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대한내과학회> Korean Journal of Medicine(구 대한내과학회지)> 골수형성이상증후군 환자의 레날리도마이드 치료

골수형성이상증후군 환자의 레날리도마이드 치료

Lenalidomide for the Treatment of Myelodysplastic Syndrome

김성용 ( Sung-yong Kim )
  • : 대한내과학회
  • : Korean Journal of Medicine(구 대한내과학회지) 95권2호
  • : 연속간행물
  • : 2020년 04월
  • : 74-77(4pages)

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Myelodysplastic syndrome (MDS) is a disease affecting clinically and cytogenetically diverse groups of patients. Consequently, MDS patients differ in their response to the individual agents used to treat their disease. Lenalidomide, which has been covered by the national health insurance system of Korea since 2019, is used to relieve transfusion-dependent anemia and has been shown to achieve a genetic response in MDS patients, especially those carrying the del(5q) mutation. Although the mechanism of action of lenalidomide is not yet clear, it may block malignant cell proliferation directly by inhibiting haplodeficient phosphatase, but also act indirectly by killing malignant cells through an immunomodulatory effect. In clinical studies, low-risk patients with the del(5q) mutation who were treated with lenalidomide had a hematologic response rate of 55-60% and a median survival of 2-2.5 years. The genetic response rate was 50-73%, and the complete genetic response rate 30-45%. However, in high-risk patients, the response rate was low (20-30%). These results demonstrate the potential utility of lenalidomide as a first-line drug for transfusion-dependent, del(5q), low-risk patients in Korea. (Korean J Med 2020;95:74-77)

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  • : 의약학분야  > 내과학
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  • : 격월
  • : 1738-9364
  • : 2289-0769
  • : 학술지
  • : 연속간행물
  • : 1949-2020
  • : 12076


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1한국의 의료관광 발전과정, 현황과 정책

저자 : 임영이 ( Yeong Yi Yim )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 2호 발행 연도 : 2020 페이지 : pp. 61-66 (6 pages)

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2코로나바이러스감염병-19 초기 유행의 임상 역학적 특성

저자 : 허중연 ( Jung Yeon Heo )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 2호 발행 연도 : 2020 페이지 : pp. 67-73 (7 pages)

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In December 2019, a novel coronavirus, which is now designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified as the etiology of pneumonia of unknown cause in patients from Wuhan of central China. Since the first report of coronavirus disease 2019 (COVID-19), the disease became pandemic causing the large-scale outbreak all over the world. In this review, we discuss the clinical and epidemiological characteristics of COVID-19 in the early stage of outbreak based on recent reports from China. (Korean J Med 2020;95:67-73)

3골수형성이상증후군 환자의 레날리도마이드 치료

저자 : 김성용 ( Sung-yong Kim )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 2호 발행 연도 : 2020 페이지 : pp. 74-77 (4 pages)

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Myelodysplastic syndrome (MDS) is a disease affecting clinically and cytogenetically diverse groups of patients. Consequently, MDS patients differ in their response to the individual agents used to treat their disease. Lenalidomide, which has been covered by the national health insurance system of Korea since 2019, is used to relieve transfusion-dependent anemia and has been shown to achieve a genetic response in MDS patients, especially those carrying the del(5q) mutation. Although the mechanism of action of lenalidomide is not yet clear, it may block malignant cell proliferation directly by inhibiting haplodeficient phosphatase, but also act indirectly by killing malignant cells through an immunomodulatory effect. In clinical studies, low-risk patients with the del(5q) mutation who were treated with lenalidomide had a hematologic response rate of 55-60% and a median survival of 2-2.5 years. The genetic response rate was 50-73%, and the complete genetic response rate 30-45%. However, in high-risk patients, the response rate was low (20-30%). These results demonstrate the potential utility of lenalidomide as a first-line drug for transfusion-dependent, del(5q), low-risk patients in Korea. (Korean J Med 2020;95:74-77)

4비소세포폐암의 표적 치료

저자 : 김정선 ( Jung Sun Kim ) , 강은주 ( Eun Joo Kang )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 2호 발행 연도 : 2020 페이지 : pp. 78-88 (11 pages)

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Treatment of progressive non-small cell lung cancer (NSCLC) has advanced remarkably, due in part to the development of targeted therapies. Several gene alterations, including EGFR, ALK, ROS1, and BRAF, play important roles in carcinogenesis. Therefore, many targeted agents focusing these gene alterations have been developed and proving their therapeutic efficacies in many clinical trials. Now we should test these gene mutations and should apply treatments individually and properly to ensure the maximal survival benefit of each patient. In this review, we summarize the target genes and respective therapeutic agents in NSCLC. (Korean J Med 2020;95:78-88)

5만성 콩팥병 환자에서 골다공증

저자 : 권영주 ( Young Joo Kwon )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 2호 발행 연도 : 2020 페이지 : pp. 89-94 (6 pages)

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Osteoporosis in chronic kidney disease (CKD) is also referred to as 'CKD with low bone mineral density (BMD)', because the cause of low BMD in CKD includes chronic kidney disease-mineral bone disorders (CKD-MBD) such as secondary hyperparathyroidism, osteomalacia, and adynamic bone disease. Diagnostic methods of osteoporosis in CKD include FRAX®, BMD, and bone turnover markers as well as CKD-MBD biochemical parameters- calcium, P, alkaline phosphatase, PTH, and 25(OH)D3. The management of osteoporosis in CKD prioritizes CKD-MBD management over selection of bone anti-resorptive agents or osteo- anabolic agents according to clinical and laboratory findings. (Korean J Med 2020;95:89-94)

6국가 폐암 검진

저자 : 장승훈 ( Seung Hun Jang )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 2호 발행 연도 : 2020 페이지 : pp. 95-103 (9 pages)

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The results of large-scale clinical studies have shown that the lung cancer mortality rate can be reduced by lung cancer screening using low-dose computed tomography (LDCT) in high-risk populations. Lung cancer screening requires rigorous quality control to ensure that imaging can be introduced into evidence-based medical systems and that results can be effectively delivered to examinees. Cessation of smoking is indispensable for reducing mortality in parallel with lung cancer screening. Pulmonary nodules found in LDCT during the Korean National Lung Cancer Screening are categorized according to their characteristics, size, and time of discovery based on the Lung Imaging Reporting And Data System (Lung-RADS); management guidelines are followed according to categorization. To improve the efficiency of lung cancer screening, studies are currently ongoing to enable selection of high-risk groups using lung cancer prediction models and biomarkers. Based on the risk estimation classification of lung cancer, it is expected that the selection of screening subjects and the screening cycle can be differentiated, which will increase the efficiency of screening, reduce the risk of unnecessary radiation exposure, and reduce the cost of screening. (Korean J Med 2020;95:95-103)

7암 환자에서의 자발적 보고자료를 통해 수집된 약물유해반응 분석

저자 : 전해수 ( Hae-soo Jeon ) , 김희규 ( Hee-kyoo Kim ) , 최길순 ( Gil-soon Choi )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 2호 발행 연도 : 2020 페이지 : pp. 104-113 (10 pages)

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Background/Aims: Although the number of domestic adverse drug reactions (ADRs) reported in Korea is rapidly increasing, the analysis of ADRs in cancer patients remains limited. We sought to investigate the clinical features of ADRs in cancer patients. 
Methods: ADR data were collected from a spontaneous reporting system at single university hospital, between July 2010 and June 2015. ADR cases assessed to be “unlikely” or “unclassifiable” as per the criteria of the World Health Organization-Uppsala Monitoring Center were excluded. Additional medical information was retrospectively collected from chart reviews, and clinical features of ADRs were analyzed. 
Results: In total, 1,455 cases were reported. Of these, 822 ADRs (52.1%) were observed in cancer patients. The mean age of cancer patients was 60.8 years (range, 17-90 years), and 45.9% were male. The most prevalent clinical features were gastrointestinal abnormalities (32.6%), such as nausea and vomiting, followed by skin (28.5%) and neurologic manifestations (26.0%). Fifty-one (6.2%) and 296 cases (36.0%) were classified as severe and moderate, respectively. The most common causative agents were parenteral nutrition (PN) supplements (40.4%), followed by antibiotics (17.8%), analgesics (16.7%), iodinated contrast media (ICM, 10.6%), and vitamins (3.9%). Antineoplastic agents were responsible for 2.9% of cases. PN supplements were commonly associated with severe reactions. 
Conclusion: Although it is well known that antibiotics, ICM, and analgesics induce ADRs, PN supplements, vitamins, and antineoplastic agents should also be considered as common causes of ADRs in cancer patients. Further investigation and monitoring to determine the causality associated with these agents is required. (Korean J Med 2020;95:104-113)

816세 청소년에서 발생한 2형 자가면역 췌장염

저자 : 김소현 ( So Hyun Kim ) , 백승호 ( Seung-ho Baek ) , 김혜영 ( Hye Yeong Kim ) , 최수진 ( Su Jin Choi ) , 김지훈 ( Ji Hoon Kim ) , 이세희 ( Se Hee Lee ) , 김명환 ( Myung-hwan Kim )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 2호 발행 연도 : 2020 페이지 : pp. 114-118 (5 pages)

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There are two forms of autoimmune pancreatitis (AIP). Type 1 is associated with immunoglobulin G4 (IgG4)-related systemic fibro- inflammatory disease, whereas type 2 AIP is localized to the pancreas and not associated with IgG4. The number of children presenting with type 2 AIP has recently increased. Here, we report a case of type 2 AIP in a 16-year-old adolescent who presented with clinical acute pancreatitis and associated pancreatic masses. He was diagnosed with type 2 AIP based on pancreatic biopsy results showing granulocytic epithelial lesions and supportive radiological imaging and steroid responsiveness. (Korean J Med 2020;95:114-118)

9크론병 환자에게 아자티오프린 치료 중 발생한 비경화성 문맥 고혈압 1예

저자 : 박민규 ( Min-kyu Park ) , 이재광 ( Jae-kwang Lee ) , 김현수 ( Hyun-soo Kim ) , 정윤진 ( Yun-jin Chung ) , 박창근 ( Chang-keun Park ) , 정재권 ( Jae-kwon Jung ) , 김대진 ( Dae-jin Kim )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 2호 발행 연도 : 2020 페이지 : pp. 119-123 (5 pages)

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Thiopurine-based drugs such as azathioprine and 6-MP are among the most common immunosuppressants used to treat inflammatory bowel disease, autoimmune hepatitis, various autoimmune diseases, and patients undergoing organ transplantation. The drugs are associated with various complications, of which one of the most serious is hepatotoxicity that may trigger non-cirrhotic portal hypertension. We report a case with this side-effect in a patient taking azathioprine to treat Crohn's disease. (Korean J Med 2020;95:119-123)

10Eculizumab 치료로 호전된 비정형 용혈요독증후군 1예

저자 : 김정현 ( Jung Hyun Kim ) , 한원경 ( Won Kyung Han )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 2호 발행 연도 : 2020 페이지 : pp. 124-128 (5 pages)

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Atypical hemolytic uremic syndrome (aHUS) is a rare syndrome characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury, which results from uncontrolled complement activation. Delayed diagnosis and treatment of aHUS may result in end-stage renal disease (ESRD) and an associated dependence on dialysis. In extreme cases, it may cause death due to multi-organ failure. Eculizumab, a humanized monoclonal antibody against C5, inhibits the formation of the terminal membrane attack complex and is used to treat aHUS. Here, we report a 46-year-old male patient who suffered from aHUS relapse, despite prior treatment with repeated plasma exchange and hemodialysis. Eculizumab therapy improved his hematologic findings without use of hemodialysis. (Korean J Med 2020;95:124-128)

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