• Korean Journal of Clinical Pharmacy
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• v.22 no.2
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• pp.123-130
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• 2012

거대세포바이러스(Cytomegalovirus; CMV) 감염은 동종조혈모세포이식 환자의 주요 사망원인 중 하나이다. 용량감소전처치(Reduced-intensity conditioning; RIC)를 이용한 조혈모세포이식은 골수억제전처치(Myeloablative conditioning; MAC)에 비해 골수억제 및 면역억제가 적으므로 CMV 감염 발생율을 감소시킬 것이라 예상되었으나 예방적 면역억제요법, T세포 제거 약제의 사용 등으로 서로 상이한 결과가 보고되고 있다. 2007년 1월부터 2009년 12월까지 총 141명의 환자(MAC 113명, RIC 28명)가 동종조혈모세포이식을 받았으며, CMV 감염은 MAC 62.8%, RIC 57.1% (p = 0.310), CMV 질환은 각각 12.4%, 14.3% (p = 0.785)에서 발생하였다. CMV 감염/질환 발생빈도와 CMV 항원 혈증검사 지속기간, 초기/최고치, 생존율은 두 군간 유의한 차이가 없었다. CMV 감염 위험인자에 대한 다변량분석 결과, 환자가 고령일수록(HR 1.024, 95% CI 1.002-1.045; p = 0.031) 또는 grade 2 이상의 급성 이식편대숙주병이 발생한 경우에(HR 1.849, 95% CI 1.031-3.315; p=0.039) CMV 감염 발생 위험율이 유의하게 높았다. 결론적으로, 전처치요법 강도에 따른 CMV 감염의 발생빈도와 발현양상의 차이는 없었으나, 고령이거나 grade 2 이상의 급성 이식편대숙주병이 발생한 환자의 경우 CMV 감염 발생과 유의한 연관성을 보였다. 이상과 같은 결과에 비춰 봐서 CMV 질환이 대부분 이식 100일 이후에 발생한 점을 고려할 때, 이식 후 CMV 감염 발생 시 ganciclovir 선제요법과 함께 이들 환자들에게 지속적인 모니터링을 실시하는 것이 필요할 것으로 사료된다.

• Radiation Oncology Journal
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• v.35 no.3
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• pp.257-267
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• 2017

Purpose: Pulmonary toxicities, including infectious pneumonia (IP) and idiopathic pneumonia syndrome (IPS), are serious side effects of total body irradiation (TBI) used for myeloablative conditioning. This study aimed to evaluate clinical factors associated with IP and IPS following TBI. Materials and Methods: Fifty-eight patients with hematologic malignancies who underwent TBI before allogeneic hematopoietic stem cell transplantation between 2005 and 2014 were reviewed. Most patients (91%) received 12 Gy in 1.5 Gy fractions twice a day. Pulmonary toxicities were diagnosed based on either radiographic evidence or reduced pulmonary function, and were subdivided into IP and IPS based on the presence or absence of concurrent infection. Results: Pulmonary toxicities developed in 36 patients (62%); 16 (28%) had IP and 20 (34%) had IPS. IP was significantly associated with increased treatment-related mortality (p = 0.028) and decreased survival (p = 0.039). Multivariate analysis revealed that the risk of developing IPS was significantly higher in patients who received stem cells from a matched unrelated donor than from a matched sibling donor (p = 0.021; hazard ratio [HR] = 12.67; 95% confidence interval [CI], 1.46-110.30). Combining other conditioning agents with cyclophosphamide produced a higher tendency to develop IP (p = 0.064; HR = 6.19; 95% CI, 0.90-42.56). Conclusion: IP and IPS involve different risk factors and distinct pathogeneses that should be considered when planning treatments before and after TBI.

• Parasites, Hosts and Diseases
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• v.50 no.4
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• pp.353-355
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• 2012

We report here a case of inguinal sparganosis, initially regarded as myeloid sarcoma, diagnosed in a patient undergone allogeneic hematopoietic transplantation (HSCT). A 56-year-old male patient having myelodysplastic syndrome was treated with allogeneic HSCT after myeloablative conditioning regimen. At day 5 post-HSCT, the patient complained of a painless palpable mass on the left scrotum and inguinal area. Pelvic magnetic resonance imaging and computed tomography revealed suspected myeloid sarcoma. Gun-biopsy was performed, and the result revealed eosinophilic infiltrations without malignancy. Subsequent serologic IgG antibody test was positive for sparganum. Excisional biopsy as a therapeutic diagnosis was done, and the diagnosis of sparganosis was confirmed eventually. This is the first report of sparganosis after allogeneic HSCT mimicking myeloid sarcoma, giving a lesson that the physicians have to consider the possibility of sparganosis in this clinical situation and perform adequate diagnostic and therapeutic approaches.

• Clinical and Experimental Pediatrics
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• v.59 no.sup1
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• pp.57-59
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• 2016

Chronic granulomatous disease (CGD) is a primary immunodeficiency disease caused by impaired phagocytic function. Hematopoietic stem cell transplantation (HSCT) is a definitive cure for CGD; however, the use of HSCT is limited because of associated problems, including transplantation-related mortality and engraftment failure. We report a case of a patient with CGD who underwent successful HSCT following a targeted busulfan and fludarabine reduced-toxicity myeloablative conditioning. Intravenous busulfan was administered once daily for 4 consecutive days (days -8 to -5), and the target area under the curve was $75,000{\mu}g{\cdot}hr/L$. Fludarabine ($40mg/m^2$) was administered once daily for 6 consecutive days from days -8 to -3. Antithymocyte globulin (2.5 mg/kg/day) was administered from days -4 to -2. The patient underwent successful engraftment and did not have any severe toxicity related to the transplantation. Conditioning with a targeted busulfan and fludarabine regimen could provide a better outcome for HSCT in CGD, with close regulation of the busulfan dose.

• IMMUNE NETWORK
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• v.2 no.1
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• pp.49-52
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• 2002

Background: The possibility that G-CSF recruits leukemic cells from the G0 to S phase, which may lead to a greater susceptibility to cytotoxic drugs, such as ara-C, has been presented in Harada's study. Methods: In this study, we referred to the protocol of Harada et al 1 to try G-CSF combined marrow-ablative chemotherapy and autologous PBSCT, for the treatment of AML patients in CR1 status. Between January 1997 and March 1998, six AML patients (3: children, 3: adults) in CR1 status were autografted and followed up to 3 years. Results: The major regimen related toxicity was composed of mucositis and diarrhea without death. The time of ANC recovery to 500/L and 1,000/L was 11~48 and 16~81 days, respectively. The mean time of platelet recovery to 20,000/L and 50,000/L was 21~233 and 35~370 days, respectively. The platelet recovery time to 50,000/L was markedly prolonged for more than 100 days in four patients (66.7%). Moreover, four patients (66.7%) experienced a relapse of leukemia after transplantation, with a mean interval of 147.5 days after PBSCT. Two patients were in CR status for 53 and 51 months after PBSCT, respectively. Conclusion: The G-CSF combined marrow-ablative chemotherapy and autologous PBSCT resulted in a markedly delayed platelet recovery and no advantages for decreasing the relapse rate of AML. But, further studies will be warranted.