Cancer Research and Treatment

Original Articles

Hematologic malignancy

Assessment of Bone Marrow Involvement in Extranodal NK/T-Cell Lymphoma: Positron Emission Tomography versus Bone Marrow Biopsy, and the Significance of Minimal Involvement by EBV+ Cells (KROG 18-09): Tae Hoon Lee, Hyun Ju Kim, Jong Hoon Lee, Jeongshim Lee, Jin Hee Kim, Dongryul Oh, Keun-Yong Eom; Cancer Res Treat. 2024;56(2):688-696. Published online December 11, 2023; DOI: https://doi.org/10.4143/crt.2023.1049

Purpose
This study aims to investigate the diagnostic significance of positron emission tomography/computed tomography (PET/CT) in assessing bone marrow (BM) involvement through a comparison of PET/CT findings with BM biopsy in extranodal natural killer/T-cell lymphoma.
Materials and Methods
The medical records of 193 patients were retrospectively reviewed. Patients were categorized as having early-stage (PET-ES) or advanced-stage (PET-AS) disease based on PET/CT results. The BM involvement was classified into three groups according to BM biopsy: gross BM involvement, minimal BM involvement (defined as the presence of a limited number of Epstein-Barr virus–positive cells in BM), and no involvement. Calculations of the accuracy of PET/CT in detecting BM involvement and analysis of the clinical outcomes (progression-free survival [PFS] and overall survival [OS]) according to the BM biopsy status were performed.
Results
PET/CT exhibited a sensitivity of 64.7% and a specificity of 96.0% in detecting gross BM involvement. For detecting any (both gross and minimal) BM involvement, the sensitivity was 30.4%, while the specificity was 99.0%. Only one patient (0.7%) demonstrated gross BM involvement among the PET-ES group. Survival outcomes of the PET-ES group with minimal BM involvement (3-year PFS, 55.6%; OS, 77.0%) were closer to those of the PET-ES group with no BM involvement (3-year PFS, 62.2%; OS, 80.6%) than to those of the PET-AS group (3-year PFS, 20.1%; OS, 29.9%).
Conclusion
PET/CT exhibits high specificity, but moderate and low sensitivity in detecting gross and minimal BM involvement, respectively. The clinical significance of minimal BM involvement for patients in the PET-ES group may be limited.

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Magnetic Resonance Imaging and [18F]‐Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography‐Guided Therapy Improves Survival in Upper Aerodigestive Tract NK/T‐Cell Lymphoma, Nasal Type: A Prospective Cohort Study
Quanguang Ren, Yue Cui, He Huang, Xueying Li, Huangming Hong, Zhao Wang, Xiaojie Fang, Chengcheng Guo, Yuyi Yao, Zegeng Chen, Ying Huang, Zhiming Li, Qingqing Cai, Ying Tian, Hanyu Wang, Xiaoping Lin, Wei Fan, Lie Zheng, Suxia Lin, Ying Guo, Tongyu Lin
Head & Neck.2025;[Epub] CrossRef

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Simultaneous Detection of Disseminated and Circulating Tumor Cells in Primary Breast Cancer Patients: Andreas D. Hartkopf, Markus Wallwiener, Markus Hahn, Tanja N. Fehm, Sara Y. Brucker, Florin-Andrei Taran; Cancer Res Treat. 2016;48(1):115-124. Published online February 16, 2015; DOI: https://doi.org/10.4143/crt.2014.287

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Purpose
Disseminated tumor cells (DTCs) from bone marrow (BM) are a surrogate of minimal residual disease (MRD) in primary breast cancer (PBC) patients and associated with an adverse prognosis. However, BM sampling is an invasive procedure. Although there is growing evidence that circulating tumor cells (CTCs) from the blood are also suitable for monitoring MRD, data on the simultaneous detection of DTCs and CTCs are limited. Materials and Methods We determined the presence of DTCs using immunocytochemistry and the pan-cytokeratin antibody A45-B/B3. CTCs were determined simultaneously using a reverse transcriptionpolymerase chain reaction–based assay (AdnaTest Breast Cancer) and CellSearch (at least one CTC per 7.5 mL blood). We compared the detection of DTCs and CTCs and evaluated their impact on disease-free and overall survival.
Results
Of 585 patients, 131 (22%) were positive for DTCs; 19 of 202 (9%) and 18 of 383 (5%) patients were positive for CTCs, as shown by AdnaTest and CellSearch, respectively. No significant association was observed between DTCs and CTCs (p=0.248 and p=0.146 as shown by AdnaTest and CellSearch, respectively). The presence of DTCs (p=0.046) and the presence of CTCs as shown by CellSearch (p=0.007) were predictive of disease-free survival. Conclusion Our data confirm the prognostic relevance of DTCs and CTCs in patients with PBC. As we found no significant relationship between DTCs and CTCs, prospective trials should include their simultaneous detection. Within those trials, the question of whether or not DTCs and CTCs are independent subpopulations of malignant cell clones should be determined by molecular characterization.

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A comprehensive review and meta-analysis of CTC isolation methods in breast cancer
Alexey S. Rzhevskiy, Guzel R. Sagitova, Tamilla A. Karashaeva, Andrey O. Morozov, Anastasia S. Fatyanova, Vlada V. Kazantseva, Simon A. Joosse, Andrei V. Zvyagin, Majid Ebrahimi Warkini
Critical Reviews in Oncology/Hematology.2025; 206: 104579. CrossRef
High serum levels of leucine-rich α-2 glycoprotein 1 (LRG-1) are associated with poor survival in patients with early breast cancer
Andy Göbel, Tilman D. Rachner, Oliver Hoffmann, Daniel Martin Klotz, Sabine Kasimir-Bauer, Rainer Kimmig, Lorenz C. Hofbauer, Ann-Kathrin Bittner
Archives of Gynecology and Obstetrics.2024; 309(6): 2789. CrossRef
Circulating tumor cells in early lobular versus ductal breast cancer and their associations with prognosis
Silver Alkhafaji, Denise M. Wolf, Mark Jesus M. Magbanua, Laura J. van ‘t Veer, John W. Park, Laura Esserman, Rita A. Mukhtar
npj Breast Cancer.2024;[Epub] CrossRef
Correlation between Imaging Markers Derived from PET/MRI and Invasive Acquired Biomarkers in Newly Diagnosed Breast Cancer
Kai Jannusch, Ann-Kathrin Bittner, Nils Martin Bruckmann, Janna Morawitz, Cleo Stieglitz, Frederic Dietzel, Harald H. Quick, Hideo A. Baba, Ken Herrmann, Lale Umutlu, Gerald Antoch, Julian Kirchner, Sabine Kasimir-Bauer, Oliver Hoffmann
Cancers.2023; 15(6): 1651. CrossRef
The Role of Circulating Tumor Cells in Breast Cancer and Implications for Radiation Treatment Decisions
Chelain R. Goodman, Corey W. Speers
International Journal of Radiation Oncology*Biology*Physics.2021; 109(1): 44. CrossRef
Disseminated tumour cells from the bone marrow of early breast cancer patients: Results from an international pooled analysis
Andreas D. Hartkopf, Sara Y. Brucker, Florin-Andrei Taran, Nadia Harbeck, Alexandra von Au, Bjørn Naume, Jean-Yves Pierga, Oliver Hoffmann, Matthias W. Beckmann, Lisa Rydén, Tanja Fehm, Rebecca Aft, Montserrat Solà, Vincent Walter, Brigitte Rack, Florian
European Journal of Cancer.2021; 154: 128. CrossRef
The Role of Circulating Tumor Cells in the Metastatic Cascade: Biology, Technical Challenges, and Clinical Relevance
Hassan Dianat-Moghadam, Mehdi Azizi, Zahra Eslami-S, Luis Enrique Cortés-Hernández, Maryam Heidarifard, Mohammad Nouri, Catherine Alix-Panabières
Cancers.2020; 12(4): 867. CrossRef
The biology and clinical potential of circulating tumor cells
Taja Lozar, Klara Gersak, Maja Cemazar, Cvetka Grasic Kuhar, Tanja Jesenko
Radiology and Oncology.2019; 53(2): 131. CrossRef
The Prognostic Value of Circulating Tumor Cells in Primary Breast Cancer Prior to any Systematic Therapy: A Systematic Review
Sepideh Mansouri, Parisa Mokhtari-Hesari, Fatemeh Naghavi-al-Hosseini, Keivan Majidzadeh-A, Leila Farahmand
Current Stem Cell Research & Therapy.2019; 14(6): 519. CrossRef
Synchronous Detection of Circulating Tumor Cells in Blood and Disseminated Tumor Cells in Bone Marrow Predicts Adverse Outcome in Early Breast Cancer
Mark Jesus M. Magbanua, Christina Yau, Denise M. Wolf, Jin Sun Lee, Aheli Chattopadhyay, Janet H. Scott, Erin Bowlby-Yoder, E. Shelley Hwang, Michael Alvarado, Cheryl A. Ewing, Amy L. Delson, Laura J. van't Veer, Laura Esserman, John W. Park
Clinical Cancer Research.2019; 25(17): 5388. CrossRef
Simultaneous detection of circulating and disseminated tumor cells in primary breast cancer patients following neoadjuvant chemotherapy
Vincent P. Walter, Florin-Andrei Taran, Markus Wallwiener, Markus Hahn, Sara Y. Brucker, Andreas D. Hartkopf
Archives of Gynecology and Obstetrics.2018; 297(3): 785. CrossRef
Clinical applications of the CellSearch platform in cancer patients
Sabine Riethdorf, Linda O'Flaherty, Claudia Hille, Klaus Pantel
Advanced Drug Delivery Reviews.2018; 125: 102. CrossRef
DIsseminated tumor cells of luminal breast cancer patients .
D. A. Ryabchikov, O. A. Beznos, I. A. Dudina, I. K. Vorotnikov, D. A. Denchik, S. V. Chulkova, O. A. Talipov, N. N. Tupitsyn
Russian Journal of Biotherapy.2018; 17(1): 53. CrossRef
Enrichment and Molecular Analysis of Breast Cancer Disseminated Tumor Cells from Bone Marrow Using Microfiltration
Sreeraj G. Pillai, Peixuan Zhu, Chidananda M. Siddappa, Daniel L. Adams, Shuhong Li, Olga V. Makarova, Pete Amstutz, Ryan Nunley, Cha-Mei Tang, Mark A. Watson, Rebecca L. Aft, Harriet Wikman
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Clinical and biological significance of circulating tumor cells in cancer
Takaaki Masuda, Naoki Hayashi, Tomohiro Iguchi, Shuhei Ito, Hidetoshi Eguchi, Koshi Mimori
Molecular Oncology.2016; 10(3): 408. CrossRef
Seroma Cytology in Breast Cancer: An Underappreciated Issue
Huseyin Ozgur Aytac, Tarik Zafer Nursal, Tamer Çolakoğlu, Filiz Aka Bolat, Gökhan Moray
Clinical Breast Cancer.2016; 16(6): e187. CrossRef
Detection and prevalence of disseminated tumor cells from the bone marrow of early stage male breast cancer patients
Andreas D. Hartkopf, Florin-Andrei Taran, Christina B. Walter, Markus Hahn, Tanja Fehm, Markus Wallwiener, Sara Y. Brucker
Breast Cancer Research and Treatment.2015; 152(1): 51. CrossRef
Expression of truncated human epidermal growth factor receptor 2 on circulating tumor cells of breast cancer patients
Galatea Kallergi, Sofia Agelaki, Maria A. Papadaki, Dimitris Nasias, Alexios Matikas, Dimitris Mavroudis, Vassilis Georgoulias
Breast Cancer Research.2015;[Epub] CrossRef

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The Clinical Utility of FDG PET-CT in Evaluation of Bone Marrow Involvement by Lymphoma: Ho Young Kim, Ju-Seok Kim, Dae Ro Choi, Hyeong Su Kim, Jung Hye Kwon, Geun-Doo Jang, Jung Han Kim, Joo Young Jung, Hun Ho Song, Young Kyung Lee, Soo Kee Min, Hee Sung Hwang, Hwa Jung Kim, Dae Young Zang, Hyo Jung Kim; Cancer Res Treat. 2015;47(3):458-464. Published online November 24, 2014; DOI: https://doi.org/10.4143/crt.2014.091

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Purpose
Bone marrow biopsy is a standard method for the evaluation of bone marrow infiltration by lymphoma; however, it is an invasive and painful procedure. Fluorodeoxyglucose positron emission tomography–computed tomography (FDG PET-CT) is a noninvasive imaging technique with the potential to detect bone marrow involvement by lymphoma. Materials and Methods We retrospectively reviewed medical records of lymphoma patients. All patients were examined by FDG PET-CT and iliac crest bone marrow biopsy for initial staging work-up. Results The study population comprised 94 patients (median age, 60 years; 56 males) with Hodgkin’s lymphoma (n=8) or non-Hodgkin’s lymphoma (n=86). Maximum standardized uptake values on the iliac crest of patients with lymphoma infiltrated bone marrow were significantly higher than those of patients with intact bone marrow (2.2±1.2 g/mL vs. 1.3±0.4 g/mL; p=0.001). The calculated values for FDG PET-CT during evaluation of bone marrow involvement were as follows: sensitivity 50%, specificity 96%, positive predictive value 80%, negative predictive value 85%, and positive likelihood ratio (LR+) 11.7. The value of LR+ was 16.0 in patients with aggressive subtypes of non-Hodgkin’s lymphoma (NHL). Conclusion FDG PET-CT could not replace bone marrow biopsy due to the low sensitivity of FDG PET-CT for detection of bone marrow infiltration in lymphoma patients. Conversely, FDG PET-CT had high specificity and LR+; therefore, it could be a useful tool for image-guided biopsy for lymphoma staging, especially for aggressive subtypes of NHL. In addition, unilateral bone marrow biopsy could be substituted for bilateral bone marrow biopsy in lymphoma patients with increased FDG uptake on any iliac crest.

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FDG PET/CT versus Bone Marrow Biopsy for Diagnosis of Bone Marrow Involvement in Non-Hodgkin Lymphoma: A Systematic Review
Jawaher Almaimani, Charalampos Tsoumpas, Richard Feltbower, Irene Polycarpou
Applied Sciences.2022; 12(2): 540. CrossRef
Comparison of the RECIST and EORTC PET criteria in the tumor response assessment: a pooled analysis and review
Jung Han Kim, Bum Jun Kim, Hyun Joo Jang, Hyeong Su Kim
Cancer Chemotherapy and Pharmacology.2017; 80(4): 729. CrossRef
Comparison of the RECIST and PERCIST criteria in solid tumors: a pooled analysis and review
Seon Jeong Min, Hyun Joo Jang, Jung Han Kim
Oncotarget.2016; 7(19): 27848. CrossRef

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Clinical Outcome of Rituximab-Based Therapy (RCHOP) in Diffuse Large B-Cell Lymphoma Patients with Bone Marrow Involvement: Byung Woog Kang, Joon Ho Moon, Yee Soo Chae, Soo Jung Lee, Jong Gwang Kim, Yeo-Kyeoung Kim, Je-Jung Lee, Deok-Hwan Yang, Hyeoung-Joon Kim, Jin Young Kim, Young Rok Do, Keon Uk Park, Hong Suk Song, Ki Young Kwon, Min Kyung Kim, Kyung Hee Lee, Myung Soo Hyun, Hun Mo Ryoo, Sung Hwa Bae, Hwak Kim, Sang Kyun Sohn; Cancer Res Treat. 2013;45(2):112-117. Published online June 30, 2013; DOI: https://doi.org/10.4143/crt.2013.45.2.112

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PURPOSE
We investigated the clinical outcome of bone marrow (BM) involvement in patients with diffuse large B-cell lymphoma (DLBCL) who received rituximab-based therapy.
MATERIALS AND METHODS
A total of 567 consecutive patients with newly diagnosed DLBCL treated with rituximab-CHOP (RCHOP) between November 2001 and March 2010 were included in the current study. All of the patients underwent a BM study at the initial staging and the clinical characteristics and prognosis of these patients with or without BM involvement were analyzed retrospectively.
RESULTS
The total cohort included 567 patients. The overall incidence of BM involvement was 8.5%. With a median follow-up duration of 33.2 months (range, 0.1 to 80.7 months) for patients who were alive at the last follow-up, the five-year overall survival (OS) and event-free survival (EFS) rate in patients without BM involvement (76.3% and 67.5%, p<0.001) was statistically higher than that in patients with BM involvement (44.3% and 40.1%, p<0.001). In multivariate analysis, among total patients, BM involvement showed a significant association with OS and EFS. In univariate and multivariate analyses, even among stage IV patients, a significant association with worse EFS was observed in the BM involvement group.
CONCLUSION
BM involvement at diagnosis affected the survival of patients with DLBCL who received RCHOP. Although use of RCHOP can result in significant improvement of the therapeutic effect of DLBCL, BM involvement is still a negative prognostic factor of DLBCL patients in the era of rituximab.

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Combination of Bone Marrow Biopsy and Flow Cytometric Analysis: The Prognostically Relevant Central Approach for Detecting Bone Marrow Invasion in Diffuse Large B-Cell Lymphoma
Haruya Okamoto, Nobuhiko Uoshima, Ayako Muramatsu, Reiko Isa, Takahiro Fujino, Yayoi Matsumura-Kimoto, Taku Tsukamoto, Shinsuke Mizutani, Yuji Shimura, Tsutomu Kobayashi, Eri Kawata, Hitoji Uchiyama, Junya Kuroda
Diagnostics.2021; 11(9): 1724. CrossRef
Assessment of CD52 expression in "double-hit" and "double-expressor" lymphomas: Implications for clinical trial eligibility
Jeffrey W. Craig, Michael J. Mina, Jennifer L. Crombie, Ann S. LaCasce, David M. Weinstock, Geraldine S. Pinkus, Olga Pozdnyakova, Francesco Bertolini
PLOS ONE.2018; 13(7): e0199708. CrossRef
HIV-infection impact on clinical–biological features and outcome of diffuse large B-cell lymphoma treated with R-CHOP in the combination antiretroviral therapy era
Maria Joao Baptista, Olga Garcia, Mireia Morgades, Eva Gonzalez-Barca, Pilar Miralles, Armando Lopez-Guillermo, Eugenia Abella, Miriam Moreno, Juan-Manuel Sancho, Evarist Feliu, Josep-Maria Ribera, Jose-Tomas Navarro
AIDS.2015; 29(7): 811. CrossRef
Non-Hodgkin Lymphomas: Impact of Rituximab on Overall Survival of Patients with Diffuse Large B-Cell and Follicular Lymphoma
José Carlos Jaime-Pérez, Carmen Magdalena Gamboa-Alonso, Alberto Vázquez-Mellado de Larracoechea, Marisol Rodríguez-Martínez, César Homero Gutiérrez-Aguirre, Luis Javier Marfil-Rivera, David Gómez-Almaguer
Archives of Medical Research.2015; 46(6): 454. CrossRef

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Clinical Outcome of Gastric Cancer Patients with Bone Marrow Metastases: Ji Yeon Kwon, Jina Yun, Han Jo Kim, Kyoung-Ha Kim, Se-Hyung Kim, Sang-Cheol Lee, Hyun Jung Kim, Sang Byung Bae, Chan Kyu Kim, Nam Su Lee, Kyu Taek Lee, Seong Kyu Park, Jong-Ho Won, Dae Sik Hong, Hee Sook Park; Cancer Res Treat. 2011;43(4):244-249. Published online December 27, 2011; DOI: https://doi.org/10.4143/crt.2011.43.4.244

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PURPOSE
The prognosis of gastric cancer patients with bone marrow metastases is extremely poor. The current study was conducted to evaluate the clinical outcomes of advanced gastric cancer patients with bone marrow metastases.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 26 advanced gastric cancer patients with bone marrow metastases who were treated at Soonchunhyang University Hospital between September 1986 and February 2009.
RESULTS
The median age was 46 years (range, 24 to 61 years). All patients had poorly differentiated adenocarcinoma, including 17 signet ring cell carcinomas. The majority of the patients had thrombocytopenia, anemia, and elevated lactate dehydrogenase levels. Sixteen patients (61.5%) received palliative chemotherapy (median, 4 cycles; range, 1 to 13 cycles). The median overall survival after detection of bone marrow metastases for the cohort of patients was 37 days (95% confidence interval, 12.5 to 61.5 days). The median overall survival after detection of bone marrow involvement was 11 days in the best supportive care group (range, 2 to 34 days) and 121 days (range, 3 to 383 days) in the palliative chemotherapy group (p<0.001). The causes of death were tumor progression (11 patients, 45%), brain hemorrhage (6 patients, 25%), infection (5 patients, 21%), and disseminated intravascular coagulation (1 patient, 4%). There were no chemotherapy-related deaths.
CONCLUSION
Palliative chemotherapy could be considered in advanced gastric cancer patients with bone marrow metastases as a treatment option.

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Asian Pacific Journal of Cancer Prevention.2014; 15(1): 61. CrossRef
Preoperative serum pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen level predicts postoperative distant metastasis in patients with non-small-cell lung cancer†
Yumi Tanaka, Tatsuya Yoshimasu, Shoji Oura, Yoshimitsu Hirai, Mitsumasa Kawago, Masako Ikeda, Yoshitaka Okamura
European Journal of Cardio-Thoracic Surgery.2013; 44(3): 539. CrossRef

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A Study for Correlation between Bone Marrow Micrometastases and Tumoric Angiogenesis in Breast Cancer: N S Choi, Y J Jaegal, J H Youn, C S Park; J Korean Cancer Assoc. 2000;32(2):253-260.

Abstract PDF: PURPOSE
Since some reports that tumoric angiogenesis in breast cancer is significantly correlated with the presence of local or distant metastases, many clinicians determined the tumoric angiogenesis just as one of the prognostic factors. However, a consistent role of tumoric angiogenesis in metastatic progression was not completely resolved yet. We tried to evaluate the direct relationship between tumoric angiogenesis and bone marrow micrometastases to reveal the actual contribution of tumoric angigenesis to systemic spread of cancer cells in breast cancer patients.
MATERIALS AND METHODS
Seventy patients with breast cancer who underwent curative surgical resection were included in this study. We observed the micrometastases in bone marrow with RT-PCR method targeting to mRNA for cytokeratin and tumoric angiogenesis with image analyzer technique followed by immunohistochemical staining to CD 34 from formalin-fixed, paraffin-embedded specimens.
RESULTS
Incidence of bone marrow micrometastases was 17.1% (12/70) in surgically curable breast cancer patients. Possibility of bone marrow micrometastases tend to be increasing with an association of the presence of axillary lymph node invasion (P=0.03). High tumoric angiogenesis is associated with a high risk of bone marrow micrometastases (P=0.039).
CONCLUSION
High tumoric angiogenesis is necessary for bone marrow micrometastases but, not sufficient by itself. A further study may need to reveal other factors contributing the bone marrow spread of cancer cells, assoiciated with angiogenesis.

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Autologous or Allogeneic Bone Marrow Transplantation Compared with Consolidation Chemotherapy in Acute promyelocytic Leukemia: Chang Ki Min, Woo Sung Min, Hee Je Kim, Hyun Suk Eom, Jong Wook Lee, Kyungja Han, Ihl Bhong Choi, Chun Choo Kim, Won IL Kim, Dong Jip Kim; J Korean Cancer Assoc. 1999;31(2):331-338.

Abstract PDF: PURPOSE
Acute promyelocytic leukemia (APL) is a distinct subtype of acute myelogenous leukemia characterized by the morphology of blast cells (M3 in FAB classification), the t (15;17) translocation, and a coagulopathy combining disseminated intravascular coagulation and fibrinolysis. It has been considered to have better response to combination chemo- therapy of an anthracycline and cytosine arabinoside and a higher cure rate than other subtypes because of recent approach of differentiating leukemic blasts by all-transretinoic acid (ATRA). The role of stem cell transplantation in APL has to be determined in comparison with that of consolidation chemotherapy.
MATERIALS AND METHODS
We compared the leukemia-free survival and overall survival between APL patients receiving the consolidation chemotherapy and those undergoing the allogeneic or autologous stem cell transplantation following the high-dose anticancer therapy. Of the 65 patients achieving the first complete remission from 1992 to 1997, 33 patients were treated with 3 courses of consolidation chemotherapies and 32 with the stem cell transplantation.
RESULTS
With a median follow-up of 22 months (8-60), the actuarial leukemia-free survival at 3 years was significantly higher in transplantation group than in chematherapy group (73.8% versus 33.5%; P=0.0087), and the probability of leukemic relapse was considerably lower in transplantation group than in chemotherapy group (6.3% versus 57.5%; P=0.001). The treatment-related mortalities of the groups were 0% in chemotherapy group and 14.3% in transplantation group. The main cause of deaths was relapse in the consolidation chemotherapy group.
CONCLUSION
These data demonstrate that the stem cell transplantation results in better leukemia-free survival than the consolidation chemotherapy for patients with APL in the first complete remission because of lower risk of relapse.

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Leukemic Red Marrow Changes Assessed by Proton Magnetic Resonance Spectroscopy Before and Following Chemotherapy: Dong Gun Shin, Hoon Chung, Jong Ki Kim, Young Hwan Rhee; J Korean Cancer Assoc. 1998;30(5):1014-1020.

Abstract PDF: PURPOSE
The purpose of this study was to investigate the possibilities for serial in vivo localized proton magnetic resonance spectroscopy (MRS) examination of bone marrow in patients with acute le,ukemia.
MATERIALS AND METHODS
Selective measurements of the relaxation times Tl and T2 for the water and fat resonance in the bone marrow spectra were performed (1.5 Tesla whole body magnetic resonance scanner). Six patients with acute leukemia were examined at diagnosis. Follow-up examinations of four patients with acute leukemia in complete remission were also examined. Six normal control subjects were examined with identical methods for comparison.
RESULTS
Significant differences could be detected in the spectral patterns from lumbar spine in patients with leukemia at diagnosis compared to healthy normal controls. The relative water content was increased in leukemic patients compared to normal subjects, which indicate an increase in the amount of hemopoietic tissue and a corresponding decrease in marrow fat content. A significant correlation was found between cellularity assessments derived from conventional bone marrow core biopsies and relative water content of proton MRS data. The Tl relaxation time of the water resonance in leukemic patients were significantly prolonged at diagnosis compared to normal controls. After chemotherapeutic induction of remission, the spectra from the bone marrow of lumbar spine resembled normal subjects.
CONCLUSIONS
This method provide the possibility for serial measurements of bone marrow in patients with leukemia, and may provide information from regions inaccessible to bone marrow biopsy. This therefore appears to be a promising application of proton MRS that can be performed on a routine basis in a clinical setting.

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High - dose Chemotherapy Followed by Autologous Bone Marrow Transplantation in High - risk Osteosarcoma and Ewing's Sarcoma: Ji Youn Han, Han Lim Moon, Dong Wook Kim, Jong Wook Lee, Jong Youl Jin, Chi Wha Han, Woo Sung Min, Chong Won Park, Choon Choo Kim, Dong Jip Kim, Hak Ki Kim, Young Gyun Woo, Jung Man Kim; J Korean Cancer Assoc. 1995;27(3):475-482.

Abstract PDF: Purpose
The poor histologic response to standard chemotherapy, a large tumor mass(more than 10 cm) at the time of the initial diagnosis, and tumors in axial bones are the risk factors for the relapse in sarcomas with preoperative and/or postoperative standard chemotherapy and curative surgery. Ta overcome these problems, high-dose chemotherapy and stem cell rescue with autologous bone marrow transplantation were done in four osteogenic and Ewings sarcomas. Methods: Bone-marrow harvest, cryopreservation and CFU-GM assay were done as described previously. As a high-dose chemotherapy, melphalan(160 mg/m) or ifosfamide(7,500 mg2/m)+etoposide(600mg/m) + carboplatin(600 mg/m(2)) were used. Bone marrow infusion and supportive cares were followed until the hematalogic recovery. Results: 1) The number of infused mononuclear cells and CFU-GM colonies were 0.8-2.9 x 10(8)/kg and 0.1-1.2 x 10(4)/kg, respectively. 2) The duration of absolute neutropenia(<500/mm(3)) and thrombocytopenia(<50,000/mm(3)) were 8-23 days and 0-25 days, respectively. 3) All but one had febrile neutropenia for 2 7 days due to sepsis and pneumonia. There waa no therapy associated death. 4) All patients had complete response and the duration of disease free survival was 5(+)-51(+) months. Of the four patients in complete response, one subsequently relapsed in scalp l0 months after transplantation and died 6 months later due to progression of disease. Conclasion: It seems that high-dose chemotherapy with atologous bone marrow transplantation is feasible in high-risk osteosarcoma and Ewing's sarcoma and the responsiveness to chemotherapy may be the most important factor to predict the prognosis.

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Clinical Results of Allogeneic Bone Marrow Transplantation in Adults ( 2 ) : 1992 ~ 1995: Seok Goo Cho, Ik Joo Chung, Jung Hyun Choi, jing Hong You, Dogn Wook Kim, Chi Hwa Han, Woo Sung Min, Whan Sik Sin, Chong Won Park, Cjun Choo Kim, Dong Jip Kim, In Ah Kim, Su Mi Chung, Ihl Bhong Choi; J Korean Cancer Assoc. 1996;28(2):308-316.

Abstract PDF: Allogeneic bone marrow transplantation has been accepted as a powerful therapeutic modality to overcome for successfull clinical reuslts in malignant hematologic disease and severe aplastic anemia in spite of various barriers. We analysed 62 patients who had been admitted to Catholic BMT Center and have performed since malignant hematologic disesaes and severe aplastic anemia were determined to be the subject of National Public Health Care Program(between Oct. l992 and Mar. 1995). Number of patients with acute myelogenous leukemia(AML), acute lymphoblastic leukemia(ALL), chronic myelogenous leukemia(CML) and severe aplastic anemia(SAA) were 17, 4, 21, 20 respectively. We have used pretransplant conditionig regimens which were consisted of total body irradiation(TBI, fractionated 1320 cGy) and cyclophosphamide(CY, 120mg/kg) in leukemic disease(39/42) and anti-thymocyte globulin(ATG, 1.5 vial/10kg, Pasteur Merieux), CY(200mg/kg) and procar- baziine(6.25 mg/kg for 6 days, rutulard, Roche) in SAA(17/20). Cyclosporin A and short course methotrexate were used to prevent graft-versus-host disease(GVHD). Disease-free overall survival rate was 71% in aute leukemia, 67% in CML and 85% in SAA respectively. Maior complications were acute GVHD<35% grade I-IV among them, grade III-IV 14.5%),CMV antigenemia(l1.2%), herpes zoster(9.6%), veno-occlussive disease(8%), TTP-like syndrome(4.8%), chronic GVHD(3%) and interstitial pneumonia(1.6%). Major causes of death were leukemic relapse(9.7%), primary engraftment failure/rejection(6.5%), acute GVHD(3%) and TTP-like syndrome(3%). We suggest again that allogeneic BMT should be considered as the effective therapeutic modality to cure malignant hematologic diseases and aplastic anemia. For the purpose of obtaining better clinical outcome of allogeneic BMT, it should be early performed as soon as possible in clinial course.

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