RESUMO
In previous observational studies, we have separately characterized patients with multiple myeloma (MM) both from Latin America (LA) and from Asia. Here, we analyze these two datasets jointly, in order to assess the overall survival (OS) in these two world regions. Data were available from 3664 patients (1968 from LA and 1696 from Asia); all of whom diagnosed between 1998 and 2007. Approximately, 26% of patients in both world regions underwent transplantation. OS (from diagnosis of MM) was explored with Kaplan-Meier analyses and Cox proportional hazards models. Patients from LA were significantly younger and had hypercalcemia more often than Asian patients, who in turn had higher proportions of anemia and International Staging System (ISS) stage III disease. The median OS was 56 months in LA, and 47 months in Asia (hazard ratio [HR] = 0.83; 95% confidence interval [CI], 0.76 to 0.91; P < 0.001). In multivariable analysis, age, ISS stage III, anemia, hypercalcemia, and world region remained significantly associated with OS (P < 0.001 for all covariates). These results were largely driven by patients not undergoing transplantation, as no difference in OS emerged between the two world regions in univariable or multivariable analysis for transplanted patients. Despite adverse prognostic features differentially favoring each region, and adjusting for such differences, we found an OS advantage for patients from LA, in comparison with contemporaneous patients from Asia. Whether this is due to different biological features, differences in access to novel agents (especially thalidomide in earlier periods of the study), unmeasured confounders, or the play of chance, remain unknown.
Assuntos
Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/terapia , Sistema de Registros , Idoso , Ásia/epidemiologia , Intervalo Livre de Doença , Feminino , Humanos , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Taxa de SobrevidaRESUMO
Tyrosine kinase inhibitors (TKIs) have dramatically changed the survival of chronic myeloid leukemia (CML) patients, and treatment-free remission (TFR) has recently emerged as a new goal of CML treatment. The aim of this work was to develop recommendations for TKI discontinuation in Latin America (LA), outside of clinical trials. A working group of CML experts from LA discussed 22 questions regarding TFR and reached a consensus for TFR recommendations in the region. TFR is indicated in patients in first chronic phase, with typical BCR-ABL transcripts, under TKI treatment of a minimum of 5 years, in sustained deep molecular response (DMR; molecular response 4.5 [MR4.5]) for 2 years. Sustained DMR must be demonstrated on at least 4 international reporting scale quantitative polymerase chain reaction (PCR) tests, separated by at least 3 months, in the immediate prior 2 years. After second-line therapy, TFR is indicated in previously intolerant, not resistant, patients. Molecular monitoring is recommended monthly for the first 6 months, every 2 to 3 months from months 7 to 12, and every 3 months during the second year, indefinitely. Treatment should be reintroduced if major molecular response is lost. Monitoring of withdrawal syndrome, glucose levels, and lipid profile is recommended after discontinuation. After TKI reintroduction, molecular monitoring is indicated every 2 to 3 months until MR4.0 achievement; later, every 3 to 6 months. For the TFR attempt, having standardized and reliable BCR-ABL PCR tests is mandatory. These recommendations will be useful for safe discontinuation in daily practice and will benefit patients who wish to stop treatment in emergent regions, in particular, with TKI-related chronic adverse events.
Assuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva , Inibidores de Proteínas Quinases , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , Reação em Cadeia da Polimerase , Inibidores de Proteínas Quinases/uso terapêutico , Recidiva , Indução de RemissãoRESUMO
This observational, multicenter study aimed to report the clinical evolution of COVID-19 in patients with chronic myeloid leukemia in Latin America. A total of 92 patients presented with COVID-19 between March and December 2020, 26% of whom were severe or critical. The median age at COVID-19 diagnosis was 48 years (22-79 years), 32% were 60 years or older, and 61% were male. Thirty-nine patients presented with at least one comorbidity (42.3%). Eighty-one patients recovered (88%), and 11 (11.9%) died from COVID-19. There was one case of reinfection. Patients with a major molecular response presented superior overall survival compared to patients with no major molecular response (91 vs. 61%, respectively; p = 0.004). Patients in treatment-free remission and receiving tyrosine kinase inhibitors showed higher survival rates than patients who underwent hematopoietic stem cell transplantation and those who did not receive tyrosine kinase inhibitors (100, 89, 50, and 33%, respectively; p < 0.001).
Assuntos
COVID-19 , Leucemia Mielogênica Crônica BCR-ABL Positiva , Teste para COVID-19 , Humanos , América Latina/epidemiologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/diagnóstico , Leucemia Mielogênica Crônica BCR-ABL Positiva/epidemiologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Masculino , SARS-CoV-2RESUMO
OBJECTIVE: To inspect and describe the results of tracheotomies carried out at our ENT Department and to assess changes in indications over the last few decades. MATERIAL AND METHODS: Retrospective study of 13 patients, aged 3 months to 14 years, admitted by the ENT Department to the Paediatric ICU at Puerta del Mar University Hospital for elective tracheotomy over a 92-month period. RESULTS: The main indication is shared by obstructive respiratory insufficiency, post-surgery extubation failure and as a means of assisting ventilation in children requiring prolonged intubation. CONCLUSIONS: In the last 30 years the indications for paediatric tracheotomy have changed and the number of children needing intubation for more than 20-30 days has increased. It is no longer an emergency procedure to overcome a blockage in the upper airways but has instead become a technique for maintaining assisted ventilation for the medium to long term.
Assuntos
Insuficiência Respiratória/cirurgia , Traqueotomia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Respiração Artificial , Insuficiência Respiratória/epidemiologia , Estudos Retrospectivos , Traqueotomia/métodos , Traqueotomia/normas , Traqueotomia/estatística & dados numéricosAssuntos
Basquetebol/lesões , Laringe/lesões , Enfisema Mediastínico/etiologia , Pneumopericárdio/etiologia , Ferimentos não Penetrantes/complicações , Adulto , Bandagens Compressivas , Tosse/etiologia , Dispneia/etiologia , Humanos , Laringe/diagnóstico por imagem , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Pneumopericárdio/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
No disponible
Assuntos
Adulto , Humanos , Masculino , Laringe/lesões , Pneumopericárdio/diagnóstico , Enfisema Mediastínico/diagnóstico , Radiografia TorácicaRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Leishmaniose Mucocutânea/diagnóstico , Leishmania/patogenicidade , Leucoplasia Oral/diagnóstico , Doenças da Laringe/diagnóstico , Diagnóstico DiferencialRESUMO
Objetivo: Revisar y describir los resultados de traqueotomías de nuestra unidad de otorrinolaringología y evaluar cambios producidos en las indicaciones en las últimas décadas. Material y métodos: Estudio retrospectivo de 13 pacientes con traqueotomía electiva en la Unidad Clínica de ORL del Hospital Universitario Puerta del Mar, admitidos en UCI pediátrica, de 3 meses a 14 años, durante 92 meses. Resultados: Las principales indicaciones son la insuficiencia respiratoria obstructiva, la imposibilidad de extubación posquirúrgica y el soporte para ventilación asistida en niños con afecciones que precisaban intubación prolongada. Conclusiones: En los últimos 30 años se han producido cambios en las indicaciones de traqueotomía infantil, y el número de niños que precisan intubación prolongada más de 20-30 días ha aumentado. La traqueotomía infantil ha dejado de ser un procedimiento de emergencia que salva una obstrucción de la vía aérea superior para convertirse en una forma de acceso a la vía respiratoria para mantener la ventilación asistida a medio-largo plazo
Objective: To inspect and describe the results of tracheotomies carried out at our ENT Department and to assess changes in indications over the last few decades. Material and methods: Retrospective study of 13 patients, aged 3 months to 14 years, admitted by the ENT Department to the Paediatric ICU at Puerta del Mar University Hospital for elective tracheotomy over a 92-month period. Results: The main indication is shared by obstructive respiratory insufficiency, post-surgery extubation failure and as a means of assisting ventilation in children requiring prolonged intubation. Conclusions: In the last 30 years the indications for paediatric tracheotomy have changed and the number of children needing intubation for more than 20-30 days has increased. It is no longer an emergency procedure to overcome a blockage in the upper airways but has instead become a technique for maintaining assisted ventilation for the medium to long term