Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 2.125
Filter
1.
Med. infant ; 31(2): 147-157, Junio 2024. Tab
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1566859

ABSTRACT

Los sobrevivientes de un trasplante alogénico de células progenitoras hematopoyéticas (TACPH) pediátrico presentan alto riesgo de padecer problemas de salud. Debido a esta vulnerabilidad, la continuidad del cuidado impacta en su pronóstico y la transición a la medicina del adulto (TMA) es un proceso clave. Objetivo: Evaluar el proceso actual de TMA de los receptores de TACPH en nuestro hospital. Métodos: Diseño: observacional retrospectivo y prospectivo. Población: todos los pacientes (p) que realizaron su TMA desde enero/2022 a marzo/2023. Instrumentos: entrevista personal; material escrito; resumen de historia clínica; escalas TRAQ 5.0 (transición), PedsQL 4.0 (CVRS) y Lansky (funcionalidad); elección de estrategias de seguimiento según complejidad y requerimientos; contacto con profesionales de adultos; entrevista telefónica luego de 6 meses posTMA; red conformada. Resultados: 36p completaron la TAM (33 presencial, 3 virtual). Edad m19 años (m6 años de seguimiento), 70% del interior del país, 58% TACPH por enfermedad maligna, 64% TACPH familiar. A la TMA: antecedente EICHc 50%, segunda enfermedad maligna 2%, compromiso órganos 75% (m2/p, r0-8, mayormente endocrinológicas, oculares y neurológicas), 94% Lansky ≥80 (r50-100), PedsQL m82 (27% ≤75), TRAQ m3.4 (r1.7- 4.8). Derivación: todos los p cubrían sus necesidades (30% en centros de alta complejidad o expertos en THA) pero 3p debieron readecuar las estrategias, 5p presentaban complicaciones en actividad o necesidad de pronta resolución. Contacto posterior: 30/33p continuaban seguimiento, 3p pudieron retomarlo, 9p nuevas complicaciones/tratamientos. Red: 20 profesionales/instituciones. Conclusiones: Se refuerza la necesidad y utilidad de un proceso de TMA tanto formal como personalizado según necesidades individuales de los pacientes con TACPH (AU)


Pediatric allogeneic hematopoietic stem cell transplant (HSCT) survivors are at high risk for health problems. Because of this vulnerability, continuity of care impacts their prognosis and transition to adult medicine (TAM) is a key process. Objective: To evaluate the current process of TAM of HSCT recipients in our hospital. Methods: A retrospective and prospective observational study was conducted. The population included all patients (p) who underwent TAM from January 2022 to March 2023. Instruments used included personal interviews, written materials, medical history summaries, the TRAQ 5.0 (transition), PedsQL 4.0 (HRQoL), and Lansky (functionality) scales. Follow-up strategies were chosen according to complexity and requirements, with contact established with adult professionals and a telephone interview conducted six months post-TAM in an established network network. Results: 36p completed TAM (33 face-to-face, 3 online). Mean age was 19 years (with a mean of 6 years of follow-up); 70% were from the provinces of the country, 58% underwent HSCT due to malignant disease, 64% had familial HSCT. At TAM: 50% had a history of GVHD, 2% had a second malignant disease, and 75% had organ involvement (mean of 2 per patient, ranging from 0 to 8, mostly endocrinological, ocular, and neurological), 94% had Lansky ≥80 (range, 50-100), mean PedsQL was 82 (27% ≤75), mean TRAQ was 3.4 (range, 1.7-4.8). Referral needs were met for all patients (30% in tertiary-level centers or with experts in allogeneic HSCT), although 3 patients had to readjust strategies, and 5 had complications requiring prompt resolution. In subsequent contact, 30 out of 33 patients continued follow-up, 3 resumed it, and 9 experienced new complications or treatments. The network included 20 healthcare providers/institutions. Conclusions: This study reinforces the need for and usefulness of a formal and personalized TAM process according to the individual needs of patients with HSCT (AU)


Subject(s)
Humans , Adolescent , Quality of Life , Survival , Transplantation, Homologous , Risk Factors , Hematopoietic Stem Cell Transplantation , Transition to Adult Care/organization & administration , Chronic Disease , Prospective Studies , Retrospective Studies , Interview , Treatment Adherence and Compliance
2.
Med. infant ; 31(1): 26-30, Marzo 2024. Ilus, Tab
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1552815

ABSTRACT

Introducción: Entre las variables que afectan el riesgo de mortalidad relacionada (MRT) al trasplante alogénico de células progenitoras hematopoyéticas (TACPH) se incluyen las comorbilidades previas. Los índices de comorbilidad (IC) buscan mejorar la predicción de eventos combinando factores de riesgo independientes. Objetivos: 1) evaluar el uso de la versión breve y adaptada para niños, adolescentes y adultos jóvenes con enfermedad maligna del índice de comorbilidad específico para trasplante alogénico de células progenitoras hematopoyéticas (smyHCT-CI ); 2) evaluar el uso de los biomarcadores ferritina y albúmina en un índice de comorbilidad ampliado (smyHCT-CIa). Población y métodos: Diseño: cohorte retrospectiva. Periodo 2017- 2022. A cada p se le asignó nuevos puntajes utilizando el smyHCT-CI y el smyHCT-CIa. Los p se clasificaron en grupos de riesgo (GR) bajo (puntaje 0), intermedio (1-2) y alto (>3) con cada índice. Se comparó el n° de p asignado a cada GR grupo de riesgo y la MRT en cada grupo al usar el HCT-CI, el smyHCTCI y el smyHCT-CIa. Resultados: n 75. Frecuencia de p por GR según cada indicador (IC95): HCT-CI bajo 36 (25-47), intermedio 57 (56-69), alto 7 (1-12); smyHCT-CI: bajo 48 (37-59), intermedio 33 (23-44), alto 19 (10-27); smyHCT-CIa: bajo 43 (31-54), intermedio 36 (25-47), alto 21 (12-31). MRT por GR según indicador (IC95): HCT-CI: bajo 6,8 (14-28), intermedio 20,9 (9-33), alto 17,9 (0-55); smyHCT-CIa bajo 12,5 (1-24), intermedio 18,5 (4-33), alto 31,2 (9-54). Conclusión: El smyHCT-CI permitió identificar mejor los pacientes con mayor comorbilidad y riesgo de MRT. La ferritina resultó un biomarcador útil en la estimación del riesgo de MRT (AU)


Introduction: Variables affecting allogeneic hematopoietic stem cell transplantation (HCT) related mortality risk (TMR) include prior comorbidities. Comorbidity indices (CI) aim to improve event prediction by combining independent risk factors. Objectives: 1) to evaluate the use of the brief and adapted version of the HCT-specific comorbidity index for children, adolescents and young adults with malignancies (ymHCT-CI); 2) to evaluate the use of the biomarkers ferritin and albumin in an expanded comorbidity index (expanded ymHCT-CI). Population and methods: Design: retrospective cohort. Period 2017- 2022. Each patient was assigned new scores using the ymHCTCI and expanded ymHCT-CI. The p were classified into low (score 0), intermediate (1-2) and high (>3) risk groups (RG) with each index. The number of patients assigned to each RG and the TMR in each group were compared using the HCTCI, the ymHCT-CI, and the expanded ymHCT-CI. Results: n 75. Frequency of patients per RG according to each indicator (95%CI): HCT-CI low 36 (25-47), intermediate 57 (56-69), high 7 (1-12); ymHCT-CI: low 48 (37-59), intermediate 33 (23-44), high 19 (10-27); expanded ymHCT-CI: low 43 (31-54), intermediate 36 (25-47), high 21 (12-31). TMR by RG according to indicator (95%CI): HCT-CI: low 6.8 (14-28), intermediate 20.9 (9-33), high 17.9 (0-55); expanded ymHCT-CI low 12.5 (1-24), intermediate 18.5 (4-33), high 31.2 (9-54). Conclusion: ymHCT-CI allowed better identification of patients with higher comorbidity and risk of TMR. Ferritin proved to be a useful biomarker to estimate TMR risk (AU)


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Transplantation, Homologous , Comorbidity , Bone Marrow Transplantation/mortality , Risk Assessment , Hematopoietic Stem Cell Transplantation/mortality , Hematologic Neoplasms/therapy , Retrospective Studies
3.
Arch. argent. pediatr ; 122(1): e202310061, feb. 2024. tab, ilus
Article in English, Spanish | BINACIS, LILACS | ID: biblio-1525854

ABSTRACT

El síndrome de Wiskott-Aldrich es un error innato de la inmunidad de herencia ligada al cromosoma X, producido por variantes en el gen que codifica la proteína del síndrome de Wiskott-Aldrich (WASp). Reportamos el caso clínico de un paciente de 18 meses con diagnóstico de Wiskott-Aldrich que no presentaba donante antígeno leucocitario humano (HLA) idéntico y recibió un trasplante de células progenitoras hematopoyéticas (TCPH) con donante familiar haploidéntico. La profilaxis para enfermedad de injerto contra huésped incluyó ciclofosfamida (PT-Cy). El quimerismo del día +30 fue 100 % del donante y la evaluación postrasplante de la expresión de la proteína WAS fue normal. Actualmente, a 32 meses del trasplante, presenta reconstitución hematológica e inmunológica y quimerismo completo sin evidencia de enfermedad injerto contra huésped. El TCPH haploidéntico con PT-Cy se mostró factible y seguro en este caso de síndrome de WiskottAldrich en el que no se disponía de un donante HLA idéntico.


Wiskott-Aldrich syndrome (WAS) is an X-linked genetic disorder caused by mutations in the gene that encodes the Wiskott-Aldrich syndrome protein (WASp). Here, we report the clinical case of an 18-month-old boy diagnosed with Wiskott-Aldrich syndrome, who did not have an HLA-matched related or unrelated donor and was treated successfully with a hematopoietic stem cell transplant (HSCT) from a haploidentical family donor. Graft-versus-host disease (GvHD) prophylaxis included post-transplant cyclophosphamide (PT-Cy). At day +30, the peripheral blood-nucleated cell chimerism was 100% and the WAS protein had a normal expression. Currently, at month 32 post-transplant, the patient has hematological and immune reconstitution and complete donor chimerism without evidence of GvHD. HSCT with PT-Cy was a feasible and safe option for this patient with WAS, in which an HLA matched donor was not available.


Subject(s)
Humans , Male , Infant , Wiskott-Aldrich Syndrome/diagnosis , Wiskott-Aldrich Syndrome/genetics , Wiskott-Aldrich Syndrome/therapy , Hematopoietic Stem Cell Transplantation/adverse effects , Graft vs Host Disease/etiology , Bone Marrow Transplantation/adverse effects , Cyclophosphamide
5.
Chin. med. j ; Chin. med. j;(24): 140-151, 2024.
Article in English | WPRIM | ID: wpr-1007742

ABSTRACT

Chimeric antigen receptor (CAR)-modified T-cell therapy has achieved remarkable success in the treatment of acute lymphoblastic leukemia (ALL). Measurable/minimal residual disease (MRD) monitoring plays a significant role in the prognostication and management of patients undergoing CAR-T-cell therapy. Common MRD detection methods include flow cytometry (FCM), polymerase chain reaction (PCR), and next-generation sequencing (NGS), and each method has advantages and limitations. It has been well documented that MRD positivity predicts a poor prognosis and even disease relapse. Thus, how to perform prognostic evaluations, stratify risk based on MRD status, and apply MRD monitoring to guide individual therapeutic decisions have important implications in clinical practice. This review assesses the common and novel MRD assessment methods. In addition, we emphasize the critical role of MRD as a prognostic biomarker and summarize the latest studies regarding MRD-directed combination therapy with CAR-T-cell therapy and allogeneic hematopoietic stem cell transplantation (allo-HSCT), as well as other therapeutic strategies to improve treatment effect. Furthermore, this review discusses current challenges and strategies for MRD detection in the setting of disease relapse after targeted therapy.


Subject(s)
Humans , Receptors, Chimeric Antigen/therapeutic use , Neoplasm, Residual , Transplantation, Homologous/methods , Transplantation Conditioning/methods , Hematopoietic Stem Cell Transplantation/methods , Recurrence , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy
6.
Hematol., Transfus. Cell Ther. (Impr.) ; 46(2): 125-130, 2024. tab
Article in English | LILACS, ColecionaSUS | ID: biblio-1564554

ABSTRACT

ABSTRACT Introduction: Infection is a serious complication among patients with hematologic malignancies (HMs) and in hematopoietic cell transplant (HCT) recipients. In most centers, the management of these complications is provided by the hematologist in person, thus demanding a knowledge of basic aspects of infection. Methods: To evaluate the knowledge of the hematologist on infections, we invited clinicians to answer two questionnaires with 20 multiple-choice questions covering epidemiology, prophylaxis, diagnosis and treatment of infection in patients with HMs and HCT. Results: We obtained 289 answers: 223 in survey 1 (febrile neutropenia) and 66 in survey 2 (infection in HCT). The median score was 5.0 in both surveys (range 0.5 - 9.0). In survey 1, the questions with the lowest number of correct answers were Q3 (8%), concerning the cefepime dose, and Q1 (9%), which asked about the epidemiologic link between the use of high dose cytarabine and viridans streptococcal bacteremia. In survey 2, two questions about cytomegalovirus (CMV) infection had the lowest percentage of correct answers (Q4, 12% and Q11, 18%). Clinicians attending to HCT recipients had higher scores, compared to clinicians attending to patients with HM only (median score of 5.0 and 4.5, p = 0.03, in survey 1 and 6.0 and 4.5, p = 0.001, in survey 2). In both surveys staff clinicians, residents and professors had similar scores. Conclusion: This is the first study in Brazil assessing the knowledge of hematologists on infectious complications. The low median score overall indicates an urgent need for continuous education. Such initiatives will eventually result in better patient care.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Surveys and Questionnaires , Hematopoietic Stem Cell Transplantation , Education , Febrile Neutropenia
7.
Rio de Janeiro; s.n; 2024. 55 p. ilus, tab, graf.
Thesis in Portuguese | LILACS | ID: biblio-1579238

ABSTRACT

Introdução: Pacientes submetidos ao Transplante Alogênico de Células Tronco Hematopoiéticas (TACTH) possuem risco potencial para deficiências de micronutrientes, incluindo a vitamina A. As funções essenciais dessa vitamina podem estar diretamente associadas aos desfechos clínicos observados no contexto do TACTH. Objetivo: Avaliar a concentração de retinol e sua relação com desfechos clínicos em adultos submetidos ao TACTH. Métodos: Estudo de coorte retrospectivo composto por 40 adultos entre 20 e 59 anos. A Doença do Enxerto contra o Hospedeiro aguda (DECHa) e a variante aguda gastrointestinal (DECHa G) foram estabelecidas por critérios clínicos e histopatológicos. Obteve-se dados sobre a incidência de complicações clínicas e IMC dos pacientes pelos prontuários da instituição, sendo este último categorizado de acordo com critérios estabelecidos pela OMS. O retinol sérico foi analisado por Cromatografia Líquida de Alta Eficiência com detector ultravioleta nos dias do transplante (D0), D+30 e D+60 após o transplante. O ponto de corte para diagnosticar a deficiência de vitamina A (DVA) foi estabelecido em retinol sérico <1,05 µmol/L. A DVA foi categorizada como grave, moderada e leve, utilizando classes intervalares de 0,35 µmol/L do retinol sérico. As concentrações de retinol foram confrontadas com as categorias de IMC e divididos em tercis (≥T3 ou

Background:Patients undergoing Allogeneic Hematopoietic Stem Cell Transplantation (ASCT) are potential at risk for micronutrient deficiencies, including vitamin A. The functions of this vitamin are essential and may be directly related to the clinical outcomes observed in the context of ASCT. Objective: To evaluate serum levels of Retinol and its relationship with clinical outcomes in adults undergoing ASCT. Methods: Retrospective study involving 40 patients where serial analyzes of serum Vitamin A levels were carried out on the day of transplantation (D0) and on days D+30 and D+60 post-transplant. Acute Graft-versus-Host Disease (aGVHD) and the acute gastrointestinal variant (aGVHD G) were established based on clinical criteria and histopathological examinations. Vitamin A was analyzed by High Performance Liquid Chromatography (HPLC-UV). Individuals were classified as having vitamin A deficiency (VAD) when the serum retinol value was < 1.05 µmol/L. VAD was classified into severe (<0.35 umol/L), moderate (≥0.35 umol/L < 0.70 umol/L) and mild (≥ 0.70 umol/L <1.05 umol/L) deficiency. Data about the incidence of complications and BMI values were obtained from the medical records. BMI was classified according to cutoff points adopted by WHO. Subsequently, results of retinol analyzes were compared with BMI values and dichotomized into ≥T3 or

Subject(s)
Humans , Adult , Middle Aged , Young Adult , Stomatitis , Transplantation, Homologous , Vitamin A , Vitamin A Deficiency , Hematopoietic Stem Cell Transplantation , Febrile Neutropenia , Graft vs Host Disease , Nutrition Assessment , Transplant Recipients
8.
Rev. Bras. Cancerol. (Online) ; 70(2): 064648, abr-jun. 2024.
Article in English, Spanish, Portuguese | LILACS, SES-SP | ID: biblio-1585987

ABSTRACT

Introdução: Na literatura, a doença do enxerto contra o hospedeiro (DECH) vulvovaginal possui uma incidência que varia entre 24,9 e 69% e não há muitos estudos que abordem essa temática. A fotobiomodulação (FBM) para a DECH vulvovaginal não foi descrita na literatura até o presente momento, mas há evidências da sua eficácia na DECH oral e na prevenção de mucosite oral relacionada ao câncer. O objetivo do estudo é descrever a avaliação e o tratamento fisioterapêutico com FBM de uma paciente diagnosticada com DECH vulvovaginal. Relato do caso: Mulher com DECH vulvovaginal com queixa de dor moderada para urinar, dificuldade para realizar a higiene íntima, ardência na vulva e desconforto severo ao utilizar roupas íntimas. A FBM favoreceu a melhora da dor e a reparação tecidual das lesões da vulva, aliviando os sintomas e facilitando a realização dos exercícios de dilatação vaginal. Conclusão: A FBM foi apropriada e eficaz na redução da dor, sensação de ardência e desconforto, proporcionando um efeito anti-inflamatório e regenerador tecidual. Isso resultou em uma percepção de melhora de outras queixas relacionadas ao uso de roupas íntimas e higiene íntima. No entanto, para que o laser se torne um recurso fortemente indicado nesse cenário, são necessários estudos mais robustos, com tempo de intervenção e acompanhamento mais longos, como ensaios clínicos randomizados e controlados.


Introduction: In the literature, vulvovaginal graft versus host disease (GVHD) has an incidence that varies between 24.9 and 69% and there are not many studies addressing this topic. Photobiomodulation (FBM) for vulvovaginal GVHD has not been described in the literature to date, but there is evidence of its effectiveness in oral GVHD and in the prevention of cancer-related oral mucositis. The objective of this study was to describe the evaluation and physical therapy treatment with FBM of a patient diagnosed with vulvovaginal GVHD. Case report: Woman with vulvovaginal GVHD complaining of moderate pain when urinating, difficulty performing intimate hygiene, burning sensation in the vulva and severe discomfort when wearing underwear. FBM favored the improvement of pain and tissue repair of vulvar injuries, relieving symptoms and facilitating the performance of vaginal dilation exercises. Conclusion:FBM was appropriate and effective in reducing pain, burning sensation and discomfort, providing an anti-inflammatory and tissue regenerating effect. This resulted in a perceived improvement in other complaints related to the use of underwear and intimate hygiene. However, for the laser to become a strongly recommended resource in this scenario, more robust studies are needed, with longer intervention and follow-up times, as randomized and controlled clinical trials.


Introducción: En la literatura, la enfermedad de injerto contra huésped vulvovaginal (EICH) tiene una incidencia que varía entre 24,9% y 69% y no existen muchos estudios que aborden este tema. La fotobiomodulación (FBM) para la EICH vulvovaginal no se ha descrito en la literatura hasta la fecha, pero existe evidencia de su eficacia en la EICH oral y en la prevención de la mucositis oral relacionada con el cáncer. El objetivo de este estudio fue describir la evaluación y el tratamiento de fisioterapia con FBM de una paciente diagnosticada de EICH vulvovaginal. Informe del caso: Mujer con EICH vulvovaginal que refiere dolor moderado al orinar, dificultad para realizar la higiene íntima, sensación de ardor en la vulva y malestar severo al usar ropa interior. La FBM favoreció la mejora del dolor y la reparación tisular de las lesiones de la vulva, aliviando los síntomas y facilitando la realización de ejercicios de dilatación vaginal. Conclusión: La FBM fue apropiada y eficaz para reducir el dolor, la sensación de ardor y el malestar, proporcionando un efecto antiinflamatorio y regenerador de tejidos. Esto resultó en una mejora percibida en otras quejas relacionadas con el uso de ropa interior y la higiene íntima. Sin embargo, para que el láser se convierta en un recurso muy recomendable en este escenario se necesitan estudios más robustos, con tiempos de intervención y seguimiento más prolongados, como ensayos clínicos aleatorizados y controlados.


Subject(s)
Humans , Female , Hematopoietic Stem Cell Transplantation/adverse effects , Low-Level Light Therapy/methods , Genital Diseases, Female/radiotherapy , Graft vs Host Reaction/immunology
9.
Rev. Bras. Cancerol. (Online) ; 70(4): 054749, out-nov-dez. 2024.
Article in English, Spanish, Portuguese | LILACS, SES-SP | ID: biblio-1587004

ABSTRACT

ntrodução: O transplante de medula óssea é um tratamento essencial para pacientes com leucemia linfoblástica aguda (LLA) e leucemia mieloide aguda (LMA). A análise da distribuição demográfica e do tempo de acesso ao transplante fornece insights sobre as disparidades no tratamento dessas condições. Objetivo: Analisar a distribuição de pacientes com LLA e LMA e identificar fatores que influenciam o tempo de acesso ao transplante no Brasil entre 2016 e 2022. Método: Foram coletados 11.908 registros de pacientes do Redome-net, dos quais 1.129 pacientes transplantados foram incluídos na análise estatística. Foram utilizados o teste de Shapiro-Wilk para normalidade, Levene para homogeneidade, e os testes Kruskal-Wallis e Mann-Whitney para comparação de medianas, com um nível de significância de 95%. Foram analisadas variáveis como sexo, raça/cor, faixa etária, tipo de serviço e Estado. Resultados: A maioria dos pacientes era masculina (57%) e adulta (62%), com predominância de brancos (59%). Apenas 19% dos pacientes foram transplantados. Pacientes mais velhos e aqueles atendidos pelo sistema público apresentaram tempos medianos de espera mais longos. Diferenças significativas foram observadas entre os Estados, com o Paraná apresentando o menor tempo de espera. Conclusão: O estudo revelou disparidades regionais e sociodemográficas no tempo de acesso ao transplante de medula óssea no Brasil, destacando a necessidade de melhorias na infraestrutura de saúde e na equidade do acesso ao tratamento. Tais descobertas sublinham a importância de políticas de saúde para reduzir desigualdades e otimizar o tratamento para pacientes com leucemias agudas.


Introduction: Bone marrow transplantation is a crucial treatment for patients with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Analyzing demographic distribution and access time to transplantation provides insights into disparities in treating these conditions. Objective: To analyze the distribution of patients with ALL and AML and identify factors influencing the time to transplantation in Brazil between 2016 and 2022. Method: Data from 11,908 patient records from Redome-net were collected, with 1,129 transplanted patients included in the statistical analysis. Shapiro-Wilk test for normality, Levene's test for homogeneity, and Kruskal-Wallis and Mann-Whitney tests for median comparisons were used, with a 95% significance level. Variables such as sex, race/color, age group, type of service, and state were analyzed. Results: Most patients were male (57%) and adult (62%), with a predominance of White individuals (59%). Only 19% of the patients were transplanted. Older patients and those from the public system had longer median waiting times. Significant differences were observed between states, with Paraná showing the shortest waiting time. Conclusion: The study revealed regional and sociodemographic disparities in the time to bone marrow transplantation in Brazil. Older patients and those from the public system face longer waiting times, highlighting the need for improvements in healthcare infrastructure and equitable access to treatment. These findings emphasize the importance of health policies targeted to reduce inequalities and optimizing treatment for patients with acute leukemias


Introducción: El trasplante de médula ósea es un tratamiento crucial para pacientes con leucemia linfoblástica aguda (LLA) y leucemia mieloide aguda (LMA). Analizar la distribución demográfica y el tiempo de acceso al trasplante proporciona información sobre las disparidades en el tratamiento de estas condiciones. Objetivo: Analizar la distribución de pacientes con LLA y LMA e identificar los factores que influyen en el tiempo de acceso al trasplante en el Brasil entre 2016 y 2022. Método: Se recopilaron datos de 11 908 registros de pacientes del Redome-net, de los cuales 1129 pacientes trasplantados fueron incluidos en el análisis estadístico. Se utilizaron las pruebas de Shapiro-Wilk para normalidad, de Levene para homogeneidad y las de Kruskal-Wallis y Mann-Whitney para comparación de medianas, con un nivel de significación del 95%. Se analizaron variables como sexo/color, raza, grupo etario, tipo de servicio y estado. Resultados: La mayoría de los pacientes eran hombres (57%) y adultos (62%), con predominio de individuos blancos (59%). Solo el 19% de los pacientes fue trasplantado. Los pacientes mayores y aquellos del sistema público presentaron medianas de tiempo de espera más largas. Se observaron diferencias significativas entre los estados, siendo Paraná el que mostró el menor tiempo de espera. Conclusión: El estudio reveló disparidades regionales y sociodemográficas en el tiempo de acceso al trasplante de médula ósea en el Brasil. Los pacientes mayores y los del sistema público enfrentan tiempos de espera más largos, destacando la necesidad de mejoras en la infraestructura de salud y en el acceso equitativo al tratamiento. Estos hallazgos subrayan la importancia de políticas de salud enfocadas en reducir desigualdades y optimizar el tratamiento para pacientes con leucemias agudas.


Subject(s)
Humans , Male , Female , Leukemia, Myeloid, Acute , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma , Hematopoietic Stem Cell Transplantation/statistics & numerical data , Health Services Accessibility
10.
Rev. chil. infectol ; Rev. chil. infectol;40(6): 665-674, dic. 2023. tab, graf
Article in Spanish | LILACS | ID: biblio-1529997

ABSTRACT

INTRODUCCIÓN: Las infecciones fúngicas invasoras (IFI) en pacientes con neoplasias hematológicas (NH) representan un desafío diagnóstico y terapéutico. OBJETIVOS: Describir la etiología, características clínicas, diagnóstico y evolución de los episodios de IFI probadas y probables en pacientes con NH y trasplante de progenitores hematopoyéticos (TPH). PACIENTES Y MÉTODOS: Estudio descriptivo, retrospectivo y de cohorte que incluyó IFI probadas y probables en pacientes adultos con NH y TPH. Se realizó seguimiento hasta el día 90. RESULTADOS: Se incluyeron 80 episodios de IFI: 49% probadas y 51% probables, 67,5% por hongos filamentosos (HF), 30% por hongos levaduriformes (HL) y 2,5% por hongos dimorfos. Los tipos de IFI más frecuentes fueron aspergilosis invasoras pulmonares (AP) y candidiasis invasoras (CI), en su mayoría por Candida spp. no albicans. Todos los casos de AP se diagnosticaron por detección de galactomanano en sangre y/o lavado broncoalveolar, y solamente 22,2% presentaban nódulos con halo en la tomografía computada (TC) de tórax, siendo los infiltrados inespecíficos los hallazgos más frecuentes. Tuvieron coinfección bacteriana y viral el 30 y 17,5%, respectivamente. El 50% fueron IFI de brecha, y la mortalidad global y mortalidad relacionada a la IFI fue 51 y 24%, respectivamente. CONCLUSIÓN: Los HF fueron la principal causa de IFI, con una gran proporción de IFI de brecha, y presentaron elevada mortalidad. Para el diagnóstico, resulta importante la utilización de biomarcadores y jerarquizar cualquier imagen patológica en la TC.


BACKGROUND: Invasive fungal infections (IFI) in patients with hematological malignancies (HM) represent a diagnostic and therapeutic challenge. AIM: To describe the etiology, clinical characteristics, diagnosis and evolution of proven and probable IFI episodes in patients with HM and hematopoietic stem cell transplantation (HSCT). METHODS: Retrospective, descriptive, cohort study performed in adult patients with HM and HSCT, who developed proven and probable IFI. Follow-up was carried out until day 90. RESULTS: A total of 80 IFI episodes were included: 49% proven and 51% probable, 67,5% due to mold (M), 30% to yeast-like fungi (Y) and 2,5% to dimorphic fungi. The most frequent causes were probable pulmonary aspergillosis (PA) and invasive candidiasis (IC), mainly due to non-albicans Candida species. PA were all diagnosed by detection of galactomannan (GM) in blood and bronchoalveolar lavage, and only 22,2% presented halo sign on chest CT. Bacterial and viral coinfections were reported in 30% and 17,5% respectively. Breakthrough IFI occurred in 50%, and global and IFI-related mortality were 51% and 24% respectively. CONCLUSION: Mold was the main cause of IFI, with a large proportion of breakthrough IFI, presenting high mortality. The use of biomarkers and the classification of any pathological image on CT contribute to the diagnosis.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Hematologic Neoplasms/complications , Invasive Fungal Infections/diagnosis , Invasive Fungal Infections/etiology , Argentina , Clinical Evolution , Retrospective Studies , Risk Factors , Hematopoietic Stem Cell Transplantation/adverse effects , Hematologic Neoplasms/mortality , Invasive Fungal Infections/mortality , Invasive Fungal Infections/drug therapy , Hospitals, University , Antifungal Agents/therapeutic use
11.
Rev. Hosp. Ital. B. Aires (En línea) ; 43(4): 214-218, dic. 2023.
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1537605

ABSTRACT

La amiloidosis AL es una enfermedad debida al depósito, en órganos y tejidos, de fibrillas formadas por cadenas livianas producidas de forma patológica por plasmocitos clonales. Su tratamiento actualmente está orientado a erradicar el clon de células plasmáticas; este históricamente se extrapoló de tratamientos disponibles y estudiados para otras discrasias sanguíneas. En el año 2020, el Grupo de Estudio de Amiloidosis (GEA) confeccionó distintas guías de práctica clínica para el tratamiento de la amiloidosis AL. Desde entonces se han publicado ensayos clínicos que arrojan contundencia al conocimiento disponible hasta el momento, y están en desarrollo nuevas líneas de investigación que robustecen y estimulan el estudio en el área. En esta revisión se realiza una actualización de las guías existentes en lo que respecta al tratamiento de la amiloidosis por cadenas livianas.Como evidencia de relevancia, en el último año estuvieron disponibles resultados de ensayos clínicos que respaldan el uso de esquemas basados en daratumumab (un anticuerpo monoclonal anti-CD38+) para pacientes con diagnóstico reciente de amiloidosis AL como primera línea. Además, para el tratamiento de la amiloidosis AL refractaria o recaída, la disponibilidad de bibliografía respaldatoria es escasa y extrapolada del tratamiento del mieloma múltiple; sin embargo, actualmente existe evidencia de calidad para recomendar el uso de ixazomib, un inhibidor de proteosoma reversible por vía oral disponible en la Argentina desde 2020. Por último, se mencionan algunas líneas de investigación con otros anticuerpos monoclonales y terapéuticas basadas en el uso de CAR-T cells. (AU)


AL amyloidosis is a disease caused by the deposit in different organs and tissues of protein fibrils formed by light chains synthetized by pathological clonal plasma cells. Its treatment is currently aimed at eradicating this plasma cell clone and it has been historically extrapolated from available and validated treatments for other blood dyscrasias. In 2020, the Amyloidosis Study Group prepared different clinical practice guidelines for the treatment of AL amyloidosis.Since then, clinical trials have been published that confirm and strengthen the knowledge available up to now, and new lines of research are being developed that stimulate study in the area. In this review, an update of the existing guidelines regarding the treatment of AL amyloidosis is made. As relevant evidence, in the last year, results of clinical trials have been made available that support the use of regimens based on Daratumumab (an anti-CD38+ monoclonal antibody) for patients with newly diagnosed AL amyloidosis as first line therapy. In addition, for the treatment of refractory or relapsed AL amyloidosis, where the availability of supporting literature is scant and extrapolated from the treatment of multiple myeloma, there is currently quality evidence to recommend the use of ixazomib, an oral reversible proteasome inhibitor, only available in Argentina since 2020. Finally, some research lines exploring the efficacy of other monoclonal antibodies and therapeutic experiments based on the use of CAR-T cells are mentioned. (AU)


Subject(s)
Humans , B-Cell Maturation Antigen/therapeutic use , Immunoglobulin Light-chain Amyloidosis/therapy , Antibodies, Monoclonal/therapeutic use , Antineoplastic Agents/therapeutic use , Recurrence , Practice Guidelines as Topic , Hematopoietic Stem Cell Transplantation
12.
Rev. latinoam. enferm. (Online) ; 31: e3995, Jan.-Dec. 2023. tab, graf
Article in Spanish | LILACS, BDENF | ID: biblio-1515339

ABSTRACT

Objetivo: evaluar y correlacionar la calidad de vida y la toxicidad financiera de pacientes adultos sometidos a trasplante de células madre hematopoyéticas durante el período de la pandemia de COVID-19. Método: estudio observacional, analítico, realizado con 35 pacientes en un hospital de referencia para trasplante en Latinoamérica. Para la recolección de datos, se utilizaron los cuestionarios Functional Assessment Cancer Therapy Bone Marrow Transplantation y el COmprehensive Score for financial Toxicity. Para el análisis de los datos se utilizaron las pruebas de correlación de Spearman y Mann-Whitney. Resultados: la calidad de vida general durante la COVID-19 mostró un puntaje bajo (67,09/108) con mayor deterioro en el bienestar funcional (14,47/28), bienestar social (16,76/28) y preocupaciones adicionales (23,41/40). Los promedios del grupo alogénico fueron inferiores a los del grupo autólogo en todos los dominios, presentando diferencia significativa en relación a preocupaciones adicionales (p=0,01) y en el índice de evaluación del tratamiento (p=0,04). Se consideró que la toxicidad financiera tenía un impacto leve (22.11/44). Se observó una relación, aunque no significativa, entre la calidad de vida y la toxicidad financiera (p=0,051). Conclusión: la calidad de vida de la muestra fue baja; existe una correlación entre la calidad de vida y la toxicidad financiera, aunque no significativa. Cuanto mayor es la toxicidad financiera, menor es la calidad de vida.


Objective: to evaluate and correlate the quality of life and financial toxicity of adult patients undergoing hematopoietic stem cell transplantation during the COVID-19 pandemic. Method: observational, analytical study, carried out with 35 patients in a reference hospital for transplantation in Latin America. For data collection, the Functional Assessment Cancer Therapy Bone Marrow Transplantation and COmprehensive Score for Financial Toxicity questionnaires were used. Spearman and Mann-Whitney correlation tests were used for data analysis. Results: general quality of life during COVID-19 had a low score (67.09/108) with greater impairment in functional well-being (14.47/28), social well-being (16.76/28) and additional concerns (23.41/40). The means of the allogeneic group were lower than those of the autologous group in all domains, showing a significant difference in relation to additional concerns (p=0.01) and in the treatment evaluation index (p=0.04). Financial toxicity was considered to have a slight impact (22.11/44). There was a relationship, albeit not significant, between quality of life and financial toxicity (p=0.051). Conclusion: the quality of life of the sample was low; there is a correlation between quality of life and financial toxicity, although not significant. The higher the financial toxicity, the lower the quality of life.


Objetivo: avaliar e correlacionar a qualidade de vida e a toxicidade financeira dos pacientes adultos submetidos ao transplante de células-tronco hematopoéticas no período da pandemia de COVID-19. Método: estudo observacional, analítico, realizado com 35 pacientes em um hospital de referência para o transplante na América Latina. Para coleta de dados, utilizaram-se os questionários Functional Assessment Cancer Therapy Bone Marrow Transplantation e COmprehensive Score for financial Toxicity. Na análise dos dados empregaram-se os testes de correlação de Spearman e Mann-Whitney. Resultados: a qualidade de vida geral, durante a COVID-19, apresentou baixo escore (67,09/108), com maior comprometimento nas funções bem-estar funcional (14,47/28), social (16,76/28) e preocupações adicionais (23,41/40). As médias do grupo alogênico foram inferiores às do autólogo em todos os domínios, apresentando diferença significativa em relação às preocupações adicionais (p=0,01) e ao índice de avaliação do tratamento (p=0,04). A toxicidade financeira foi considerada de impacto leve (22,11/44). Observou-se relação, ainda que não significativa, entre a qualidade de vida e a toxicidade financeira (p=0,051). Conclusão: a qualidade de vida da amostra foi baixa, logo há uma correlação entre qualidade de vida e a toxicidade financeira, embora não significativa. Quanto maior a toxicidade financeira, menor a qualidade de vida.


Subject(s)
Humans , Adult , Quality of Life , Hematopoietic Stem Cell Transplantation/adverse effects , Financial Stress , COVID-19
13.
Rev. chil. infectol ; Rev. chil. infectol;40(5): 481-490, oct. 2023. ilus, tab
Article in Spanish | LILACS | ID: biblio-1521875

ABSTRACT

INTRODUCCIÓN: Las opacidades pulmonares en receptores de trasplante de precursores hematopoyéticos (TPH) representan un desafío diagnóstico y son una causa de morbimortalidad. Existen grandes discrepancias con respecto a la sensibilidad diagnóstica del lavado broncoalveolar (LBA), sus complicaciones, y los factores asociados a la identificación microbiológica. OBJETIVO: Conocer la utilidad del estudio microbiológico del LBA en el diagnóstico, modificación de la conducta médica y estimar las complicaciones y mortalidad asociada al procedimiento, en receptores de TPH con opacidades pulmonares. PACIENTES Y MÉTODOS: Estudio de cohorte, retrospectivo, en adultos receptores de TPH a los que se les realizó una broncoscopía con LBA por presentar opacidades pulmonares, en el Hospital Italiano de Buenos Aires entre el 01/01/2011 y el 31/12/2020. RESULTADOS: De los 189 procedimientos analizados, en 79 se logró un hallazgo microbiológico (41,8%) y 122 permitieron modificar la conducta médica (64,6%). En 11 casos se observaron complicaciones graves dentro de las 12 horas (5,8%) de efectuado el LBA. La mortalidad intrahospitalaria fue de 16,8% (N = 21/125). El valor de neutrófilos en sangre previo al LBA (p = 0,037) y la presencia de nódulos pulmonares como lesión tomográfica predominante (p = 0,029) se asociaron independientemente al hallazgo microbiològico global. CONCLUSIONES: Nuestra investigación apoya la realización del LBA como herramienta diagnóstica en pacientes que reciben un TPH y presentan opacidades pulmonares.


BACKGROUND: Lung opacities are a cause of morbimortality in bone marrow transplant patients, and represent a diagnostic challenge. There are large discrepancies regarding the diagnostic sensitivity of bronchoalveolar lavage (BAL), its complications, and the factors associated with microbiological detection. AIM: To know the usefulness of the microbiological study of BAL in the diagnosis, in the modification in medical behavior and to estimate the complications and associated mortality of this diagnostic procedure in patients transplanted with hematopoietic progenitor cells with pulmonary opacities. METHODS: Retrospective cohort study in bone marrow transplant adult patients who underwent bronchoscopy with BAL due to lung opacities at Hospital Italiano de Buenos Aires between 01/01/2011 and 12/31/2020. RESULTS: Of the 189 BAL analyzed, 79 presented a microbiological detection (41.8%) and 122 allowed to modify the medical behavior (64.6%). Severe complications were observed within 12 hours after the procedure in11 cases (5.8%). In-hospital mortality was 16,8% (N = 21/125). The value of blood neutrophils prior to bronchoalveolar lavage (p = 0.037) and the presence of pulmonary nodules as the predominant tomographic lesion (p = 0.029) were independently associated with global microbiological detection. CONCLUSION: Our research supports the performance of BAL as a diagnostic tool in bone marrow transplant patients with lung opacities.


Subject(s)
Humans , Male , Female , Middle Aged , Bronchoscopy/methods , Bronchoalveolar Lavage Fluid/microbiology , Hematopoietic Stem Cell Transplantation/adverse effects , Bronchoalveolar Lavage/methods , Hematologic Neoplasms/therapy , Bacteria/isolation & purification , Viruses/isolation & purification , Multivariate Analysis , Cohort Studies , Immunocompromised Host , Transplant Recipients , Fungi/isolation & purification , Lung/microbiology
14.
Rev. chil. infectol ; Rev. chil. infectol;40(4): 328-333, ago. 2023. tab, graf
Article in Spanish | LILACS | ID: biblio-1521844

ABSTRACT

INTRODUCCIÓN: La infección por citomegalovirus (CMV) sigue siendo la infección con relevancia clínica más frecuente luego del trasplante alogénico de progenitores hematopoyéticos (TPHa), presentando alta morbilidad y mortalidad. Por este motivo, es importante implementar estrategias de prevención para reducir la frecuencia de la infección por CMV. OBJETIVO: Describir la frecuencia de infección, infección clínicamente significativa (ICS) y enfermedad por CMV en pacientes seropositivos que recibieron un TPHa y profilaxis primaria con letermovir. PACIENTES Y MÉTODOS: Estudio descriptivo de cohorte longitudinal, en pacientes con TPHa seropositivos para CMV que recibieron profilaxis primaria con letermovir hasta el día 100 posTPH. RESULTADOS: Se incluyeron 25 pacientes adultos con una mediana de edad de 41 años, el 44% fue de donante no relacionado y 36% de donante haploidéntico. Ochenta por ciento tenía tres o más factores de riesgo para infección por CMV y a 52% se le estratificó como de alto riesgo para enfermedad por CMV. La profilaxis con letermovir tuvo una mediana de duración de 97 días. Durante los 100 días pos-TPH, 20% de los pacientes presentaron infección por CMV, con carga viral plasmática detectable no cuantificable, que se negativizó en el siguiente control semanal sin discontinuación del letermovir. Ningún paciente presentó ICS ni enfermedad por CMV durante este período. CONCLUSIÓN: La profilaxis con letermovir fue efectiva para prevenir la ICS y la enfermedad por CMV.


BACKGROUND: Cytomegalovirus (CMV) infection remains the most common clinically significant infection after allogeneic stem cell transplantation (aSCT), with a high morbidity and mortality rate. In order to reduce its frequency, prevention strategies should be implemented. AIM: To describe the frequency of infection, clinically significant infection (CSI) and CMV disease in seropositive patients who received aSCT and primary prophylaxis with letermovir. METHODS: Longitudinal descriptive cohort study in seropositive patients who received aSCT and primary prophylaxis with letermovir until day 100 post-SCT. RESULTS: Twenty-five adult patients with a median age of 41 years were included; 44% were unrelated donors, and 36% were haploidentical donors. Eighty percent had three or more risk factors for CMV infection, and 52% were stratified as high risk for CMV disease. Letermovir prophylaxis had a median duration of 97 days. Twenty percent of the patients developed CMV infection through day 100 post-SCT, with detectable non-quantifiable CMV viral load in plasma. This became negative in the following weekly control without discontinuation of letermovir. No patient developed CSI or CMV organ disease during this period. CONCLUSION: Letermovir prophylaxis proved to be effective in preventing CSI and CMV disease.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Antiviral Agents/administration & dosage , Cytomegalovirus Infections/prevention & control , Cytomegalovirus Infections/epidemiology , Hematopoietic Stem Cell Transplantation , Quinazolines/administration & dosage , Longitudinal Studies , Chemoprevention , Acetates/administration & dosage
15.
Hematol., Transfus. Cell Ther. (Impr.) ; 45(supl.2): S43-S50, July 2023. tab, graf
Article in English | LILACS | ID: biblio-1514204

ABSTRACT

ABSTRACT Introduction: Acute myeloid leukemia (AML) is most commonly presented in older adults; however, it appears 10 years earlier in Latin American countries. Clinical evolution in older adults from this populations has not been characterized. We analyzed outcomes and survival predictors. Methods: Patients ≥ 55 years old diagnosed with AML at a hematology referral center from 2005 to 2020 receiving intensive chemotherapy (IC), low-dose cytarabine (LDAC) and best supportive care (BSC) were included. Survival analysis included the Kaplan-Meier and Cox models and the cumulative incidence of relapse (CIR). Results: Seventy-five adults were included and the overall survival (OS) was 4.87, 1.67 and 1.16 months, using IC, LDAC and BSC, respectively. The IC led to a higher OS (p < 0.001) and was a protective factor for early death, at a cost of more days spent hospitalized and more non-fatal treatment complications; non-significant differences were found between the LDAC and BSC. Eight (10.7%) patients underwent hematopoietic cell transplantation, with a higher OS (p = 0.013). Twenty (26.7%) patients achieved complete remission; 12 (60%) relapsed with a 6-month CIR of 57.9% in those < 70 years old vs. 86.5% in those ≥ 70 years old, p = 0.034. Multivariate analysis showed the white blood cell count (WBC) and IC had a significant impact on the patient survival, whereas chronological age and the Charlson comorbidity index (CCI) did not. Conclusion: AML in low-middle income countries demands a different approach; the IC improves survival, even with a high incidence of relapse, and should be offered as first-line treatment. Eligibility criteria should include WBC and a multidimensional evaluation. The age per se and the CCI should not be exclusion criteria to consider IC.


Subject(s)
Humans , Middle Aged , Aged , Leukemia, Myeloid, Acute , Hematopoietic Stem Cell Transplantation , Cytarabine , Drug Therapy
19.
Online braz. j. nurs. (Online) ; Online braz. j. nurs. (Online);22(supl.1): e20236605, 03 fev 2023. ilus
Article in English | BDENF, LILACS | ID: biblio-1414695

ABSTRACT

OBJECTIVE: to assess the effectiveness and safety of the peripherally inserted central catheter for hematopoietic stem cell transplantation. METHOD: this review will follow the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and the search steps will be presented through the flow diagram. The search strategy aims to locate both published and unpublished studies. No time or language restrictions will be applied. The review will consider experimental and observational studies that include adult and pediatric patients undergoing hematopoietic stem cell transplantation. Patients using peripherally inserted central catheters will be compared with those using other central catheters.


Subject(s)
Catheterization, Peripheral , Hematopoietic Stem Cell Transplantation , Transplantation Conditioning
20.
J. Oral Diagn ; 8: e20230211, 01 out. 2023. ilus, tab
Article in English | LILACS, BBO | ID: biblio-1571929

ABSTRACT

Oral graft-versus-host disease (GVHD) and oral mucositis (OM) are important complications of hematopoietic stem cell transplantation (HSCT) that significantly impact the patient's quality of life. In this context, this study aimed to evaluate the profile of patients undergoing allogeneic HSCT, assessing oral GVHD and OM occurrence. Data from medical records of patients that underwent HSCT between 2019 and 2021 were collected. Patients over 18 years old, with diseases or conditions requiring HSCT, were included. A clinical examination was performed to evaluate the occurrence of GVHD and OM. A total of 47 patients undergoing HSCT were evaluated of which 34.04% developed GVHD, and of these 81.25% have had oral involvement. As for OM, it affected 82.97% of the patients, with grades 3 and 4 being more detected. The most frequent previous disease was acute myeloid leukemia, and most of these patients received a related type of transplant (84.61%), fully compatible (53.84%), with bone marrow as a source of stem cells (53.84%). Most patients received the myeloablative conditioning regimen (69.23%). Cyclosporine was the most immunosuppressive agent used for the GVHD prevention associated with methotrexate (76.92%). Oral GVHD and OM are frequent and debilitating oral complications of HSCT, which can compromise a patient's general health and overall survival. Early diagnosis is important for a quick start of treatment and to reduce the impact on the patient's prognosis. (AU)


Subject(s)
Humans , Adult , Middle Aged , Stomatitis , Transplantation Conditioning , Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Mucositis , Mouth
SELECTION OF CITATIONS
SEARCH DETAIL