We initiated this study to investigate whether combining Helicobacter pylori eradication with immunosuppressive therapy provides an additional benefit to patients with idiopathic thrombocytopenic purpura (ITP) that has relapsed or has not responded to steroid and/or danazol therapy in patients who have H. pylori infection. Thirty- four patients with chronic ITP that had relapsed or failed to steroid and/or danazol therapy were assessed for H. pylori infection. Of the 21 confirmed cases, 12 patients were given H. pylori eradication therapy alone (EA), while 9 patients received eradication therapy combined with immunosuppressive therapy (EI). The response rate was not significantly different between patients in the EA and those in the EI group (41.7% in the EA group vs. 66.7% in the EI group, p=0.345). The median platelet count at 6 months after therapy was higher in the EI group patients (75X10(9)/L in the EI group patients vs. 18x109/L in the EA group patients, p=0.028). The median response duration was also longer in the EI group patients (9 months in the EI group patients vs. 3 months in the EA group patients, p=0.049). These results show that a significant benefit is gained by the use of H. pylori eradication combined with immunosuppressive therapy over the use of eradication therapy alone for patients with chronic ITP.
Adult ; Aged ; Anti-Bacterial Agents/*administration & dosage ; Chronic Disease ; Danazol/administration & dosage ; Drug Therapy, Combination ; Estrogen Antagonists/administration & dosage ; Female ; Helicobacter Infections/complications/*drug therapy ; *Helicobacter pylori ; Humans ; Immunosuppressive Agents/*administration & dosage ; Male ; Middle Aged ; Purpura, Thrombocytopenic, Idiopathic/complications/*drug therapy ; Steroids/administration & dosage ; Treatment Outcome

No abstract available.
Drug Therapy*

No abstract available.

BACKGROUND: Although adding rituximab to the chemotherapy regimen of cyclophosphamide, vincristine, doxorubicin, and prednisone (R-CHOP) has improved clinical outcomes of patients with diffuse large B-cell lymphoma (DLBCL), several recent studies have shown that the effect of rituximab is dominantly in the non-germinal center (non-GC) subtype compared to the germinal center (GC) subtype. Natural killer (NK) cell count, a surrogate marker of immune status, is associated with clinical outcomes in DLBCL patients in the rituximab era. We investigated whether the impact of NK cells on clinical outcomes differed according to the immunophenotype of DLBCL. METHODS: This study analyzed 72 DLBCL patients treated with R-CHOP between January 2010 and January 2014. RESULTS: Low NK cell counts (<100/microL) were associated with poor progression-free survival (PFS) and overall survival (OS) compared to high NK cell counts. In multivariate analysis, low NK cell count was an independent prognostic factor for PFS and OS. However, survival did not significantly differ between the GC and non-GC subtypes. We examined the clinical influence of NK cells according to the immunophenotype and found that low NK cell counts were significantly associated with poor PFS and OS in non-GC cases, but not in GC cases. CONCLUSION: Low NK cell counts at diagnosis are associated with poor clinical outcomes in DLBCL patients treated with R-CHOP therapy. However, the impact is significant only in non-GC subtype DLBCL, not in the GC subtype.
Biomarkers ; Cell Count ; Cyclophosphamide ; Diagnosis ; Disease-Free Survival ; Doxorubicin ; Drug Therapy ; Germinal Center ; Humans ; Killer Cells, Natural* ; Lymphoma, B-Cell* ; Multivariate Analysis ; Prednisone ; Vincristine ; Rituximab

Previous reports have suggested that a high serum cyclosporine A (CsA) level could result in a lower incidence of acute-graft-versus-host disease (aGVHD). An elevated serum lactate dehydrogenase (LDH) level has been reported to be an adverse predictor of outcome in stem cell transplantation (SCT) for acute myeloid leukemia. In this study, we retrospectively analyzed the records of 24 patients who received allogeneic SCT from an HLA-matched sibling donor for acute and chronic myelogenous leukemia. Univariate analysis showed that two factors (the serum CsA level at the third week after SCT and the LDH level at the third week after SCT) were significantly associated with the incidence of aGVHD among several variables (age, sex, stem cell source, cell dose, C-reactive protein, absolute lymphocyte count, conditioning regimens, and time to engraftment). A higher serum level of CsA and lower serum LDH level at the third week after SCT were associated with a lower incidence of aGVHD (P=0.015, 0.030). In multivariate analysis, the serum CsA level (hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.022-0.652, P=0.0014) and serum LDH level (HR, 6.59; 95% CI, 1.197-36.316, P=0.030) at the third week after SCT were found to be independent factors that were significantly associated with the development of aGVHD. We conclude that a high CsA level and low LDH level might predict a low cumulative incidence of aGVHD after allogeneic transplantation from a matched sibling donor.
Acute Disease ; Adult ; Cyclosporine/*blood ; Female ; Graft vs Host Disease/*epidemiology/etiology ; Humans ; L-Lactate Dehydrogenase/*blood ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy ; Leukemia, Myeloid, Acute/therapy ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; *Stem Cell Transplantation ; Transplantation, Homologous

No abstract available.
Aged ; Amylases/blood/*metabolism/urine ; Bone Marrow/pathology ; Electrophoresis, Agar Gel ; Gene Rearrangement ; Humans ; Immunohistochemistry ; Isoenzymes/blood/metabolism/urine ; Male ; Multiple Myeloma/*diagnosis/metabolism/pathology ; Plasmacytoma/pathology ; Pleural Effusion, Malignant/pathology

BACKGROUND/AIMS: Serum ferritin is a marker of acute phase reactions and iron storage. In addition, hematologic malignancies are associated with elevated serum ferritin levels. Other studies have suggested that ferritin is a surrogate for advanced disease and has an impact on relapse, because elevated serum ferritin predicts overall survival (OS) and relapse-free survival following autologous stem cell transplantation for lymphomas. METHODS: We studied 89 consecutive patients with newly diagnosed multiple myeloma to determine the value of serum ferritin in comparison with known prognostic factors. RESULTS: The OS in the elevated serum ferritin group (> or =300 ng/mL) was shorter than that in the normal serum ferritin group (<300 ng/mL, p<0.001) after a median follow-up of 25 months. In univariate analysis, elevated ferritin was correlated with poor survival in the patients (relative risk [RR], 2.588; 95% confidence interval [CI], 1.536 to 4.358; p<0.001). Furthermore, multivariate analysis showed that elevated serum ferritin was an independent predictor of mortality in patients with multiple myeloma (RR, 2.594; 95% CI, 1.403 to 4.797; p=0.002). CONCLUSIONS: The serum ferritin can a prognostic parameter of survival as well as disease activity in patients with multiple myeloma.
Adult ; Aged ; Aged, 80 and over ; C-Reactive Protein/analysis ; Female ; Ferritins/*blood ; Humans ; Male ; Middle Aged ; Multiple Myeloma/*blood ; Prognosis ; Proportional Hazards Models ; beta 2-Microglobulin/blood

Pulmonary nodular lymphoid hyperplasia (NLH) is a term first suggested by Kradin and Mark to describe one or more pulmonary nodules or localized lung infiltrates consisting of reactive lymphoid proliferation. To date, there have been only a few cases of pulmonary NLH reported associated with autoimmune disorders. There is no case of NLH associated with Sj?gren's syndrome from Korea in the medical literature. A 56-year-old woman was referred to our hospital with cough productive of sputum and chest tightness. The Computed tomography scans of the chest revealed multiple and well-defined peribronchiolar nodular opacities. A video assisted thoracoscopic surgery (VATS) biopsy was performed and the nodular opacity in the lung parenchyma was pathologically confirmed as NLH. Through meticulous review of patient's record, we found that she had been suffering from dry eye and dry mouth. The symptoms suggested Sj?gren's syndrome, which was confirmed by specific laboratory tests including the Schirmer test, anti-nuclear antibody and anti-Ro/La antibody. The patient is followed regularly and has no further progression of symptoms.
Biopsy ; Female ; Humans ; Immunohistochemistry ; Middle Aged ; Pseudolymphoma/complications/*pathology/*radiography ; Sjogren' ; s Syndrome/*complications ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed

Systemic lupus erythematosus (SLE) is an autoimmune disease with a loss of the control over B lymphocytes which is normally exerted by T-suppressor cell. The thymus play a central role in regulating and controlling immune reaction through its effects on T cell differentiation of both T helper and T suppressor cells. Tumors of the thymus are rare but have been reported in concurrence with a variety of autoimmune diseases, including most frequently myasthenia gravis and rarely SLE and other disorders. The association of thymoma and SLE is very rare, fewer than 10 case reports in the world literature. The woman had been thymectomized because of incidental thymoma. After two years, she was diagnosed as SLE with features of arthritis, leukopenia, high titer of ANA, positivity of anti-dsDNA and hypocomplementemia. We report here one case of concurrent SLE and thymoma.
Arthritis ; Autoimmune Diseases ; B-Lymphocytes ; Cell Differentiation ; Female ; Humans ; Leukopenia ; Lupus Erythematosus, Systemic* ; Myasthenia Gravis ; Thymectomy ; Thymoma* ; Thymus Gland

BACKGROUND: It is widely known that the prognosis of acute myeloid leukemia (AML) depends on chromosomal abnormalities. The majority of AML patients relapse and experience a dismal disease course despite initial remission. METHODS: We reviewed the medical records and laboratory findings of 55 AML patients who had relapsed between 2004 and 2013 and who had been treated at the Division of Hematology of the Pusan National University Hospital. RESULTS: The event-free survival (EFS) was related to prognostic karyotype classification at the time of diagnosis and relapse (unfavorable vs. favorable or intermediate karyotypes at diagnosis, 8.2 vs. 11.9 mo, P=0.003; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.2 vs. 11.9 mo, P=0.009). The overall survival (OS) was significantly correlated with karyotype classification only at diagnosis (unfavorable vs. favorable or intermediate vs. karyotypes at diagnosis, 8.5 vs. 21.8 mo, P=0.001; unfavorable vs. favorable or intermediate karyotypes at relapse, 8.5 vs. 21.2 mo, P=0.136). A change in karyotype between diagnosis and relapse, which is regarded as a factor of resistance against treatment, was not a significant prognostic factor for OS, EFS, and post-relapse survival (PRS). A Cox proportional hazards model showed that the combined use of fludarabine, cytosine arabinoside, and granulocyte colony-stimulating factor (FLAG) as a salvage regimen, was a significant prognostic factor for OS (hazard ratio=0.399, P=0.010) and the PRS (hazard ratio=0.447, P=0.031). CONCLUSION: The karyotype classification at diagnosis predicts survival including PRS in relapsed AML patients as well as in treatment-naïve patients. We suggest that presently, administration of salvage FLAG could be a better treatment option.
Busan ; Chromosome Aberrations ; Classification ; Clonal Evolution* ; Cytarabine ; Diagnosis ; Disease-Free Survival ; Granulocyte Colony-Stimulating Factor ; Hematology ; Humans ; Karyotype ; Leukemia, Myeloid, Acute ; Medical Records ; Prognosis ; Proportional Hazards Models ; Recurrence