Multicenter study of subcutaneous alemtuzumab administered at reduced dose in patients with fludarabine-relapsed/refractory chronic lymphocytic leukemia: final analysis.

Optimal management of patients with relapsed/refractory chronic lymphocytic leukemia (CLL) has been the motive behind a large number of studies in recent years, and previous response, its duration, and development of clonal evolution appear to be the best indicators for the choice of a new regimen. Although alemtuzumab in relapsed/refractory CLL may be beneficial, the optimal dosage and risk of infection related to its use remain thus far deeply controversial issues. In this pilot phase II study we investigated the feasibility of, toxicity of, and response to alemtuzumab at a reduced dose (30 mg s.c. for 2 weeks and then once a week at extended intervals: every 2, 4, 6 weeks up to 1 year). The overall response rate was 95%, with 51% complete response. The complete response range was 55% in fludarabine-relapsed patients and 28% in patients with fludarabine-refractory disease, without significant difference between the two groups. The regimen was well tolerated with mild toxicity and few cytomegalovirus (CMV) infections. With a median follow-up of 27 months, the overall survival (46% at 3 years) appears to be similar to that with other regimens although with fewer adverse events. In conclusion, treatment with alemtuzumab at a reduced dose seems to be safe and increases the event-free survival of patients with relapsed/refractory CLL, compared with the standard dose. A randomized study comparing both regimens including a larger number of patients is warranted.

Seroprevalence of human herpesvirus-8 in blood donors from different geographical regions of Argentina, Brazil, and Chile.

Human herpesvirus-8 (HHV-8) causes Kaposi's sarcoma (KS) and lymphoproliferative disorders in both HIV-infected and uninfected patients. HHV-8 has a worldwide occurrence but infection rates vary according to a combination of geographic and behavioral risks. The main transmission route seems to be sexual, nevertheless, nasal secretions, saliva, blood, and organ graft have been proposed. HHV-8 was postulated as a new infectious agent for screening in blood donors. The aim of this study was to evaluate the prevalence of antibodies against HHV-8 antigens in blood donors of South America. Serum samples from 2,470 blood donors from Argentina, Brazil, and Chile corresponding to five geographic regions were studied by indirect immunofluorescence assay (IFA). Seroprevalence rate was 3.7% (92/2,470; 95% CI 2.9-4.5) in the entire blood donor population distributed as follows: Argentina, 4.0% (Buenos Aires city, 4.3%; Bahia Blanca, 2.4%; and Córdoba, 4.0%), Campinas (Brazil), 2.8%; and Santiago de Chile, 3.0%. There was no difference (P>0.05) between men and women or age related, except in Brazil where positive cases were 30-49-year-old males. The present study, which includes different geographical areas of multiple countries from South America, has not been done before. The results show similar prevalence rates among the studied zones corresponding to low-prevalence regions. South America is a large sub-continent with a wide spectrum of population and geographical characteristics, thus, more HHV-8 prevalence studies should be necessary to establish possible regional differences.

Evaluación de la terapia transfusional / Evaluation of transfusion therapy

Objetivo: el principal problema relacionado con las transfusiones sanguíneas es su sobreutilización. Por esta razón, se realizó un estudio para determinar si en nuestra institución la indicación de la terapia transfusional es adecuada. Materiales y métodos: se tomaron como elegibles los actos transfusionales registrados en el Servicio de Hematología durante un período de cuatro meses y se seleccionaron al azar 135 historias clínicas de distintos servicios clínicos y quirúrgicos. Se consideró como criterio de exclusión la ausencia de datos de la historia clínica, relacionados con la terapia transfusional. Tres especialistas fueron los responsables de determinar si cada acción fue justificada o no, sobre la base de criterios corrientes en las normativas de diferentes instituciones internacionales. Resultados: se seleccionaron 135 historias, de las cuales 41 (30,4%) fueron excluidas por no poseer registro alguno vinculado con la transfusión. De las 94 restantes, 64 (68%) pertenecían al departamento clínico y 31 (32%), al quirúrgico. Por el acuerdo de dos o tres especialistas, fueron consideradas injustificadas 53 (56,3%), y no se observaron diferencias significativas entre los diferentes departamentos. El número de transfusiones injustificadas fue de 67,8% con hematocrito pretransfusional mayor que 25% y 39,4%, cuando éste fue menor que 25% (p < 0,01). Las transfusiones injustificadas fueron significativamente mayores los días de semana (61,5%), respecto de los fines de semana (31,2%) (p < 0,05). Conclusiones: el porcentaje de transfusiones, calificadas como injustificadas, fue inaceptablemente elevado. Asimismo, existe un importante subregistro de las transfusiones en las historias clínicas, hecho que destaca la poca jerarquía que se le otorga a este recurso. Se propone la realización de un consenso institucional que tenga como objetivo la racionalización de su uso, a través del asesoramiento de médicos clínicos y cirujanos acerca de esta terapia.