The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 29
Slide Session
OS-HEM-05 Hematology
Gene Mutation Profi le in Chronic Myelogenous Leu- kemia BCR-ABL Positive Chronic Phase Patients Which Not Response to Imatinib Treatment in Dr.soetomo Teaching Hospital Surabaya Indonesia
Ugroseno Yudho BINTORO1, Made Putra SEDANA2, Agung SOSIAWAN3, Ami Ashariati PRAYOGO4, Soebandiri SOEBANDIRI5
Dr. Soetomo Hospital Airlangga University, Indonesia1, Dr. Soetomo Hospital Airlangga University, Indone- sia2, Human Genetic Division, Institute of Tropical Disease Airlangga University, Indonesia3, Dr. Soetomo Hospital Airlangga University, Indonesia4, Dr. Soetomo Hospital Airlangga University, Indonesia5 Background: To determine patterns of gene mutations in BCR-ABL tyrosine kinase in chronic myelogenous leukemia BCR-ABL positive chronic phase are not complete mo- lecular response to Imatinib treatment
Methods: Gene Mutation Analysis has been done in sixteen chronic myelogenous leu- kemia patients with BCR-ABL positive chronic phase who are not complete molecular response to Imatinib after 18 months treatment
Results: We found C944T gene mutation in 9 (56,25%) patients, T1052C gene mu- tation in 16 patients (100%), and T932C gene mutation in 13 patients (81,25%). One type of mutation found in one patient, two types of mutations in 6 patients, and 3 mutations in 9 patients.
Conclusions: No signifi cant effect of the C944T mutation and the T932C mutation with a single mutation of the tyrosine kinase drug resistance. There is infl uence of the T1052C single mutation to tyrosine kinase drug resistance.
OS-HEM-06 Hematology
Cardiotoxicity Effect of Doxorubicin in Non Hodgkin Lymphoma Patients Based on the Decrement Left Ven- tricel Ejection Fraction
Merlyna SAVITRI1, Rano ISMAIL2, Ugroseno Yudho BINTORO3, Rachmad ROMDONI4, Ami Ashariati PRAYOGO1
Hematology Oncology Division Department of Internal Medicine, Dr. Soetomo Hospital Airlangga Univer- sity, Indonesia1, Departement of Internal Medicine, Dr. Soetomo Hospital Airlangga University, Indonesia2, Hematology Oncology Division Department of Internal Medicine, Dr. Soetomo Hospital Airlangga Univer- sity, Indonesia3, Departement of Cardiology, Dr. Soetomo Hospital Airlangga University, Indonesia4, He- matology Oncology Division Department of Internal Medicine, Dr. Soetomo Hospital Airlangga University, Indonesia5
Background: To study the incidence of doxorubicin cardiotoxicity of in NHL patients who received CHOP (cyclophosphamide, doxorubicin, oncovin, prednisone) regimen in Dr.Soetomo Hospital, using echocardiography (EF, ejection fraction).
Methods: Fifteen NHL patients treated with CHOP were studied longitudinally. Echo- cardiography was done in patients at baseline, and after cumulative dose of doxoru- bicin = 200 and = 300 mg/m². Cardiotoxicity was defi ned as a decrease of LVEF = 10% from baseline or absolute LVEF < 50%.
Results: There was a decrease of mean LVEF after cumulative dose of doxorubicin = 200 mg/m² (2.87% from baseline, p>0,05) but without cardiotoxicity effect. There was a signifi cant decrease of mean LVEF of 6,36% from baseline (p<0,05) after cumulative dose of doxorubicin = 300 mg/m² with cardiotoxicity effect observed in 2 patients (13,3%). The decrement of LVEF of these 2 patients were 10.45% and 26.09%.
Conclusions: Cardiotoxicity effects were observed signifi cantly in NHL patients receiv- ing CHOP regimen.after cumulative doses of doxorubicin = 300 mg/m² (or after the 6th cycle)
OS-HEM-07 Hematology
Prognostic Impact of Beta-2 Microglobulin in Patients with Non-Gastric Marginal Zone Lymphoma
Changhoon YOO1, Dok Hyun YOON1, Shin KIM1, Chan-Sik PARK2, Jooryung HUH2, Sang-Wook LEE3, Jung Sun PARK1, Cheolwon SUH1
Asan Medical Center, University of Ulsan College of Medicine, Korea1, Asan Medical Center, University of Ulsan College of Medicine, Korea2, Asan Medical Center, University of Ulsan College of Medicine, Korea3 Background: Although serum Beta-2 microglobulin (B2M) has been suggested as a prognostic factor for several hematologic malignancies, this was rarely investigated in marginal zone lymphoma (NZL).
Materials: Between January, 2000, and May, 2013, a total of 270 patients with non-gastric (NG)-MZL were identifi ed from database of Asan Medical Center, Seoul, Korea. Among them, pretreatment baseline serum B2M was available in 204 patients.
Progression-free survival (PFS) and overall survival (OS) were compared according to the level of B2M with cut-off value of 2.5 mg/L.
Results: Median age of study population was 51 year-old (range, 16-81) and 85 (42%) patients were male. Thirty (15%) patients had nodal MZL and 174 (85%) had extranodal MALToma. B2M =2.5 mg/L was related with more adverse clinical features, such as poor performance status, =2 extranodal sites, advanced stage (III-IV), anemia, elevated LDH, bone marrow invasion, and higher IPI risk group. In univariate analysis, serum B2M (<2.5 mg/L vs =2.5 mg/L) was signifi cantly associated with PFS (p<0.001) and OS (p<0.001). In multivariate analysis including B2M and International Prognostic Index (IPI), serum B2M =2.5 mg/L was an independent adverse prognostic factor in terms of PFS (hazard ratio [HR]=3.7, 95% CI, 1.5-9.1; p=0.005) and OS (HR=7.5, 95%
CI, 1.7-32.7; p=0.008). In analysis including Korean MZL Prognostic Index (MZLPI: nod- al MZL, ECOG performance status =2 and advanced stage), B2MG =2.5 mg/L was also signifi cant for PFS (HR=3.5, 95% CI, 1.5-7.7; p=0.003) and OS (HR=7.3, 95% CI 1.9- 28.2; p=0.004).
Conclusion: In patients with NG-MZL, baseline serum B2M is a powerful prognostic factor for PFS and OS, independent of validated prognostic indexes, such as MZLPI and IPI.
OS-HEM-08 Hematology
Infl uence of Underlying Diseases and Vital Organ In- volvement in the Survival of 612 Patients with System- ic Amyloidosis (RAMYD-Geas-Semi)
Marta PEREZ DE LIS NOVO1, Pilar BRITO ZERÓN2, Luis Enrique CAJAMARCA3, Rosa JORDANA3, Roberto PÉREZ ALVAREZ4, Diego REAL DE ASÚA5, Sara BENITO CONEJERO6, Ferrán MARTÍNEZ VALLE7, Guadalupe FRAILE8, Iria VILLAVERDE9, Ester MONCLÚS10, Esther GONZÁLEZ GARCÍA11, Lina ACEVEDO AYALA12, Laura GONZÁLEZ VÁZQUEZ13, Jessica RUIZ IZQUIERDO14, Gloria DE LA RED14, Carlos SANTIAGO15, Elvira GONZÁLEZ VÁZQUEZ16, Luis INGLADA17, Angel ROBLES MARHUENDA18, Jorge Francisco GÓMEZ CEREZO19, Xavier BOSCH10, Manuel RAMOS CASALS2
CHUVI, Spain1, Hospital Clinic, Spain2, Parc Taulí Hospital, Spain3, Meixoeiro Hospital, Spain4, La Princ- esa Hospital, Spain5, Juan Ramón Jiménez Hospital, Spain6, Vall d’Hebrón Hospital, Spain7, Ramón y Cajal Hospital, Spain8, Xeral Hospital, Spain9, Hospital Clínic, Spain10, Cabueñes Hospital, Spain11, Gre- gorio Marañón Hospital, Spain12, POVISA Hospital, Spain13, Espíritu Santo Hospital, Spain14, Virgen De Las Nieves Hospital, Spain15, Complejo Hospitalario De Ourense, Spain16, Río Hortega Hospital, Spain17, La Paz Hospital, Spain18, Infanta Sofía Hospital, Spain19
Background: To analyze mortality and risk factors in a large series of patients with amyloidosis diagnosed in Internal Medicine Departments.
Methods: The national registry of amyloidosis patients (RAMYD) of the Study Group on Autoimmune Diseases of the Spanish Society of Internal Medicine included a total of 612 patients (331 men and 281 women, mean age at diagnosis of 64 years) on June 15, 2014.
Results: Information on the vital status of patients could be obtained in 523 cases, of which 325 (62%) died. Epidemiologically, there were no signifi cant differences with respect to gender, with a higher rate of mortality in older patients (67.28 vs 57.57 years, p<0.001). A higher mortality rate was observed in patients with chronic/degen- erative diseases in comparison with other etiologies (84% vs 59%, p<0.001). The high- est mortality rates were observed in patients with renal involvement (78% vs 59%, p<0.001) and cardiac involvement (78% vs 61%, p=0.001), while lower mortality rates were observed in patients with peripheral neuropathy (47% vs 70%, p<0.001) and skin
WCIM 2014
30 32nd World Congress of Internal Medicine (October 24-28, 2014)
involvement (27% vs 67%, p=0.004). According to the classifi cation of amyloidosis, increased mortality rates were observed in patients with AL amyloidosis (77% vs 57%, p<0.001), and lower rates in TTR (47% vs 68%, p<0.001) and other types of amyloi- dosis (40% vs 66%, p<0.001). Multivariate logistic regression analysis identifi ed as independent prognostic factors of mortality age (p<0.001), underlying chronic/degen- erative diseases (p <0.001) and renal (p=0.002) and cardiac (p=0.024) involvements.
Conclusions: The mortality rate in patients diagnosed with systemic amyloidosis in internal medicine reached two thirds of cases, with AL amyloidosis showing the high- est rate (80%). The main baseline prognostic factors independently associated with mortality were an older age, underlying chronic/degenerative disease and renal and cardiac involvement.
OS-HEM-09 Hematology
Prevalence and Mortality of Cardiac Involvement in Patients with Amyloidosis of an Institutional Registry Amyloidosis
María Adela AGUIRRE1, María Lourdes POSADAS-MARTINEZ1, Melisa BLOMBERG1, Dorotea Beatriz FANTL2, Diego Hernan GIUNTA1, Fernán GONZALEZ BERNALDO DE QUIRÓZ1, María Florencia GRANDE RATTI1, Gustavo GRELONI3, María Soledad SAEZ4, Patricia Beatríz SORROCHE4, Carlos Federico VARELA3, Gabriel Dario WAISMAN1, Elsa Mercedes NUCIFORA2
Clinical Research Unit, Hospital Italiano De Buenos Aires, Argentina1, Hematology Unit, Hospital Italiano De Buenos Aires, Argentina2, Nephrology Unit, Hospital Italiano De Buenos Aires, Argentina3, Biochemis- try Unit, Hospital Italiano De Buenos Aires, Argentina4
Background: Cardiac involvement is the leading cause of morbidity and mortality of amy- loidosis, especially due to light-chain (AL) and transthyretin, both wild and hereditary types.
Objectives: To estimate the prevalence and mortality of patients with evidence of cardiac involvement in patients diagnosed with amyloidosis.
Methods: Ambispective cohort study, with data obtained from all patients included between 01/2007 and 03/2013 with evidence of amyloidosis in the Institutional Regis- try Amyloidosis of the Hospital Italiano de Buenos Aires. The diagnostic criteria of car- diac amyloidosis were predefi ned. Mortality from cardiac amyloidosis was measured using a combination of active and passive assessment. Survival time was evaluated using the Kaplan-Meier estimator. SPSS 19.0 was used.
Results: The registry included 126 patients and the prevalence of cardiac amyloidosis was 40% (95%, CI:31-49%). Among the 40% (50/126) of patients with confi rmed amy- loidosis and suspected of cardiac involvement, the median age was 72 years (IQR 79-81) and 26% were women (13/50). Suspected diagnosis of cardiac involvement was: clinical 82.4% (42/50), from complementary studies 67% (34/50), and diagnosed from another hospital 6% (3/50). From all patients with suspected cardiac involvement, 47% had con- fi rmed biopsy. Overall mortality of patients with cardiac involvement was 20% (11/50), the median survival was 1782 days of follow up (CI 95% 1365-2199).
Conclusions: The prevalence of cardiac involvement and mortality in patients with amyloidosis was high. Advances in diagnosis of the possible causes of amyloidosis in the future will allow the detection of patients with high risk of death from cardiac causes in our country.
OS-HEM-10 Hematology
The Evidence of Graft-Versus-Tumor Effect in the Real World: Hsct for Refractory Leukemia
Inho KIM1, Youngil KOH1, Sung-Soo YOON1, Seonyang PARK1, Joon Ho MOON2, Sang Kyun SOHN2, June-Won CHEONG3, Yoo Hong MIN3, Hyeon Gyu YI4, Chul Soo KIM4, Sung-Kyu PARK5, Dae-Sik HONG5, Dae-Young KIM6, Jung-Hee LEE6, Je-Hwan LEE6, Kyoo-Hyung LEE6
Seoul National University Hospital, Korea1, Kyungpook National University Hospital, Korea2, Yonsei Uni- versity Severance Hospital, Korea3, Inha University Hospital, Korea4, Soonchunhyang University Hospital, Korea5, Asan Medical Center, Korea6
Background: Chemotherapy-refractory acute leukemia is only salvaged by allogeneic stem cell transplantation(ASCT). We intended to analyze clinical outcome of patients with acute leukemia who received ASCT in chemo-refractory state. With this analysis, we tried to fi nd subset who could be salvaged by ASCT.
Methods: We retrospectively analyzed patients who received ASCT for chemo-refrac- tory acute leukemia. We included patients who received ASCT while the disease was not in complete remission.
Results: A total of 226 patients were analyzed. Disease included acute myeloid leu- kemia (AML, N=156), acute lymphocytic leukemia (ALL, N=52), and acute biphenotypic leukemia (ABL, N=18). Proportion of secondary leukemia was 15.9%. 41.6% of patients were primary chemo-refractory, while 58.4% of patients developed chemo-refractori- ness after achievement of CR at least once. CR was achieved in 79.6% of patients by ASCT. CR rate seemed to be higher in AML (84%) compared to ALL (71%) or ABL (67%) (p=0.058). OS was signifi cantly superior in patients with AML or ABL compared to ALL (p=0.020). Five-years OS rate was more than 20% in patients with AML or ABL, while 5-years OS rate was less than 5% in patients with ALL. Patients who received sibling ASCT had better survival outcome compared to unrelated ASCT or haploidentical ASCT (p<0.001). Primary chemo-refractoriness (p=0.284) and conditioning intensity (p=0.404) did not affect survival outcome. Karyotypic risk grouping had prognostic value in these patients with shorter OS observed in patients with poor risk group com- pared to standard or good risk group (p=0.006).
Conclusions: Among acute leukemias, only AML and ABL are salvaged by ASCT when they are chemo-refractory. However, outcome of primary chemo-refractory disease is not inferior, hence ASCT should be considered in this disease. For ASCT in chemo-re- fractory acute leukemia, sibling ASCT has better outcome than unrelated ASCT.
OS-HEM-11 Hematology
Impact of Stem Cell Dose and Performance Status on Cord Blood Transplantation (CBT) Outcome in Adult Patients with Advanced Hematologic Diseases: 13-Year Experience in Korea
Ji-Won KIM1, Junglim LEE2, So Young CHONG3, Chul Won JUNG4, Yeo-Kyeoung KIM5, Yeung-Chul MUN6, Deog-Yeon JO7, Hong Ghi LEE8, Jong-Ho WON9, Joon Seong PARK10, Jae Hoon LEE11, Joon Ho MOON12, Young Rok DO13, June-Won CHEONG14, Je-Hwan LEE15, Ho-Young YHIM16, Haesook KIM17, Sung-Soo YOON1
Seoul National University Hospital, Korea1, Daegu Fatima Hospital, Korea2, Bundang CHA University, Korea3, Samsung Medical Center, Korea4, Chonnam National University Hwasun Hospital, Korea5, Ewha Womans University Mokdong Hospital, Korea6, Chungnam National University Hospital, Korea7, Konkuk University Hospital, Korea8, Soon Chun Hyang University Hospital, Korea9, Ajou University Hospital, Korea10, Gachon University Gil Hospital, Korea11, Kyungpook National University Hospital, Korea12, Dongsan Medical Center, Korea13, Yonsei University Severance Hospital, Korea14, Asan Medical Center, Korea15, Chonbuk National University Hospital, Korea16, Dana-Farber Cancer Institute, USA17 Background: CBT is an established alternative donor transplantation for treatment of patients with advanced hematologic diseases.
Methods: To assess clinical outcome after CBT and provide future recommendations for alternative donor, we conducted the fi rst retrospective multicenter study of adult CBT in Korea.
Results: Between June 2001 and April 2014, 48 patients (male, 19) were enrolled from 16 hospitals. The median age was 36 years (range, 16-65 years). Forty patients (83.3%) were acute leukemia: 33 (68.8%) in remission and 7 (14.6%) in persistence.
The others were myelodysplastic syndrome (n=3, 6.3%), severe aplastic anemia (n=3, 6.3%), and lymphoma (n=2, 4.2%). Thirty two patients (66.7%) underwent double unit CBT. Twenty two patients (45.8%) underwent myeloablative conditioning and 26 patients (54.2%), reduced-intensity conditioning. Total body irradiation (TBI)- based conditioning regimens were used in 23 patients (47.9%). The median time to neutrophil >500/μL was 20 days among grafted, and 14 patients (29.2%) failed to recover. During follow-up, 8 patients died of disease and non-relapse mortality (NRM)
