Yunsuk Choi

Cervical epidural blockade (CEB) is used to treat cervical radiculopathy, which causes functional impairment of and pain in the neck and arms. However, the relationship between pain reduction and functional recovery remains unclear. This study evaluated the effects of CEB and assessed pain intensity using the numeric rating scale (NRS), functional disability using the neck disability index (NDI), Copenhagen neck functional disability scale (CNFDS), and patient-reported pain percentage reduction (PRPPR) questionnaires. Correlations among the changes in these measures were examined. This study recruited 23 patients with cervical radiculopathy confirmed by magnetic resonance imaging. Fluoroscopy-guided CEB was performed in all enrolled patients who were reassessed after 2-3 weeks. The NRS, NDI, CNFDS, and PRPPR were measured pre- and post-operatively. Pre-post changes (Δ) and correlations were analyzed using Pearson’s or Spearman’s coefficients with bootstrapped confidence intervals. CEB significantly reduced pain (ΔNRS, 1.70, P<0.001) and improved functional scores (ΔNDI, 5.04, P=0.001; ΔCNFDS, 3.48, P=0.002). Pain reduction was correlated with functional improvement (ΔNRS-ΔNDI, r=0.48; ΔNRS-ΔCNFDS, r=0.55). PRPPR was correlated with ΔNRS (r=0.57) but not with the functional measures. CEB resulted in short-term improvements in pain and function; however, functional outcomes should be interpreted cautiously and assessed using multidimensional measures.

Introduction: Updated classifications incorporating myelodysplasia‐related (MR) gene mutations reclassify many cases previously diagnosed as acute myeloid leukemia, not otherwise specified (AML, NOS). We evaluated the clinical significance of MR gene mutation burden, defined by mutation number and variant allele frequency (VAF), in AML, NOS. Methods: We retrospectively reviewed adults diagnosed with AML, NOS who underwent next‐generation sequencing between 2018 and 2023. After excluding cases with KMT2A rearrangements or biallelic TP53 inactivation, 95 patients were included. Associations between MR gene mutation burden and complete remission (CR) failure were assessed using logistic regression; exploratory survival analyses were performed. Results: MR gene mutations were identified in 57.9%–63.2% of patients. For CR analysis, 89 patients were evaluable after excluding five treated with FLT3 inhibitors and one lost to follow‐up. The CR rate was lower in patients with MR gene mutations than in those without MR gene mutations (39.7% vs. 64.5%, p = 0.025). Patients with ≥ 2 MR gene mutations had the lowest CR rate (29.7%). An exploratory ROC‐derived VAF cutoff of 28.6% predicted CR failure with modest discriminatory performance (AUC, 0.658). In multivariate analysis, the highest VAF among MR gene mutations was independently associated with CR failure (odds ratio, 1.022; p = 0.028). Exploratory survival analyses showed inferior outcomes in patients with high‐VAF MR gene mutations. Conclusion: A greater number of MR gene mutations and higher VAF were associated with inferior early treatment response in AML, NOS. MR gene mutation burden may provide additional prognostic information among patients reclassified as AML with MR gene mutations.

Summary: Myelodysplastic neoplasms (formerly myelodysplastic syndromes, MDS) are heterogeneous clonal haematological malignancies that primarily affect the elderly, though a notable proportion of patients are diagnosed at younger ages. We retrospectively analysed 1437 patients diagnosed or treated at Asan Medical Center between 1989 and 2022, comparing clinical and genetic characteristics by age group. Younger patients (≤50 years) demonstrated improved overall survival (OS) and leukaemia‐free survival (all p < 0.001), a higher proportion of females, lower platelet levels, reduced bone marrow blasts, decreased mutation burden and lower scores on the International Prognostic Scoring System. In contrast, the response rates to hypomethylating agents did not significantly differ between age groups ( p = 0.543); however, SF3B1 mutation predicted favourable therapeutic response. Mutations in ASXL1 , DDX41 , DNMT3A , RUNX1 , SF3B1 , SRSF2 , TET2 , TP53 and ZRSR2 occurred more frequently in older MDS patients, whereas SAMD9 mutations predominated in younger cohort. In patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT), OS did not differ significantly between younger and older patients; only TP53 mutation reliably predicted inferior post‐HSCT OS (hazard ratio 3.099, p = 0.003). In analyses limited to younger patients, the presence of DNMT3A , TP53 and U2AF1 mutations was associated with worse OS. These findings suggest that younger patients represent a biologically distinct subset of MDS.

Background: The myelodysplastic syndromes (MDS) frequently present with heterogeneous autoimmune diseases (AD). However, the pathobiology and prognostic impact of AD in MDS have not been fully elucidated. Therefore, we aimed to investigate cytogenetic and molecular characteristics and prognostic significance of autoimmune disease in MDS.Methods: We retrospectively analyzed 1456 patients diagnosed with MDS at Asan Medical Center, Seoul, Korea, between 1989 and 2021.Results: Among all patients, 90 (6.2%) had AD. The most frequent cytogenetic abnormalities in AD+ group were trisomy 8 (22.2%), complex karyotypes (5.6%), and der (1;7) (q10;p10) (4.4%). BCORL1 (9.8% vs. 1.2%, P=0.006) and DNAH9 mutations (11.9% vs. 0%, P=0.014) were significantly more frequent in AD+ patients. SETD2 (4.9% vs. 0.7%, P=0.069) and WT1 mutations (7.3% vs. 1.7%, P=0.055) showed a trend toward higher frequency in the AD+ group. The MDS patients with AD+ demonstrated significantly higher overall survival (OS) (58.7% vs. 40.7% at 5 years, P=0.011) and leukemia-free survival (LFS) rates (53.9% vs. 34.7%, P=0.006) compared to those without AD. The favorable prognostic impact of AD was significant, particularly in higher-risk MDS. The skin manifestation of AD and diagnosis of AD (> 1 month) after MDS onset predicted better survival.Conclusion: AD in MDS is associated with distict clinical and molecular features and a more favorable prognosis, especially in higher-risk MDS. Trisomy 8 and der (1;7) as well as somatic mutations in BCORL1, DNAH9, SETD2, and WT1, may be associated with the co-occurrence of AD in MDS.

Jang HM, et al. J Korean Med Sci. 2026 Sep;41:e228. https://doi.org/10.3346/jkms.2026.41.e228

Myeloablative conditioning is standard for younger acute myeloid leukemia (AML) patients undergoing allogeneic hematopoietic cell transplantation (HCT), but optimal busulfan dosing remains unclear. We retrospectively analyzed 686 AML patients aged p < 0.001) and lower non-relapse mortality (p = 0.005) compared to Bu2 and Bu4. Although Bu4 had the lowest relapse rate (p < 0.001), event-free survival was similar to Bu3. In multivariate analysis, only Bu3 maintained an OS benefit (hazard ratio 0.513, p = 0.016). Graft-versus-host disease-free, relapse-free survival did not differ among groups. Among patients in complete remission, Bu3 also showed a significant OS advantage (p = 0.040), while higher busulfan doses did not improve survival in refractory cases. These findings support Bu3 as the optimal conditioning regimen in younger AML patients undergoing HCT.