Current treatment preferences in acute myeloid leukemia: a survey in Brazil

ABSTRACT Introduction:: Most adults with acute myeloid leukemia (AML) will eventually relapse from their disease. The combination of 7-day cytarabine and an anthracycline on days 1-3 (the so called "7 + 3" regimen) can be considered standard of care of younger patients with AML. However, the treatment of the elderly ineligible for intensive chemotherapy remains a challenge. Low-dose of subcutaneous cytarabine or hypomethylating agents (HMA) have been studied this group. There are no studies investigating physician practice variation in treating AML in Brazil. Methods:: We developed a survey with ten questions in order to explore the approach to AML in Brazil. Results:: The sample size comprised 100 hematologists. Most reported regular (63%) or occasional (29%) treatment of AML patients. Karyotype analysis and polymerase chain reaction were available in 88% and 71% of institutions, respectively. Next generation sequencing analysis was used in 7% of instituitions. Younger patients receive the "7 + 3" protocol with continuous infusion of cytarabine and anthracycline in 98% of cases. The preferred anthracycline is daunorubicin (64%), followed by idarubicin (34%). The most prescribed daunorubicin dose was 60 mg/m2 (56%). Consolidation after CR with high cytarabine doses (HIDAC) was indicated by 84% of hematologists and 70% use 3 g/m2 twice a day for 3 days. Elderly and unfit patients received HMA (47%) as the preferred treatment. Conclusion:: We showed that the most prevalent AML treatments were according to current guidelines. There is room to improve on the availability of diagnostic tools and the capacity to perform bone marrow transplantation.

Current treatment preferences in acute myeloid leukemia: a survey in Brazil.

INTRODUCTION: Most adults with acute myeloid leukemia (AML) will eventually relapse from their disease. The combination of 7-day cytarabine and an anthracycline on days 1-3 (the so called "7 + 3" regimen) can be considered standard of care of younger patients with AML. However, the treatment of the elderly ineligible for intensive chemotherapy remains a challenge. Low-dose of subcutaneous cytarabine or hypomethylating agents (HMA) have been studied this group. There are no studies investigating physician practice variation in treating AML in Brazil. METHODS: We developed a survey with ten questions in order to explore the approach to AML in Brazil. RESULTS: The sample size comprised 100 hematologists. Most reported regular (63%) or occasional (29%) treatment of AML patients. Karyotype analysis and polymerase chain reaction were available in 88% and 71% of institutions, respectively. Next generation sequencing analysis was used in 7% of instituitions. Younger patients receive the "7 + 3" protocol with continuous infusion of cytarabine and anthracycline in 98% of cases. The preferred anthracycline is daunorubicin (64%), followed by idarubicin (34%). The most prescribed daunorubicin dose was 60 mg/m2 (56%). Consolidation after CR with high cytarabine doses (HIDAC) was indicated by 84% of hematologists and 70% use 3 g/m2 twice a day for 3 days. Elderly and unfit patients received HMA (47%) as the preferred treatment. CONCLUSION: We showed that the most prevalent AML treatments were according to current guidelines. There is room to improve on the availability of diagnostic tools and the capacity to perform bone marrow transplantation.

Púrpura trombocitopênica trombótica: apresentaçäo de quatro casos / Thrombotic thrombocytopenic purpura: report of 4 cases

Apresenta-se uma revisäo da literatura e a descriçäo dos casos. Relatam-se os métodos diagnósticos e a terapêutica instituída. Alerta-se para a necessidade de levantar a suspeita da doença em mulher com quadro de confusäo mental e manifestaçöes hemorrágicas, pois somente o tratamento precoce oferece alguma possibilidade de êxito. Recomenda-se iniciá-lo por transfusäo de substituiçäo, passando à plasmaferese e à pulsoterapia pelos glicocorticóides

Tricoleucemia: tratamento com alfa-interferon; relato de dois casos

Säo relatados dois casos de tricoleucemia, tratados com sucesso com interferon alfa recombinante. Um paciente havia sido esplenectomizado, com melhora transitória das citopenias, e o outro recebeu interferon como primeira forma de tratamento. Ambos desenvolveram infecçöes graves no curso de suas enfermedades e obtiveram remissäo completa, sete e oito meses após o início do interferon, respectivamente. A tentativa da retirada da droga em um paciente resultou em recaída três meses após, com pronta recuperaçäo com a sua reinstituiçäo. É feita uma revisäo do uso de interferon na tricoleucemia e os critérios de remissäo e retirada da medicaçäo säo comentadas

Leucemia linfoblástica aguda: análise e resultados terapêuticos em 21 casos em populaçäo näo-pediátrica / Acute lymphoblastic leukemia: report of 21 cases in non-pediatric population

Säo analisados os parâmetros clínicos e hematológicos de 21 casos de leucemia linfóide aguda acompanhadas no período de maio de 1979 a março de 1983. O índice de remissäo completa obtido foi de 60%. A percentagem de recaídas até a presente data é de 33,3%. Procurando melhorar estes índices, é proposto um protocolo mais agressivo, incluindo uma intensificaçäo precoce e modificaçäo no esquema de manutençäo, obedecendo à atual orientaçäo seguida pelos principais grupos cooperativos que vêm se dedicando ao problema da LLA no adulto