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In this study, we examined the thermal stability, bonding strength, and interfacial characteristic of a Ni–W–P coating applied for solder joint of Bi2Te3thermoelectric modules. This layer had uniform thickness and was confirmed to be amorphous even after annealing at 200°C for 150 h, demonstrating its thermal stability. Moreover, the barrier layer hindered the interdiffusion between Sn and Te, eliminating the formation of brittle intermetallic at the solder joint. Thus, the bonding strengths of p- and n-type thermoelectric units were improved approximately 1.3- and 2.8-fold, respectively, compared to the bonding strengths obtained without a Ni–W–P layer. In addition, the bonding strength was not affected by heating at 200°C for 150 h. The reliability of bonding strength was caused by the excellent thermal stability, and solder wettability of the barrier layer, which resulted in a bonding interface without brittle intermetallic and defects.

In this study, we examined the thermal stability, bonding strength, and interfacial characteristic of a Ni–W–P coating applied for solder joint of Bi2Te3thermoelectric modules. This layer had uniform thickness and was confirmed to be amorphous even after annealing at 200°C for 150 h, demonstrating its thermal stability. Moreover, the barrier layer hindered the interdiffusion between Sn and Te, eliminating the formation of brittle intermetallic at the solder joint. Thus, the bonding strengths of p- and n-type thermoelectric units were improved approximately 1.3- and 2.8-fold, respectively, compared to the bonding strengths obtained without a Ni–W–P layer. In addition, the bonding strength was not affected by heating at 200°C for 150 h. The reliability of bonding strength was caused by the excellent thermal stability, and solder wettability of the barrier layer, which resulted in a bonding interface without brittle intermetallic and defects.

This study investigates a brazing method for manufacturing PbTe thermoelectric modules using a Ag-based filler metal with a melting point of about 650 °C. To improve the bonding strength between the Ag-based brazing layer and the PbTe thermoelectric module, an electroless Ni-P plating layer is formed on the surface of the thermoelectric module as a diffusion barrier layer. The bonding strength of the PbTe thermoelectric module manufactured by the electroless Ni-P plating and Ag-based brazing has a high value of approximately 8.3 MPa. No defects such as pores or cracks were observed at the bonding interface between the thermoelectric element and the brazing layer. Furthermore, because of the high bonding strength of the manufactured thermoelectric module, fractures occur inside the thermoelectric element rather than at the bonding interface. Accordingly, the electroless Ni-P plating and Ag-based brazing method proposed in this study is found to be effective in manufacturing PbTe-based thermoelectric modules with high bonding strength.

Bortezomib/thalidomide/dexamethasone (VTD) induction therapy followed by autologous stem cell transplantation (ASCT) is one of the standard therapies for newly diagnosed multiple myeloma (NDMM). However, the appropriate depth of response to induction therapy and timing of upfront ASCT are still debated. We investigated if two additional cycles of VTD (VTD6) improved the responses and progression-free survival (PFS) compared with four cycles of VTD (VTD4). We retrospectively reviewed outcomes of 190 NDMM patients treated with at least four cycles of VTD followed by ASCT between September 2014 and August 2017 [VTD4, n= 129 (67.9%); VTD6, n= 61 (32.1%)]. The VTD6 group had a higher pre-ASCT complete response (CR) rate than the VTD4 group (31.1% versus 10.1%, P< 0.001), but, the pre- and post-ASCT ≥ very good partial response (VGPR), and 2-year PFS were similar. Multivariate analysis revealed age, β2-microglobulin, and pre-ASCT CR as important factors for PFS. Two additional cycles of VTD prolonged PFS in patients with PR only after VTD4 [Hazard ratio (HR) = 0.29, P= 0.016] or those with Revised International Staging System stage I/II (HR = 0.36, P= 0.039). In conclusion, two additional VTD cycles may be helpful for patients with PR only after VTD4 but high risk MM needs the other treatment options.

Background:The treatment goals of Polycythemia Vera (PV) have been focused on reducing the thrombotic and hemorrhagic risks and preventing disease transformation. A short-term way to confirm the effect of treatment is to check peripheral blood count remission. Recently, published researches have demonstrated that JAK2 driver mutation is associated with not only disease progression but hematologic response. Although it is still controversial whether a decrease in JAK2 mutation should be one of the treatment goals or not, the molecular response (MR) is frequently assessed in clinical trials. Moreover, the interest in treatment is moving toward disease modification. Ropeginterferon alfa-2b(P1101) showed it was more effective in achieving durable hematological and molecular remissions than hydroxyurea and well tolerated during long-term application. However, there are limited data on the clinical relevance of MR during P1101 and the efficacy and safety of P1101 in Eastern Asians.

In a previous study (SY Ahn et al, Cancer Res Treat 2023), we reported that the presence of only the basic leucine zipper in-frame mutation (bZIP in-f) CEBPAis associated with favorable outcomes in patients with CEBPAdouble mutations. However, when bZIP in-fCEBPAmutations were accompanied by certain mutations in chromatic/DNA modifiers, cohesion complex, and splicing genes, patients exhibited inferior overall survival (OS). FLT3-ITD or additional cytogenetic abnormalities is known to rarely co-occur with CEBPAmutation in patients with AML. In cases where both bZIP in-fCEBPAand FLT3-ITD coexist, there are conflicting aspects in risk stratification, and research on its prognostic significance is limited. Therefore, we aimed to evaluate the prognostic significances of the co-occurrence of bZIP in-fCEBPAmutation with unfavorable genetic abnormalities in acute myeloid leukemia.

Previous retrospective studies have revealed that a substantial portion of PV patients experience resistance to hydroxyurea (HU-R) and intolerance to HU (HU-I). Currently, the therapeutic options for both groups of patients do not differ, and most clinical trials investigating second-line therapies have enrolled patients with HU-R or HU-I without considering potential clinical distinctions between the two groups. Direct comparisons between patients with HU resistance and HU intolerance have not been conducted, and prognostic factors related to clinical outcomes, such as thrombosis, bleeding, disease progression, and survival, remain unclear for patients experiencing HU resistance or intolerance.

We conducted a phase 3 randomized trial comparing 2 different doses of daunorubicin as induction chemotherapy in young adults (60 years of age or younger) with acute myeloid leukemia (AML). Of 383 patients who were analyzed, 189 received standard-dose daunorubicin (SD-DN, 45 mg/m2 per day times 3 days) and 194 received high-dose daunorubicin (HD-DN, 90 mg/m2 per day times 3 days) in addition to cytarabine (200 mg/m2 per day times 7 days) to induce complete remission (CR). The CR rates were 72.0% in the SD-DN arm and 82.5% in the HD-DN arm (P = .014). At a median follow-up of 52.6 months, overall (OS) and event-free (EFS) survival were higher in the HD-DN arm than in the SD-DN arm (OS, 46.8% vs 34.6%, P = .030; EFS, 40.8% vs 28.4%, P = .030). Differences in CR rate and both OS and EFS remained significant after adjusting for other variables (CR, hazard ratio [HR], 1.802, P = .024; OS, HR, 0.739, P = .032; EFS, HR, 0.774, P = .048). The survival benefits of HD-DN therapy were evident principally in patients with intermediate-risk cytogenetic features. The toxicity profiles were similar in the 2 arms. In conclusion, HD-DN improved both the CR rate and survival duration compared with SD-DN in young adults with AML. This study is registered at www.clinicaltrials.gov as #NCT00474006.

We conducted a phase 3 randomized trial comparing 2 different doses of daunorubicin as induction chemotherapy in young adults (60 years of age or younger) with acute myeloid leukemia (AML). Of 383 patients who were analyzed, 189 received standard-dose daunorubicin (SD-DN, 45 mg/m2per day times 3 days) and 194 received high-dose daunorubicin (HD-DN, 90 mg/m2per day times 3 days) in addition to cytarabine (200 mg/m2per day times 7 days) to induce complete remission (CR). The CR rates were 72.0% in the SD-DN arm and 82.5% in the HD-DN arm (P= .014). At a median follow-up of 52.6 months, overall (OS) and event-free (EFS) survival were higher in the HD-DN arm than in the SD-DN arm (OS, 46.8% vs 34.6%, P= .030; EFS, 40.8% vs 28.4%, P= .030). Differences in CR rate and both OS and EFS remained significant after adjusting for other variables (CR, hazard ratio [HR], 1.802, P= .024; OS, HR, 0.739, P= .032; EFS, HR, 0.774, P= .048). The survival benefits of HD-DN therapy were evident principally in patients with intermediate-risk cytogenetic features. The toxicity profiles were similar in the 2 arms. In conclusion, HD-DN improved both the CR rate and survival duration compared with SD-DN in young adults with AML. This study is registered at www.clinicaltrials.govas #NCT00474006.

Background

No relevant conflicts of interest to declare.

Yoon: Novartis: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Kyowa Hako Kirin: Research Funding; Janssen: Consultancy; Yuhan Pharma: Research Funding; Genentech, Inc.: Research Funding; MSD: Consultancy.

Background

No relevant conflicts of interest to declare.

No relevant conflicts of interest to declare.

Introduction

Introduction: Hypocellular myelodysplastic syndrome (h-MDS) comprised approximately 10-20% of total MDS cases. The difference in clinical features and prognosis between h-MDS and normo/hypercellular MDS (NH-MDS) remains uncertain and the treatment strategy of h-MDS patients has not been well-defined in epigenetic therapy era. Therefore, we conducted this study to define the prognostic factors and response to the hypomethylating agents (HMA) for Korean h-MDS patients.

Kim: Green Cross Corp.: Employment. Lee:Green Cross Corp.: Employment.

This study investigated the safety and efficacy of IV-Globulin SN, a 10% intravenous immunoglobulin (IVIg), in patients with severe ITP (platelet count ¡Â20 x 109/L). Among 81 eligible patients, 31 patients were newly diagnosed, 7 patients had persistent ITP, and 43 patients had chronic ITP. Five patients had received splenectomy. Patients received IV-Globulin SN 1 g/kg/day on two consecutive days; infusion rate was initially 1 mg/kg/minute and then doubled every 30 minutes to a maximum of 8 mg/kg/minute.

Kim: Celgene: Research Funding; Alexion Pharmaceuticals: Research Funding; Il-Yang: Research Funding; Novartis: Research Funding.

No relevant conflicts of interest to declare.

Background

No relevant conflicts of interest to declare.

No relevant conflicts of interest to declare.

Off Label Use: Rituximab has been used as an off-label drug for adult ALL, and has been provided by Roche Inc. for scientific purpose. .

No relevant conflicts of interest to declare.

Introduction:The effect of imatinib plus combination chemotherapy were assessed in 87 patients, aged 16-71 years, with newly diagnosed Philadelphia Chromosome-Positive (Ph+) acute lymphoblastic leukemia (ALL).

Introduction

INTRODUCTION

Relapsed/refractory acute myeloid leukemia (R/R AML) is hard to treat especially in elderly patients. We previously assessed continuous infusion (CI) of fludarabine and cytarabine plus idarubicin (CI-FLAG2) for patients under 65-years old with R/R AML. Also we started prospective phase II study of attenuated version of CI-FLAG2 for elderly patients (C-FLAG). R/R AML in elderly (¡Ã60 years old) patients were eligible. Induction chemotherapy consisted fludarabine and cytarabine (ARAC) as a 24-hr CI without idarubicin. Total 38 and 68 patients were enrolled in CI-FLAG1 and CI-FLAG2, respectively. There were no differences in terms of patients' characteristics except for median age (p<0.001), HCT prior to salvage (p=0.002), WBC>20K/uL at salvage (p=0.004) and PB blast>40% at salvage, all which factors were unfavorable in C-FLAG. When comparing outcomes between CI-FLAG2 and C-FLAG, there were no difference in terms of CR rate (p=0.572) and objective response rate (ORR; p=0.899). Treatment failure patterns were also similar between C-FLAG and CI-FLAG2 (p=0.742). The most common treatment failure was resistant (66.7%) in C-FLAG. There were more frequent HCT in CI-FLAG2 (p<0.001) and consolidation chemotherapy in C-FALG (p=0.001). Poor predictors on ORR in C-FLAG were PB WBC>20K/uL at salvage (p=0.024) and PB blast >0% on early evaluation (p=0.013) by multivariate analysis. The overall survival of patients who achieve CR/CRp/CRi showed significantly prolonged survival compared with patients who did not in C-CLAG (p<0.001; Figure 1A). The median overall survivals were similar between CI-FLAG2 and C-FALG (p=0.427; Figure 1B).Figure 1Overall survivalFigure 1. Overall survival

No relevant conflicts of interest to declare.

VMP regimen for newly diagnosed myeloma patients is well-documented treatment. However patients in real practice generally have worse performance status and less attention than those in clinical trials. Thus we conducted observational study to evaluate the efficacy and toxicity of VMP treatment in newly diagnosed Korean myeloma patients.

VMP regimen for newly diagnosed myeloma patients is well-documented treatment. However patients in real practice generally have worse performance status and less attention than those in clinical trials. Thus we conducted observational study to evaluate the efficacy and toxicity of VMP treatment in newly diagnosed Korean myeloma patients.Data were prospectively collected from 39 hospitals. One hundred seventy three patients who started VMP as first line from 2011 May to 2012 April were included for analysis.Median age was 71 and 22.5% were more than 75 years old. Fifty-seven per cent were male sex. IgG type was most common (61.9%) and IgA 24.9%. ISS stage I was 13.8% and III was 51.5%. Patients with high risk FISH (Del17p, t(4;14), and t(4;16)) were 4.1%, 4.1%, and 2.3% respectively. Dose and schedule was followed original VISTA trial except for use of prednisolone instead of prednisone. Median 5cycles (range 1-9) were given and 105 patients stopped in the course of treatment. Most common cause were adverse event (28.8%) followed by disease progression or no response (19.6%). Twenty-five mortality cases were reported and 22 were in the course of treatment. The most common cause of mortality was infection (61%) followed by disease progression (13%). Overall response rate was 72.3% and response more than VGPR was 37.6%. Median progression free survival is 455 days and median OS was 504 days. One year PFS was 80.9 % and one year OS was 83.4%. Most common toxicity was cytopenia, peripheral neuropathy, and gastrointestinal toxicities such as nausea and diarrhea. Peripheral neuropathy of all grade and grade 3 or more was 58.6% and 6.36%, respectivelyEven though patients with higher proportion of ISS stage, efficacy of VMP regimen was considerable in Korean patients. With relatively high mortality due to infection in the course of treatment prophylactic measures for infection need to be developed. To reduce the incidence of peripheral neuropathy, close observation and intervention are needed to prevent aggravation of neuropathy.Off Label Use: lenalidomide in newly diagnosed myeloma. Kwak:celgene: Research Funding.

Since the first case report of Gimaz et al., several investigators have reported that the secondary immune thrombocytopenia (ITP) can occur in patients with Helicobactor pylori (H. pylori) infection. Eradication of H. pylori has been shown to result in improvement in thrombocytopenia. In one systematic review of 696 patients with H. pylori infection it showed 50.3% overall response (platelet count >= 30 X 109/L and at least a doubling of the base line count) after H. pylori eradication. Under these results, ASH 2011 guidelines for ITP recommended that eradication therapy be administered in adult patients who are found to have H. pylori infection (grade 1b). But also they recommended that treatment be administered for newly diagnosed patients with a platelet count < 30 X 109/L. To the best of our knowledge, there was no prospective study to evaluate the efficacy of H. pylori eradication for ITP patient with moderate thrombocytopenia and positive H. pylori. In Korea, the prevalence of H. pylori was reported as high as 60 – 65% in general adult population. The response rate and price of 1st line triple regimen for H. pylori eradication were known to be 70 - 80% and around 100 US dollars in Korea. With these circumstances, tolerable treatment like H. pylori eradication for ITP patients with platelet count >=30 X 109/L is challengeable. Thus, we performed the prospective multicenter phase II study to evaluate the efficacy of H. pylori eradication for the 1st line treatment of persistent or chronic ITP patients with moderate thrombocytopenia.We enrolled patients with persistent (3 to 12 months from diagnosis) or chronic (lasting for more than 12 months) ITP defined by international working group. The platelet counts of patients were between 30 X 109/L and 70 X 109/L. And all patients had positive result of C13-urea breath test (UBT) and had never been treated for ITP or H. pylori. Patients with other secondary ITP could not be enrolled. Patients received lansoprazole 30mg twice daily, amoxicillin 1000mg twice daily and clarithromycin 500mg, twice daily for one week. Eradication of H. pylori was evaluated at eighth week after treatment by UBT. Platelet counts were monitored at 2 weeks and after then at every month for a year. Complete response (CR) was defined as a platelet count >= 100 X 109/L. Partial response (PR) was defined as a platelet increase of >= 30 X 109/L and at least a doubling of the base line count. The primary endpoint was CR rate at 3 months after treatment. All patients provided written informed consents and this trial was registered at www.ClinicalTrials.gov (NCT01255332).Twenty-six patients were enrolled between November 2010 and May 2013 from 6 medical centers in Korea. Two patients with HCV infection and one patient with more than 70 X 109/L of platelet counts were excluded from analysis. The mean initial platelet counts of 23 patients (7 males, 16 females, median age 43 years and range 19 - 58 years) was 52.7 ± 9.5 X 109/L (range 39 – 68 X 109/L). All patients except one checked UBT after treatment and H. pylori eradication was achieved in 86.3% (19/22) of patients. CR was obtained in 13 of 23 patients (56.5%) within 3 months after treatment. And no PR was found until this time point. The median time to CR after initiating treatment was 4 weeks (range 2 – 8 weeks). CR rate of the patients who achieved H. pylori eradication was 63.2% (12/19). Unlike other reports, there was no significant difference on initial platelet counts among CR group and non-responder group and no significant correlation on the platelet levels between baseline and initial 3 months (Fig 1). Only 2 of 26 patients could not continue medication due to nausea and diarrhea, respectively. There was no other significant adverse event.The eradication of H. pylori is an effective first line treatment for persistent or chronic ITP with moderate thrombocytopenia with high CR rate and rapid onset. And it has acceptable toxicity and relatively low cost. This study supports routine detection and eradication of H. pylori infection in ITP patients especially in populations with a high prevalence of this infection.No relevant conflicts of interest to declare.

No relevant conflicts of interest to declare.

Venous thromboembolism (VTE) is a major cause of morbidity and mortality after gynecologic and urologic surgeries and previously reported VTE incidence in major genitourinary surgery without VTE prophylaxis was 15-40% in Western countries. VTE is a preventable complication using thromboprophylaxis, however, pharmacologic thromboprophylaxis after major abdomino-pelvic surgery may involve serious bleeding complication. Here, we evaluated the exact incidence and risk factors of VTE following major genitourinary surgery in Korean patients and proposed evidence-based VTE prevention guidelines in such patients.In March 2012, the committee for the development of guidelines for preventing VTE in Korea was organized by receiving recommendations from the VTE working party members in the Korean Society on Thrombosis and Hemostasis (KSTH). Using nation-wide date from Korea Health Insurance Review and Assessment Service (HIRA) from 2007 to 2011, symptomatic VTE frequencies after major genitourinary surgeries were retrospectively collected and evaluated. For the categorization of those patients by their VTE incidences, we used the methods described in AT9 guidelines (American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, 9th ed.)According to the HIRA database, 255,324 and 85,191 patients' data were collected and evaluated their incidence of VTE and risk factors, which underwent major gynecologic and urologic surgeries, respectively. In detail, there were 87,136 hysterectomies for benign uterine diseases (76,284) and uterine cervical cancer (10,852), 168,188 oophorectomies for benign ovarian diseases (156,697) and ovarian cancer (11,491), 35,970 prostatectomies for benign prostatic hyperplasia (BPH, transurethral, 26,590) and prostatic cancer (retropubic, 9,380), 12,462 nephrectomies for renal cell cancer and 36,759 radical cystectomies for bladder cancer. As shown in Table 1, most Korean patients undergoing genitourinary surgeries were identified as very low VTE risk category. In the aspect of gynecologic cancer surgery, ovarian cancer showed highest rate of VTE incidence (1.21%, moderate risk; 0.70% deep vein thrombosis, DVT + 0.51% pulmonary embolism, PE) and cervical cancer showed 0.59% (low risk; 0.47% DVT + 0.12% PE). On the basis of these data and a literature search results, the recommendation was made by a consensus of the guideline development committee. To take the advice of outside experts, survey and review for the developed guidelines were performed by other KSTH members and the related Academic Societies.Even when considering relatively lower incidence of VTE in Asian people than that in Western, Korean genitourinary surgery patients revealed very low incidence of VTE. As stated above, abdomino-pelvic surgery is a procedure for high risk of bleeding complications. Therefore, it is reasonable to assume that the recommendation of pharmacologic thromboprophylaxis for other gynecologic surgeries except ovarian cancer surgery should be deferred until they reveal hard evidence of higher incidence of VTE in Korea.No relevant conflicts of interest to declare.

The treatment of localized extranodal NK/T-cell lymphoma (ENKTL), nasal type has shifted to non-anthracycline-based intensive chemotherapy with radiotherapy since the poor response of ENKTL to anthracycline due to the expression of a multidrug-resistant (MDR) p-glycoprotein was proven. We previously proposed concurrent chemoradiotherapy (CCRT) followed by chemotherapy which is not affected by MDR and reported a significant improvement of outcomes of localized ENKTL. Based on our accumulated data, we designed a new treatment protocol. First, we added tri-weekly administration of L-asparaginase to reduce the probability of systemic progression during CCRT. Second, we designed MIDLE (methotrexate, ifosfamide, etoposide, dexamethasone, and L-asparaginase) according to previous excellent outcomes of methotrexate-containing regimens such as SMILE (dexamethasone, methotrexate, ifosfamide, L-asparaginase, etoposide) and MLD (methotrexate, L-asparaginase, dexamethasone).The treatment scheme of CCRT consisted of radiation 40 Gy and weekly administration of cisplatin 30 mg/m2 (total: 4 doses). During the CCRT, tri-weekly intravenous (IV) administration of 4,000 IU of Escherichia coli L-asparaginase was done. The chemotherapy, MIDLE (methotrexate 3g/m2 on day 1, etoposide 100mg/m2, Ifosfamide 1000mg/m2 on day 2-3, dexamethasone 40mg on day 1-4, and L-asparaginase 6000IU/m2 IV on day 4, 6, 8, 10) was repeated every 28 days up to 2 cycles. All patients provided informed written consents and this trial was registered at www.ClinicalTrials.gov(NCT01238159).Twenty-eight patients with stage IE/IIE ENKTL were enrolled, and the median age was 51 years (range, 30–77 years). 24 patients were male while only four patients were female. Twenty-two patients were stage IE and six were IIE. All patients completed CCRT, which resulted in 92.9% of overall response rate including 20 complete responses and 6 partial responses. One patient showed stable disease after CCRT whereas the other patient progressed. No grade 3 or 4 hematologic toxicity was found during CCRT. However, grade 3 non-hematologic toxicities included bilirubin elevation (n = 4), mucositis (n = 1), and nausea/vomiting (n = 6). After the completion of CCRT, 23 patients entered the MIDLE chemotherapy as five patients including one disease progression and four cases of withdrawal could not receive MIDLE. All patients achieved complete response after they completed the planned two cycles of MIDLE chemotherapy whereas two patients dropped out after their first cycle due to non-hematologic toxicity. The final complete response rate of patients enrolled was 92.9% (26/28). The major toxicity of MIDLE was grade 3/4 leucopenia, and the non-hematologic toxicity included mucositis and nausea/vomiting. The hepatic toxicity-associated with L-asparaginase was frequent. However, the majority of the hepatic toxicities were grade 1 or 2. With the median potential follow-up of 25 months (95% confidence interval: 19 – 31 months), four patients relapsed.L-asparaginase plus concurrent chemoradiotherapy followed by MIDLE chemotherapy can be an effective treatment strategy with acceptable toxicity in stage I/II extranodal NK/T-Cell lymphoma, nasal type.Kwak: celgene: Research Funding.

International Prognostic Scoring System (IPSS) is commonly used to distinguish various subgroups of myelodysplastic syndrome (MDS) patients with different prognosis and to make a therapeutic decision. However, the classic IPSS, defining lower-risk as low and intermediate-1 IPSS, seems to be insufficient to discriminate the prognostic groups of lower-risk MDS. Recently, IPSS was updated into the revised score (IPSS-R) to refine the IPSS by reassessing the major predictive features of MDS. The hypomethylating agents (HMA) are usually recommended for patients with lower-risk MDS who is not responsive to other therapies. However the role of HMA for the patients with lower-risk IPSS are still on debate. This study was conducted to find the rationale to treat HMA for the patients with lower-risk IPSS and to know whether IPSS-R further discriminate the prognosis of patients treated with HMA.The data of 334 patients diagnosed with MDS lower-risk defined by IPSS after Jan 2006 were retrospectively reviewed. Lower-risk IPSS was revised into IPSS-R to know whether it could further discriminate the prognosis of this group of patients. The prognosis of lower-risk by IPSS and IPSS-R were analyzed in terms of overall survival (OS) and prognostic power was calculated with time-dependent Cox-hazard models. To define the role of HMA for patients with lower-risk IPSS, we categorized the lower risk patients into No-HMA group, early HMA group (HMA within 2 mo.), and late HMA group (HMA after 2 mo).Out of 334 lower-risk patients (39 low and 295 intermediate-1), 195 patients (58.4%) were treated with HMA (azacitidine 163, decitabine 32). Median time to HMA treatment was 43 days (range 0-1778 days). 3yr-OS rate was not significantly different between HMA group (43.1¡¾4.2%) and non-HMA group (62.3¡¾5.9%) (p=0.099). Early HMA treatment (3yr-OS 36.4¡¾5.4%) didn't show survival benefits compared to late HMA group (54.6¡¾6.3%) or no-HMA group (62.3¡¾5.9%) (p=0.003). Plus, HMA response (CR/PR/HI) didn't guarantee OS benefits: 3yr-OS of 45.2¡¾7.4% in responders (CR/PR/HI, n=74) and 43.4¡¾5.0 in non-responders (SD/PD, n=121) (p=0.239).Among 39 patients with IPSS low, 11 patients (28.2%) were revised into IPSS-R very low, 24 (61.5%) into low, 3 (7.7%) into intermediate, and 1 (2.6%) into high. Among 295 patients with IPSS intermediate-1, 4 patients (1.4%) were revised into IPSS-R very low, 84 (28.5%) into low, 133 (45.1%) into intermediate, 71 (24.1%) into high and 3 (1.0%) into very high. IPSS-R could further discriminate the IPSS lower-risk patients with regard to OS: 3yr-OS rates of 100% in very low, 64.5¡¾5.9% in low, 46.1¡¾5.5% in intermediate, 26.1¡¾6.6% in high, and 0% in very high (p<0.001).The survival benefits of HMA for lower risk groups (very low and low) defined by IPSS-R (n=123) was not defined in the current study, where 3yr-OS was 83.8¡¾6.4% in no-HMA group (n=60) vs. 60.5¡¾7.1% in HMA group (n=63) (p=0.198).The prognosis of the patients with lower-risk IPSS (low and intermediate-1) were successfully refined by IPSS-R. The IPSS intermediate-1 risk was heterogeneous group, which subdivided into very low to very high by IPSS-R. However, the beneficial effect of HMA for patients with lower-risk MDS, defined by IPSS (low and intermedite-1) and IPSS-R (very low and low), should be elucidated in the future studies.No relevant conflicts of interest to declare.

Allogeneic hematopoeitic cell transplantation (alloHCT) is a curative therapy for severe/very severe aplastic anemia (sAA) in adult. alloHCT from haplo-identical family donor (HD) is an alternative approach while alloHCT from matched sibling donor (MSD) is the choice of therapy. Our previous study suggested that alloHCT from matched unrelated donor (MUD) were comparable with MSD when pre-transplantation conditions were well-matched. It means poor outcome of MUD might come from poor pre-transplantation clinical factors such as delayed alloHCT. Same will be applied to HD. In this study we compared HD with alternative donors (AD; MUD or mismatched family donor) by matched case study.

Since the first case report of Gimaz et al., several investigators have reported that the secondary immune thrombocytopenia (ITP) can occur in patients with Helicobactor pylori (H. pylori) infection. Eradication of H. pylorihas been shown to result in improvement in thrombocytopenia. In one systematic review of 696 patients with H. pyloriinfection it showed 50.3% overall response (platelet count >= 30 X 109/L and at least a doubling of the base line count) after H. pylorieradication. Under these results, ASH 2011 guidelines for ITP recommended that eradication therapy be administered in adult patients who are found to have H. pylori infection (grade 1b). But also they recommended that treatment be administered for newly diagnosed patients with a platelet count < 30 X 109/L. To the best of our knowledge, there was no prospective study to evaluate the efficacy of H. pylorieradication for ITP patient with moderate thrombocytopenia and positive H. pylori. In Korea, the prevalence of H. pyloriwas reported as high as 60 – 65% in general adult population. The response rate and price of 1stline triple regimen for H. pylorieradication were known to be 70 - 80% and around 100 US dollars in Korea. With these circumstances, tolerable treatment like H. pylorieradication for ITP patients with platelet count >=30 X 109/L is challengeable. Thus, we performed the prospective multicenter phase II study to evaluate the efficacy of H. pylorieradication for the 1stline treatment of persistent or chronic ITP patients with moderate thrombocytopenia.