• Clinical and Experimental Pediatrics
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• v.49 no.10
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• pp.1079-1085
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• 2006

Purpose : The purpose of this study was to evaluate factors affecting hematologic recovery and infection in high-dose chemotherapy(HDCT) and autologous stem cell transplantation(ASCT) in patients with high-risk solid tumor. Methods : From January 2004 to December 2005, 72 HDCTs and ASCTs were applied to children with high-risk solid tumor at Samsung Medical Center. Medical records of these 72 HDCTs and ASCTs were retrospectively analyzed. Results : The single most powerful predictor of neutrophil and platelet recovery was the number of transplanted $CD34^+$ cells. The duration of high fever was significantly longer in young patients, in patients treated with total body irradiation and/or thiotepa, and in patients transplanted with lower $CD34^+$ cell dose(<$2{\times}10^6/kg$). However, the difference in the duration of high fever according to the number of $CD34^+$ cells was not clinically significant. Conclusion : Findings in this study suggest that HDCT and ASCT with low $CD34^+$ cell dose is clinically feasible despite delayed hematologic recovery, especially at a dose >$1{\times}10^6/kg$ per transplantation. Therefore, it is important not to defer the appropriate time for HDCT for an additional collection of hematopoietic stem cells if the number of collected $CD34^+$ cells is >$1{\times}10^6/kg$ per transplantation.

• Radiation Oncology Journal
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• v.21 no.3
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• pp.192-198
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• 2003

Purpose: Current results of autologous stem cell transplantation (SCT) suggest that this procedure may prolong disease free survival In patients with acute myeloid leukemia (AML). Autologous SCT is increasingly used as treatment for AML in first remission. The aim of this study was to evaluate the outcome of autologous SCT for patients with AML in first remission treated by autologous SCT using cytarabine, melphalan and total body irradiation (TBI) as the conditioning regimen. Materials and Methods: Between January 1995 and December 1999, 29 patients with AML in first remission underwent autologous SCT. The median age of patients was 33 years (range, 16 to 47). The conditioning regimen consisted of cytarabine ($3.0\;gm/m^2$ for 3 days), melphalan ($100\;gm/m^2$ for 1 day) and TBI (total 1000 cGy in five fractions over 3 days). Results: The median follow up was 40 months with a range of 3 to 58 months. The 4-year cumulative probability of disease free survival was 69.0%, and median survival was 41.5 months. The 4-year relapse rate was 27.6%. The factor Influencing disease free survival and relapse rate was the French-American-British (FAB) classification ($M_3$ group vs. other groups; p=0.048, p=0.043). One patient died from treatment-related toxicity. Conclusion:: Although the small number of patients does not allow us to draw any firm conclusion, our results were encouraging and suggest that the association of cytarabine, melphalan and TBI as a conditioning regimen for autologous SCT for AML on first remission appears to be safe and effective.

• Clinical and Experimental Pediatrics
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• v.49 no.2
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• pp.173-180
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• 2006

Purpose : Cytomegalovirus(CMV) infection still remains as a major cause of morbidity and mortality after stem cell transplantation. In this study, we analyzed the results of antigenemia-guided preemptive therapy among children with allogeneic hematopoietic stem cell transplantation to determine the incidence and risk factors associated with CMV antigenemia, and evaluated the efficacy of the CMV antigenemia based preemptive therapy. Methods : We enrolled 213 pediatric patients following allogeneic hematopoietic stem cell transplantation(HSCT), at the Catholic HSCT center between October 1998 and December 2003. Pre-emptive ganciclovir was started when more than 5 CMV Ag-positive cells were detected in matched sibling HSCT, and when any Ag-positive cells were seen in unrelated allogenic HSCT. Results : CMV antigenemia was observed in 88(41.3 percent) of 213 patients on median day 28(day 11-99). In univariated analysis, use of unrelated donors(other than siblings), age of recipient(more than 5 years at transplant) at transplantation, the presence of recipient CMV-IgG before transplantation, TBI-based conditioning regimen and the presence of acute GvHD(grade ${\geq}II$) were the risk factors for positive CMV antigenemia. In multivariate analysis, unrelated bone marrow transplantation, positive recipient CMV serology and acute GvHD(grade ${\geq}II$) were the independent risk factors for positive CMV antigenemia. Conclusion : Risk factors of CMV infection in children were CMV serostatus of the recipient, the source of stem cells, and acute graft-versus-host disease. The pre-emptive therapy based on CMV antigenemia was effective in the prevention of CMV disease.

• Journal of Hospice and Palliative Care
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• v.8 no.2
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• pp.190-199
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• 2005

Purpose: Objectives of this study was to investigate the level of anxiety and depression according to the stages of autologous and allogeneic hematopoietic stem cell transplantation (HSCT). It would be provide the basis for effective psycho-emotional nursing intervention. Methods: We report on 52 patients, including 19 with autologous HSCT, and 33 with allogeneic HSCT from August 2002 to August 2003, at a university hospital. Spielberger's State-Trait Anxiety Inventory and Jung's Depression Inventory were used to measure levels of anxiety and depression, respectively, at admission time, the day before HSCT, and discharge time. Data was analyzed using SAS program that included Chi-square test, Fisher's exact test, repeated measures ANOVA and Stepwise multiple regression analysis. Results: In all stages of HSCT, the level of anxiety of patients who underwent allogeneic HSCT was significantly higher than that of autologous HSCT (P=0.047). The depression at the day before HSCT was significantly higher than that at admission. The major variable affecting anxiety in autologous HSCT was depression. Specially depression and gender were significant predictors to explain anxiety in allogeneic HSCT at admission time (61%). Experience of relapse and gender were significant predictors to explain anxiety in allogeneic HSCT at discharge time (36%). Conclusion: We recommend that the anxiety and depression be researched during the stages of allogeneic HSCT, specifically in the day before HSCT. It is necessary to develop an effective psycho-emotional nursing intervention according to the stages of HSCT.

• 건강소식
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• v.34 no.1
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• pp.8-9
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• 2010

'암'이라는 단어가 풍기는 뉘앙스는 두려움을 넘어 공포로 다가온다. 그래서 모든 암 환자들과 그 가족들이 받는 고통은 상상을 초월한다. 백혈병도 마찬가지로, 발병한지 4개월 만에 죽음에 이르기도 하는 무서운 암이다. 하지만 조혈모세포 이식으로 완치 가능한 암이 또한 백혈병이다. 그래서 절망적이지만 희망적이다.

• Clinical and Experimental Pediatrics
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• v.51 no.1
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• pp.67-72
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• 2008

Purpose : In this study, we retrospectively analyzed the clinical outcomes of patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT) grafted from HLA-matched parents. Methods : Seven children with acute leukemia (4 acute lymphoblastic leukemia, 3 acute myeloid leukemia) in first complete remission received allogeneic HSCT from their respective parents at the St. Marys Hospital between April, 1999 and October, 2005. The median age of patients at transplantation was 5 years (range, 1-11 years; 2 male, 5 female) and the median age of donors was 35 years (range, 30-41 years; 5 male, 2 female). We investigated the clinical outcomes such as engraftment, acute and chronic graft-versus-host disease (GVHD), transplant-related morbidity and mortality, relapse and survival. Results : Median time from transplantation to last follow-up was 69.5 months (range, 18.8-96.5 months). All patients were successfully engrafted, with a median time of 11 days (range, 10-16 days) and 26 days (range, 13-39 days) for neutrophil and platelet recovery, respectively. Grade II acute GVHD occurred in 3, and grade III acute GVHD in 1 of 7 recipients. Extensive chronic GVHD developed in 2, and limited chronic GVHD in 1 of 7 recipients. Death from transplant-related complications occurred in 1, and relapse occurred in 1 of 7 recipients. Estimated 5-year overall survival was $83{\pm}15%$. Conclusion : The clinical outcomes of recipients who underwent HSCT from HLA-matched parents were comparable to those of patients who received HSCT grafted from HLA-matched sibling donors in childhood leukemia. HLA typing of parents, as well as siblings will increase the likelihood of finding an HLA-matched family donor for patients who need HSCT.

• Korean Journal of Adult Nursing
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• v.20 no.2
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• pp.341-352
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• 2008

Purpose: The purpose of this study was to identify relatively important predictors of quality of life (QOL) of HSCT recipients among client's characteristics(age, gender, family income, religiosity), HSCT-related characteristics(time since HSCT, type of HSCT, decision maker of HSCT) and social support. Methods: Eighty two participants who had a HSCT were recruited for the study. Data were analyzed by descriptive analysis, pearson's correlation, ANOVA and stepwise multiple regression using SPSS for Window(version 12.0) program to answer the research questions. Results: Family income, time since HSCT and religiosity explained 23.8% of the variance in the QOL of HSCT recipients. HSCT recipients who had higher family income, longer time past since HSCT, and more religious tend to have higher quality of life. Conclusion: Based on the findings of this study, we could know that the HSCT recipients need certain amount of time to recover their QOL after HSCT. Opportunities of reemployment and religious support should be considered when we develop intervention program for HSCT recipients.

• Asian Oncology Nursing
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• v.12 no.1
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• pp.110-116
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• 2012

Purpose: This study was performed to identify the pre-and post-transplant nutritional assessment for patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Methods: The subjects of this study were 25 patients undergoing allogeneic HSCT. The data collection was performed from January 31st to March 31st, 2011. The Patient-Generated Subjective Global Assessment (PG-SGA), anthropometrics and biochemical test were collected from the time they entered the isolation unit until they left. Results: Pre-transplant nutritional assessment status indicated moderate malnutrition which scored $7.32{\pm}1.68$ in PG-SGA. There were 22 patients (88.0%) with moderate malnutrition and 3 patients (12.0%) with severe malnutrition. Post-transplant nutritional assessment indicated severe malnutrition status which scored $11.92{\pm}3.26$ in PG-SGA. Pre-and post-transplant nutritional assessment displayed significant differences (p<.001) in PG-SGA score. Hematopoietic stem cell transplantation led to a deterioration of patients' nutritional status. Pre-transplant patients were already in malnutrition status and patients undergoing allogeneic HSCT were at risk for malnutrition. Conclusion: Pre-and post-transplant patients were categorized as having undernutritional and malnutritional status. Pre-transplant nutrition status impacted on post-transplant nutritional status. Health care personnel should pay attention to patient's nutrition status when undergoing allogeneic HSCT with appropriate nutritional assessment tools.

• Journal of Oral Medicine and Pain
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• v.37 no.3
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• pp.147-154
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• 2012

Hematopoietic stem-cell transplantation (HSCT) is a treatment for immune deficiency, autoimmune diseases, and hematopoietic malignancies. The main complication of allogenic HSCT is graft-versus-host disease (GVHD). Oral mucosal biopsy is needed for a definitive diagnosis and treatment planning of GVHD, but this procedure causes bleeding and bacteremia in a poor general condition. We evaluated the efficacy of laser-assisted biopsy as a minimally invasive treatment. Three cases were described in this article. All patients' medical records, clinical photographs, and histopathologic findings were reviewed. All patients felt comfortable and no severe complications occurred. The quality of the obtained biopsy material was adequate for a definitive diagnosis of GVHD. Laser-assisted, minimally invasive biopsy of the oral mucosa does not cause bleeding, and it reduces the chances of infection, bacteremia, and postoperative scarring compared to the usual histopathologic biopsy procedure. It would thus be advantageous to use this procedure to biopsy GVHD patients.

• Pediatric Infection and Vaccine
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• v.21 no.2
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• pp.81-95
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• 2014

Purpose: Hematopoietic cell transplantation (HCT) recipients are vulnerable to invasive infection by Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (Sp). This study was performed to evaluate immune responses after Hib and Sp vaccination in Korean pediatric HCT recipients. Methods: Patients were prospectively enrolled at Samsung Medical Center during 2009-2011. ELISA tests to detect anti-PRP IgG antibody and antibodies to Sp serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F were performed at the Center for Vaccine Evaluation and Study, Ewha Medical Research Institute. Results: Ten patients (two allogeneic, eight autologous recipients) with median age 5.4 years (range 2.7-12.2 years) were enrolled. Before Hib vaccination, 60% of patients' anti-PRP IgG titers were below $0.15{\mu}g/mL$. After vaccination, 100% of patients' anti-PRP IgG titers increased above $0.15{\mu}g/mL$ (cut-off value for detection) and $1.0{\mu}g/mL$ (cut-off value for seroprotection). For pneumococcus, in 2-5 year-old patients, pre-vaccination geometric mean concentrations (GMCs) of IgG for six serotypes (4, 6B, 9V, 14, 18C, and 23F) were below $0.35{\mu}g/mL$ and at 5 months post-vaccination GMCs of IgG for all seven serotypes increased to above $0.35{\mu}g/mL$. In patients older than 5 years, pre-vaccination GMCs of IgG for four serotypes (4, 9V, 14, and 23F) were below $0.35{\mu}g/mL$ and at 3 months post-vaccination GMCs of IgG for all seven serotypes increased to above $0.35{\mu}g/mL$. Conclusion: Most HCT recipients had low or no protective antibodies to Hib and Sp before vaccination, but showed good immune responses to protective levels after vaccination.