BACKGROUND: New therapeutic modalities such as high dose chemotherapy and stem cell support have been tried to prolong the survival period of the patients with multiple myeloma. However, little is known about the criteria for the application of those new therapies. There are only a few reports for the prognostic factors of multiple myeloma in Korea. The purpose of this study is to analyze the prognostic factors affecting chemotherapy response and survival in patients with multiple myeloma. METHODS: We retrospectively analysed the clinical records of 122 patients who were newly diagnosed as multiple myeloma by SWOG criteria, between November, 1989 and April, 1997 at Asan Medical Center. RESULTS: 1) The peak incidence was the 7th decade and male to female ratio was 1.3:1. The most common presenting symptom at first diagnosis was bone pain. 2) Initial clinical stage was as followed: stage I in 17.2% , stage II in 16.4% and 66.4% in III. The immunoglobulin classes were IgG in 51.6%, light chain only in 25.4%, IgA in 16.4%, IgD in 4.1%, and non-secretory type in 2.5%. Plasma cell types in bone marrow were classified as plasmablastic type in 45.9%, plasmacytic type in 54.1%. 3) Eighty two patients who recieved chemotherapy more than 3 cycles were evaluable for chemotherapy response. Overall response rate was 69.5%. Factors affecting response to chemotherapy were serum creatinine level, plasma cell type, total plasma cell percentage and plasmablast percentasge of total nucleated cells in bone marrow. 4) For total 122 patients, overall median survival period was 21 months, and estimated 5 year survival rate was 23.5%. Factors affecting survival were serum creatinine, corrected calcium, albumin, beta2-microglobulin level, response to chemotherapy, total plasma cell percentage and plasmablast percentage in bone marrow. CONCLUSION: Bone marrow findings at initial diagnosis are significantly associated with response to chemotherapy and survival duration.
Bone Marrow ; Calcium ; Chungcheongnam-do ; Creatinine ; Diagnosis ; Drug Therapy* ; Female ; Humans ; Immunoglobulin A ; Immunoglobulin D ; Immunoglobulin G ; Immunoglobulin Isotypes ; Incidence ; Korea ; Male ; Multiple Myeloma* ; Plasma Cells ; Retrospective Studies ; Stem Cells ; Survival Rate

Myelodysplastic syndrome is a closely related group of acquired bone marrow disorders characterized by ineffective and dysplastic hematopoiesis. These clonal disorders frequently progress to acute leukemia. Acute myelomonocytic leukemia with eosinophilia is characterized by an increase in abnormal eosinophils in the bone marrow, relatively good clinical course and inv (16) chromosomal abnormality. We experienced one case of refractory anemia with excess blasts which progressed to refractory anemia with excess blasts in transformation and finally to acute myelomonocytic leukemia with eosinophilia showing peculiar chromosomal abnormalities of der (1;7).
Adult ; Anemia/pathology ; Anemia/genetics ; Anemia/etiology ; Bone Marrow/pathology ; Case Report ; Chromosomes, Human, Pair 16* ; Disease Progression ; Eosinophilia/pathology ; Eosinophilia/genetics* ; Eosinophilia/etiology ; Human ; Inversion (Genetics)* ; Karyotyping ; Leukemia, Myelocytic, Acute/pathology ; Leukemia, Myelocytic, Acute/genetics* ; Leukemia, Myelocytic, Acute/etiology ; Male ; Myelodysplastic Syndromes/pathology ; Myelodysplastic Syndromes/genetics* ; Myelodysplastic Syndromes/complications

BACKGROUND: Essential thrombocythemia (ET) is a rare chronic myeloproliferative disorder characterized by an extremely high platelet count in the circulating blood and abnormal proliferation of the megakaryocytes in bone marrow, resulting in splenomegaly, thromboembolic or hemorrhagic complications. We studied the presence of nuclear hyperploidy of the megakaryocytes in bone marrow, the presence of abnormal response to the individual reagent on platelet aggregation test, and its clinical implication. METHODS: We analyzed the 43 cases of ET at the Asan Medical Center between January, 1989 and March, 1999. The Polycythemia Vera Study Group criteria were used to diagnose ET. RESULTS: Nuclear hyperploidy was observed at 43 cases (100%). Platelet aggregation test was done at 32 (74.4%) cases, of which 27 (84.4%) cases showed abnormal response to more than one reagent, 16 (50%) cases to more than two reagents. Abnormal response to epinephrine and collagen was most common, but 5 cases showed normal response. By individual reagent, 1 (3%) cases to adenosine diphosphate, 1 (3%) case to ristocetin, 22 (69%) cases to epinephrine, 19 (59%) cases to collagen showed abnormal response. CONCLUSION: We observe that nuclear hyperploidy of the megakaryocyts and abnormal response on platelet aggregation test are frequent in ET in this study.
Adenosine Diphosphate ; Blood Platelets* ; Bone Marrow ; Chungcheongnam-do ; Collagen ; Epinephrine ; Indicators and Reagents ; Megakaryocytes* ; Myeloproliferative Disorders ; Platelet Aggregation* ; Platelet Count ; Polycythemia Vera ; Ristocetin ; Splenomegaly ; Thrombocythemia, Essential*

BACKGROUND: It has been well known that normal leukocyte counts in blood can vary depending on age, gender, other environmental factors and ethnic differe nces. However, the normal white blood cell counts in Koreans has not been settled yet. Over past several years, a large number of patients were referred to the Hematology Clinic of Asan Medical Center (AMC) for evaluation of "leukopenia", and most of them were found to have no medical problems other than leukocyte counts less than 4,000/mm3. We performed this study on persons who visited Health Screening Center to analysis of leukopenic patients and also to establish the normal value of white blood cell counts in Korean. METHOD: We studied 31,307 persons (19,540 men, 11,767 women, aged 15-90), who visited to Health Screening Center of AMC during the period from January through December 1995. We have carried out retrospec tive analysis of complete medical record of 2,406 patients (838 men, 1,568 women, aged 20-81) who were found to have leukocyte counts less than 4,000/ mm3. And we tried to establish the normal values of leukocyte counts and differential counts of 24,079 adults (15,807 men, 8,272 women, aged 19-90), who were assessed to be healthy at Health Screening Center of AMC. RESULTS: 1) Leukopenia (WBC<4,000/mm3) were found in 2,406 subjects (7.7%) among 31,307 persons screened. 2) Among them, 77 subjects (3%) had medical illness; 39 of them had chronic B or C viral hepatitis, 24 of them had iron deficiency anemia, and other diseases were de tected in remaining 14 patients. But other hematologic dis eases or significant infectious diseases were not detected. Follow-up study of them has indicated no increased incidence of infection or other hematologic diseases. 3) The total white blood cell counts of 24,097 healthy Korean adults were 3,640-9,870/mm3 (5,900/ mm3) in men, and 3,270-8,400/mm3 (5,264/mm3) in women. Neutrophil counts ranged 1,288-6,866/mm3 (3,098/mm3) in men, and 1,180-5,985/mm3 (2,816/mm3) in women. Leukocyte counts were significantly lower in female, but no significant variation was found among age groups. CONCLUSION: Normal range of leukocyte counts and neutrophil counts of healthy Korean adults were lower than those of white populations. Thus, a new normal values of leukocyte and neutrophil counts should be established in Koreans. And many persons with leuko cyte counts less than 4,000/mm3 who are otherwise he althy could be normal.
Adult ; Anemia, Iron-Deficiency ; Chungcheongnam-do ; Communicable Diseases ; Female ; Follow-Up Studies ; Hematologic Diseases ; Hematology ; Hepatitis ; Humans ; Incidence ; Leukocyte Count ; Leukocytes ; Leukopenia* ; Male ; Mass Screening ; Medical Records ; Neutropenia* ; Neutrophils ; Reference Values

Alpha-storage pool deficiency of platelet is a very rare disorder associated with a variety of conditions, including autoimmune disease, disseminated intravascular coagulation, myeloproliferative disorders, and cardiopulmonary bypass. This bleeding disorder is characterized by a moderate thrombocytopenia and a selective abnormality in platelet alpha-granules. We experienced the first case of alpha-storage pool deficiency of platelet in a 28-year-old male with severe valvular heart disease in Republic of Korea. Two years ago, mitral valve replacement was performed in other university hospital. Since a few months ago, dyspnea was developed and progressively exacerbated. Transesophageal echocardiogram showed severe mitral valve regurgitation and aortic valve regurgitation. He had moderate thrombocytopenia. Bleeding time was prolonged. Peripheral blood smear showed hypogranular platelets with indistinct cell membrane. In bone marrow biopsy, there showed evidence of mild hyperplasia of megakaryocytes. Platelet aggregation test revealed abnormal response to collagen and epinephrine. Electron microscopy of periphral blood showed the vacuolization of alpha- granules of platelets. Following platelet transfusion, double valve replacement could be performed successfully. Six months later, platelet morphology was moderately normalized. But bleeding time and platelet aggregation test were still abnormal.
Adult ; Aortic Valve ; Autoimmune Diseases ; Biopsy ; Bleeding Time ; Blood Platelets* ; Bone Marrow ; Cardiopulmonary Bypass ; Cell Membrane ; Collagen ; Disseminated Intravascular Coagulation ; Dyspnea ; Epinephrine ; Heart Valve Diseases* ; Hemorrhage ; Humans ; Hyperplasia ; Male ; Megakaryocytes ; Microscopy, Electron ; Mitral Valve ; Mitral Valve Insufficiency ; Myeloproliferative Disorders ; Platelet Aggregation ; Platelet Storage Pool Deficiency ; Platelet Transfusion ; Republic of Korea ; Thrombocytopenia

BACKGROUND: Because there are lower incidence of graft versus host disease in HLA mismatched cord blood transplantation compared to bone marrow transplantation, development of smaller scale cord blood bank could be possible. So we analysed the content of hematopoietic stem cell in cord blood and the distribution of HLA as a basic study for cord blood bank. METHODS: Seventy eight cord bloods were collected in heparinized bottle immediately after caesarian section. After expulsion of placenta, additional cord blood and placental blood were collected with heparinized syringe. Fifteen mL was sent to the laboratory for analysis and the rest was cryopreserved. RESULTS: The mean collected cord blood volume was 96.8mL (range, 55~163mL). And mean 81.8mL (range, 40~148mL) was cryopreserved. It contained mean 7.4x108 (range, 2.8x108~12.2x108) nucleated cells. In 2x105 mononuclear cells, 85 +/- 48 BFU-E, 19 +/- 17 CFU-E, 107 +/- 73 CFU-GM and 124 +/- 113 CFU-GEMM were present. With dextran/albumin thawing media, the viability of cryopreserved cord blood mononuclear cell was better than usual washing method with IMDM (82.3% vs. 74.6% P=0.004). Each cord blood could findHLA full matched, 5 loci matched and 4 loci matched cord blood in the remainders with the probability of 0, 11.9% and 58.4%. CONCLUSION: Development of more smaller scale cord blood bank could be possible compared to bone marrow bank.
Bone Marrow ; Bone Marrow Transplantation ; Erythroid Precursor Cells ; Fetal Blood* ; Graft vs Host Disease ; Granulocyte-Macrophage Progenitor Cells ; Hematopoietic Stem Cells* ; Heparin ; Humans* ; Incidence ; Myeloid Progenitor Cells ; Placenta ; Syringes

OBJECTIVES: Rate of complete remission and long-term survival in adult acute lymphoblastic leukemia group has not been as satisfactory as that in childhood ALL. Recently introduction of induction chemotherapy of more intensive combination and various trials of postremission therapy are making improved results better looked forward to. And subtypes of ALL according to the degree of differentiation into T and B cells are identified by using immunologic markers hopefully to work out proper treatment for each subtype. METHODS: We analited results of treatment and differences of complete remission rate, remission duration and overall survival as to various immunologic markers and clinicopathologic characteristics in 33adult ALL patients. RESULTS: Eighty five percents of the 27cases that had VPDL chemotherapy achieved complete remission and both overall median survival and mediom duration of remission were 52weeks. No definite prognostic factors were detected influencing complete remission rate, remission duration and overall survival except that patients with serum albumin level higher than 4.0mg/dL showed highter complete remission rate. Although mature B-ALL showed the shortest overall median survival, degree of differenciation of B-cell and other immunologic markers did not influence on complete remission rate, remission duration or overall survival. CONCLUSION: Further studies are needed to delire the prognostic factors in adult ALL.
Adult ; B-Lymphocytes ; Biomarkers ; Drug Therapy ; Humans ; Induction Chemotherapy ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Serum Albumin

Patients with acute myelocytic leukemia (AML) have varied outlooks for survival after the diagnosis. To identify pretreatment prognostic indicators in AML, we analyzed 132 cases of AML seen at our hospital between June, 1989 and December, 1994. The median age of the patients was 40 years (range, 15-81). There were 63 male and 69 female patients. One hundred eight patients (82%) received induction chemotherapy which was based on cytarabine plus anthracyclines. Sixty six patients achieved complete remission (CR) and the CR rate among the patients given induction chemotherapy was 61%. The median duration of CR was 11.2 months. After median follow up of 6.6 months (range 0.5-51.4), 26 patients (39%) remain in continuous CR. The median duration of overall survival of the patients was 6.7 months. After median follow up of 10.6 months (range, 0.1-52.7), 41 patients (31%) are alive. Variables affecting duration of CR included the age of the patients, performance status of the patients, percentage of blast in the peripheral blood, hemoglobin level, percentage of blast in the bone marrow, FAB subtype, and CD7 marker positivity. Variables affecting survival duration included age of the patients, performance status of the patients, absolute blast count (ABC) in the peripheral blood, bone marrow cellularity, the percentage of blast in the bone marrow, and CD5 marker positivity. Multivariate analysis showed that the age of the patients and percentage of blast in the bone marrow were significant independent indicators for overall survival of the patients. Further studies utilizing cytogenetics and molecular characteristics of leukemic cell are warranted to better define the prognostic factors of patients with AML.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Female ; Human ; Leukemia, Myelocytic, Acute/*mortality ; Male ; Middle Age ; Multivariate Analysis ; Prognosis ; Survival Rate

Acute promyelocytic leukemia(APL) is a subtype of acute myelocytic leukemia(AML) associated with unique features such as the presence of atypical promyelocytes and bleeding tendency due to disseminated intravascular coagulation(DIC). In a retrospective study, we analyzed 96 cases of AML seen at our hospital between June, 1989 and December 1993. Thirteen cases of APL(14%) were identified and their clinicopathologic characteristics were analyzed. The 86 cases of other types of AML served as controls. The distinct clinicopathologic features of APL as contrasted to other types of AML included younger age of patients, shorter duration of symptom before diagnosis, higher level of albumin at presentation, and a higher proportion of patients having coagulation abnormalities (75 vs. 25%). Bone marrow cellularity was higher in APL when compared to other types of AML (100 vs. 90%, P = 0.013). Of 13 patients with APL, 4 died of bleeding/sepsis between days 2 to 4 after admission. Seven of 9 patients who received induction therapy achieved complete remission(CR). CR rate in APL was similar to other types of AML (78 vs. 64%, P = 0.743). Five of seven patients who achieved CR remain in continuous CR at 9+ to 42+ months. CR duration is significantly longer in APL when compared to other types of AML (P = 0.029). In conclusion, this study showed that APL is a distinct entity among subtypes of AML with clinically significant bleeding tendency and rapidly fatal course if untreated. With appropriate antileukemic therapy, CR can be achieved in the majority of patients and the patients show a longer duration of CR when compared to other types of AML.
Acute Disease ; Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Blood Cell Count ; Bone Marrow/pathology ; Comparative Study ; Disease-Free Survival ; Disseminated Intravascular Coagulation/etiology ; Female ; Hemorrhagic Disorders/etiology ; Human ; Immunophenotyping ; Korea/epidemiology ; Korea/epidemiology ; Leukemia, Myeloid/*classification/mortality/pathology ; Leukemia, Promyelocytic, Acute/*classification/complications/drug therapy/mortality/pathology ; Male ; Middle Age ; Remission Induction ; Retrospective Studies ; Serum Albumin/analysis

No abstract available.
Ascites* ; Immunoglobulins* ; Plasmacytoma*