sponse with IFRT or investigative approaches are necessary. NMT has dramatically decreased the nonrelapse mortality after allogeneic stem cell transplantation for HL, although relapse remains the greatest challenge. A recent report PD184352 CI-1040 by Peggs et al using donor lymphocyte infusion after a T cell depleted NMT had an impressive 4 year EFS of 59%, however, remission at the time of NMT remains the most important prognostic factor for this modality of therapy.14 There are now a number of new agents, including brentuximab vedotin,15 bendamustine, panobinostat, everolimus, or lenalidomide, that can be used as a potential bridge to a NMT.16 Administering these agents alone or in combination to achieve an FDG PET negative response can be followed by referral to an allogeneic stem cell transplant center.
A patient with nodal disease that remains FDG PET positive after SLT in a site that has not been previously irradiated is a unique subset of HL. We have used IFRT in daily fractions as a salvage therapy for these patients. Notably, 2 patients in this study who failed SLT achieved an FDG PET negative state with IFRT, were auto transplanted, and probably cured. The administration of IFRT has been an independent predictor for EFS in all of our previous reports as well as for the transplanted only patients in this study, however, the true role of IFRT in this setting remainsGlioblastoma multiforme is the most aggressive and common primary brain tumor in adults. The median survival was 14.6 months with radiotherapy plus temozolomide and 12.1 months with radiotherapy alone in a multicenter trial.
Age, performance status, extent of surgical resection, and mental status are the most consistently reported prognostic factors. In addition, since 2000 the promoter methylation status of the O6 methylguanineeDNA methyltransferase gene has been suggested as a predictive factor in GBM, especially in patients who receive chemoradiation with alkylating agents. In prognostic factor analyses of the European Organisation for Research and Treatment of Cancer and the National Cancer Institute of Canada trial 26981 22981, methylated MGMT was associated with improved survival in patients whose tumors were resected and who received radiotherapy and TMZ. The MGMT gene is located on chromosome 10q26 and encodes a DNA repair protein that removes alkyl groups from the O6 position of guanine, an important site of DNA alkylation.
Epigenetic MGMT gene silencing by promoter methylation is associated with loss of MGMT expression and diminished DNA repair activity, which results in increased sensitivity to TMZ and longer overall survival. There are few studies about MGMT gene promoter methylation in Korean patients with GBM. We evaluated whether MGMT gene promoter methylation is associated with survival in patients with GBM who were treated in a single institution. Methods and Materials Patient characteristics Between January 2001 and December 2008, 165 patients with newly diagnosed GBM were treated with postoperative radiotherapy at Yonsei University Health System. Of these, 93 patients with histologically proven GBM who received involved field radiotherapy with TMZ were selected for this study. Seventy two patients were excluded: 49 were treated with radiotherapy alone without chemother