 230, 000. After discharge, the average outpatient visit was 22 days. The average expenditure per patient during the one year from onset of stroke was won 5, 235, 000. The hospital charge was 59% of the total cost, the cost for hiring a care-giver was 14%, and the fee for the outpatient clinic was 13%. Thirty-nine percent (won 2, 051, 000) of the total expenditure was consumed in the first month, 12% was in the second, 8% was in the third, and around 5% monthly was after 3 months. CONCLUSIONS: Our study is the first one to investigate the resource utilization and the related costs in stroke patients in Korea. The results of this study should not be generalized to all Korean stroke patients, but this study may serve as a reference for inferring the real status in Korea and may be a starting point for further nationwide resource utilization and costs studies.
Ambulatory Care Facilities ; Delivery of Health Care* ; Fees and Charges ; Health Expenditures ; Hospital Charges ; House Calls ; Humans ; Inpatients ; Korea ; Length of Stay ; Outpatients ; Stroke*

FMS-like tyrosine kinase 3 (FLT3) mutations, the most frequently detected genetic aberrations in patients with acute myeloid leukemia (AML), are identified in approximately 30% of patients with newly diagnosed AML and are more common in patients with normal karyotypes. Since the discovery of FLT3 mutations in AML, clinical trials have been actively conducted in patients with FLT3 mutated AML, and FLT3 inhibitors have been introduced into clinical practice. The current standard treatment for patients with newly diagnosed FLT3-mutated AML is 7+3 induction chemotherapy combined with midostaurin.Additionally, gilteritinib is more effective than salvage chemotherapy for relapsed or refractory FLT3-mutated AML. Ongoing trials are expected to provide additional treatment options depending on the disease state and patient vulnerability. This review summarizes information on clinically available FLT3 inhibitors for the management of AML with FLT3 mutations.

PURPOSE: The quality of life has become increasingly important as an outcome when assessing patients who have had surgery for advanced gastric cancer in the elderly. The purpose of this study was to study the validity of quality of postoperative life as a criterion in the decision-making process as well as the results of operation for advanced gastric cancer in the elderly. MATERIALS AND METHODS: Spitzer's quality of life index, postoperative mortality and survival were evaluated in 67 patients(over 65 years of age) with advanced gastric cancer who had undergone operation between 1988 and 1997 at the Department of Surgery, Kangnam Sacred Heart Hospital. RESULTS: The quality of life score and median survival correlated with TNM clinical stage(IIIa; 7.1+/-1.8, 36.0 months vs. IIIb: 5.8+/-2.8, 28.6 months vs. IV: 2.9+/-1.9, 4.5 months), resectability(reseetion: 5.9+/-2.7, 21.0 months vs. no resection: 3.0+/-2.0, 4.0 months), curability(curative operation: 6.5+/-2.4, 29.0 months vs. palliative operation: 3.3+/-2.4, 6.0 months), type of gastrectomy(subtotal gastrectomy: 6.4+/-2.7, 28.0 months vs. totai gastrectomy: 4.5+/-2.6, 9.0 months), but not with age or sex. There was a difference in operative mortality according to age group(65~70 years: 7.8% vs. >70 years: 18.8%), resectability(resection: 7.4% vs. no resection: 23.0%) and curability (curative operation: 2.3% vs. palliative operation: 25.0%). CONCLUSION: The results suggest that surgical resection offers the only chance for improved survival and qulaity of life. Gastric resection, even with total gastrectomy, can be undertaken to reduce tumor burden, decrease threats of obstruction, hemarrhage, or perforation and improve quality of life in the elderly if there is little coexisting impairment.
Aged* ; Gastrectomy ; Heart ; Humans ; Mortality ; Quality of Life ; Stomach Neoplasms* ; Tumor Burden

Azacitidine is recommended for patients with higher-risk myelodysplastic syndromes (MDS) who are not eligible for intensive therapy or for patients with lower-risk MDS who have thrombocytopenia or neutropenia or have anemia that is unresponsive to other therapies. However, standard treatment with azacitidine has not been optimized and many issues about the use of azacitidine remain unresolved. The use of azacitidine is expanding rapidly, but limited comparative clinical trial data are available to (i) define the optimal use of azacitidine in patients with higher-risk MDS or around the time of allogeneic hematopoietic stem cell transplantation, (ii) identify those patients with lower-risk MDS who may benefit from treatment, and (iii) guide physicians on alternative therapies after treatment failure. Increasing evidence suggests that the clinical features, prognostic factors, and cytogenetic profiles of patients with MDS in Asia differ significantly from those of patients in Western countries, so the aim of this review is to summarize the evidence and provide practical recommendations on the use of azacitidine in patients with MDS in the Republic of Korea. Evidence considered in this review is based on published clinical data and on the clinical experience of an expert panel from the acute myeloid leukemia/MDS Working Party of the Korean Society of Hematology.
Anemia ; Asia ; Azacitidine ; Complementary Therapies ; Cytogenetics ; Hematology ; Hematopoietic Stem Cell Transplantation ; Humans ; Myelodysplastic Syndromes ; Neutropenia ; Practice Guidelines as Topic ; Republic of Korea ; Thrombocytopenia ; Treatment Failure

Successful hematopoietic stem cell transplantation (HSCT) involves the restoration of hematopoietic function after engraftment, arising from the differentiation and proliferation of hematopoietic stem cells. Several factors could influence the course of allogeneic-HSCT (allo-HSCT). Therefore, knowledge of serum proteome changes during the allo-HSCT period might increase the efficacy of diagnosis and disease prevention efforts. This study conducted proteomic analyses to find proteins that were significantly altered in response to allo-HSCT. Sera from five representative patients who underwent allo-HSCT were analyzed by 2-dimensional gel electrophoresis and liquid chromatography tandem mass spectrometry, and were measured on a weekly basis before and after allo-HSCT in additional 78 patients. Fourteen protein spots showing changes in expression were further examined, and most proteins were identified as acute phase proteins (APPs). Studies of 78 additional patients confirmed that C-reactive protein (CRP) and haptoglobin undergo expression changes during allo-HSCT and thus may have the potential to serve as representative markers of clinical events after allo-HSCT. Maximal CRP level affected the development of major transplant-related complications (MTCs) and other problems such as fever of unknown origin. Particularly, an increase in CRP level 21 days after allo-HSCT was found to be an independent risk factor for MTC. Maximal haptoglobin and haptoglobin level 14 days after allo-HSCT were predictive of relapses in underlying hematologic disease. Our results indicated that CRP and haptoglobin were significantly expressed during allo-HSCT, and suggest that their level can be monitored after allo-HSCT to assess the risks of early transplant-related complications and relapse.
Adolescent ; Adult ; Biological Markers ; C-Reactive Protein/*metabolism ; Female ; Haptoglobins/*metabolism ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Humans ; Male ; Middle Aged ; Proteome/*metabolism ; Proteomics ; Transplantation Conditioning ; Transplantation, Homologous ; Young Adult

To compare the clonogenicity and distribution of CD34+ subsets in bone marrow (BM), granulocyte colony-stimulating factor (G-CSF) mobilized peripheral blood (PB) and cord blood (CB), we analyzed in vitro colony formation and CD34+ cells co-expressing differentiation molecules (CD38, HLA-DR), myeloid associated molecules (CD13, CD33), a T-cell associated molecule (CD3), and a B-cell associated molecule (CD19) from mononuclear cells (MNCs) in the three compartments. The proportions of CD34+CD38- cells (BM: 4.4+/-2.8%, PB: 5.3+/-2.1%, CB: 5.9+/-3.9%) and CD34+HLA-DR cells (BM: 4.7+/-3.4%, PB: 5.5+/-2.3%, CB: 6.1+/-3.7%) did not differ significantly among the compartments. In contrast, a significantly higher proportion of CD34 cells of PB and CB co-expressed CD13 (75.0+/-11.4%, 77.7+/-17.3%) and CD33 (67.1 +/-5.7%, 56.8+/-10.3%) compared with those of BM (43.0+/-6.3%, 27.6+/-5.1%) and a significantly higher number of granulocyte-macrophage colony-forming units (CFU-GM) and erythroid burst-forming units (BFU-E) were detected in MNCs derived from PB and CB compared with those from BM (p<0.01). The proportion of CD34+CD19+ cells was higher in BM (34.9+/-11.9%) than those in PB (5.6+/-3.0%) and CB (4.7=2.1%) (p<0.05). The proportion of CD34+CD3+ was comparable in all three compartments. In conclusion, our findings show that MNCs of mobilized PB and CB display similar phenotypic profiles of CD34+ subsets and clonogenicity, different from those of BM.
Adult ; Antigens, CD34/immunology* ; Bone Marrow/immunology* ; Colony-Forming Units Assay ; Comparative Study ; Fetal Blood/immunology* ; Flow Cytometry ; Granulocyte Colony-Stimulating Factor/pharmacology ; HLA-DR Antigens/immunology ; Hematopoietic Stem Cells/immunology* ; Human ; Leukocytes, Mononuclear/immunology ; Lymphocyte Subsets/immunology ; Male ; Phenotype ; Reference Values