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22 "Stem cell transplantation"
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Pediatric cancer
The Effect of Hematopoietic Stem Cell Transplantation on Treatment Outcome in Children with Acute Lymphoblastic Leukemia
Hee Young Ju, Na Hee Lee, Eun Sang Yi, Young Bae Choi, So Jin Kim, Ju Kyung Hyun, Hee Won Cho, Jae Kyung Lee, Ji Won Lee, Ki Woong Sung, Hong Hoe Koo, Keon Hee Yoo
Cancer Res Treat. 2025;57(1):240-249.   Published online July 5, 2024
DOI: https://doi.org/10.4143/crt.2024.155
AbstractAbstract PDFPubReaderePub
Purpose
Hematopoietic stem cell transplantation (HSCT) has been an important method of treatment in the advance of pediatric acute lymphoblastic leukemia (ALL). The indications for HSCT are evolving and require updated establishment. In this study, we aimed to investigate the efficacy of HSCT on the treatment outcome of pediatric ALL, considering the indications for HSCT and subgroups.
Materials and Methods
A retrospective analysis was conducted on ALL patients diagnosed and treated at a single center. Risk groups were categorized based on age at diagnosis, initial white blood cell count, disease lineage (B/T), and cytogenetic study results. Data on the patients’ disease status at HSCT and indications of HSCT were collected. Indications for HSCT were categorized as upfront HSCT at 1st complete remission, relapse, and refractory disease.
Results
Among the 549 screened patients, a total of 418 patients were included in the study; B-cell ALL (n=379) and T-cell ALL (T-ALL) (n=39). HSCT was conducted on a total of 106 patients (25.4%), with a higher frequency as upfront HSCT in higher-risk groups and specific cytogenetics. The overall survival (OS) was significantly better when done upfront than in relapsed or refractory state in T-ALL patients (p=0.002). The KMT2A-rearranged ALL patients showed superior event-free survival (p=0.002) and OS (p=0.022) when HSCT was done as upfront treatment.
Conclusion
HSCT had a substantial positive effect in a specific subset of pediatric ALL. In particular, frontline HSCT for T-ALL and KMT2A-rearranged ALL offered a better prognosis than when HSCT was conducted in a relapsed or refractory setting.
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Hematologic malignancy
Long-term Psychiatric and Endocrine Complications Following Hematopoietic Stem Cell Transplantation in Hematologic Disease in Korea: A Nation-Wide Cohort Study
Min Ji Jeon, Eunjin Noh, Seok Joo Moon, Eun Sang Yu, Chul Won Choi, Dae Sik Kim, Eun Joo Kang
Cancer Res Treat. 2024;56(4):1262-1269.   Published online May 9, 2024
DOI: https://doi.org/10.4143/crt.2024.047
AbstractAbstract PDFPubReaderePub
Purpose
Numerous patients experience long-term complications after hematopoietic stem cell transplantation (HSCT). This study aimed to identify the frequency and risk factors for psychiatric and endocrine complications following HSCT through big data analyses.
Materials and Methods
We established a cohort of patients with hematologic disease who underwent HSCT in Korea between 2010 and 2012 using the Health Insurance Review & Assessment Service data. A total of 3,636 patients were identified, and insurance claims were tracked using psychiatric and endocrine diagnostic International Classification of Diseases, 10th Revision codes for the ensuing decade. We identified the incidence rates of long-term complications based on the baseline disease and HSCT type. Prognostic factors for each complication were scrutinized using logistic regression analysis.
Results
A total of 1,879 patients underwent allogeneic HSCT and 1,757 patients received autologous HSCT. Post-HSCT, 506 patients were diagnosed with depression, 465 with anxiety disorders, and 659 with diabetes. The highest incidence of long-term complications occurred within the first year post-HSCT (12.2%), subsequently decreasing over time. Risk factors for depressive disorders after allogeneic HSCT included female sex, a total body irradiation–based conditioning regimen, and cyclosporine. Identified risk factors for diabetes mellitus comprised old age, total body irradiation–based conditioning regimen, and non-antithymocyte globulin protocol. Regarding autologous HSCT, only female sex was identified as a risk factor for depressive disorders, whereas elderly patients and those with multiple myeloma were identified as poor prognostic factors for diabetes mellitus.
Conclusion
The incidence of long-term psychiatric and endocrine complications post-HSCT remains high, and patients with risk factors for these complications require vigilant follow-up.
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Nation-Wide Retrospective Analysis of Allogeneic Stem Cell Transplantation in Patients with Multiple Myeloma: A Study from Korean Multiple Myeloma Working Party (KMM1913)
Ho-Jin Shin, Do-Young Kim, Kihyun Kim, Chang-Ki Min, Je-Jung Lee, Yeung-Chul Mun, Won-Sik Lee, Sung-Nam Lim, Jin Seok Kim, Joon Ho Moon, Da Jung Kim, Soo-Mee Bang, Jong-Ho Won, Jae-Cheol Jo, Young Il Koh
Cancer Res Treat. 2024;56(3):956-966.   Published online March 4, 2024
DOI: https://doi.org/10.4143/crt.2024.074
AbstractAbstract PDFPubReaderePub
Purpose
The role of allogeneic stem cell transplantation (alloSCT) in multiple myeloma (MM) treatment remains controversial. We conducted a retrospective, multicenter, nationwide study in Korea to evaluate the outcomes of alloSCT in Asian patients with MM.
Materials and Methods
Overall, 109 patients with MM who underwent alloSCT between 2003 and 2020 were included in this study. Data were collected from the Korean Multiple Myeloma Working Party Registry.
Results
The overall response rate and stringent complete response plus complete response (CR) rates were 67.0 and 46.8%, respectively, after alloSCT. At a median follow-up of 32.5 months, the 3-year probability of progression-free survival (PFS) and overall survival (OS) rates were 69.3% and 71.8%, respectively. The 3-year probabilities of OS rates in the upfront alloSCT, tandem auto-alloSCT, and later alloSCT groups were 75.0%, 88.9%, and 61.1%, respectively. Patients who achieved CR before or after alloSCT had significantly longer OS (89.8 vs. 18 months and 89.8 vs. 15.2 months, respectively). Even though patients who did not achieve CR prior to alloSCT, those who achieve CR after alloSCT had improved PFS and OS compared to those who had no achievement of CR both prior and after alloSCT. Patients who underwent alloSCT with 1-2 prior treatment lines had improved PFS (22.4 vs. 4.5 months) and OS (45.6 vs. 15.3 months) compared to those with three or more prior treatment lines.
Conclusion
AlloSCT may be a promising therapeutic option especially for younger, chemosensitive patients with earlier implementation from relapse.
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Pediatric cancer
Ten-Year Trends of Hematopoietic Stem Cell Transplantation in Korean Pediatric Cancer from the National Health Insurance Claims Data
Hyery Kim, Hwa Jung Kim, Youngjun Jo, Su Hyun Yoon, Young Kwon Koh, Sunghan Kang, Kyung-Nam Koh, Ho Joon Im
Cancer Res Treat. 2024;56(1):294-304.   Published online September 7, 2023
DOI: https://doi.org/10.4143/crt.2023.598
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
We aimed to determine the current application and survival trends of hematopoietic stem cell transplantation (HSCT) among Korean children and adolescents with cancer.
Materials and Methods
Data of patients aged < 20 years with KCD-10 (Korean Classifications of Diseases, 10th revision) C codes and specific designation codes were collected from the National Health Insurance Service database. Thirty claim codes for HSCT were included, and data from 2009 to 2019 were analyzed.
Results
The operational definition of pediatric cancer yielded an annual average of 2,000, with annual cases decreasing. In 2019, 221 HSCTs were performed, a decrease from the ten-year average of 276. Allografts outnumbered autografts with a ratio of 1.5:1. The source of allograft was bone marrow in 15% of patients in 2009; however, it substantially decreased to 3.3% in 2019. Furthermore, 70.5% of allogeneic HSCT used peripheral blood stem cell (PBSC) grafts, which increased to 89.3% by 2015. Cord blood utilization markedly decreased to 2.7% in 2018. The 5-year overall survival (OS) rate of all patients was 85.1%. Overall mortality decreased among patients who underwent recent HSCT, and they exhibited a higher 5-year OS rate.
Conclusion
In Korea, the number of pediatric patients with cancer is declining; however, the ratio of transplants to all patients remains constant. Patients who recently underwent transplantation showed better survival rates, possibly due to HSCT optimization. Korea showed a substantially greater PBSC utilization in pediatric HSCT. An in-depth examination encompassing donor relations and cause of death with a prospective registry is required in future studies.
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Hematologic malignancy
Incidence and Features of Lymphoid Proliferation and Lymphomas after Solid Organ or Hematopoietic Stem Cell Transplantation in a National Database Cohort
Seung Min Hahn, Myeongjee Lee, JongHoon Hyun, Sungmin Lim, Ji-Man Kang, Jong Gyun Ahn, Dong Jin Joo, Inkyung Jung, Kyong Ihn
Cancer Res Treat. 2024;56(1):305-313.   Published online July 18, 2023
DOI: https://doi.org/10.4143/crt.2023.647
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Post-transplantation lymphoproliferative disorders (PTLDs) after hematopoietic stem transplantation (HCT) or solid organ transplantation (SOT) result in poorer outcomes, including death. There are limited large cohort data on the incidence and natural course of PTLD in Asians.
Materials and Methods
We investigated PTLD using Korean national health insurance claims data of 47,518 patients who underwent HCT or SOT in 2008-2020. Patient demographics, time and type of PTLD diagnosis, type of PTLD treatment, and death data were collected. We used Fine and Gray subdistribution hazard models to calculate the cumulative incidence and risk factors for PTLD.
Results
During median follow-up of 5.32 years, PTLD occurred in 294 of 36,945 SOT patients (0.79%) and 235 of 10,573 HCT patients (2.22%). Cumulative incidence of PTLD were 0.49% at 1 year, 1.02% at 5 years, and 1.50% at 10 years post-transplantation. Age < 20 years (subdistribution hazard ratio [SHR] of 1.67 in age 10-19, SHR 1.51 in age 0-9), HCT (SHR 3.02), heart transplantation (SHR 2.27), and liver transplantation (SHR 1.47) were significant risk factors for PTLD. The presence of PTLD was associated with an increased risk of death (hazard ratio of 2.84). Overall, 5-year survival of PTLD patients was 68.9% (95% confidence interval, 64.9 to 73.2).
Conclusion
We observed a steady increase in PTLD over 10 years after HCT or SOT in this large cohort study. Pediatric age group, HCT, liver transplantation, and heart transplantation were suggested to be risk factors for PTLD, and PTLD was associated with a higher risk of death.
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Current Treatment Patterns and the Role of Upfront Autologous Stem Cell Transplantation in Patients with Peripheral T-Cell Lymphoma: A Korean Nationwide, Multicenter Prospective Registry Study (CISL 1404)
Hyungwoo Cho, Dok Hyun Yoon, Dong-Yeop Shin, Youngil Koh, Sung-Soo Yoon, Seok Jin Kim, Young Rok Do, Gyeong-Won Lee, Jae-Yong Kwak, Yong Park, Min Kyoung Kim, Hye Jin Kang, Jun Ho Yi, Kwai Han Yoo, Won Sik Lee, Byeong Bae Park, Jae Cheol Jo, Hyeon-Seok Eom, Hyo Jung Kim, Seong Hyun Jeong, Young-Woong Won, Byeong Seok Sohn, Ji-Hyun Kwon, Cheolwon Suh, Won Seog Kim
Cancer Res Treat. 2023;55(2):684-692.   Published online January 2, 2023
DOI: https://doi.org/10.4143/crt.2022.1434
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
We conducted a nationwide, multicenter, prospective registry study for newly diagnosed patients with peripheral T-cell lymphoma (PTCL) to better define the clinical characteristics, treatment patterns, survival outcomes, and the role of upfront autologous stem cell transplantation (ASCT) in these patients.
Materials and Methods
Patients with PTCL receiving chemotherapy with curative intent were registered and prospectively monitored. All patients were pathologically diagnosed with PTCL.
Results
A total of 191 patients with PTCL were enrolled in this prospective registry study. PTCL, not otherwise specified (PTCL-NOS) was the most common pathologic subtype (n=80, 41.9%), followed by angioimmunoblastic T-cell lymphoma (AITL) (n=60, 31.4%). With a median follow-up duration of 3.9 years, the 3-year progression-free survival (PFS) and overall survival (OS) rates were 39.5% and 60.4%, respectively. The role of upfront ASCT was evaluated in patients who were considered transplant-eligible (n=59). ASCT was performed as an upfront consolidative treatment in 32 (54.2%) of these patients. There were no significant differences in PFS and OS between the ASCT and non-ASCT groups for all patients (n=59) and for patients with PTCL-NOS (n=26). However, in patients with AITL, the ASCT group was associated with significantly better PFS than the non-ASCT group, although there was no significant difference in OS.
Conclusion
The current study demonstrated that the survival outcomes with the current treatment options remain poor for patients with PTCL-NOS. Upfront ASCT may provide a survival benefit for patients with AITL, but not PTCL-NOS.

Citations

Citations to this article as recorded by  
  • Successful Treatment, with Chemotherapy and Intravenous Administration of Ascorbic Acid, of a Patient with Peripheral T-Cell Lymphoma, Not Otherwise Specified
    Chiaki Tokoro, Atsushi Tashiro, Kenji Ina, Yoshiteru Tanaka, Hiroyuki Kobayakawa, Takashi Yoshida, Satoshi Kayukawa
    Journal of Cancer Research Updates.2024; 13: 1.     CrossRef
  • Role of upfront autologous transplant for peripheral T-cell lymphoma patients achieving a complete remission with first-line therapy: a systematic review and meta-analysis
    L. Girard, Y. J. Koh, L. P. Koh, Y. L. Chee, H. L. Chan, J. Lee, S. de Mel, L. M. Poon, M. Samuel
    Bone Marrow Transplantation.2024; 59(6): 838.     CrossRef
  • Angioimmunoblastic T-cell lymphoma and correlated neoplasms with T-cell follicular helper phenotype: from molecular mechanisms to therapeutic advances
    Luís Alberto de Pádua Covas Lage, Hebert Fabricio Culler, Cadiele Oliana Reichert, Sheila Aparecida Coelho da Siqueira, Juliana Pereira
    Frontiers in Oncology.2023;[Epub]     CrossRef
  • Advances in the pathogenesis and therapeutic strategies of angioimmunoblastic T-cell lymphoma
    Qingyang Zhang, Le Yin, Qinqiao Lai, Yan Zhao, Hongling Peng
    Clinical and Experimental Medicine.2023; 23(8): 4219.     CrossRef
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Busulfan, Melphalan, and Etoposide (BuME) Showed an Equivalent Effect to Busulfan, Cyclophosphamide, and Etoposide (BuCE) as Conditioning Therapy for Autologous Stem Cell Transplantation in Patients with Relapsed or High-Risk Non-Hodgkin’s Lymphoma: A Multicenter Randomized Phase II Study bythe Consortium for Improving Survival of Lymphoma (CISL)
Kyoung Ha Kim, Jae Hoon Lee, Mark Lee, Hoon-Gu Kim, Young Rok Do, Yong Park, Sung Yong Oh, Ho-Jin Shin, Won Seog Kim, Seong Kyu Park, Jee Hyun Kong, Moo-Rim Park, Deok-Hwan Yang, Jae-Yong Kwak, Hye Jin Kang, Yeung-Chul Mun, Jong-Ho Won
Cancer Res Treat. 2023;55(1):304-313.   Published online March 30, 2022
DOI: https://doi.org/10.4143/crt.2022.004
AbstractAbstract PDFPubReaderePub
Purpose
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard management for relapsed or high-risk non-Hodgkin’s lymphoma (NHL). We reported the busulfan, melphalan, and etoposide (BuME) conditioning regimen was effective in patients with relapsed or high-risk NHL. Moreover, the busulfan, cyclophosphamide, and etoposide (BuCE) conditioning regimen has been used widely in ASCT for NHL. Therefore, based on these encouraging results, this randomized phase II multicenter trial compared the outcomes of BuME and BuCE as conditioning therapies for ASCT in patients with NHL.
Materials and Methods
Patients were randomly assigned to receive either BuME (n=36) or BuCE (n=39). The BuME regimen was comprised of busulfan (3.2 mg/kg/day, intravenously) administered on days –7, –6, and –5, etoposide (400 mg/m2 intravenously) on days –5 and –4, and melphalan (50 mg/m2/day intravenously) on days –3 and –2. The BuCE regimen was comprised of busulfan (3.2 mg/kg/day intravenously) on days –7, –6, and –5, etoposide (400 mg/m2/day intravenously) on days –5 and –4, and cyclophosphamide (50 mg/kg/day intravenously) on days –3 and –2. The primary endpoint was 2-year progression-free survival (PFS).
Results
Seventy-five patients were enrolled. Eleven patients (30.5%) in the BuME group and 13 patients (33.3%) in the BuCE group had disease progression or died. The 2-year PFS rate was 65.4% in the BuME group and 60.6% in the BuCE group (p=0.746). There were no non-relapse mortalities within 100 days after transplantation.
Conclusion
There were no significant differences in PFS between the two groups. Therefore, busulfan-based conditioning regimens, BuME and BuCE, may be important treatment substitutes for the BCNU-containing regimens.

Citations

Citations to this article as recorded by  
  • CEAC (oral semustine, etoposide, cytarabine and cyclophosphamide) vs BEAM (carmustine, etoposide, cytarabine, and melphalan) conditioning regimen of autologous stem cell transplantation for diffuse large B-cell lymphoma: a post-hoc, propensity score-match
    Tao Wang, Ping Liu, Lili Xu, Lei Gao, Xiong Ni, Gusheng Tang, Li Chen, Jie Chen, Libing Wang, Yang Wang, Weijia Fu, Wenqin Yue, Na Liu, Ruobing Li, Guihua Lu, Yanrong Luo, Jianmin Yang
    Annals of Hematology.2024; 103(2): 575.     CrossRef
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Pediatric cancer
Outcome of Intensive Therapy for Children with Relapsed Acute Myeloid Leukemia: A Single Institution Korean Study
Jae Wook Lee, Jae Won Yoo, Seongkoo Kim, Pil-Sang Jang, Nack-Gyun Chung, Bin Cho
Cancer Res Treat. 2022;54(4):1230-1239.   Published online December 17, 2021
DOI: https://doi.org/10.4143/crt.2021.1011
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Approximately 30%-40% of pediatric acute myeloid leukemia (AML) patients relapse. In this study, we analyzed the outcome and prognostic factors of relapsed AML patients who had previously received first-line therapy at our institution.
Materials and Methods
The study group consisted of 50 patients who had been diagnosed with AML from April 2009 to December 2018, and then showed first relapse. Thirty-two of the patients (64%) had previously received allogeneic hematopoietic stem cell transplantation (HSCT) in first complete remission (CR).
Results
Forty-five of the patients (90%) received intensive chemotherapy upon diagnosis of relapse, and 76% (34/45) of these patients achieved a second CR. Estimated 5-year overall survival for these 45 patients was 44.9%±7.6%. Time from diagnosis to relapse, extramedullary involvement (EMI) at diagnosis, core binding factor AML, and complex karyotype were significant prognostic factors; in multivariate study, both time from diagnosis to relapse and EMI at diagnosis proved significant. There was no difference in 5-year disease-free survival between patients previously treated with chemotherapy only and those who received HSCT in first CR (52.4%±14.9% vs. 52.6%±11.5%). Of the 19 patients who achieved second CR after previous allogeneic HSCT in first CR and subsequent relapse, 11 were treated with chemotherapy only, and seven survive disease-free.
Conclusion
Intensive therapy allowed for long-term survival in 40%-50% of patients, and 50% of patients who achieved second CR, regardless of prior treatment modalities in first CR. Intensive treatment may allow for salvage of a significant portion of patients with relapsed pediatric AML.

Citations

Citations to this article as recorded by  
  • Diagnosis and Treatment of Pediatric Acute Megakaryoblastic Leukemia with NUP98::KDM5A Rearrangement: Case Report
    Hyemin Kang, Suejung Jo, Jae Won Yoo, Seongkoo Kim, Jae Wook Lee, Nack-Gyun Chung, Bin Cho, Chae Yeon Lee, Myungshin Kim
    Clinical Pediatric Hematology-Oncology.2024; 31(2): 56.     CrossRef
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HBsAg-Negative, Anti-HBc–Negative Patients Still Have a Risk of Hepatitis B Virus–Related Hepatitis after Autologous Stem Cell Transplantation for Multiple Myeloma or Malignant Lymphoma
Hyunsung Park, Do Young Kim, Soo-Jeong Kim, Haerim Chung, Hyunsoo Cho, Ji Eun Jang, June-Won Cheong, Yoo Hong Min, Jae-Woo Song, Jin Seok Kim
Cancer Res Treat. 2018;50(4):1121-1129.   Published online December 4, 2017
DOI: https://doi.org/10.4143/crt.2017.329
AbstractAbstract PDFPubReaderePub
Purpose
Although hepatitis B surface antigen (HBsAg)–negative, hepatitis B core antibody (anti-HBc)–negative patients are not considered to be at risk for hepatitis B virus (HBV)–related hepatitis, the actual risk remains to be elucidated. This study aimed to evaluate the risk of HBV-related hepatitis in HBsAg-negative, anti-HBc–negative patients receiving autologous stem cell transplantation (ASCT) for multiple myeloma (MM) or malignant lymphoma.
Materials and Methods
We retrospectively reviewed data from 271 HBsAg-negative patients (161 anti-HBc–negative and 110 anti-HBc–positive at the time of ASCT) who received ASCT for MM or lymphoma. The risk of HBV-related hepatitis was analyzed according to the presence of anti-HBc. HBV serology results at the time of ASCT were compared with those at the time of diagnosis of MM or lymphoma.
Results
Three patients (two anti-HBc–negative MMs and one anti-HBc–positive MM) developed HBV-related hepatitis after ASCT. The rate of HBV-related hepatitis did not differ among patients with or without anti-HBc status (p=0.843). HBV-related hepatitis more frequently occurred in MM patients than in lymphoma patients (p=0.041). Overall, 9.1% of patients (16.7% with MM and 5.4% with lymphoma) who were HBsAg–negative and anti-HBc–positive at the time of diagnosis had lost anti-HBc positivity during chemotherapy prior to ASCT.
Conclusion
Our data suggest that HBsAg-negative, anti-HBc–negative patients at the time of ASCT for MM or lymphoma still might be at a risk for HBV-related hepatitis.

Citations

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  • Seroreversion of hepatitis B surface antigen among subjects with resolved hepatitis B virus infection: A community‐based cohort study
    Ming‐Lun Yeh, Po‐Cheng Liang, Ching‐I Huang, Meng‐Hsuan Hsieh, Yi‐Hung Lin, Tyng‐Yuan Jang, Yu‐Ju Wei, Po‐Yao Hsu, Cheng‐Ting Hsu, Chih‐Wen Wang, Ming‐Yen Hsieh, Zu‐Yau Lin, Shinn‐Cherng Chen, Chung‐Feng Huang, Jee‐Fu Huang, Chia‐Yen Dai, Wan‐Long Chuang,
    Journal of Gastroenterology and Hepatology.2021; 36(11): 3239.     CrossRef
  • Seronegative occult HBV reactivation complicated with fulminant acute liver failure after rituximab for chronic inflammatory demyelinating polyneuropathy
    A. R. Buonomo, G. Viceconte, R. Scotto, M. De Angelis, S. Tozza, F. Manganelli, A. G. Lanza, G. G. Di Costanzo, I. Gentile
    Infectious Diseases.2020; 52(3): 216.     CrossRef
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Comparison of Total Body Irradiation (TBI) Conditioning with Non-TBI for Autologous Stem Cell Transplantation in Newly Diagnosed or Relapsed Mature T- and NK-Cell Non-Hodgkin Lymphoma
Chi Hoon Maeng, Young Hyeh Ko, Do Hoon Lim, Eun Suk Kang, Joon Young Choi, Won Seog Kim, Seok Jin Kim
Cancer Res Treat. 2017;49(1):92-103.   Published online May 9, 2016
DOI: https://doi.org/10.4143/crt.2015.476
AbstractAbstract PDFPubReaderePub
Purpose
This retrospective study was conducted for comparison of survival outcomes and toxicities of autologous stem cell transplantation (ASCT) based on the use of total body irradiation (TBI) as a part of the conditioning regimen in patients with mature T- and natural killer (NK)-cell lymphomas.
Materials and Methods
Patients who underwent ASCT in the upfront or salvage setting between January 2000 and December 2013 were analyzed. Patients were dichotomized according to the TBI group (n=38) and non-TBI group (n=60) based on the type of conditioning regimen for ASCT.
Results
Patients with responsive disease underwent upfront ASCT (TBI, n=16; non-TBI, n=29) whereas patients with refractory disease (TBI, n=9; non-TBI, n=12) or relapsed disease (TBI, n=13; non-TBI, n=19) underwent ASCT after salvage treatment. Hematologic and non-hematologic toxicities were manageable, and the median cumulative toxicity score according to Seattle criteria was estimated as 2 (range, 0 to 7) in both groups. No significant difference in 100-day mortality was observed between the TBI (13%, 5/38) and non-TBI (12%, 12/60) groups, and most deaths were related to disease progression. There was no difference in overall and progression-free survival; however, the TBI group showed a trend of better survival in upfront and salvage ASCT than the non-TBI group. However, patients with refractory disease showed the worst outcome regardless of the use of TBI. Patients who showed complete response before ASCT showed better progression-free survival than thosewho showed partial response.
Conclusion
TBI could be used as an effective part of conditioning for ASCT in patients with mature T- and NK-cell lymphomas.

Citations

Citations to this article as recorded by  
  • Whole body irradiation with intensity-modulated helical tomotherapy prior to haematopoietic stem cell transplantation: analysis of organs at risk by dose and its effect on blood kinetics
    Mümtaz Köksal, Jonathan Baumert, Danny Jazmati, Felix Schoroth, Stephan Garbe, David Koch, Davide Scafa, Gustavo R. Sarria, Christina Leitzen, Gregor Massoth, Achilles Delis, Annkristin Heine, Tobias Holderried, Peter Brossart, Thomas Müdder, Leonard C. S
    Journal of Cancer Research and Clinical Oncology.2023; 149(10): 7007.     CrossRef
  • The impacts of total body irradiation on umbilical cord blood hematopoietic stem cell transplantation
    Hao Wang, Kristin N. Berger, Elizabeth L. Miller, Wei Fu, Larisa Broglie, Frederick D. Goldman, Heiko Konig, Su Jin Lim, Arthur S. Berg, Julie-An Talano, Melanie A. Comito, Sherif S. Farag, Jeffrey J. Pu
    Therapeutic Advances in Hematology.2023;[Epub]     CrossRef
  • Helical versus static approaches to delivering tomotherapy to the junctional target for patients taller than 135 cm undergoing total body irradiation
    Mümtaz Köksal, Jonathan Baumert, Felix Schoroth, Thomas Müdder, Davide Scafa, David Koch, Christina Leitzen, Gustavo R. Sarria, Leonard C. Schmeel, Frank A. Giordano
    European Journal of Medical Research.2022;[Epub]     CrossRef
  • National survey of myeloablative total body irradiation prior to hematopoietic stem cell transplantation in Japan: survey of the Japanese Radiation Oncology Study Group (JROSG)
    Naoya Ishibashi, Toshinori Soejima, Hiroki Kawaguchi, Takeshi Akiba, Masatoshi Hasegawa, Kouichi Isobe, Hitoshi Ito, Michiko Imai, Yasuo Ejima, Masaharu Hata, Keisuke Sasai, Emiko Shimoda, Toshiya Maebayashi, Masahiko Oguchi, Tetsuo Akimoto
    Journal of Radiation Research.2018; 59(4): 477.     CrossRef
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Tandem High-Dose Chemotherapy and Autologous Stem Cell Transplantation for Atypical Teratoid/Rhabdoid Tumor
Ki Woong Sung, Do Hoon Lim, Eun Sang Yi, Young Bae Choi, Ji Won Lee, Keon Hee Yoo, Hong Hoe Koo, Ji Hye Kim, Yeon-Lim Suh, Yoo Sook Joung, Hyung Jin Shin
Cancer Res Treat. 2016;48(4):1408-1419.   Published online April 1, 2016
DOI: https://doi.org/10.4143/crt.2015.347
AbstractAbstract PDFPubReaderePub
Purpose
We prospectively evaluated the effectiveness of tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) in improving the survival of patients with atypical teratoid/rhabdoid tumors while reducing the risks of late adverse effects from radiotherapy (RT).
Materials and Methods
For young children (< 3 years old), tandem HDCT/auto-SCT was administered after six cycles of induction chemotherapy. RT was deferred until after 3 years of age unless the tumor showed relapse or progression. For older patients (> 3 years old), RT including reduced-dose craniospinal RT (23.4 or 30.6 Gy) was administered either after two cycles of induction chemotherapy or after surgery, and tandem HDCT/auto-SCT was administered after six cycles of induction chemotherapy.
Results
A total of 13 patients (five young and eight older) were enrolled from November 2004 to June 2012. Eight patients, including all five young patients, had metastatic disease at diagnosis. Six patients (four young and two older) experienced progression before initiation of RT, and seven were able to proceed to HDCT/auto-SCT without progression during induction treatment. Three of six patients who experienced progression during induction treatment underwent HDCT/auto-SCT as salvage treatment. All five young patients died from disease progression. However, four of the eight older patients remain progression-freewith a median follow-up period of 64 months (range, 39 to 108 months). Treatment-related late toxicities were acceptable.
Conclusion
The required dose of craniospinal RT might be reduced in older patients if the intensity of chemotherapy is increased. However, early administration of RT should be considered to prevent early progression in young patients.

Citations

Citations to this article as recorded by  
  • ESTRO-SIOPE guideline: Clinical management of radiotherapy in atypical teratoid/rhabdoid tumors (AT/RTs)
    Beate Timmermann, Claire Alapetite, Karin Dieckmann, Rolf-Dieter Kortmann, Yasmin Lassen-Ramshad, John H. Maduro, Monica Ramos Albiac, Umberto Ricardi, Damien C. Weber
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Case Report
Second Primary Glioblastoma Multiforme Following Autologous Hematopoietic Stem Cell Transplantation in a Patient with Acute Myelogenous Leukemia
Eun-Oh Kim, Hee-Je Kim, Ki-Seong Eom, Byung-Sik Cho, Sung-Eun Lee, Seung-Ah Yahng, Jong-Wook Lee, Woo-Sung Min
Cancer Res Treat. 2011;43(3):195-198.   Published online September 30, 2011
DOI: https://doi.org/10.4143/crt.2011.43.3.195
AbstractAbstract PDFPubReaderePub
Glioblastoma multiforme (GM) is one of the most aggressive primary brain tumors, and has a poor prognosis despite intensive treatment. GM is also the most malignant astrocytoma, with histopathological features that include cellular polymorphism, rapid mitotic activity, microvascular proliferation, and necrosis. The causes of GM remain obscure, but several reports have shown associations between GM and genetic alterations and radiation exposure. Furthermore, high-dose chemotherapy/radiotherapy with autologous stem cell transplantation is increasingly being used to treat patients with leukemia, and patients who undergo stem cell transplantation have a higher risk of solid tumor cancer development later in life. Based on these associations, we discuss GM development in a patient who underwent chemoradiotherapy conditioning prior to stem cell transplantation.

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  • Glioblastoma Multiforme in a Post Allogeneic Stem Cell Transplant Patient. A Case Report and Literature Review of Post Transplant Neurological Tumors
    Abhijeet P. Ganapule, Sunita Susan Varghese, Geeta Chacko, I. Aparna, Auro Viswabandya
    Indian Journal of Hematology and Blood Transfusion.2016; 32(S1): 192.     CrossRef
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Original Articles
Clinical Characteristics and Treatment Results of Pediatric Osteosarcoma: The Role of High Dose Chemotherapy with Autologous Stem Cell Transplantation
Ji Won Lee, Hyery Kim, Hyoung Jin Kang, Han-Soo Kim, Sung-Hye Park, In-One Kim, Hyo Seop Ahn, Hee Young Shin
Cancer Res Treat. 2008;40(4):172-177.   Published online December 31, 2008
DOI: https://doi.org/10.4143/crt.2008.40.4.172
AbstractAbstract PDFPubReaderePub
Purpose

In this study, we investigated the clinical characteristics and treatment results of osteosarcoma during the past 7 years, and evaluated the role of high dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT).

Materials and Methods

We retrospectively analyzed the clinical data of patients who were diagnosed as osteosarcoma at our center from January, 2000 to December, 2007.

Results

The 5-year overall survival and event-free survival of the patients were 72.6% and 55.9%, respectively. Seventeen (41.5%) patients showed disease progression during treatment or relapse after the end of treatment. The patients who had metastasis at diagnosis or who had a lower grade of necrosis after neoadjuvant chemotherapy showed decreased overall and event-free survival. Four patients received ASCT after HDCT, and 3 of them are alive without disease.

Conclusions

The patients who relapsed or had refractory osteosarcoma or who had metastasis at diagnosis or a lower grade of necrosis after neoadjuvant chemotherapy showed poor prognosis. HDCT with ASCT could be an alternative treatment option for these patients.

Citations

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  • High‐dose chemotherapy followed by autologous stem cell transplantation in pediatric patients with relapsed osteosarcoma
    Sung Han Kang, Wanlim Kim, Jong Seok Lee, Jin Kyung Suh, Hyery Kim, Dong Kwan Kim, Se Hoon Choi, Hee Won Cho, Hee Young Ju, Keon Hee Yoo, Ki Woong Sung, Hong Hoe Koo, Sung Wook Seo, Ho Joon Im, Ji Won Lee, Kyung‐Nam Koh
    Pediatric Blood & Cancer.2023;[Epub]     CrossRef
  • Favorable outcome of high-dose chemotherapy and autologous hematopoietic stem cell transplantation in patients with nonmetastatic osteosarcoma and low-degree necrosis
    Kyung Taek Hong, Hyun Jin Park, Bo Kyung Kim, Hong Yul An, Jung Yoon Choi, Jung-Eun Cheon, Sung-Hye Park, Han-Soo Kim, Hyoung Jin Kang
    Frontiers in Oncology.2022;[Epub]     CrossRef
  • The Outcome of Children With Malignant Bone Tumors: A Single-Center Experience
    Mohammadreza Bordbar, Ali Sarfaraz, Sezaneh Haghpanah, Omidreza Zekavat, Soheila Zareifar, Tahereh Zarei
    Global Pediatric Health.2021;[Epub]     CrossRef
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    L.V. Hryvkova
    Practical oncology.2021; 4(1): 30.     CrossRef
  • Retrospective analysis of high-dose chemotherapy followed by autologous stem cell transplantation for high-risk pediatric osteosarcoma
    Suguru Uemura, Takeshi Mori, Shinya Ishiko, Satoru Takafuji, Nanako Nino, Nobuyuki Yamamoto, Akira Hayakawa, Noriyuki Nishimura, Hitomi Hara, Teruya Kawamoto, Toshihiro Akisue, Kazumoto Iijima
    Pediatric Hematology and Oncology.2020; 37(4): 337.     CrossRef
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    Kyungsoo Bae, Kyung Nyeo Jeon, Hoon Sik Choi, Dae Hyun Song, Ho Cheol Kim
    Medicine.2019; 98(27): e16398.     CrossRef
  • High-dose chemotherapy and autologous stem cell transplantation with melphalan, etoposide and carboplatin for high-risk osteosarcoma
    C R Hong, H J Kang, M S Kim, H Y Ju, J W Lee, H Kim, H-S Kim, S-H Park, K D Park, J D Park, H Y Shin, H S Ahn
    Bone Marrow Transplantation.2015; 50(10): 1375.     CrossRef
  • High‐dose chemotherapy with stem cell rescue in the primary treatment of metastatic and pelvic osteosarcoma: Final results of the ISG/SSG II study
    Kjetil Boye, Adalberto Brach Del Prever, Mikael Eriksson, Gunnar Sæter, Amelia Tienghi, Paula Lindholm, Franca Fagioli, Sigmund Skjeldal, Stefano Ferrari, Kirsten Sundby Hall
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  • LY294002 suppresses the malignant phenotype and sensitizes osteosarcoma cells to pirarubicin chemotherapy
    XIN HUA LONG, ZHEN HAO ZHONG, AI FEN PENG, LIANG BO ZHU, HENG WANG, GUO MEI ZHANG, ZHI LI LIU
    Molecular Medicine Reports.2014; 10(6): 2967.     CrossRef
  • Prognostic significance of early lymphocyte recovery in pediatric osteosarcoma
    Colin Moore, Don Eslin, Alejandro Levy, Jessica Roberson, Vincent Giusti, Robert Sutphin
    Pediatric Blood & Cancer.2010; 55(6): 1096.     CrossRef
  • Cryoimmunologic Antitumor Effects Enhanced by Dendritic Cells in Osteosarcoma
    Masanori Kawano, Hideji Nishida, Yasunari Nakamoto, Hiroshi Tsumura, Hiroyuki Tsuchiya
    Clinical Orthopaedics and Related Research®.2010; 468(5): 1373.     CrossRef
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Autologous Stem Cell Transplantation using a Modified TAM Conditioning Regimen for Clinically Aggressive Non-Hodgkin's Lymphoma
Sook Hee Hong, Young Seon Hong, In Sook Woo, Yoon Ho Koh, Sang Young Rho, Ji Yean Peak, Myung Ah Lee, Byoung Yong Shim, Jae Ho Byun, Ji Chan Park, Jong Wook Lee, Woo Sung Min, Chun Choo Kim
Cancer Res Treat. 2007;39(2):54-60.   Published online June 30, 2007
DOI: https://doi.org/10.4143/crt.2007.39.2.54
AbstractAbstract PDFPubReaderePub
Purpose

High-dose chemotherapy (HDT) and autologous stem cell transplantation (ASCT) have been used for the treatment of clinically aggressive non-Hodgkin's lymphoma (NHL). However, the superiority of specific conditioning regimens has not yet been established. The present study evaluated the efficacy and toxicity of a conditioning regimen involving fractionated total body irradiation (TBI), and the use of Ara-C and melphalan (TAM) for clinically aggressive NHL.

Materials and Methods

Between March 2002 and December 2004, 31 patients with aggressive NHL received fractionated TBI with a dose of 12 Gy over 3 days, and were administered 9 g/m2 Ara-C and 100 mg/m2 melphalan followed by autologous peripheral blood stem Cell Transplantation at the Catholic Hematopoietic Stem cell transplantation Center Korea. Patients that responded to first line chemotherapy and achieved complete remission (CR), or were in a first sensitive relapse were defined as having less advanced disease, while the other patients were defined as having more advanced disease.

Results

Objective responses were obtained in 24 of 31 patients (77.4%), comprising complete remission in 19 patients (61.3%) and partial remission in 5 (16.1%) patients. The median follow-up time was 28 months (range 1~62 months). At 3 years, the overall survival and event-free survival (EFS) rates were 62.3% and 47.3%, respectively. Patients with less advanced disease and more advanced disease showed 3-year EFS rates of 73.3% and 22.5 %, respectively (p=0.006). Early (within the first 100 days) treatment-related mortality occurred in 3 (9.7%) patients. Of the 31 total patients, 15 (48.4%) developed grade 3 mucositis, 22 (70.9%) developed neutropenic fever, and two (6.5%) developed interstitial pneumonia syndrome>grade 3.

Conclusion

The modified TAM conditioning regimen and ASCT appear to be a feasible treatment regimen for clinically aggressive NHL, particularly for patients with less advanced disease.

Citations

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  • Comparison of regional arterial chemotherapy and systemic intravenous chemotherapy for advanced pancreatic cancer: a systematic review and meta-analysis
    Chengqing Li, Wenyi Guo, Shihong Chen, Jianwei Xu, Feng Li, Lei Wang
    Journal of Pancreatology.2022; 5(2): 49.     CrossRef
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Prognostic Factors in Non-Hodgkin's Lymphoma Patients Treated by Autologous Stem Cell Transplantation: A Single Center Experience
Cheolwon Suh, Sang Hee Kim, Hyo Jung Kim, Geundoo Jang, Eun Kyung Kim, Ok Bae Ko, Shin Kim, Hee Jung Sohn, Jung Shin Lee, M. Wookun Kim, Jooryung Huh
Cancer Res Treat. 2005;37(5):294-301.   Published online October 31, 2005
DOI: https://doi.org/10.4143/crt.2005.37.5.294
AbstractAbstract PDFPubReaderePub
Purpose

Autologous stem cell transplantation (ASCT) is increasingly used in patients with non-Hodgkin's lymphoma (NHL). Various clinical parameters-were evaluated to obtain significant predictors of the outcome following ASCT in patients with NHL.

Materials and Methods

Between April 1994 and December 2003, ASCT was performed on 80 patients with NHL at the Asan Medical Center.

Results

Patients had various histological subtypes and disease status. The two year progression free survival (PFS) and overall survival for all patients were 34 and 31%, respectively. A univariate analysis showed the performance status, stage, modified extranodal involvement category, International Prognostic Index (IPI) at mobilization, disease status at mobilization, and history of radiation prior to mobilization as significant predictors of the outcome following ASCT. Four risk groups, with different 2 year PFS, were identified by the age adjusted IPI at mobilization (mAAIPI): low risk 44%; low intermediate risk 40%; high intermediate risk 19%; and high risk 0% (p=.0003). A multivariate analysis revealed 3 significant factors for the PFS: disease status, prior RT and mAAIPI.

Conclusion

The mAAIPI was found to be an independent predictor of the outcome of NHL patients undergoing ASCT. This powerful prognostic tool should be used to evaluate potential candidates for ASCT.

Citations

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  • Real-world Experience of Improvement in the Survival of Lymphoma and Myeloma Patients with Autologous Stem Cell Transplantation over a 25-year Period
    Hyungwoo Cho, Shin Kim, Kyoungmin Lee, Jung Sun Park, Cheolwon Suh
    The Korean Journal of Medicine.2021; 96(6): 501.     CrossRef
  • Disease characteristics of diffuse large B‐cell lymphoma predicting relapse and survival after autologous stem cell transplantation: A single institution experience
    Daria Gaut, Tahmineh Romero, David Oveisi, Grant Howell, Gary Schiller
    Hematological Oncology.2020; 38(1): 38.     CrossRef
  • Autologous stem cell transplantation for diffuse large B-cell lymphoma with residual extranodal involvement
    Ock Bae Ko, Geundoo Jang, Shin Kim, Jooryung Huh, Cheolwon Suh
    The Korean journal of internal medicine.2008; 23(4): 182.     CrossRef
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High-Dose Chemotherapy of Cyclophosphamide, Thiotepa and Carboplatin (CTCb) followed by Autologous Stem-Cell Transplantation as a Consolidation for Breast Cancer Patients with 10 or more Positive Lymph Nodes: a 5-Year follow-Up Results
Hee-Jung Sohn, Sang-Hee Kim, Gyeong-Won Lee, Shin Kim, Jin-Hee Ahn, Sung-Bae Kim, Sang-We Kim, Woo Kun Kim, Cheolwon Suh
Cancer Res Treat. 2005;37(3):137-142.   Published online June 30, 2005
DOI: https://doi.org/10.4143/crt.2005.37.3.137
AbstractAbstract PDFPubReaderePub
Purpose

The benefit of consolidation high-dose chemotherapy (HDC) for high-risk primary breast cancer is controversial. We evaluated the efficacy and safety of consolidation HDC with cyclophosphamide, thiotepa and carboplatin (CTCb) followed by autologous stem-cell transplantation (ASCT) in resected breast cancer patients with 10 or more positive lymph nodes.

Materials and Methods

Between December 1994 and April 2000, 22 patients were enrolled. All patients received 2 to 6 cycles of adjuvant chemotherapy after surgery for breast cancer. The HDC regimen consisted of cyclophosphamide 1,500 mg/m2/day, thiotepa 125 mg/m2/day and carboplatin 200 mg/m2/day intravenous for 4 consecutive days.

Results

With a median follow-up of 58 months, 11 patients recurred and died. The median disease-free survival (DFS) and median overall survival (OS) were 49 and 69 months, respectively. The 5-year DFS and OS rates were 50% and 58%, respectively. The 12 patients with 10 to 18 involved nodes had better 5-year DFS (67%) and OS (75%) than 10 patients with more than 18 involved nodes (30% and 38%, respectively). The most common grade 3 or 4 nonhematologic toxicity was diarrhea, which occurred in 5 patients (23%). No treatment-related death was observed.

Conclusion

Consolidation HDC with CTCb followed by ASCT for resected breast cancer with more than 10 positive nodes had an acceptable toxicity but does not show promising survival.

Citations

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  • Real-world Experience of Improvement in the Survival of Lymphoma and Myeloma Patients with Autologous Stem Cell Transplantation over a 25-year Period
    Hyungwoo Cho, Shin Kim, Kyoungmin Lee, Jung Sun Park, Cheolwon Suh
    The Korean Journal of Medicine.2021; 96(6): 501.     CrossRef
  • Prospective study of cyclophosphamide, thiotepa, carboplatin combined with adoptive DC-CIK followed by metronomic cyclophosphamide therapy as salvage treatment for triple negative metastatic breast cancers patients (aged <45)
    X. Wang, J. Ren, J. Zhang, Y. Yan, N. Jiang, J. Yu, L. Di, G. Song, L. Che, J. Jia, X. Zhou, H. Yang, H. K. Lyerly
    Clinical and Translational Oncology.2016; 18(1): 82.     CrossRef
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High Dose Chemotherapy and Autologous Peripheral Blood Stem Cell Transplantation for Persistent/Relapsed Ovarian Cancer
So Eun Kim, Jong Ho Won, Hyun Soo Kim, Joon Sung Park, Chan Kyu Kim, Kyu Taeg Lee, Sung Kyu Park, Seung Ho Baick, Dae Sik Hong, Hee Sook Park, Hugh Chul Kim
Cancer Res Treat. 2002;34(6):439-443.   Published online December 31, 2002
DOI: https://doi.org/10.4143/crt.2002.34.6.439
AbstractAbstract PDF
PURPOSE
High dose chemotherapy (HDC) is increasingly being used for ovarian cancer. Although early studies of autotransplantation for advanced ovarian cancer have been encouraging, most reported series were small, and no randomized trials have been reported. HDC and autologous hematopoietic stem cell transplantation were rarely performed in patients with ovarian cancer in Korea, and no results have been reported with the exception of one case report.
MATERIALS AND METHODS
We retrospectively analyzed 10 patients with refractory or relapsed ovarian cancer having received HDC and autologous peripheral blood stem cell transplantation (APBSCT), between January 1996 and September 1998, at the Soon Chun Hyang and Ajou University Hospitals.
RESULTS
Ten patients were treated with HDC and APBSCT. Six patients achieved complete response (CR) and 1 a partial response (PR), with a response rate of 70%. Three patients did not respond following mobilization chemotherapy, and failed to respond after HDC. The median duration of progression free survival (PFS) and overall survival (OS) were 6 (4~46) and 13 (3~50+) months, respectively. The median duration of OS of the responders following mobilization chemotherapy was 23 (8~50+) compared with 12 (3~18) months of the non- responders. With regard to the treatment related toxicity, 8 patients had neutropenic fevers, and bacteremia was documented in 4. The non-hematological toxicities were never life threatening, and there were no treatment related deaths.
CONCLUSION
HDC, followed by APBSCT, is well-tolerated patients with refractory or relapsed ovarian cancer, and following mobilization chemotherapy the responders survived longer than the non-responders.

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  • Analysis of chromosomal changes in serous ovarian carcinoma using high‐resolution array comparative genomic hybridization: Potential predictive markers of chemoresistant disease
    Sang Wun Kim, Jae Wook Kim, Young Tae Kim, Jae Hoon Kim, Sunghoon Kim, Bo Sung Yoon, Eun Ji Nam, Hye Yeon Kim
    Genes, Chromosomes and Cancer.2007; 46(1): 1.     CrossRef
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Retrospective Analysis of the Results of Adjuvant Chemotherapy in Breast Cancer Patients with 10 or More Positive Nodes: Nonrandomized Comparison of Adriamycin-Containing Regimens
Jin Hee Ahn, Haeseoung Bahng, Jeong Gyun Kim, Sung Bae Kim, Sei Hyun Ahn, Hyesook Chang, Jung Shin Lee, Sang Hee Kim, Woo Kun Kim
Cancer Res Treat. 2002;34(2):84-90.   Published online April 30, 2002
DOI: https://doi.org/10.4143/crt.2002.34.2.84
AbstractAbstract PDF
PURPOSE
To evaluate the results of adriamycin-based adjuvant chemotherapy with or without high dose chemotherapy (HDC) with stem cell transplantation (SCT) in breast cancer with 10 or more positive axillary nodes.
MATERIALS AND METHODS
Seventy-one breast cancer patients who had undergone surgery and had 10 or more positive axillary nodes were included in this study held between January 1997 and December 1999. The pathologic and clinical records were reviewed retrospectively.
RESULTS
Twenty-nine patients were treated with adriamycin followed by 8 courses of CMF (group I); 22 patients received 4 courses of adriamycin and 7 patients received 3 courses of adriamycin. Twenty-six patients received median 6 courses of CAF (group II) and 16 patients underwent HDC and autologous SCT (group III). With a median follow-up of 27.1 months, relapses were observed in 24 patients (33.8%) and the 3-year disease-free survival (DFS) rate was 57.1%; group I/II 55.4%, and group III 62.7%. The three-year overall survival (OS) rate was 86.1%; group I/II 83.0%, group III 93.8%. There were no difference in the 3-year DFSs or in the OSs of group I and group II. However, patients who received only 3 courses of the sequential adriamycin in group I showed a significantly poorer 3-year OS than those that received 4 courses of adriamycin (42.9% vs. 95.5%).
CONCLUSION
Our study shows that adriamycin-containing combination chemotherapy is as effective as HDC with SCT in patients with 10 or more positive axillary lymph nodes judging by 3-year DFS and OS, and shows that three courses of adriamycin seems to be inadequate.

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  • Alternative Therapy and Abnormal Liver Function During Adjuvant Chemotherapy in Breast Cancer Patients
    Jin-Hee Ahn, Sung-Bae Kim, Mi Ra Yun, Jung-Shin Lee, Yoon-Koo Kang, Woo Kun Kim
    Journal of Korean Medical Science.2004; 19(3): 397.     CrossRef
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High Dose Chemotherapy with Ifosfamide, Carboplatin, and Etoposide Followed by Autologous Stem Cell Transplantation in Breast Cancer
Soo Mee Bang, Se Hoon Lee, Eun Kyung Cho, Jung Ae Lee, Young Suk Park, Dong Bok Shin, Jae Hoon Lee, Yung Jue Bang, Seonyang Park, Byoung Kook Kim, Noe Kyeong Kim
J Korean Cancer Assoc. 2000;32(6):1059-1066.
AbstractAbstract PDF
PURPOSE
To establish the feasibility of high dose ifosfamide, carboplatin, and etoposide (ICE) chemotherapy followed by autologous stem cell transplantation (ASCT) in patients with high-risk or metastatic breast cancer.
MATERIALS AND METHODS
High-risk breast cancer is defined as 10 or more involved axillary lymph nodes (n=3) or stage III (n=2). Patients with metastatic cancer have relapsed diseases after curative resection (n=10) or initially metastatic lesion (n=1). Colony stimulating factor with either cyclophosphamide or combination chemotherapy was administered to mobilize the stem cells. High dose chemotherapy consisted of ifosfamide 16 g/m2, carboplatin 1.8 g/m2, and etoposide 0.75 g/m2 (dose I) and later modified to ifosfamide 12 g/m2, carboplatin 1.35 g/m2, and etoposide 1.2 g/m2 (dose II).
RESULTS
The median duration of grunulocyte nadir (<500/ microliter) was 11 (10~17) days and platelet transfusion dependency (<20,000/ microliter) was 11 (7~53) days in 14 patients who achieved engraftment. One out of 5 patients with high-risk breast cancer relapsed after high dose therapy. Two patients remain disease-free at 18th and 40th months. Two among the 4 patients treated with dose I died due to treatment-related complications. The responses of metastatic diseases to ICE chemotherapy were 1 continuing CR, 1 CR, 1 PR, 4 SD and 3 PD in 10 evaluable patients.
CONCLUSION
High dose ICE chemotherapy, especially dose II and ASCT were feasible in high-risk or metastatic breast cancer.
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Conventional Treatments in Patients with Hodgkin's Disease
Jong Beom Park, Chul Won Seo, Sang Hee Kim, Kyung No Lee, Hun Ho Song, Soon Seo Park, Hyo Jung Kim, Yung Joo Min, Jin Hee Park, Sung Joon Choe, Jung Koon Kim, Tae Won Kim, Dae Yung Jang, Je Hwan Lee, Sung Bae Kim, Sang Wee Kim, Koo Hyung Lee, Jung Sin Lee, Woo Keon Kim
J Korean Cancer Assoc. 1999;31(4):821-829.
AbstractAbstract PDF
PURPOSE
We conducted this study to determine the efficacy of conventional treatments for patients with Hodgkin's disease and identify the patients who have poor prognosis and need high-dose chemotherapy and autologous stem cell transplantation.
MATERIALS AND METHODS
Between Jun. 1989 and Dec. 1997, 50 patients were enrolled and 39 patients were evaluable. Patients were treated with radiotherapy (5 patients) or combination chemotherapy (21 patients) or combined chemotherapy and radiotherapy (13 patients) according to their disease stage. Chemotherapy regimens were C-MOPP (cyclo- phosphamide, vincristine, procarbazine, and prednisone), MOPP (mechlorethamine, vin- cristine, procarbazine, and prednisone), ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), alternating C-MOPP/ABVD, and MOPP/ABV hybrid. Radiation therapy was performed when there was residual tumor after chemotherapy or bulky disease. The response to treatments was analyzed by clinical stage I-II and stage III-IV patients group, respectively.
RESULTS
The complete response rate was 76.9% for total patients, 83.3% for stage I-II patients, and 71.4% for stage III-IV patients. Of the 30 patients achieving complete response, four (13.3%) relapsed at 6, 12, 22, and 28 months after complete response, respectively. The median follow-up duration was 24 months. Nine patients died. Four patients died of Hodgkins disease. Three-year overall survival rate was 72.9% for total patients, 72.5% for stage I-II patients, and 70% for stage III-IV patients. Two-year disease- free survival rate was 77.6% for total patients, 79% for stage I-II stage patients, and 73.9% for stage III-IV patients. The prognostic factor analysis showed that performance status affected the disease-free survival rate.
CONCLUSION
Conventional treatments in patients with Hodgkins disease showed results comparable to previous studies. But we were unable to identify the patients, who need high-dose chemotherapy and autologous stem cell transplantation, because of small number of study patients and short follow up duration.
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Clinical Trial
High Dose Cyclophosphamide, Thiotepa, and Carboplatin followed by Autologous Peripheral Stem Cell Rescue in Patients with Responsive Metastatic or High - Risk Primary Breast Cancer
Se Haeng Cho, Sang Hee Kim, Young Joo Min, Sung Joon Choi, Jung Kyun Kim, Tae Won Kim, Jong Soo Choi, Dai Young Zang, Je Hwan Lee, Sung Bae Kim, Cheol Won Suh, Kyoo Hyung Lee, Jung Shin Lee, Woo Kun Kim, Se Hyun Ahn, Jung Mi Park, Sang We Kim
J Korean Cancer Assoc. 1998;30(1):100-105.
AbstractAbstract PDF
PURPOSE
Positive correlation between dosage of antineoplastic agents and tumor response is well demonstrated in advanced breast cancer. But severe bone marrow depression limit the clinical application of high dose chemotherapy. Autologous peripheral blood stem cell transplantation(PBSCT) after high dose chemotherapy(HDC) was introduced to promote rapid bone marrow recovery. This study was designed to establish the feasibility of combining high dose cyclophosphamide, thiotepa, and carboplatin chemotherapy followed by stem cell rescue in patients with responsive metastatic or high risk primary breast cancer.
MATERIALS AND METHOD
Eligibility criteria included the presence of high risk primary breast cancer(10 or more involved axillary lymph node, n=4), recurrent disease after curative resection(n=6) or stage IV disease at the time of diagnosis(n=1). The responses of recurrent disease to initial chemotherapy were 4 complete responses and 1 partial responses. One recurrent case with solitary pulmonary metastasis underwent metastasectomy and got chemotherapy after operation. Colony stimulating factor was administered to mobilize stem cells from bone marrow to peripheral blood. The stem cell collection was performed 4~10 times(median 4) and the number of collected stem cell was 1.95~7.34x10(8)kg(median 4.87x10(8)/kg). High dose chemotherapy with CTCb (cyclophosphamide 1,500 mg/m2/day, thiotepa 125 mg/m2/day, carboplatin 200 mg/m2/ day) was performed from day -7 to day -4 and peripheral stem cell infusion was performed on day 0 as planned.
RESULT
Eleven patients were enrolled in this study. Their median age was 39 years old. The median time for bone marrow recovery was 11 days for neutrophil(>500/mm2) and 28 days for platelet(>50,000/mm2). Packed red blood cell and platelet transfusion were performed in 11 patients. The group whose infused mononuclear cell count was less than 4.0 x 10(8)/kg(n=9) needed longer time for bone marrow recovery than those(n=2) who had more than 4.0 x 10(8)/kg( 20 vs 13 day, p < 0.05 ). For non-hematologic toxicity, none have experienced toxicity more than grade III. There were 2 recurrences of 4 cases with high risk breast cancer at the 22 th, and 25 th month but they are still alive at the 28 th, and 29 th month each. The other 2 cases are alive without recurrences at the 18 th, and 20 th months each. In the recurrent disease group, one case who showed partial response to initial chemotherapy recurred at the 4 th month and died at the 13 th month after PBSCT. The other 5 cases are alive without recurrence at the 1st, 3 rd, 3 rd, 5 th, and 31 th month each. One case with stage IV disease(bone metastasis) is alive without evidence of progression at the 3 rd month.
CONCLUSION
High dose chemotherapy with PBSCT can be performed safely. Long term survival of patients with advanced breast cancer would be possible by PBSCT after HDC. Further clinical trials based on larger patient population is required to evaluate clinical efficacy of PBSCT after HDC in high risk and recurrent breast cancer.
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Original Article
CD34+ Selected Peripheral Blood Stem Cell Transplantation
Hoon Kook, Hyeoung Joon Kim, Jin Soo Hwang, Keun Mo Kim, Keun Mo Kim, Ik Joo Chung, Tai Ju Hwang
J Korean Cancer Assoc. 1996;28(5):910-921.
AbstractAbstract PDF
The CD34 antigen is a 115 kDa glycoprotein that marks 1%-4% of human bone marrow cells, including virtually all committed progenitor cells and long-term reconstituting stem cells. The selection of CD34+ cells may be useful in several areas of clinical stem cell transplantation, including purging of tumor cells, T cell depletion, stem cell expansion and gene therapy. Using immunomagnetic beads method (Isolex-50TM), we report hereby the first two Korean experiences of CD34+ selected peripheral blood stem cell (PBSC) transplantations. As a mean of tumor cell purging, CD34+ cells were positively selected from mobilized PBPCs and infused to a 5-year-old girl with a relapsed stage IV neuroblastoma with resultant early short-term trilineage hematopoietic recovery. In the second patient with chronic myelogenous leukemia who showed poor graft function after having underwent an initial partially-matched bone marrow transplant, CD34+ selected allogeneic PBSC transplantation was attempted to reduce the likelihood of inducing graft-versus-host disease. Augmentation of marrow function was noted with infused PBSCs which were depleted of T cells to the degree of log3.65. As CD34+ selected PBSCs are capable of restoring hematopoietic recovery after high dose therapy, further development of selection technique to ensure high purging efficiency without significant loss of stem cells and further identification of best mobilizing and conditioning regimens are required in this new field of clinical transplantation.
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Cancer Res Treat : Cancer Research and Treatment
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