Acute myeloid leukemia: challenges for diagnosis and treatment in Latin America.

OBJECTIVE: to review the current diagnostic and therapeutic landscape of AML in Latin America as a reflection of other low- and middle-income countries and regions of the world. Encompassing both acute promyelocytic and non-promyelocytic disease types. METHODS: We reviewed the literature and study registries concerning epidemiological features of patients with AML/APL treated in Latin America, as well as evaluated diagnostic and genetic stratification and patient fitness assessment challenges, the importance of early mortality and supportive care capacity, intensive and non-intensive chemotherapy alternatives, consolidation, and maintenance strategies including novel agents and hematopoietic stem cell transplantation. RESULTS: Although most of the current technologies and treatment options are available in the region, a significant fraction of patients have only limited access to them. In addition, mortality in the first weeks from diagnosis is higher in the region compared to developed countries. CONCLUSIONS: Disparities in access to technologies, supportive care capacity, and availability of novel agents and HSCT hinder results in our region, reflecting barriers common to other LMICs. Recent developments in the diagnosis and treatment of this disease must be implemented through education, collaborative clinical research, and advocacy to improve outcomes.

High ME1 Expression Is a Molecular Predictor of Post-Transplant Survival of Patients with Acute Myeloid Leukemia.

Several laboratory and clinical variables have been reported to be associated with the outcome of intensive chemotherapy for acute myeloid leukemia (AML), but only a few have been tested in the context of hematopoietic stem cell transplant (HSCT). This study aimed to identify genes whose expression of AML at diagnosis were associated with survival after HSCT. For this purpose, three publicly available adult AML cohorts (TCGA, BeatAML, and HOVON), whose patients were treated with intensive chemotherapy and then subjected to allogeneic or autologous HSCT, were included in this study. After whole transcriptome analysis, we identified ME1 as the only gene whose high expression was associated with shorter survival in patients subjected to HSCT. In addition, the inclusion of ME1 expression was able to improve the European LeukemiaNet risk stratification. Pathways related to lipid biosynthesis, mainly fatty acids, and cholesterol were positively correlated with ME1 expression. Furthermore, ME1 expression was associated with an M2 macrophage-enriched microenvironment, mature AML blasts hierarchy, and oxidative phosphorylation metabolism. Therefore, ME1 expression can be used as biomarker of poor response to HSCT in AML.

Transfusion of ABO non-identical platelets increases the severity of trauma patients at ICU admission

ABSTRACT Background: Transfusion of ABO-compatible non-identical platelets (PTLs), fresh plasma (FP) and red blood cells (RBCs) has been associated with increased morbidity and mortality of recipients. Trauma victims are frequently exposed to ABO non-identical products, given the need for emergency transfusions. Our goal was to evaluate the impact of the transfusion of ABO non-identical blood products on the severity and all-cause 30-day mortality of trauma patients. Methods: This was a retrospective single-center cohort, which included trauma patients who received emergency transfusions in the first 24 h of hospitalization. Patients were divided in two groups according to the use of <3 or ≥3 ABO non-identical blood products. The patient severity, measured by the Acute Physiology and Chronic Health Evaluation (APACHEII) score at ICU admission, and the 30-day mortality were compared between groups. Results: Two hundred and sixteen trauma patients were enrolled. Of these, 21.3% received ≥3 ABO non-identical blood products (RBCs, PLTs and FP or cryoprecipitate). The transfusion of ≥3 ABO non-identical blood products in the first 24 h of hospitalization was independently associated with a higher APACHEII score at ICU admission (OR = 3.28 and CI95% = 1.48-7.16). Transfusion of at least one unit of ABO non-identical PTLs was also associated with severity (OR = 10.89 and CI95% = 3.38-38.49). Transfusion of ABO non-identical blood products was not associated with a higher 30-day mortality in the studied cohort. Conclusion: The transfusion of ABO non-identical blood products and, especially, of ABO non-identical PLTs may be associated with the greater severity of trauma patients at ICU admission. The transfusion of ABO non-identical blood products in the trauma setting is not without risks.

Associação da quimiotoxicidade com o estado (de la quimiotoxicidad con el estado) nutricional em pacientes oncológicos / Nutritional status and chemotoxicity in oncology patients

Introdução: O câncer é uma enfermidade caracterizada pelo (El cáncer es una enfermedad que se caracteriza por el) crescimento desordenado de células, cujo tratamento com quimioterapia atua no seu controle ou (cuyo tratamiento con quimioterapia actúa en su control o) remissão e pode prolongar a sobrevida. No entanto (Sin embargo), a quimioterapia pode causar uma série de efeitos colaterais, denominados quimiotoxicidade, levando ao déficit nutricional e comprometendo sua tolerância e (llevando al déficit nutricional y comprometiendo su tolerancia y) eficácia. Objetivo: Verificar a associação da quimiotoxicidade com o estado nutricional de pacientes oncológicos. Métodos: Estudo transversal, de caráter retrospectivo, com análise de prontuário (con análisis de historia clínica) de pacientes com neoplasia de tumores sólidos, com 3 ciclos realizados de quimioterapia. Foram coletadas variáveis (Fueron contempladas variables) sociodemográficas, clínicas, antropométricas e a quimiotoxicidade foi categorizada conforme a National Cancer Institute (NCI). Resultados: Foram avaliados 126 pacientes, com idade média 54.6 ± 13.9 anos, predominantemente do sexo feminino (68.3%). As neoplasias mais prevalentes foram mama (51%) e trato gastrointestinal (34.5%) e o estadiamento IV foi prevalente (con prevalencia del estadio IV) (40.5%). A quimiotoxicidade apresentou-se desde o primeiro ciclo, com 52.5% de toxicidade bioquímica. Comparando o primeiro e terceiro ciclo não foi observada associação significativa entre a toxicidade e o índice de massa corporal (IMC), leucócitos, plaquetas e hemoglobina, mas observou-se tendência na toxicidade (pero se observó una tendencia en la toxicidad) de neutrófilos (p = 0.053). A toxicidade gastrointestinal afetou significativamente a perda de peso durante o (la pérdida de peso durante el) tratamento (p = 0.024). Conclusão: A quimiotoxicidade foi observada desde o primeiro ciclo, no entanto apenas a toxicidade do trato gastrointestinal apresentou (sin embargo, solo la toxicidad del tracto gastrointestinal presentó una) associação com a perda de peso corporal.

Introduction: Cancer is a disease characterized by the uncontrolled growth of cells, whose treatment with chemotherapy acts as a control or remission and may prolong survival. However, chemotherapy can cause a number of side effects, called chemotoxicity, leading to malnutrition and compromising its effectiveness and tolerance. Objective: To investigate the association between chemotoxicity and the nutritional status of cancer patients. Methods: Longitudinal and retrospective study with chart analysis of patients with cancer of solid tumors, with at least 3 cycles of chemotherapy performed. Sociodemographic, clinical, anthropometric variables were collected and chemotoxicity was categorized according to the National Cancer Institute (NCI, 1999). Results: We evaluated 126 patients, mean age of 54.6 ± 13.9 years, predominantly female (68.3%). The most common cancers were breast (51%) and gastrointestinal tract (34.5%) and most were classified as stage IV (40.5%). Chemotoxicity showed up from the first cycle, with 52.5% biochemical toxicity. Comparing the first and the third cycles, no difference in toxicity was observed in relation to body mass index (BMI), white blood cells, platelets and hemoglobin; but there was a trend in the association of toxicity with neutrophils (p = 0.053). The GI toxicity significantly affected weight loss during treatment (p = 0.024). Conclusion: chemotoxicity was observed from the first cycle; however only the toxicity of the gastrointestinal tract was associated with weight loss.