RESUMO
The Hodgkin lymphoma International Study for Individual Care (HoLISTIC) Consortium's A-HIPI model, developed in 2022 for advanced-stage classical Hodgkin lymphoma (cHL), predicts survival within 5 years amongst newly diagnosed patients. This study validates its performance in the Brazilian Hodgkin lymphoma registry. By 2022, the Brazilian HL registry included 1357 cHL patients, with a median 5-year follow-up. Probabilities for 5-year progression-free survival (PFS) and overall survival (OS) were calculated using A-HIPI-model equations. Discrimination (Harrell C-statistic/Uno C-statistic) and calibration measures assessed external validation and calibration. Lab values beyond the allowed range were excluded, mirroring the initial A-HIPI analysis. A total of 694 advanced-stage cHL patients met the original inclusion criteria (age 18-65 years, Stage IIB-IV). Median age was 31 years; 46.3% were females. Stage distribution was IIB (33.1%), III (27.4%), IV (39.5%). Bulky disease in 32.6%. Five-year PFS and OS were 68.4% and 86.0%, respectively. Harrell C-statistics were 0.60 for PFS and 0.69 for OS, and Uno C-statistics were 0.63 for PFS and 0.72 for OS. Calibration plots demonstrated well-calibrated predictions with calibration slopes of 0.91 and 1.03 for 5-year OS and PFS, respectively. Despite differing patient, clinical characteristics, and socioeconomic factors, the baseline prediction tool performed well in the Brazilian cohort, demonstrating adequate discrimination and calibration. This supports its reliability in diverse settings.
RESUMO
Paciente de 16 anos, sexo masculino, com vírus da imunodeficiência humana (HIV) negativo e sem doença hematológica prévia, desenvolveu anemia acentuada devido à infecção por parvovírus B19. A doença apresentou evolução bifásica, com acalmia clínica e retorno dos sintomas após 15 dias. Ao exame físico, apresentava-se descorado e febril, sem adeno e organomegalias, com sinais de insuficiência cardíaca. O aspirado de medula óssea mostrava megaloblastos com nucléolos aberrantes e, na histologia, foram observadas células gigantes com nucleolação aberrante e presença do corpúsculo de inclusão nuclear típico da parvovirose. O exame de imuno-histoquímica mostrou positividade para anticorpo específico para parvovírus. A sorologia comprovou a infecção.
A 16-year-old human immunodeficiency virus (HIV) negative male patient without hematological disease developed acute anemia due to parvovirus B19 infection. The disease showed a biphasic evolution: clinical remission and return of symptoms after 15 days. Physical examination revealed paleness and fever, neither adeno nor organomegalies, and signs of heart failure. The bone marrow aspiration showed megaloblasts with aberrant nucleoli. As far as histology is concerned, giant cells with aberrant nucleoli and the presence of intranuclear inclusions typical of Parvoviruses were observed. Immunohistochemistry revealed positivity for specific Parvovirus antibody. Serology confirmed parvovirus B19 infection.