ABSTRACT
ABSTRACT: The novel Coronavirus (CoVid-19) outbreak is now consider a world pandemic, affecting more than 1,300,000 people worldwide. Cancer patients are in risk for severe disease, including a higher risk of intensive care unit (ICU) admission, need for invasive ventilation or death. Management of patients with lymphoid malignancies can be challenging during the outbreak, due to need of multiple hospital visits and admissions, immunosuppression and need for chemotherapy, radiotherapy and stem cell transplantation. In this article, we will focus on the practical management of patients with lymphoid malignancies during the COVID-19 pandemic, focusing on minimizing the risk for patients.
Subject(s)
Leukemia, Lymphoid , Coronavirus , COVID-19 , Lymphoma , Hodgkin Disease , Leukemia, Lymphocytic, Chronic, B-Cell , Lymphoma, B-Cell , Lymphoma, T-Cell, Peripheral , Lymphoma, Mantle-CellABSTRACT
ABSTRACT Chronic lymphocytic leukemia is characterized by clonal proliferation and progressive accumulation of B-cell lymphocytes that typically express CD19+, CD5+ and CD23+. The lymphocytes usually infiltrate the bone marrow, peripheral blood, lymph nodes, and spleen. The diagnosis is established by immunophenotyping circulating B-lymphocytes, and prognosis is defined by two staging systems (Rai and Binet) established by physical examination and blood counts, as well as by several biological and genetic markers. In this update, we present the recommendations from the Brazilian Group of Chronic Lymphocytic Leukemia for the diagnosis and treatment of chronic lymphocytic leukemia. The following recommendations are based on an extensive literature review with the aim of contributing to more uniform patient care in Brazil and possibly in other countries with a similar social-economic profile.
Subject(s)
Prognosis , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Leukemia, Lymphocytic, Chronic, B-Cell/therapy , Immunophenotyping , Cytogenetics , Neoplasm StagingABSTRACT
O cromossomo Filadélfia (Ph1) é a alteração citogenética mais comum da Leucemia Linfoblástica Aguda do adulto (LLA). Esta alteração citogenética predomina nos adultos com mais de 50 anos e na LLA de origem na célula B, principalmente CD10 positiva. O diagnóstico requer a análise citogenética e a pesquisa do mRNA do gene BCR-ABL no sangue periférico ou na medula óssea. A LLA Ph1 apresenta uma sobrevida global em cinco anos inferior a 20 por cento quando tratada com protocolos para LLA. Os poucos casos de cura ocorrem nos pacientes submetidos ao transplante alogênico de medula óssea (TMO). A adição do imatinibe à quimioterapia resultou em melhora na taxa de remissão completa, maior taxa de remissão molecular completa, maior número de pacientes aptos para realizar o TMO, uma maior sobrevida livre de eventos e maior sobrevida global, embora o tempo de seguimento seja ainda muito curto. Entretanto, a taxa de recaídas e o aparecimento de mutações do BCR-ABL resistentes ao imatinibe ainda são preocupantes. No futuro, novos inibidores de tirosina quinase poderão ser incorporados ao tratamento da LLA Ph1.
The Philadelphia chromosome (Ph1) is the most frequent abnormality in acute adult lymphoblastic leukemia (ALL). Ph1 positive ALL is more frequent in over 50-year-old adults, in B-cell ALL and CD10-positive ALL. Diagnosis is based on the identification of the BCR-ABL gene mRNA in peripheral blood or bone marrow. The 5-year overall survival of patients with Ph1 positive ALL treated with chemotherapy alone is less than 20 percent. A few cases may be cured by allogeneic stem cell transplantation. The addition of imatinib to the chemotherapeutic treatment has resulted in more complete remissions, more complete molecular responses, more patients able to perform stem cell transplantation, better event-free survival and better overall survival, although the study follow-up period is very short so far. High relapse rates and the emergence of BCR-ABL mutants resistant to imatinib are still significant. In the future, newer tyrosine-kinase inhibitors may be added to the chemotherapy.
Subject(s)
Humans , Bone Marrow Transplantation , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Philadelphia Chromosome , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Protein Kinase Inhibitors , Transplantation, HomologousABSTRACT
Neste relato apresento os resultados de 51 pacientes portadores de leucemia mielóide aguda (39 leucemias primárias, 9 secundárias a síndrome mielodisplásica e 3 de origem indeteminada). Comparamos os resultados desta casuística com resultados anteriores do Serviço de Hematologia do HUCFF e observamos que a percentagem de casos de leucemia subtipo M3 elevou-se de 24 para 38 por cento dos casos e o número de pacientes que não receberam tratamento foi reduzido de 37 para 18 por cento. A taxa de remissão completa em ambas as casuísticas foi idêntica, 59 por cento e a sobrevida global não pode ser terminada devido à diferença do período de observação de 13 anos no primeiro trabalho, contra 5 anos no atual.