Laser de baixa potência previne mucosite oral grave em pacientes submetidos à transplante de medula óssea: ensaio clínico randomizado / Low-Power Laser Prevents Severe Oral Mucositis in Bone Marrow Transplant Patients: Randomized Trial

Introdução: estima-se, em 2020, cerca de 15 milhões de novos casos de câncer no mundo. Dentre eles, há o câncer hematológico, que acomete o sangue e tecidos produtores de células sanguíneas. O transplante de medula ósssea significou um avanço terapêutico para este tipo de neoplasia. No entanto, as quimioterapias utilizadas, geralmente, resultam em efeitos colaterais graves, como a mucosite oral. O laser de baixa potência demonstrou ser útil para o tratamento da mucosite oral porém, no que se refere ao seu uso para prevenção, os resultados são contraditórios. Objetivo: avaliar a efetividade do laser de baixa potência na prevenção da mucosite oral em pacientes submetidos ao transplante de medula óssea. Método: foi realizado um ensaio clínico de superioridade, randomizado, paralelo, encoberto com 36 pacientes divididos em dois grupos: laser (17 pacientes) e sham (18 pacientes), termo utilizado para tratamento simulado não medicamentoso. A variável primária foi mucosite oral (grau II pela classificação da Organização Mundial de Saúde); já as secundárias foram mucosite oral grave (Grau III e IV) e presença de dor, avaliada pela Escala Visual Analógica (EVA). Foi utilizado laser de InGaAlP com comprimento de onda central de 650nm, potência de 100 mW e densidade de energia de 70 J/cm2, aplicadas, preventivamente, do primeiro dia do condicionamento até o D+5, e o grupo sham recebeu tratamento simulado com laser durante o mesmo período. Os dados foram analisados usando o STATA versão 13.1 e SPSS versão 20. O viii teste exato de Fisher foi utilizado para comparar os grupos em relação a variáveis categóricas e a análise de sobrevida foi realizada pelo método de Kaplan-Meier. Para avaliar a dor utilizando a EVA, foi adotada a análise de variância para medidas repetidas (ANOVA). Foram também calculados o risco no grupo exposto (Rt), risco no grupo não exposto (Rc), risco relativo (RR), eficácia / redução relativa de risco (RRR), redução do risco absoluto (RRA) e o número necessário para tratar para beneficiar uma pessoa (NNTB). A análise foi realizada com a intenção de tratar, e foi aceito um nível de significância de 5%. Resultados: não foi encontrada evidência de diferença significativa em relação à incidência de mucosite oral (p = 0,146). Mucosite grave foi observada em 40% dos pacientes (14/35 pacientes), sendo apenas 3 (17,65%) no grupo laser contra 11 (61,11%) no grupo sham (p=0,015). A probabilidade de sobrevivência acumulada para mucosite grave foi superior a 0,6 para o grupo laser, enquanto que para o grupo sham chegou a zero (p=0,0397). Em relação à intensidade da dor, no dia considerado de pior dor, os pacientes do grupo sham classificaram mais frequentemente sua dor como grave quando comparado com o grupo laser (p=0,041). Conclusão: o laser de baixa potência mostrou-se efetivo na prevenção de mucosite oral grave e da dor oral intensa em pacientes submetidos ao transplante de medula óssea

Comparison of a human T-cell lymphotropic virus type I strain from cerebrospinal fluid of a Jamaican patient with tropical spastic paraparesis with a prototype human T-cell lymphotropic virus type I

The isolation and characterization of a human T-cell lymphotrophic virus type I (HTLV-I) from cerebrospinal fluid of a Jamaican patient with tropical spastic paraparesis is described. The virus isolate is a typical type C retrovirus as seen by electron microscopy and is related to prototype HTLV-I isolated from patients with adult T-cell leukemia but is not identical to this prototype HTLV-I as seen by restriction enzyme mapping.(AU)

Human T lymphotropic virus type I antibody patterns: evidence of difference by age and risk group

Detection of human T lymphotropic virus type I (HTLV-I) antibody was assessed on 368 sera from subjects with different clinical features and from different parts of the world. Enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay for purified p24 antibodies (p24-RIA) used as screening tests agreed in 88.7 percent of the sera. The results from 247 selected sera were compared with western blot (WB). WB was reactive in sera five to 25 times more dilute than the last positive ELISA or p24-RIA, but different WB batches varied in sensitivity. ELISA was more sensitive than p24-RIA, and p24-RIA was more specific than ELISA. Indeterminate WB interpretations were common (25.5 percent). Most seropositive intravenous drug abusers had unusually strong p24 bands by WB. Among healthy individuals, positive WB reactivity increased with age, whereas indeterminate reactivity declined (P=.034). Thus more sensitive and -specific HTLV-I antibody tests are needed. (AU)

HTLV-I-associated leukemia : a model for chronic retroviral diseases

Human T-lymphotropic virus type I (HTLV-I) has been associated with adult T-cell leukemia/lymphoma (ATL), a malignancy of mature CD4-positive lymphocytes, and tropical spastic paraparesis (TSP), a demyelinating neurological syndrome. This article describes the clinical and pathological features of ATL and reviews the epidemiology of this disease and of its putative etiological agent, HTLV-I. From what is known about the molecular biology and epidemiology of HTLV-I, hypotheses on the etiology of TSP are proposed, and strategies for studying the neurological syndrome are suggested. (AU)

Studies in healthy human T-cell-leukemia lymphoma virus (HTLV-I) carriers from the Caribbean

Six healthy relatives of 3 adult T-cell leukemia lymphoma (ATLL) patients and 6 members of a Caribbean family immigrant to the UK have been investigated for the presence of HTLV-I and expression of interleukin 2(IL-2) receptors. Serum antibodies to HTLV-I were detected in all but 4 samples. Four to 10 percent of circulating cells from 3/4 seropositive donors studied displayed IL-2 receptors (anti-Tac+) and were shown to be convoluted lymphocytes by light microscopy morphology and immunoelectromicroscopy. After 5 to 28 days in culture, cells from 4 seropositive donors reacted with monoclonal antibodies (MAbs) against the HTLV-I core proteins, p19 and p24, and released retrovirus particles. Simmilar experiments with blood from 3 seronegative donors from the same families and 4 normal controls proved negative. Our findings indicate that seropositive individuals harbour the virus in a population of T-lymphocytes which may then acquire receptors for IL-2. These individuals are at risk of developing ATLL. (AU)

Racial and other characteristics of human T cell leukemia/lymphome (HTLV-1) and AIDS (HTLV-111) in Trinidad

Adult T cell leukaemia/lymphoma was first recognised as a clinical entity in southwest Japan. Subsequently the Caribbean has been found to be another area where the disease is endemic, and sporadic cases have been identified in different parts of the world. The human T cell leukaemia/lymphoma virus (HTLV-1) is causally related to adult T cell leukaemia/lymphoma. A sub-group of HTLV, designated HTLV-111, has recently been isolated from many patients with the acquired immunodeficiency syndrome (AIDS) and preAIDS, and there is now evidence that this variant is the primary cause of AIDS. This is the first report from Trinidad to describe twelve cases of adult T cell leukaemia/lymphoma and 14 of AIDS. All were in patients of African descent. No cases were seen in subjects of East Indian descent, who, like those of African descent, comprise as much as 40 percent of the population

Adult T-cell leukemia/lymphoma in Jamaica and its relationship to human T-cell leukemia/lymphoma virus type I-associated lymphoproliferative disease

We had shown previously that the prevalence of human T-cell leukemia/lymphoma virus type I (HTLV-I) antibody positivity is high in Jamaican non-Hodgkin's lymphoma (NHL) patients and that virus-positive patients have the clinical features and poor prognosis of adult T-cell leukemia/lymphoma (ATL). 62 percent of 45 NHL patients diagnosed consecutively between 2/1/82 and 1/31/84 and studied prospectively were HTLV-I-antibody positive. Skin involvement (38 percent), hypercalecemia (44 percent), and leukemia (40 percent) were unusually prevalent and there was a strong association (p < 0.05) with HTLV-I-antibody positivity. 52 percent of the patients had bone marrow infiltration, and 74 percent of these patients were HTLV-I-antibody positive (p=.06). Lymphadenopathy (96 percent), hepatomegaly (60 percent), and splenomegaly (25 percent) were detected with about the same frequency as in other series of NHL patients with advanced disease, and 61-88 percent of these patients were HTLV-I-antibody positive. Patients were classified into those with "typical ATL" (NHL associated with 2 of the 4 features) i) hypercalecemia; ii) histologically proven skin infiltration; iii) leukemia; and iv) bone marrow infiltration, providing that the morphology of infiltrating of leukemic cells was characteristic of ATL; those "consistent with ATL" (NHL associated with 1 of these 4 features); and "non-ATL" (NHL without any of these 4 additional features). Thirty-two (71 percent) of the NHL patients were ATL patients, i.e. had features typical of or consistent with ATL, and 78 percent of these were HTLV-I-antibody positive. HTLV-I provirus was detected in tumour cells of all HTLV-I-antibody positive patients tested. Three (23 percent) of the non-ATL patients were HTLV-I-antibody positive. There was no correlation between histopathological features and the clinical classification of HTLV-I-antibody positivity. Median survival of ATL and non-ATL patients was 16 and 53 weeks. Although the disease was unusually fulminant, 34 percent of the ATL patients had a subacute or chronic course. Skin involvement and leukemia were prominent in these patients. Hypercalecemia was the chief prognostic determinant. Median < 0.05). Hypercalecemia caused 10 deaths, infections 12, and death was due to tumour progression in 4 patients. Infections were usually due to pyogenic organisms and only 2 patients had systemic opportunistic infections. Six (27 percent) of 22 chronic lymphocytic leukemia (CLL) patients were HTLV-I-antibody positive. (AU)

The human type-C retrovirus, in Blacks from the Caribbean region, and relationship to adult T-cell leukemia/lymphoma

Type-C RNA tumour viruses have been implicated in the etiology of naturally occurring leukemias and lymphomas of animals. Human T-cell leukimia/lymphoma virus (HTLV) is the first human virus of this class consistently identified in association with a specific type of human leukemia/lymphoma. The isolation of HTLV was made possible by the ability to grow mature T-cell in tissue culture usually with T-cell growth factor (TCGF). We now report a cluster usually with T-cell leukemia/lymphoma among Blacks from the Caribbean in which all eight cases are positive for HLV virus and/or antibody. These patients have diseases that appears indistinguisable from Japanese adult T-cell leukemia/lymphoma which, as we have also reported, is associated with HTLV in over 90 percent of cases. The finding of HTLV antibodies in some of the normal population in the Caribbean and Japan, and the clustering of a specific form of T-cell leukemia/lyphoma in these virus-endemic areas, suggest that HTLV infection may be associated with the occurrence of a distinctive clinico-pathologic entity (Summary)

Management of acute leukaemia - abstract

This report summarizes the results of management of 50 patients with acute leukaemia treated at the University Hospital, Jamaica, including a preliminary assessment of new treatment regimes introduced in 1971. Up to this time prednisone and 6-mercaptopurine or vincristine were the drugs most commonly used for induction of remission. The median survival for adults with acute non-lymphoblastic leukaemia (ANLL) was 5 months, only 25 percent achieving complete remission was induced in 60 percent of the children with acute lympathic leukaemia (ALL) and the median survival was 10 months. Since 1971, Pinkel's "total therapy" regime" has been introduced for the management of ALL, and combination cytosine, vincristine, prednisone and cyclophosphamide for the mangement of ANLL. There are already indications of a higher rate remission induction, longer duration of remission and longer survival, in the patients studied up to now (AU)

Report on 151 childhood malignancies observed in Jamaica

During a 10-year period 1958-67, 151 tumors were noted in children under 15 years of age in Jamaica. This comprised 2.9 percent of all malignant tumors observed. Leukemia was the most common form of cancer. The incidence of retinoblastomas was high and surpassed incidences of neuroblastomas and of Wilms' tumors. Kaposi's sarcoma was not observed, and hepatocellular carcinoma was extremely rare. The tumor incidence pattern in Jamaica therefore largely resembles that in the United States and in Western Europe. It contrasts significantly with that in Uganda and in Western Nigeria. This merits attention, since over 90 percent of the Jamaican population is either pure Negro or of predominantly Negro descent as a result of importation from West Africa in former days. (Summary)

An estimation of survival probability for leukemia patients

The exponential distribution in which the paramatic depends on one or several characteristics of patient or indices of severity of disease, are generally used for prognosis of survival time due to chronic diseases such as cancer. The assumption of such distribution of survival time is based on the fact that diagnosis of cancer in most of the cases is purely accidental in the sense that the patient might be suffering from the disease quite a long time before appearing for diagnosis or else an examination for a routine treatment may discover cancer. Therefore, the survival time is from time of diagnosis to death. Though in addition to the survival time, there are objective measures available which indicate the severity of disease at the time the patient first came under observation, yet in some studies of chronic disease, the survival time is the only quantitative response variable for statistical investigation. Under these circumstances the exponential distribution could still justified on the basis of its empirical fit with observed data which are available. This paper deals with the statistical theory of an exponential distribution which has found its most important application in blood cancer. In estimating the survival time for leukemia patients, the blast cell counts have been considered as the dependent variable or characteristic befitting the exponential distribution with two parameters. The parameters are estimated by the method of maximum likelihood and application has been shown with an example of sixteen leukemia patients who died with acute lymphoblastic, acute lymphatic, myeloid, monocytic and acute leukemia patients. In the example, the assumption of exponential distribution of survival time seemed justified by the way in which the results reproduced the original data. The comparison between the empirical survival distribution with the estimated survival curve associated with the median blast cells count, portrays the adequacy of the exponential distribution which is further tested with chi-square and found insignificant. It is striking that the survival probabilities depend strongly on blast cell counts. On a side investigation it was revealed that survival probabilities of male outweigh the female. The estimates of survival probabilities of individual patients with corresponding blast cell counts are also given in a monogram reckoning its important application from clinical trials point of view, when a patient's ability to respond to treatment depends more often on the severity of disease rather than effect of the treatment within the sample group. In conclusion, the statisitcal theory discussed in the paper has been further extended in its application in (1) prognosis of survival of leukemia patients with various treatments and therapy (2) the status of patient (dead or alive) at the end of study affecting treatment or therapy and (3) the evaluation of survival data from clinical trials (AU)

An investigation of clustering of cases of leukaemia in Jamaican children

The cause of leukaemia is not yet known. Recently attention has been drawn to its epidemiological aspects and in particular to clustering of cases, i.e. association of cases in regard to time of occurrence and locality. If this phenomenon can be demonstrated, it suggests an environmental factor, virus infection being one possibility. The present study is an attempt to apply mathematical methods of analysis to 58 cases of childhood leukaemia presenting in Kingston, Jamaica, from January 1, 1958, to December 31, 1966. Of these 58 cases, 37 were domicile in the parish of Kingston and St. Andrew and 21 were from the rest of Jamaica. Owing to geographical factors it is felt that whereas the case finding rate for the Kingston and St. Andrew cases is high, the number of cases from the Jamaican countryside which are included in this series can represent only a fraction of the expected total. The sex incidence in the series was 30 boys to 28 girls. There were 35 cases of acute lymphatic leukaemia, 8 acute stem cell, 10 acute myeloid, 4 chronic myeloid and one case of erythro-leukaemia. The peak age incidence was in the fifth year. Acute lymphatic leukaemia was mostly found in those under six years, acute myloid in the over sixes and in the under twos. The incidence of recorded cases of leukaemia has risen over the period studied. In 1964 there was a distict peak of 15 cases (an epidemic year). Some degree of seasonal incidence was shown in a reduction in cases in the last three months of the year, the six months April to September having 37 cases as against 21 for the other half year. Finally the incidence of pairing in Kingston cases was - Leukemia pairs - distance 1 Km, 1 Km, 2 Km, time 1 year, 6 months, 6 months, respectively, expected pairs 12.6, 6.5, 17.9 respectively, observed pairs 16, 7, 22, respectively. The degree of clustering is consistently greater than that calculated on a chance basis. However the increase of observed pairs over expected pairs does not achieve statistical significance. A larger series might be needed to demonstrate clustering in a conclusive fashion (AU)

Leukaemia in Jamaica: a statistical survey of seventy cases

Information from all parts of the world indicates that the incidence of leukaemia has been increasing in recent years. In a survey of leukaemia in Jamaica for the years 1953-1957, evidence is brought forward to suggest that a similar increase is occurring here and the figures for 1957 show an incidence of leukaemia comparable to that of most European countries. An analysis of 70 cases of leukaemia show chronic myeloid leukaemia to be the commonest variety. The frequency of the acute leukaemias is similar to British figures, and the overall picture of age and sex distribution is also almost identical. The possible reasons for this general increase in leukaemia are discussed. (AU)