We report a 4.7 kg infant who received a therapeutic leukapheresis as an immediate treatment for acute lymphoblastic leukemia with severe hyperleukocytosis. By decreasing the number of circulating white blood cells, therapeutic leukapheresis helps prevent the risks of hyperviscosity and cerebrovascular and pulmonary leukostasis. In addition, it potentially reduces metabolic and renal complications associated with rapid cell lysis when applied before chemotherapy. This six-week-old female presented with vomiting for 15 days. Initial WBC count was 1,532,800/muL. After placement of 4 french two-lumen central venous catheter in both femoral vein, the CS 3000 plus was primed with 250 mL of paternal whole blood mixed with 150 mL of normal saline. After therapeutic leukapheresis, the CBC showed WBC count of 560,000/muL. Our successful experience in performing this procedure suggests that therapeutic leukapheresis be a feasible treatment even for very young infants with hyperleukocytosis.
Central Venous Catheters ; Drug Therapy ; Female ; Femoral Vein ; Humans ; Infant* ; Leukapheresis* ; Leukocytes ; Leukostasis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Vomiting

Cord blood is a useful source of allogeneic hematopoietic stem cells for bone marrow reconstitution. The number of umbilical cord blood transplants is increasing worldwide. In this a case 15- month-old boy with acute myeloid leukemia was treated with umbilical cord blood transplant from an HLA-3 loci mismatched unrelated donor. Granulocyte recovery greater than 500/mm3 occurred at day 49, and the platelet recovered greater than 20,000/mm3 independent of transfusion at day 81 after stem cell infusion.
Blood Platelets ; Bone Marrow ; Fetal Blood* ; Granulocytes ; Hematopoietic Stem Cells ; Humans ; Leukemia, Myeloid, Acute* ; Male ; Stem Cells ; Umbilical Cord* ; Unrelated Donors*

PURPOSE: Brain tumors are the second most common tumor in childhood, and medulloblastomas comprise 15-25% of brain tumors. The well known prognostic factors are age at diagnosis, stage of disease, and extent of surgical excision. In this study, we analysed the prognostic factors in patients who received chemotherapy after excision. METHODS: We reviewed the medical records of 61 patients who received chemotherapy among the 94 patients who were diagnosed and treated between Jan 1985 and Sep 2001 in the Department of Pediatrics and Neurosurgery at Severance Hospital. RESULTS: Among the total survival rate of patients who underwent chemotherapy, the 3-yr progression-free survival rate was 66.5+/-6.3% and the 15-yr progression-free survival rate was 60.3+/-6.7%. The progression-free survival rate for patients with age at diagnosis over 3 yrs old and under 3 yrs old, was 64.5+/-7.7% and 48.2+/-12.9% respectively and there was no statistically significant difference. The survival rate of the high vs low risk group by staging was 72.7+/-10.5% and 54.6+/-8.3% respectively, and there was no significant difference. The survival rate of patients with total removal vs subtotal removal was 65.8+/-11.8% and 56.8+/-8.2% respectively, showing no statistical difference. CONCLUSION: The reason there is no difference in survival rate according to the traditional prognostic factors is that chemotherapy has improved not only the total survival rate but also the survival rate in patients with poor traditional prognostic factors. So, sufficient removal of tumor followed by proper chemotherapy and radiotherapy is an important factor which influences the survival rate of medulloblastoma patients.
Brain Neoplasms ; Diagnosis ; Disease-Free Survival ; Drug Therapy* ; Humans ; Medical Records ; Medulloblastoma* ; Neurosurgery ; Pediatrics ; Radiotherapy ; Survival Rate*

OBJECTIVE: The aim of this study is to apply a prognostic factor scoring system in patients with lymph node-negative stage IB - IIA cervical cancer. METHODS: One hundred and ninety-one stage IB - IIA cervical cancer patients were enrolled in this retrospective study from 1994 to 2005 in our gynecologic department. All patients were treated by radical abdominal hysterectomy with lymph node dissection, and there were no patients with involvement of lymph nodes or parametrial invasion. Statistical analysis comprised of clinical characteristics, pathology result, post-operative adjuvant therapy, and recurrence rate. RESULTS: Among the 191 patients, recurrence occurred in 9 patients (4.7%), while no recurrence was observed in the remaining 182 patients (95.3%). No significant difference was found between the two study groups in terms of average age, weight, parity, FIGO stage, and postoperative adjuvant therapy. After univariate analysis, tumor size and deep stromal invasion were factors found to be statistically significant for risk of recurrence. Cell type, close surgical margin, lymphovascular permeation were not significant factors. Multivariate analysis demonstrated deep stromal invasion was the only significant prognostic factor (RR=11.7, p=0.028). The scoring system was applied to tumor size, close surgical margin, and deep stromal invasion, 1, 1, and 2 points given for each factor, respectively. Using the ROC curve, based on 2 points as the cut-off level, the recurrence rate was significantly higher (p<0.0025). CONCLUSION: Deep stromal invasion was the most important prognostic factor in patients with early stage cervical cancer in the absence of lymph node metastasis. Herein, the scoring system may be applied to predict disease outcome.
Female ; Humans ; Hysterectomy ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Parity ; Pathology ; Prognosis ; Recurrence ; Retrospective Studies ; ROC Curve ; Uterine Cervical Neoplasms*

OBJECTIVE: To characterize prognostic factors in patients with pulmonary metastasis in recurrent cervical cancer. METHODS: The records of 2,042 patients treated for cervical cancer from 1994 to 2004 at two institutions were retrospectively reviewed. Twenty-five (1.04%) patients had pulmonary lesions consistent with metastatic cervical cancer. The data were analyzed retrospectively and reviewed for patient characteristics. RESULTS: Patients were treated with chemotherapy, radiotherapy only, chemoradiotherapy, surgery, and conservative treatment. There were no significant differences in survival rates between each treatment method (p=0.3410). Mean survival after treatment of pulmonary metestasis was 23 months. Histologic type, lymph node metastasis, other organ metastasis, and pretreatment SCC level were not significant prognostic factors, but FIGO stage (p=0.039) and disease-free interval (p=0.033) were significant factors. CONCLUSION: This study revealed that FIGO stage and disease-free interval were independent prognostic factors of pulmonary metestasis in recurrent cervical cancer.
Chemoradiotherapy ; Drug Therapy ; Humans ; Lymph Nodes ; Neoplasm Metastasis* ; Prognosis ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms*

OBJECTIVE: To evaluate the clinical characteristics of struma ovarii. METHODS: Twenty-five cases of struma ovarii were reviewed retrospectively from June 1994 to April 2007. The presenting clinical, radiologic, and pathologic features of the patients were reviewed. RESULTS: The mean age of the patients in this study was 45.3 years. The majority was of premenopausal status. Sixteen patients had clinical symptoms such as low abdominal pain, palpable abdominal mass and vaginal bleeding. Although one patient had an abnormal thyroid function test, the laboratory findings normalized after operative treatment. CA-125 levels were elevated in 6 cases. Diagnosis by preoperative imaging studies were 8 dermoid cysts, while only 3 cases were diagnosed as struma ovarii. There were 4 cases of malignant struma ovarii, and no patients with recurrent disease. CONCLUSION: Struma ovarii is a rare tumor. The presented clinical, laboratory and radiological findings of patients are very diverse. The diagnosis was confirmed by pathologic findings. The treatment of benign struma ovarii is surgical resection only. The cases of malignant struma ovarii may need adjuvant treatment, but recurrence is uncommon.
Abdominal Pain ; Dermoid Cyst ; Humans ; Recurrence ; Retrospective Studies ; Struma Ovarii ; Thyroid Function Tests ; Uterine Hemorrhage

OBJECTIVE: The purpose of this study was to evaluate whether the decline in serum CA-125 levels following primary cytoreductive surgery prior to starting adjuvant chemotherapy has a prognostic value in patients with stage IIIC/IV ovarian carcinoma. METHODS: A retrospective review was conducted of all patients with stage IIIC/IV ovarian carcinoma who underwent primary cytoreductive surgery followed by platinum-based chemotherapy from 1994 to 2007. Demographic, pathologic, treatment, and survival data were collected. Patients were included if serum CA-125 levels were drawn preoperatively and within one week prior to their first chemotherapy cycle, and whose postoperative CA-125 level declined. Percentage decline was calculated, and was compared with standard statistical tests in groups by 25% declination intervals. RESULTS: Of the 112 stage IIIC/IV patients, 81 (72.3%) met the above inclusion criteria. The median time from surgery to postoperative CA-125 sampling was 16 days (range: 7-42). A > or =75% decline was associated with a median progression-free survival (PFS) of 25 months (95% CI=0-63). This was significantly longer when compared with each of the other 25% interval groups. After multivariate analysis, independent prognostic factors included a > or =75% decline in CA-125 levels after surgery and the presence of residual tumor. Age, grade, histology, and preoperative CA-125 levels were not statistically significant factors. CONCLUSION: A > or =75% decline in serum CA-125 serum levels from primary cytoreductive surgery to the start of adjuvant chemotherapy has independent prognostic value for PFS in patients with stage IIIC/IV ovarian carcinoma.
Chemotherapy, Adjuvant ; Disease-Free Survival ; Humans ; Multivariate Analysis ; Neoplasm, Residual ; Ovarian Neoplasms ; Retrospective Studies

Background: Hodgkin's lymphoma (HL) constitutes 10%–20% of all malignant lymphomas and has a high cure rate (5-year survival, around 90%). Recently, interest has increased concerning preventing secondary complications (secondary cancer, endocrine disorders) in long-term survivors. We aimed to study the epidemiologic features and therapeutic outcomes of HL in children, adolescents, and young adults in Korea. Methods: We performed a multicenter, retrospective study of 224 patients aged < 25 years diagnosed with HL at 22 participating institutes in Korea from January 2007 to August 2016. Results: A higher percentage of males was diagnosed at a younger age. Nodular sclerosis histopathological HL subtype was most common, followed by mixed cellularity subtype.Eighty-one (36.2%), 101 (45.1%), and 42 (18.8%) patients were classified into low, intermediate, and high-risk groups, respectively. Doxorubicin, bleomycin, vinblastine, dacarbazine was the most common protocol (n = 102, 45.5%). Event-free survival rate was 86.0% ± 2.4%, while five-year overall survival (OS) rate was 96.1% ± 1.4%: 98.7% ± 1.3%, 97.7% ± 1.6%, and 86.5% ± 5.6% in the low, intermediate, and high-risk groups, respectively (P = 0.021). Five-year OS was worse in patients with B-symptoms, stage IV disease, highrisk, splenic involvement, extra-nodal lymphoma, and elevated lactate dehydrogenase level.In multivariate analysis, B-symptoms and extra-nodal involvement were prognostic factors for poor OS. Late complications of endocrine disorders and secondary malignancy were observed in 17 and 6 patients, respectively. Conclusion This is the first study on the epidemiology and treatment outcomes of HL in children, adolescents, and young adults in Korea. Future prospective studies are indicated to develop therapies that minimize treatment toxicity while maximizing cure rates in children, adolescents, and young adults with HL.