Prevalence of PICC-related thrombosis in patients with hematological malignancies: a systematic review.

PURPOSE: To estimate the prevalence of peripherally inserted central catheter (PICC)-related venous thrombosis in patients with hematological malignancies. METHODS: A systematic review of observational studies that evaluated the occurrence of PICC-related venous thrombosis in children, adults, and older people with hematological malignancies was conducted. Searches were carried out on June 12th, 2023 on PubMed, CINAHL, Embase, Web of Science Core Collection, Scopus, and LILACS, and to gray literature on Google Scholar, and ProQuest Dissertations and Theses Global. Eligibility criteria were applied independently by two reviewers, first on the titles and abstracts on the Rayyan platform and then on the full text of eligible studies. Risk of bias was assessed by the JBI checklist. Data were summarized descriptively, and the meta-analysis was carried out using the MetaXL 5.3 software. The review followed JBI guidelines and PRISMA for reporting. RESULTS: In the 40 studies included, prevalence of PICC-related venous thrombosis was 9% in general, 9% in adults, and 6% in children with hematological malignancies. Most studies only evaluated cases of symptomatic thrombosis (n = 25; 64%). CONCLUSION: Patients with hematological malignancies using PICC have an estimated prevalence of PICC-related venous thrombosis of 9%, and this rate may be underestimated due to the consideration of mostly symptomatic cases.

Evaluation of secondary malignancies in a large series of mycosis fungoides.

BACKGROUND: An increased risk of Secondary Malignancies (SMs) in Mycosis Fungoides (MF) has been suggested previously. However, the relationship between this risk and the features of MF is not well-known. OBJECTIVE: To investigate the rate and types of SMs in a large cohort of MF patients focusing on the associated features of these patients. METHODS: The demographic features, subtype, and stage of MF, as well as the temporal relationship between the diagnosis of MF and the development of SMs were determined. Major clinical features of MF in this group were compared with MF patients without association of SMs. RESULTS: Among 730 MF patients with a mean follow-up period of 67.9 ± 52.4 months, 56 SMs were identified in a total of 52 (7.1%) patients. While 28.8% of patients were previously diagnosed with other malignancies, then subsequently had a diagnosis of MF, it was vice versa in 53.8% of patients. Most of the SM-associated MF patients had early-stage (80.7%) and classical type of MF (86.5%) without a significant difference from MF patients without association of SMs; 85.5% and 72.5%, respectively. The most commonly identified SMs were hematologic malignancies (64.3%) including lymphomatoid papulosis (n = 22), Hodgkin's lymphoma (n = 4), non-Hodgkin's lymphoma (n = 5), polycythemia vera (n = 2). Other most commonly associated malignancies were breast cancer (n = 4), prostate cancer (n = 3), renal cell carcinoma (n = 2), melanoma (n = 2), and Kaposi's sarcoma (n = 2). STUDY LIMITATIONS: A single tertiary dermatology center study with a retrospective design. CONCLUSION: Apart from the well-known lymphomatoid papulosis association, systemic hematological malignancies were also quite common in the large cohort of MF patients.

Evaluation of secondary malignancies in a large series of mycosis fungoides

Abstract Background An increased risk of Secondary Malignancies (SMs) in Mycosis Fungoides (MF) has been suggested previously. However, the relationship between this risk and the features of MF is not well-known. Objective To investigate the rate and types of SMs in a large cohort of MF patients focusing on the associated features of these patients. Methods The demographic features, subtype, and stage of MF, as well as the temporal relationship between the diagnosis of MF and the development of SMs were determined. Major clinical features of MF in this group were compared with MF patients without association of SMs. Results Among 730 MF patients with a mean follow-up period of 67.9 ± 52.4 months, 56 SMs were identified in a total of 52 (7.1%) patients. While 28.8% of patients were previously diagnosed with other malignancies, then subsequently had a diagnosis of MF, it was vice versa in 53.8% of patients. Most of the SM-associated MF patients had early-stage (80.7%) and classical type of MF (86.5%) without a significant difference from MF patients without association of SMs; 85.5% and 72.5%, respectively. The most commonly identified SMs were hematologic malignancies (64.3%) including lymphomatoid papulosis (n = 22), Hodgkin's lymphoma (n = 4), non-Hodgkin's lymphoma (n = 5), polycythemia vera (n = 2). Other most commonly associated malignancies were breast cancer (n = 4), prostate cancer (n = 3), renal cell carcinoma (n = 2), melanoma (n = 2), and Kaposi's sarcoma (n = 2). Study limitations A single tertiary dermatology center study with a retrospective design. Conclusion Apart from the well-known lymphomatoid papulosis association, systemic hematological malignancies were also quite common in the large cohort of MF patients.

Caracterización epidemiológica del Linfoma de Hodgkin en pacientes atendidos en el hospital de SOLCA - Guayaqui / Epidemiological characterization of Hodgkin lymphoma in patients treated at the SOLCA - Guayaquil

Introducción: El linfoma de Hodgkin es una enfermedad en la que se forman células malignas en el sistema linfático y que en los últimos años ha venido aumentando su presencia en la población. Objetivo: Caracterizar epidemiológicamente los linfomas de Hodgkin atendidos en el hospital de SOLCA - Guayaquil durante el periodo 2010-2021. Materiales y métodos: Se realizó un estudio de datos abiertos de diseño observacional, descriptivo, de corte transversal, de casos nuevos atendidos con linfoma de Hodgkin diagnosticados en el hospital de SOLCA Guayaquil, entre 2010 y 2021. Resultados: Las atenciones del linfoma de Hodgkin en el hospital de SOLCA Guayaquil fueron del 4 % en el 2010 y del 12 % en el 2021. Se tuvo sobre todo el linfoma de Hodgkin con esclerosis nodular, en hombres; los grupos etarios más frecuentes fueron hombres entre 0 y 19 años (37,7 %) y mujeres entre 20 y 29 años (45,3 %), procedentes de la provincia del Guayas. Conclusiones: Durante este periodo incrementaron las atenciones por linfoma de Hodgkin, en las que se observó más la esclerosis nodular en los pacientes, en hombres de 0 a 19 años y en mujeres de 20 a 39 años, similar al estándar de comportamiento de esta enfermedad

Introduction: Hodgkin lymphoma is a disease in which malignant cells form in the lymphatic system; its presence in the population has been increasing in recent years. Objective: Epidemiological characterization of the Hodgkin lymphomas treated at the SOLCA - Guayaquil hospital during the period 2010­2021. Material and methods: A study was carried out with open data from a cross-sectional observational descriptive design of the new cases of Hodgkin Lymphoma diagnosed and treated at the SOLCA - Guayaquil hospital between 2010 and 2021. Results: Hodgkin lymphoma care at the SOLCA - Guayaquil Hospital went from 4% in 2010 to 12% in 2021. Hodgkin lymphoma with nodular sclerosis was mostly observed in men; however, by age group, it was more frequent in men between 0 and 19 years old (37.7%) and in women between 20 and 29 years old (45.3%) from the Guayas province. Conclusions: During this period, Hodgkin lymphoma has garnered more attention due to an increase in nodular sclerosis cases observed in men aged 0 to 19 and women aged 20 to 39, which aligns with the standard behavior of this disease

The effect of oral dietary interventions on nutritional status and treatment tolerance in patients with hematologic neoplasms receiving chemotherapy: a systematic review.

CONTEXT: Adverse events from chemotherapy treatment affect food intake, nutritional status, and treatment tolerance in cancer patients. However, the effect of nutritional intervention in patients with hematologic neoplasms receiving chemotherapy remains unknown. OBJECTIVE: The aim of this systematic review was to evaluate the evidence on nutritional interventions on nutritional status, treatment tolerance, inflammatory markers, quality of life, and mortality in patients with hematologic neoplasms receiving chemotherapy. DATA SOURCES: The MEDLINE, LILACS, CINAHL, Web of Science, Embase, ICTRP, CENTRAL, and ClinicalTrials.gov databases were searched. Additional literature and the bibliographies of identified articles were also considered. DATA EXTRACTION: Randomized controlled trials in individuals with hematologic neoplasms receiving chemotherapy along with nutritional counseling and oral nutritional supplementation, and intake of supplementary food products, alone or in combination, were assessed as criteria of interest. The data were extracted independently by 2 researchers. The risk of bias was assessed through the Cochrane risk-of-bias tool (RoB 2). DATA ANALYSIS: Ten studies were included up to August 15, 2022 (updated in November of 2022). With regard to the outcomes, 4 studies assessed nutritional status and 2 studies showed a positive result of the intervention on some of the markers. Seven studies assessed certain markers of treatment tolerance and only 2 studies showed improvement in the outcome after the intervention. CONCLUSION: The studies that found positive results are quite different from each other in terms of intervention, study time, and design. More randomized controlled trials are needed to test different dietary interventions using placebo and blinding, when possible, and with reduced sample variability in individuals with hematologic neoplasms receiving chemotherapy. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42020196765.

Cycle threshold predicted mortality in a cohort of patients with hematologic malignancies infected with SARS-CoV-2 / El umbral de ciclado predijo la mortalidad en una cohorte de pacientes conneoplasias hematológicas infectados con SARS-CoV-2 / Microbiología clinica y enfermedades infecciosas

Abstract When a SARS-CoV-2 RT-qPCR test is performed, it may determine an indirect measureof viral load called cycle threshold (Ct). Respiratory samples with Ct <25.0 cycles are consideredto contain a high viral load. We aimed to determine whether SARS-CoV-2 Ct at diagnosis couldpredict mortality in patients with hematologic malignancies (lymphomas, leukemias, multiplemyeloma) who contracted COVID-19. We included 35 adults with COVID-19 confirmed by RT-qPCR performed at diagnosis. We evaluated mortality due to COVID-19 rather than mortalitydue to the hematologic neoplasm or all-cause mortality. Twenty-seven (27) patients survivedand 8 died. The global mean Ct was 22.8 cycles with a median of 21.7. Among the survivors,the mean Ct was 24.2, and the median Ct value was 22.9 cycles. In the deceased patients, themean Ct was 18.0 and the median Ct value was 17.0 cycles. Using the Wilcoxon Rank Sum test,we found a significant difference (p = 0.035). SARS-CoV-2 Ct measured in nasal swabs obtainedat diagnosis from patients with hematologic malignancies may be used to predict mortality.

Resumen Cuando se realiza una RT-qPCR para SARS-CoV-2, es posible determinar una medidaindirecta de la carga viral llamada umbral de ciclado (Ct). Las muestras respiratorias con Ct<25,0 ciclos se consideran de alta carga viral. Nos propusimos determinar si el Ct para SARS-CoV-2 al diagnóstico predice la mortalidad en pacientes con neoplasias hematológicas (linfomas,leucemias, mielomas) que contrajeron COVID-19. Incluimos 35 adultos con COVID-19 confirmadopor RT-qPCR al diagnóstico. Evaluamos la mortalidad por COVID-19, no la mortalidad por la neo-plasia hematológica o la mortalidad por cualquier causa. De los 35 pacientes, 27 sobrevivierony 8 fallecieron. El Ct global medio fue 22,8 ciclos con una mediana de 21,7 ciclos. Entre lossobrevivientes, el Ct medio fue 24,2 ciclos con una mediana de 22,9 ciclos. Entre los fallecidos,el Ct medio fue 18,0 y el Ct mediano fue 17,0 ciclos. Empleando la prueba de suma de rangosde Wilcoxon, encontramos una diferencia significative (p = 0,035). En pacientes con neoplasiashematológicas infectados con coronavirus, el Ct de SARS-CoV-2 medido en hisopados nasales almomento del diagnóstico podría ser utilizado para predecir la mortalidad.

Respuesta inmunológica a la vacunación y riesgo de COVID-19 en adultos con neoplasias hematológicas / Immunological response to vaccination and risk of COVID-19 in adults with hematological malignancies

Los pacientes con malignidades hematológicas tienen un riesgo más alto de hospitalización, admisión a cuidado crítico y muerte cuando contraen COVID-19. En este grupo se ha propuesto la vacunación y los refuerzos para disminuir el riesgo de complicaciones. Sin embargo, es posible ver una pobre respuesta humoral y celular a las vacunas. En esta revisión se presenta la evidencia sobre la respuesta a la vacunación, poniendo de presente algunas patologías y tratamientos que pueden disminuirla de forma significativa. Los pacientes con neoplasias hematológicas se deben considerar en riesgo de complicaciones, incluso después de haber sido vacunados de forma completa y haber recibido los refuerzos. Se debe mantener la vigilancia de forma estrecha después de haber sido vacunados y evaluar la posibilidad de otras estrategias (medicamentos, anticuerpos monoclonales) para la prevención o el manejo de COVID-19.

Patients with hematological malignancies have a higher risk of hospital admission, critical care and death when they suffer from COVID-19. In this group of patients, vaccination and boosters have been proposed to mitigate the risk of complications. However, it is possible to observe a diminished rate of humoral and cellular response. In this review, evidence is shown about the response to COVID-19 vaccination, considering some specific pathologies and treatments that can affect such response in a significant account. Patients with malignant neoplasm must be considered at risk of COVID-19 complications, even after a complete vaccine schedule and boosters. Surveillance must be maintained after vaccination over these patients and other strategies must be considered (drugs, monoclonal antibodies) for prevention and management of COVID-19.

Cycle threshold predicted mortality in a cohort of patients with hematologic malignancies infected with SARS-CoV-2.

When a SARS-CoV-2 RT-qPCR test is performed, it may determine an indirect measure of viral load called cycle threshold (Ct). Respiratory samples with Ct <25.0 cycles are considered to contain a high viral load. We aimed to determine whether SARS-CoV-2 Ct at diagnosis could predict mortality in patients with hematologic malignancies (lymphomas, leukemias, multiple myeloma) who contracted COVID-19. We included 35 adults with COVID-19 confirmed by RT-qPCR performed at diagnosis. We evaluated mortality due to COVID-19 rather than mortality due to the hematologic neoplasm or all-cause mortality. Twenty-seven (27) patients survived and 8 died. The global mean Ct was 22.8 cycles with a median of 21.7. Among the survivors, the mean Ct was 24.2, and the median Ct value was 22.9 cycles. In the deceased patients, the mean Ct was 18.0 and the median Ct value was 17.0 cycles. Using the Wilcoxon Rank Sum test, we found a significant difference (p=0.035). SARS-CoV-2 Ct measured in nasal swabs obtained at diagnosis from patients with hematologic malignancies may be used to predict mortality.

Descriptive analysis of Cycle Threshold in patients with hematologic malignancies infected with SARS-COV-2.

INTRODUCTION: SARS-CoV-2 has caused over 200 million documented infections, more than 4 million deaths, and unprecedented consequences worldwide. The cycle threshold (Ct), the number of amplification cycles required to obtain a product detectable through fluorescence during a quantitative RT-PCR test, is an indirect measurement of viral load. Patients with hematologic malignancies have an increased risk of death by the SARS-CoV-2. CASES PRESENTATION: We conducted a retrospective, observational, descriptive analysis of the Ct obtained from patients with history of hematologic malignancies who tested positive for SARS-CoV-2 in our hospital, from March 3rd, 2020, to August 17th, 2021. We used the mean Ct at diagnosis. 15 adults, with previous diagnosis of lymphomas, acute leukemias and chronic lymphocytic leukemia, were included. 9 of the 15 patients (60 %) developed pneumonia, 6 of them required supplementary oxygen and 5 mechanical ventilation. 5 patients died between 7-86 days from symptom onset. Ct was lower among the group of patients who died (15.5 cycles; SD= 2.28, CI95%= 9.17-21.86) compared with those who survived (20.2 cycles; SD= 8.87, CI95%= 13.9-26.6). Ct was also lower in the pneumonia group (18.2 cycles; SD= 2.28, CI95%= 12.98-23.51) than in the no-pneumonia group (19.3 cycles; SD= 4.11; CI95%= 8.73-29.9). DISCUSSION: Ct was lowest in severe forms of CoViD-19. Further studies with larger populations of patients with hematologic malignancies could establish the validity of Ct as a quantitative laboratory determination as a course-prediction and infectivity tool.

Introducción: SARS-CoV-2 ha causado más de 200 millones de infecciones documentadas, más de 4 millones de muertes, y consecuencias sin precedentes globalmente. El umbral de ciclado (Ct), número de ciclos de amplificación requerido para obtener un producto detectable durante una prueba cuantitativa de RT-PCR, es una medida indirecta de la carga viral. Los pacientes con enfermedades oncohematológicas tienen mayor riesgo de muerte por SARS-CoV-2. Presentación de casos: Realizamos un estudio observacional, retrospectivo y descriptivo de los valores de Ct obtenidos de pacientes con enfermedades oncohematológicas que resultaron positivos para SARS-CoV-2 en nuestro hospital, desde el 3 de marzo de 2020, hasta el 17 de agosto de 2021. Empleamos el Ct promedio al diagnóstico. Fueron incluidos 15 adultos, con diagnóstico de linfomas, leucemias agudas y leucemia linfocítica crónica. 9 pacientes (60 %) desarrollaron neumonía, 6 requirieron oxígeno suplementario y 5 ventilación mecánica. 5 murieron a los 7-86 días desde el inicio de síntomas. Ct fue menor entre los pacientes que murieron (15.5 ciclos; DS= 2.28, IC95%= 9.17-21.86), comparado con los que sobrevivieron (20.2 ciclos; DS= 8.87, IC95%= 13.9-26.6). La misma tendencia se observó en el grupo de los que desarrollaron neumonía (18.2 ciclos; DS= 2.28, IC95%= 12.98-23.51), comparado con lo que no tuvieron neumonía (19.3 ciclos; DS= 4.11; IC95%= 8.73-29.9). Discusión: El valor de Ct fue más bajo en las formas más graves de CoViD-19. Estudios adicionales con poblaciones mayores de pacientes con enfermedades oncohematológicas podrían establecer la validez de Ct como determinación cuantitativa de laboratorio útil como predictora de evolución e infectividad.

Screening for SARS-COV-2 Using RT-qPCR in Patients with Hematologic Neoplasms Receiving Chemotherapy.

It has been recommended that patients with leukaemias and lymphomas undergo universal screening for SARS-COV-2 using RT-qPCR before each treatment on the grounds of their high risk of experiencing severe forms of COVID-19. This raises a conflict with different recommendations which prioritise testing symptomatic patients. We found that among 56 RT-qPCR obtained in asymptomatic patients with hematologic neoplasms before chemotherapy administration, 2 (3.5%) were positive. A negative result did not exclude SARS-COV-2 infection in 1 patient (1.8%). It is unclear what the benefit of screening for SARS-COV-2 using RT-qPCR in patients with hematologic neoplasms who receive chemotherapy is.

Elements for assistance to patients with hematological malignancies to propose care lines: a scoping review / Elementos de asistencia a pacientes con neoplasias hematológicas para proponer líneas de atención: revisión de alcance / Elementos para assistência a pacientes com neoplasias hematológicas para propor linhas de cuidado: scoping review

ABSTRACT Objectives: to identify the elements for assistance to patients with hematological malignancies to propose a care line. Methods: this is a scoping review, anchored in the JBI theoretical framework, with searches carried out in April 2021, in eight electronic databases and 10 repositories of theses and dissertations. Results: the final sample consisted of 93 studies, and the main forms of assistance provided that can support a care line for this public were imaging tests, immunophenotyping, chemotherapy regimens, radiotherapy, infection management, assessment of nutritional status, maintenance of oral function, symptom management and screening for second malignancies. Conclusions: the elaboration of a care line for onco-hematologic patients is necessary, considering the complexity surrounding the diagnosis and treatment of hematologic malignancies, in addition to the difficulties that are imposed in relation to access and continuity of care in the network.

RESUMEN Objetivos: identificar los elementos para la asistencia a pacientes con neoplasias hematológicas para proponer una línea de atención. Métodos: se trata de una revisión de alcance, anclada en el marco teórico del JBI, con búsquedas realizadas en abril de 2021 en ocho bases de datos electrónicas y 10 repositorios de tesis y disertaciones. Resultados: la muestra final estuvo compuesta por 93 estudios, y las principales formas de asistencia brindadas que pueden sustentar una línea de atención a este público fueron pruebas de imagen, inmunofenotipificación, regímenes de quimioterapia, radioterapia, manejo de infecciones, evaluación del estado nutricional, mantenimiento de la función oral, manejo de síntomas y detección de segundas neoplasias malignas. Conclusiones: es necesario el desarrollo de una línea de atención al paciente oncohematológico, dada la complejidad que rodea al diagnóstico y tratamiento de las neoplasias hematológicas, además de las dificultades que se imponen en relación al acceso y continuidad de la atención en una red.

RESUMO Objetivos: identificar os elementos para assistência a pacientes com neoplasias hematológicas para propor uma linha de cuidado. Métodos: trata-se de uma scoping review, ancorada no referencial teórico do JBI, com buscas realizadas em abril de 2021 em oito bases de dados eletrônicas e 10 repositórios de teses e dissertações. Resultados: a amostra final foi composta por 93 estudos, e as principais formas de assistências prestadas que podem embasar uma linha de cuidado para esse público foram exames de imagem, imunofenotipagem, regimes quimioterápicos, radioterapia, gestão de infecções, avaliação do estado nutricional, manutenção da função oral, gerenciamento de sintomas e rastreio para segundas neoplasias. Conclusões: a elaboração de uma linha de cuidados para pacientes onco-hematológicos se faz necessária, tendo em vista a complexidade que cerca o diagnóstico e tratamento das neoplasias hematológicas, além das dificuldades que se impõem em relação ao acesso e continuidade do cuidado em rede.

Malignant hypercalcemia as the debut of acute lymphoblastic leukemia in a pediatric patient-a diagnostic and therapeutic approach: Case report.

Background: Hypercalcemia is a rare metabolic disorder in the pediatric population, with several differential diagnoses that resemble hematologic malignancies. In cases of severe hypercalcemia, therapeutic strategies other than hyperhydration, such as the use of bisphosphonates, have been described. Case presentation: We present the case of a previously healthy 12-year-old boy who was admitted to the emergency department due to fatigue, hypo-responsiveness, and progressively worsening poor appetite for the previous 19 days. Initial laboratory tests revealed severe hypercalcemia (total calcium: 19 mg/dl), hyperphosphatemia, elevated creatinine, and hyperuricemia. Management with hyperhydration and xanthine oxidase inhibitor (allopurinol) was provided. The patient was transferred to the pediatric intensive care unit where treatment with furosemide, systemic corticosteroid, and zoledronic acid was started. Metabolic, infectious, renal, and endocrinological causes were excluded. Follow-up paraclinical studies showed a progressive hematologic involvement with heterogeneous hypochromic microcytic anemia, thrombocytopenia, and elevated lactic dehydrogenase. Bone marrow aspiration and biopsy were performed, which confirmed the diagnosis of B-precursor acute lymphoblastic leukemia. Hypercalcemia was resolved 72 h after the application of bisphosphonates. Conclusion: Hypercalcemia as an oncological metabolic emergency in the onset of acute lymphoblastic leukemia is uncommon in children. The use of intravenous bisphosphonates is an effective therapy in the early resolution of the condition. We present the case of a 12-year-old patient with malignant hypercalcemia who responded favorably to the use of a single dose of bisphosphonates.

Pharmacokinetics of Vancomycin among Patients with Chemotherapy-Associated Febrile Neutropenia: Which Would Be the Best Dosing to Obtain Appropriate Exposure?

Previous research has determined that the required doses for treating febrile neutropenia with vancomycin are higher than the doses used conventionally. These recommendations have been made considering pharmacotherapeutic goals based on minimum concentration (Cmin) between 15-20 mg/L. This study was developed to evaluate dose recommendations based on the achievement of a target consisting of ratio of area under the curve over minimum inhibitory concentration (AUC24h/MIC) ≥400 in this population of individuals. This study was conducted in a referral hospital for cancer treatment, study participants received vancomycin doses of 1g every 12 h in 2-4-h infusions. Vancomycin was described by a two-compartment pharmacokinetic model with clearance dependent on the estimated glomerular filtration rate. Simulations were performed taking into account a reduced version of the model to establish the influence of controllable and non-controllable variables on the probability of achieving several PK-PD targets. A dose of 2.5g/day in patients with estimated glomerular filtration rate (eGFR) between 80 and 122mL/min/1.73m2 was adequate to achieve the pharmacotherapeutic target. A discrepancy was found between AUC-based and Cmin-based PK/PD indices, the former being affected by the dose and creatinine clearance while the latter highly influenced by the interval between doses.

Análise do desenvolvimento de alterações bucais em pacientes sob transplante de células-tronco hematopoiéticas e seus fatores de risco: um estudo de coorte / Analysis of the development of oral changes in patients undergoing hematopoietic stem cell transplantation and their risk factors: a cohort study

O transplante de células-tronco hematoiéticas (TCTH) pode causar efeitos adversos no meio ambiente bucal, podendo influenciar a resposta do paciente ao tratamento e, consequentemente, no prognóstico. Este estudo objetivou identificar as alterações bucais mais prevalentes durante o período de internação para a realização do TCTH, analisar o tempo de desenvolvimento destas alterações neste mesmo período, bem como os fatores inerentes ao paciente e ao TCTH associados ao desenvolvimento destas alterações. Tratou-se de um estudo observacional, longitudinal, do tipo coorte, realizado em 30 pacientes assistidos pelo setor de transplante de medula óssea em um hospital de referência no Rio Grande do entre dezembro de 2021 a junho de 2022. Os dados sobre o exame físico bucal, diagnóstico da desordem hematológica, o tipo de transplante, as comorbidades, os protocolos quimioterápicos e os fatores de risco individuais dos pacientes no período do TCTH obtidos foram submetidos a testes estatísticos para estimar o tempo de surgimento das alterações e associação de fatores de risco. A significância estatística adotada foi de 5%. Dos 30 pacientes selecionados, 56,7% eram do sexo masculino, mediana de 35 anos, no qual 93,3% desenvolveram alguma alteração bucal e 53,3% iniciaram o tratamento com algum fator de risco bucal. As desordens hematológicas mais frequentes foram as leucemias (mieloide e linfoide) e os mielomas múltiplos (23,3% cada). O FluBuMel foi o protocolo de condicionamento mais utilizado (46,7%). A alteração bucal mais frequente foi o edema de mucosa jugal (83,3%) seguida da mucosite oral (80%; grau 01 - 54,2%). O tempo de seguimento foi em média 23 dias e, foi verificado que no 5.º dia de internação a probabilidade do paciente estar livre de alterações bucais foi de 93,3%, com essa taxa diminuindo ao longo do tempo, atingindo 6,7% no 28.º dia. O protocolo Mel200 foi associado ao desenvolvimento mais precoce das alterações bucais (p=0,02), assim como o transplante do tipo autólogo (p=0,004). Nossos resultados sugerem que o tempo de surgimento das alterações bucais é influenciado pelo tipo de transplante e protocolo de condicionamento quimioterápico e, adicionalmente, reforçam que a presença de um cirurgiã-dentista na equipe influencia positivamente no controle da severidade das alterações bucais (AU).

Hematopoietic stem cell transplantation (HSCT) can cause adverse effects in the oral environment that can affect the patient's response to treatment and prognosis. Thereby, this study aimed to identify the most prevalent oral alterations during the period of hospitalization for the performance of HSCT, to analyze the development time of these alterations in this period, as well as the factors associated with the development of these alterations. It was an observational, longitudinal, cohort study, carried out on patients assisted by the bone marrow transplant sector in a main hospital in Rio Grande do Norte between December 2021 and June 2022. Data about oral physical examination, diagnosis of hematological disorder, type of transplant, comorbidities, chemotherapy protocols and oral risk factors of patients obtained during the HSCT period were submitted to statistics tests to estimate the time of oral changes' onset and association of risk factors. The statistical significance adopted was 5%. 57.7% of the 30 selected patients were male, with a median age of 35 years, where 93.3% developed some oral alteration and 53.3% started treatment with some individual risk factor. The most frequent neoplasms were leukemias (myeloid and lymphoid) and multiple myeloma (23.3% each). FluBuMel was the most commonly used conditioning protocol (46.7%). The most frequent oral alteration was buccal mucosa edema (83.3%) followed by oral mucositis (80%; grade 1­54.2%). The follow-up time was on average 23 days and it was found that on the 5th day of hospitalization, the probability of the patient being free of alterations was 93.3%, with this rate decreasing over time, reaching 6.7% on the 28th day. The Mel200 protocol is associated with earlier development of alterations (p=0.02), as well as autologous transplantation (p=0.004). The results suggest that the time of onset oral alterations is affected by the type of transplant and chemotherapy conditioning protocol and, additionally, reinforce that the alterations' severity are positively affected by the presence of a dentist in the team (AU).

Linfoma del tejido linfoide asociado a las mucosas en paciente con tiroiditis de Hashimoto / Mucosa-associated lymphoid tissue lymphoma in a patient with Hashimoto's thyroiditis

RESUMEN El linfoma del tejido linfoide asociado a las mucosas es una variedad poco común y recientemente descubierta del linfoma no Hodgkin. Suele presentarse en la sexta década de la vida, con un predominio del sexo femenino y en sitios como el tracto digestivo, pulmón, riñón, hígado, piel, y solo en el 2 % de los casos, en la glándula tiroides, donde en muchas ocasiones se asocia a la tiroiditis autoinmune de Hashimoto. Su evolución es favorable cuando se diagnostica en estadios iniciales de la enfermedad. Se presenta una paciente de 22 años, con una historia de trastornos endocrinos, perceptibles desde la adolescencia, a quien se le diagnosticó una tiroiditis de Hashimoto, sobre la que subyacía un linfoma del tejido linfoide asociado a las mucosas, y que evolucionó satisfactoriamente luego del tratamiento quirúrgico.

ABSTRACT Mucosa-associated lymphoid tissue lymphoma is a rare and recently discovered variant of non-Hodgkin's lymphoma. It usually occurs in the sixth decade of life, with a predominance of females and may be observed in sites such as the digestive tract, lung, kidney, liver, skin, and only in 2% of cases, in the thyroid gland, where in many occasions it is associated with Hashimoto's autoimmune thyroiditis. Its evolution is favorable when it is diagnosed in the initial stages of the disease. We present a 22-year-old female patient with a history of perceptible endocrine disorders since adolescence, who was diagnosed with Hashimoto's thyroiditis, underlying mucosa-associated lymphoid tissue lymphoma, and who evolved satisfactorily after surgical treatment.

Características y desenlace clínico de 30 pacientes con hemopatías malignas y COVID-19 en un hospital público regional / Features of COVID-19 infection among patients with hematological malignancies

BACKGROUND: COVID-19 infection can be especially severe in certain risk populations such as patients with hematologic malignancies. Aim: To describe the characteristics and clinical outcomes of a population of patients with hematologic malignancies and COVID-19. MATERIAL AND METHODS: Review of medical records of patients with COVID-19 and hematologic malignancies, treated in Hematology Service of a regional hospital in Chile, between April 1 and October 30, 2020. Demographic characteristics, chronic comorbidities and clinical characteristics related to the underlying disease and COVID-19 infection were recorded. Results: Thirty adults aged 17 to 73 years (67% men) with COVID-19 confirmed by RT-PCR, were evaluated. Forty percent had comorbidities, mainly hypertension (30%), obesity (27%) and diabetes (10%). Two thirds of cases came from a nosocomial outbreak and 77% were symptomatic. Half of the cases had mild disease and 20% required mechanical ventilation. Five patients (17%) died from COVID 19. Female sex, the presence of comorbidities and obesity were more common among deceased patients. Only 1 of 5 deceased patients were in complete remission. No differences were found in the mean survival according to requirement for intubation or the presence of complete remission. CONCLUSIONS: This population with hematologic malignancies and COVID-19 had special characteristics leading to a greater fatality rate which, in this series, does not increase with the use of mechanical ventilation.

Riesgo de infección en pacientes oncológicos colonizados por bacterias productoras de p-lactamasas de espectro extendido y enterobacterias productoras de carbapenemasas / Risk of infection in cancer patients colonized by extended expectrum p-lactamases and carbapenem producing Enterobacteriaceae

INTRODUCCIÓN: La prevalencia de microorganismos multirresistentes es un problema de salud pública que continúa creciendo a lo largo del mundo. Existe una población principalmente susceptible de ser colonizada y posteriormente infectarse, son los pacientes oncológicos. OBJETIVO: Identificar las características clínicas y patológicas de los pacientes oncológicos y su relación con la infección con microorganismos productores de BLEE y EPC. PACIENTES Y MÉTODOS: Se condujo un estudio retrospectivo y de carácter analítico entre el primero de enero de 2019 y el 30 de junio de 2020 en tres unidades hemato-oncológicas. RESULTADOS: Incluyó a 3.315 pacientes, de los cuales 217 (6,5%) se encontraban colonizados por microorganismos productores de BLEE y EPC; de éstos, 106/217 (48,8%) presentaron al menos un episodio de infección. El microorganismo más frecuentemente aislado fue Klebsiella pneumoniae, en 29/106 (27,4%). De los infectados, 18/106 (17%) presentaron infección por el mismo microorganismo colonizador. La mucositis (p = 0,002), edad mayor a 65 años (p = 0,041), hipoalbuminemia (p < 0,01), neutropenia (p < 0,01) y la presencia dispositivos invasivos (p < 0,01) demostraron una relación con el desarrollo de infección. CONCLUSIÓN: La presencia de hipoalbuminemia (OR 3,3, IC 1,5-7,1, p < 0,01), dispositivos invasivos (OR 5,8, IC 3.0-11,4, p < 0,01) y neutropenia (OR 4,1, IC 1,5-11,4, p < 0,01) predicen el desarrollo de infecciones.

BACKGROUND: The prevalence of multi-resistant microorganisms is a public health problem that continues to grow globally. There is a population that is mainly susceptible to being colonized and subsequently infected, and these are cancer patients. AIM: To identify the clinical and pathological characteristics of cancer patients and their relationship with infection with ESBL and CPE producing microorganisms. METHODS: A retrospective and analytical study was conducted between January 1, 2019 and June 30, 2020 in three hematooncological units. RESULTS: We included 3315 patients of which 217 (6.5%) were colonized by microorganisms producing ESBL and CPE. Of these, 106/217 (48.8%) had at least one episode of infection. The most frequently isolated microorganism was Klebsiella pneumoniae 29/106 (27.4%). Of those infected, 18/106 (17%) presented infection by the same colonizing microorganism. Mucositis (p = 0.002), age over 65 years (p = 0.041), hypoalbuminemia (p < 0.01), neutropenia (p < 0.01) and the presence of invasive devices (p < 0.01) demonstrated a relationship with development of infection. The presence of hypoalbuminemia (OR 3.3, CI 1.5-7.1, P < 0.01), invasive devices (OR 5.8, CI 3.0-11.4, p < 0.01) and neutropenia (OR 4.1, CI 1.5-11.4, p < 0.01) predict the development of infections.

Prevention of venous thromboembolism in hematologic neoplasms: an expert consensus from SEHH-SETH.

Venous thromboembolism (VTE) is a serious complication in hematologic neoplasms, so finding adequate prevention strategies is an urgent requirement. However, prospective studies with large enough cohorts are scarce, limiting the development of evidence-based thromboprophylaxis guidelines. The present position paper is addressed to all hematologists treating patients affected by hematologic neoplasms with the aim to provide clinicians with a useful tool for the prevention of VTE.

Unstimulated salivary flow and oral streptococci in pediatric patients with hematological tumors: A longitudinal study.

AIMS: To evaluate the unstimulated salivary flow (USF) and salivary colonization of total Streptococcus spp. (TS) and mutans-group (MS) in pediatric patients with hematological tumors. Correlations of salivary and microbiological changes with chemotherapy and patient-related factors were also verified. METHODS AND RESULTS: Eligible children (n = 31) were evaluated before (control) and after (2, 5, and 10-weeks) the chemotherapy protocol was applied. Saliva samples were collected by the traditional spitting method to determine the USF (ml/min). Salivary TS and MS were determined by colony-forming units (CFU ) counts in a selective medium. The caries experience was evaluated by DMFT/dmft indexes. Data were submitted to Student's t-test, one-way ANOVA, and correlation tests (α = 0.05). The USF rate at baseline was 0.89 (±0.73) ml/min with up to 20% reduction during the follow-up and did not differ statistically during chemotherapy (p  > .05). Chemotherapy did not modify the salivary TS load (p > .05), but induced a dysbiotic shift with higher MS counts (∼ 5 fold-increase) at 10-weeks (p < .05). There is a correlation of USF with age (r = .390) and SM load with caries experience (rs  = -.540) at 5-weeks. CONCLUSION: Chemotherapy may promote a specific increase of mutans-group streptococci without changing the Streptococcus spp. load and unstimulated saliva flow. Correlation reinforced the need for further enlightenment about the chemotherapy mechanisms in the salivary and microbiological parameters.

Effects of glucocorticoids on interstitial glucose concentrations in individuals with hematologic cancer and without known diagnosis of diabetes: a pilot study

ABSTRACT Objective To analyze interstitial glucose behavior during glucocorticoid use in non-diabetic patients receiving chemotherapy for hematologic malignancies. Methods Prospective pilot study carried out to assess interstitial glucose levels in 15 non-diabetic individuals with hematologic malignancies who received glucocorticoids in combination with chemotherapy. The FreeStyle Libre flash monitoring system (Abbott Diabetes Care) was used for up to 14 days to measure interstitial glucose. Results Median age and body mass index were 53 (42-61) years and 25 (23-28) kg/m2 respectively. Interstitial glucose levels >180mg/dL lasting at least one hour were detected in 60% of participants. Interstitial glucose profile parameters (median and peak interstitial glucose levels and percentage of time during which interstitial glucose levels were >180mg/dL) were significantly (p<0.01) higher during glucocorticoid use (115mg/dL, 218mg/dL and 10% respectively) than after glucocorticoid discontinuation (97mg/dL, 137mg/dL and 0% respectively). Mean interstitial glucose levels increased in the afternoon and at night during glucocorticoid use. Conclusion This pilot study was the first to evaluate interstitial glucose levels in non-diabetic individuals using glucocorticoids in treatment of hematologic cancer. Glucocorticoid use during chemotherapy significantly increases interstitial glucose levels in these patients.