Purpose: Chronic myeloid leukemia (CML) in children, adolescents, and young adults is rare and differs from older adults. This study evaluated the outcomes of allogeneic hematopoietic stem cell transplantation (HSCT) in young Korean CML patients during the tyrosine kinase inhibitor (TKI) era. Materials and Methods: A retrospective analysis of 35 CML patients aged < 40 years who underwent allogeneic HSCT from 2009 to 2019 was conducted using Korean Blood and Marrow Transplantation Registry data. Patients were grouped by age < 20 years at HSCT (group 1, n=15) and 20-40 years at HSCT (group 2, n=20). Survival outcomes including overall survival (OS), relapse-free survival (RFS), and event-free survival (EFS) were analyzed using the Kaplan-Meier method. Results: The median time between diagnosis and HSCT was 8.9 months. All the patients achieved engraftment but platelet recovery was significantly slower in group 1 (p=0.034). Acute and chronic graft-versus-host disease occurred in 54.3% and 34.3%, respectively. Five-year OS, RFS, and EFS rates of total patients were 66.8%, 50.8%, and 47.6%, with better OS was observed in group 1 by multivariable analysis (p=0.048). Disease status at HSCT was a significant predictor of OS (p=0.028), RFS (p=0.003), and EFS (p=0.004). Disease progression occurred in 13 out of 35 patients (37.1%); treatment-related mortality accounted for 63.6% of deaths (7 out of 11). Conclusion When performed at a younger age, allogeneic HSCT result in superior outcome in CML. Achieving remission before HSCT is critical for improved outcomes, highlighting the importance of pretransplant remission via optimal TKI strategies and minimal residual disease monitoring.

Purpose: Current guidelines recommend vaccination at least 2 weeks before chemotherapy initiation to optimize the immune response despite limited evidence. Our previous study indicated no differences in short-term immune response for the 13-valent pneumococcal conjugate vaccine (PCV13) according to the vaccination timing. This study aims to investigate the long-term efficacy of PCV13 and clinical factors associated with the respective antibody response. Materials and Methods: Patients with gastric or colorectal cancer who received adjuvant chemotherapy were enrolled and divided into two groups: vaccinated 2 weeks before chemotherapy (arm A) and vaccinated concurrently with chemotherapy (arm B). Serum samples were collected before vaccination and in one month, 3 years, and 5 years. Immune responses were measured using enzyme-linked immunosorbent assay and multiplex opsonophagocytosis assay. Results: Including 63 patients, both groups showed an initial increase in the geometric mean titers of opsonophagocytic activity and the geometric mean concentrations of serotype-specific IgG levels after one month, followed by a decline at 3 and 5 years, particularly for serotypes 1, 14, 18C, and 19A. Despite the decline, global protection was maintained for 5 years, although global response decreased. The two arms did not show significant differences in immunogenicity nor in factors such as vaccination timing, age, cancer type, or chemotherapy regimen. Conclusion Vaccination timing is not a significant factor for the immunogenicity of PCV13 in cancer patients undergoing adjuvant chemotherapy. Global protection against pneumococcal infection was sustained for > 5 years, and global response remained in over half of patients.

Purpose: Stem cell transplantation (SCT) has historically played a major role in the long-term remission of mantle cell lymphoma (MCL), an incurable hematological malignancy. Using data from the Korean Society of Bone and Marrow Transplantation registry, we retrospectively analyzed the role of autologous (auto) and allogeneic (allo) SCT in longterm MCL survival. Methods: This study analyzed data from 188 patients (age ≥ 19 years at the time of transplantation) who underwent a transplant for MCL from 2011 to 2020. Progression-free survival (PFS) was defined as the time from transplantation to disease progression, relapse, or death from any cause. Overall survival (OS) was defined as the time from transplan‑ tation to death from any cause or the last follow-up. Results: In total, 109 patients underwent consolidative SCT after first-line chemotherapy. The 3-year PFS and OS rates were 65.4% and 78.5%, respectively, in the auto-SCT group, and 66.7% and 71.4%, respectively, in the allo-SCT group. The PFS and OS did not differ significantly between the auto- and allo-SCT groups. As part of salvage treatment, 52 patients with relapsed or refractory disease underwent auto- or allo-SCT. Patients who underwent auto-SCT with complete remis‑ sion/partial remission status reported better outcomes. In patients with refractory status, allogeneic transplantation using human leukocyte antigen (HLA) fully matched donors was a significantly favorable factor for PFS and OS. Conclusion The long-term survival of patients who underwent consolidative transplantation was similar to that reported in previous studies. Auto-SCT may be beneficial in patients who respond to salvage therapy, whereas allo-SCT with HLA-matched donors may be an alternative for patients with refractory disease. 

Multiple myeloma (MM), a hematological malignancy, is characterized by malignant plasma cell proliferation in the bone marrow. Recent treatment advances have significantly improved patient outcomes associated with MM.In this study, we aimed to develop comprehensive, evidence-based guidelines for the diagnosis, prognosis, and treat‑ ment of MM. We identified 12 key clinical questions essential for MM management, guiding the extensive literature review and meta-analysis of the study. Our guidelines provide evidence-based recommendations by integrating patient preferences with survey data. These recommendations include current and emerging diagnostic tools, thera‑ peutic agents, and treatment strategies. By prioritizing a patient-centered approach and rigorous data analysis, these guidelines were developed to enhance MM management, both in Korea and globally.

Background: The 2023 Obesity Fact Sheet aims to present an updated overview of obesity prevalence across all age groups, including children and adolescents. Methods: This study included individuals aged ≥20 years (n=16,941,423 in 2021) who underwent health checkups provided by the Korean National Health Insurance Service between 2012 and 2021. The prevalence of obesity and abdominal obesity was standardized by age and sex using data from the 2010 population and housing census. For children and adolescents (6 to 18 years) (n= 884 in 2021), we used the Korea National Health and Nutrition Examination Survey (2012 to 2021), and obesity was defined by the corresponding sex- and agespecific body mass index percentile of 95th or greater based on the 2017 Korean National Growth Chart for Children and Adolescents. Results: The overall prevalence of obesity in 2021 is 38.4% (49.2% in men and 27.8% in women), which is a 1.27-fold increase from 30.2% in 2012. The prevalence of obesity has increased across all age groups, particularly among those aged 20, 30, and 80 years. The prevalence of class III obesity substantially increased from 0.35% (men) and 0.42% (women) in 2012 to 1.21% and 0.97% in 2021, with 3.46- and 2.31-fold increases, respectively.This increase was particularly pronounced in young adults. The prevalence of obesity in children and adolescents has surged from 9.7% in 2012 to 19.3% in 2021, with a greater increase among boys. Conclusion Our study provides information on the current status of obesity prevalence based on the 2023 Obesity Fact Sheet, emphasizing the urgency of implementing timely strategies to reverse this increasing trend.

Purpose: Osteosynthesis of a clavicular fracture can obtain good clinical results even with conservative treatment. The development of surgical techniques and improvements in internal fixation have led to the use of metal plates and screws. Although there are intramedullary nails or minimally invasive plate osteosynthesis that can reduce soft tissue damage, these techniques are not used often because most require a skin incision about the length of the metal plate to be inserted. This study compared the postoperative pain to determine the appropriate injection depth. Materials and Methods: A prospective, single-institute, single-blind, randomized study was designed. The patients in the study had clavicular fractures and who underwent the removal of implant. The patients judged to have difficulty indicating pain were excluded.Ropivacaine was injected between plate fixation and muscle suturing. The visual analog scale (VAS) pain score, patient-controlled analgesia (PCA) use, and additional pain medication usage were measured after surgery and every 4 hours. Results: Thirty-four clavicle shaft fracture patients were classified into 16 patients in the subcutaneous injection group and 18 in the muscle injection group. Seventeen implant removal patients were divided into eight patients in the subcutaneous injection group and another nine in the muscle injection group. In the fracture group, the mean VAS for the subcutaneous injection group was 4.20±2.68 immediately after surgery, 4.47±1.85 at 4 hours, 1.93±1.44 at 24 hours, and 1.60±1.35 at 48 hours. The mean VAS for the muscle injection group was 4.23±1.59 immediately after surgery, 3.00±1.47 at 4 hours, 1.69±1.03 at 24 hours, and 1.31±1.11 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.332). In the implant removal group, the mean VAS for the subcutaneous injection group was 4.75±1.58 immediately after surgery, 3.75±1.04 at 4 hours, 1.75±0.89 at 24 hours, and 1.75±0.89 at 48 hours. The mean VAS for the muscle injection group was 3.78±1.20 immediately after surgery, 3.22±0.83 at 4 hours, 1.89±1.17 at 24 hours, and 1.11±1.01 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.181). Conclusion The postoperative VAS pain score and PCA usage were not statistically significant regardless of the ropivacaine injection site in clavicular surgery, but each group had significantly different VAS pain scores and PCA usage according to time after surgery. In addition, the muscle injection group tended to have a lower average VAS than the subcutaneous injection group in the implant removal patient group.

Objective: SHAPE (Simple Hysterectomy And PElvic node assessment) was an international phase III trial demonstrating that simple hysterectomy was non-inferior to radical hysterectomy for pelvic recurrence risk, but superior for quality of life and sexual health.The objective was to conduct a cost-effectiveness analysis comparing simple vs. radical hysterectomy for low-risk early-stage cervical cancer. Methods: Markov model compared the costs and benefits of simple vs. radical hysterectomy for early cervical cancer over a 5-year time horizon. Quality-adjusted life years (QALYs) were estimated from health utilities derived from EQ-5D-3L surveys. Sensitivity analyses accounted for uncertainty around key parameters. Monte Carlo simulation estimated complication numbers according to surgical procedure. Results: Simple hysterectomy was more effective and less costly than radical hysterectomy. Average overall costs were $11,022 and $12,533, and average gains were 3.56 and 3.54 QALYs for simple and radical hysterectomy, respectively. Baseline health utility scores were 0.81 and 0.83 for simple and radical hysterectomy, respectively. By year 3, these scores improved for simple hysterectomy (0.82) but not for radical hysterectomy (0.82). Assuming 800 early cervical cancer patients annually in Canada, the model estimated 3 vs. 82 patients with urinary retention, and 49 vs. 86 patients with urinary incontinence persisting 4 weeks after simple vs.radical hysterectomy, respectively. Results were most sensitive to variability in health utilities after surgery, but stable through wide ranges of costs and recurrence estimates. Conclusion Simple hysterectomy is less costly and more effective in terms of quality-adjusted life expectancy compared to radical hysterectomy for early cervical cancer.

Background: The 2023 Obesity Fact Sheet aims to present an updated overview of obesity prevalence across all age groups, including children and adolescents. Methods: This study included individuals aged ≥20 years (n=16,941,423 in 2021) who underwent health checkups provided by the Korean National Health Insurance Service between 2012 and 2021. The prevalence of obesity and abdominal obesity was standardized by age and sex using data from the 2010 population and housing census. For children and adolescents (6 to 18 years) (n= 884 in 2021), we used the Korea National Health and Nutrition Examination Survey (2012 to 2021), and obesity was defined by the corresponding sex- and agespecific body mass index percentile of 95th or greater based on the 2017 Korean National Growth Chart for Children and Adolescents. Results: The overall prevalence of obesity in 2021 is 38.4% (49.2% in men and 27.8% in women), which is a 1.27-fold increase from 30.2% in 2012. The prevalence of obesity has increased across all age groups, particularly among those aged 20, 30, and 80 years. The prevalence of class III obesity substantially increased from 0.35% (men) and 0.42% (women) in 2012 to 1.21% and 0.97% in 2021, with 3.46- and 2.31-fold increases, respectively.This increase was particularly pronounced in young adults. The prevalence of obesity in children and adolescents has surged from 9.7% in 2012 to 19.3% in 2021, with a greater increase among boys. Conclusion Our study provides information on the current status of obesity prevalence based on the 2023 Obesity Fact Sheet, emphasizing the urgency of implementing timely strategies to reverse this increasing trend.

Objective: SHAPE (Simple Hysterectomy And PElvic node assessment) was an international phase III trial demonstrating that simple hysterectomy was non-inferior to radical hysterectomy for pelvic recurrence risk, but superior for quality of life and sexual health.The objective was to conduct a cost-effectiveness analysis comparing simple vs. radical hysterectomy for low-risk early-stage cervical cancer. Methods: Markov model compared the costs and benefits of simple vs. radical hysterectomy for early cervical cancer over a 5-year time horizon. Quality-adjusted life years (QALYs) were estimated from health utilities derived from EQ-5D-3L surveys. Sensitivity analyses accounted for uncertainty around key parameters. Monte Carlo simulation estimated complication numbers according to surgical procedure. Results: Simple hysterectomy was more effective and less costly than radical hysterectomy. Average overall costs were $11,022 and $12,533, and average gains were 3.56 and 3.54 QALYs for simple and radical hysterectomy, respectively. Baseline health utility scores were 0.81 and 0.83 for simple and radical hysterectomy, respectively. By year 3, these scores improved for simple hysterectomy (0.82) but not for radical hysterectomy (0.82). Assuming 800 early cervical cancer patients annually in Canada, the model estimated 3 vs. 82 patients with urinary retention, and 49 vs. 86 patients with urinary incontinence persisting 4 weeks after simple vs.radical hysterectomy, respectively. Results were most sensitive to variability in health utilities after surgery, but stable through wide ranges of costs and recurrence estimates. Conclusion Simple hysterectomy is less costly and more effective in terms of quality-adjusted life expectancy compared to radical hysterectomy for early cervical cancer.

Purpose: Osteosynthesis of a clavicular fracture can obtain good clinical results even with conservative treatment. The development of surgical techniques and improvements in internal fixation have led to the use of metal plates and screws. Although there are intramedullary nails or minimally invasive plate osteosynthesis that can reduce soft tissue damage, these techniques are not used often because most require a skin incision about the length of the metal plate to be inserted. This study compared the postoperative pain to determine the appropriate injection depth. Materials and Methods: A prospective, single-institute, single-blind, randomized study was designed. The patients in the study had clavicular fractures and who underwent the removal of implant. The patients judged to have difficulty indicating pain were excluded.Ropivacaine was injected between plate fixation and muscle suturing. The visual analog scale (VAS) pain score, patient-controlled analgesia (PCA) use, and additional pain medication usage were measured after surgery and every 4 hours. Results: Thirty-four clavicle shaft fracture patients were classified into 16 patients in the subcutaneous injection group and 18 in the muscle injection group. Seventeen implant removal patients were divided into eight patients in the subcutaneous injection group and another nine in the muscle injection group. In the fracture group, the mean VAS for the subcutaneous injection group was 4.20±2.68 immediately after surgery, 4.47±1.85 at 4 hours, 1.93±1.44 at 24 hours, and 1.60±1.35 at 48 hours. The mean VAS for the muscle injection group was 4.23±1.59 immediately after surgery, 3.00±1.47 at 4 hours, 1.69±1.03 at 24 hours, and 1.31±1.11 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.332). In the implant removal group, the mean VAS for the subcutaneous injection group was 4.75±1.58 immediately after surgery, 3.75±1.04 at 4 hours, 1.75±0.89 at 24 hours, and 1.75±0.89 at 48 hours. The mean VAS for the muscle injection group was 3.78±1.20 immediately after surgery, 3.22±0.83 at 4 hours, 1.89±1.17 at 24 hours, and 1.11±1.01 at 48 hours; the mean VAS score was not statistically significant in the two groups (p=0.181). Conclusion The postoperative VAS pain score and PCA usage were not statistically significant regardless of the ropivacaine injection site in clavicular surgery, but each group had significantly different VAS pain scores and PCA usage according to time after surgery. In addition, the muscle injection group tended to have a lower average VAS than the subcutaneous injection group in the implant removal patient group.