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2.
J Glob Oncol ; 5: 1-19, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31774711

RESUMO

PURPOSE: Limited information is available on multiple myeloma (MM), chronic lymphocytic leukemia (CLL), and non-Hodgkin lymphoma (NHL) management in Latin America. The primary objective of the Hemato-Oncology Latin America (HOLA) study was to describe patient characteristics and treatment patterns of Latin American patients with MM, CLL, and NHL. METHODS: This study was a multicenter, retrospective, medical chart review of patients with MM, CLL, and NHL in Latin America identified between January 1, 2006, and December 31, 2015. Included were adults with at least 1 year of follow-up (except in cases of death within 1 year of diagnosis) treated at 30 oncology hospitals (Argentina, 5; Brazil, 9; Chile, 1; Colombia, 5; Mexico, 6; Panama/Guatemala, 4). RESULTS: Of 5,140 patients, 2,967 (57.7%) had NHL, 1,518 (29.5%) MM, and 655 (12.7%) CLL. Median follow-up was 2.2 years for MM, 3.0 years for CLL, and 2.2 years for NHL, and approximately 26% died during the study observation period. Most patients had at least one comorbidity at diagnosis. The most frequent induction regimen was thalidomide-based chemotherapy for MM and chlorambucil with or without prednisone for CLL. Most patients with NHL had diffuse large B-cell lymphoma (DLBCL; 49.1%) or follicular lymphoma (FL; 19.5%). The majority of patients with DLBCL or FL received rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. CONCLUSION: The HOLA study generated an unprecedented level of high-quality, real-world evidence on characteristics and treatment patterns of patients with hematologic malignancies. Regional disparities in patient characteristics may reflect differences in ethnoracial identity and level of access to care. These data provide needed real-world evidence to understand the disease landscape in Latin America and may be used to inform clinical and health policy decision making.


Assuntos
Leucemia Linfocítica Crônica de Células B/epidemiologia , Linfoma não Hodgkin/epidemiologia , Mieloma Múltiplo/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , América Latina/epidemiologia , Pessoa de Meia-Idade , Sistema de Registros , Adulto Jovem
3.
Int J Lab Hematol ; 41(4): 536-541, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31066993

RESUMO

INTRODUCTION: Flow cytometry (FC) is a helpful tool for the diagnosis of myelodysplastic syndrome (MDS). Different FC score systems have been developed. The "Ogata score" is a simple diagnostic score that has been validated having a sensitivity of 69% and a specificity of 92% in low-risk MDS. We aimed to study the feasibility and the utility of the "Ogata score" for the diagnosis of MDS among Latin America (LA) Laboratories. METHODS: This is a case and control study conducted in LA institutions members of Grupo Latinoamericano de Mielodisplasia (GLAM). A total of 146 MDS patients and 57 control patients were included. "Ogata score" was calculated. RESULTS: The sensitivity of "Ogata score" was 75.6% (95% CI, 66.8-81.3), specificity was 91.2% (95% CI, 79.7-96.7), PPV was 95.6% (95% CI, 88.5-98.3), and NPV was 65.4% (95% CI, 49.1-71.9). In low/intermediate-1 IPSS patients group, the sensitivity was 70.1% (95% CI, 60.2-78.2), specificity was 91.2% (CI-95%, 79.7-96.7), PPV was 94.2% (95% CI, 86.4-97.8), and NPV was 62.1% (95% CI, 53.0-78.7). In the group of patients "without MDS specific markers" (patients without ring sideroblasts, blast excess, or chromosomal abnormalities), the sensitivity was 66.7% (CI-95%, 55.8-76.0), specificity was 91.2% (95% CI, 79.7-96.7), PPV was 92.3% (95% CI, 82.2-97.1), and NPV was 63.5% (95% CI, 51.9-73.5). CONCLUSIONS: The diagnostic power found in this study was similar to the reported by Della-Porta et al. Also in LA, the analysis was made in modern equipment with acquisition of at least 100 000 events which permits a good reproducibility of the results.


Assuntos
Citometria de Fluxo , Síndromes Mielodisplásicas/sangue , Síndromes Mielodisplásicas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , América Latina , Masculino , Pessoa de Meia-Idade
4.
Clin Lymphoma Myeloma Leuk ; 17(11): 743-752.e5, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28797621

RESUMO

BACKGROUND: A large group of patients with myelodysplastic syndromes (MDS) will die of causes intrinsic to bone marrow failure. One third of patients will develop acute myeloid leukemia (AML), which is associated with an extremely poor outcome and a short survival. Our objectives were to analyze the prognostic variables and scoring systems in the attempt to determine the influence of progression on the overall survival of MDS patients. PATIENTS AND METHODS: We performed a retrospective analysis of 831 MDS patients, including those from the Argentine Registry. RESULTS: Of the 831 MDS patients, 158 (19.0%) experienced transformation, with a median overall survival of 17.9 months from diagnosis and 3.5 months after progression. The survival of patients with adverse karyotypes or greater risk, according to the International Prognostic Scoring System-revised (IPSS-R) or World Health Organization-based Prognostic Scoring System (WPSS) was not affected when stratified by patients with and without evolution to AML (P > .05). In contrast, the survival of lower risk patients was significantly reduced for those patients with progression to AML (P < .001) and those younger (P = .024) than those who died of non-AML-related causes. The intermediate-risk patients were heterogeneously distributed; however, an upgrade from a lower IPSS-R to a higher WPSS-hemoglobin risk category was associated with a worse outcome, not affected by progression (P = .420), with a median event-free survival of 16 months. CONCLUSION: The use of the IPSS-R and WPSS systems simultaneously might help in identifying those patients who require more aggressive treatment. Nevertheless, more efforts are needed to improve the identification of those lower risk patients whose survival is significantly reduced by progression to AML.


Assuntos
Leucemia Mieloide Aguda/genética , Síndromes Mielodisplásicas/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Bases de Dados Factuais , Progressão da Doença , Feminino , Humanos , Leucemia Mieloide Aguda/mortalidade , Leucemia Mieloide Aguda/patologia , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/mortalidade , Síndromes Mielodisplásicas/patologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
5.
Cancer ; 116(21): 4991-5000, 2010 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-20665487

RESUMO

BACKGROUND: Treatment recommendations have been developed for management of patients with chronic myeloid leukemia (CML). METHODS: A 30-item multiple-choice questionnaire was administered to 435 hematologists and oncohematologists in 16 Latin American countries. Physicians self-reported their diagnostic, therapeutic, and disease management strategies. RESULTS: Imatinib is available as initial therapy to 92% of physicians, and 42% of physicians have access to both second-generation tyrosine kinase inhibitors. Standard-dose imatinib is the preferred initial therapy for most patients, but 20% would manage a young patient initially with an allogeneic stem cell transplant from a sibling donor, and 10% would only offer hydroxyurea to an elderly patient. Seventy-two percent of responders perform routine cytogenetic analysis for monitoring patients on therapy, and 59% routinely use quantitative polymerase chain reaction. For patients who fail imatinib therapy, 61% would increase the dose of imatinib before considering change to a second-generation tyrosine kinase inhibitor, except for patients aged 60 years, for whom a switch to a second-generation tyrosine kinase inhibitor was the preferred choice. CONCLUSIONS: The answers to this survey provide insight into the management of patients with CML in Latin America. Some deviations from current recommendations were identified. Understanding the treatment patterns of patients with CML in broad population studies is important to identify needs and improve patient care.


Assuntos
Antineoplásicos/uso terapêutico , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Piperazinas/uso terapêutico , Padrões de Prática Médica , Inibidores de Proteínas Quinases/uso terapêutico , Pirimidinas/uso terapêutico , Antineoplásicos/efeitos adversos , Benzamidas , Acesso aos Serviços de Saúde , Inquéritos Epidemiológicos , Humanos , Mesilato de Imatinib , América Latina , Piperazinas/efeitos adversos , Pirimidinas/efeitos adversos , Padrão de Cuidado , Inquéritos e Questionários , Falha de Tratamento
6.
Haematologica ; 95(2): 232-40, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20139391

RESUMO

BACKGROUND: Dasatinib 100 mg once daily achieves intermittent BCR-ABL kinase inhibition and is approved for chronic-phase chronic myeloid leukemia patients resistant or intolerant to imatinib. To better assess durability of response to and tolerability of dasatinib, data from a 2-year minimum follow-up for a dose-optimization study in chronic-phase chronic myeloid leukemia are reported here. DESIGN AND METHODS: In a phase 3 study, 670 chronic-phase chronic myeloid leukemia patients with resistance, intolerance, or suboptimal response to imatinib were randomized to dasatinib 100 mg once-daily, 50 mg twice-daily, 140 mg once-daily, or 70 mg twice-daily. RESULTS: Data from a 2-year minimum follow-up demonstrate that dasatinib 100 mg once daily achieves major cytogenetic response and complete cytogenetic response rates comparable to those in the other treatment arms, and reduces the frequency of key side effects. Comparable 2-year progression-free survival and overall survival rates were observed (80% and 91%, respectively, for 100 mg once daily, and 75%-76% and 88%-94%, respectively, in other arms). Complete cytogenetic responses were achieved rapidly, typically by 6 months. In patients treated with dasatinib 100 mg once daily for 6 months without complete cytogenetic response, the likelihood of achieving such a response by 2 years was 50% for patients who had achieved a partial cytogenetic response, and only 8% or less for patients with minor, minimal, or no cytogenetic response. Less than 3% of patients suffered disease transformation to accelerated or blast phase. CONCLUSIONS: Intermittent kinase inhibition can achieve rapid and durable responses, indistinguishable from those achieved with more continuous inhibition.


Assuntos
Proteínas de Fusão bcr-abl/antagonistas & inibidores , Leucemia Mieloide de Fase Crônica/tratamento farmacológico , Piperazinas/farmacologia , Inibidores de Proteínas Quinases/uso terapêutico , Proteínas Tirosina Quinases/antagonistas & inibidores , Pirimidinas/farmacologia , Pirimidinas/uso terapêutico , Tiazóis/uso terapêutico , Benzamidas , Análise Citogenética , Dasatinibe , Esquema de Medicação , Resistência a Medicamentos , Seguimentos , Proteínas de Fusão bcr-abl/metabolismo , Humanos , Mesilato de Imatinib , Piperazinas/efeitos adversos , Inibidores de Proteínas Quinases/administração & dosagem , Proteínas Tirosina Quinases/metabolismo , Pirimidinas/administração & dosagem , Pirimidinas/efeitos adversos , Tiazóis/administração & dosagem
7.
Leuk Lymphoma ; 50 Suppl 2: 9-15, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20017606

RESUMO

The presence of the Philadelphia chromosome is a poor prognosis factor in acute lymphoblastic leukemia (ALL), in both children and adults. Using molecular techniques of the gen bcr/abl, it is possible to detect the abnormality, in up to the 40% of adult patients. The unsatisfactory results with conventional chemotherapy schemes have determined the intensification of the treatments and the consideration of allogenic bone marrow transplants as the best therapeutic instance. The development of tyrosine kinase inhibitors have become a therapeutic improvement in the treatment of Philadelphia chromosome-positive ALL, being combined with chemotherapy schemes, only in a selected group of patients, even in therapeutic programs that include transplant.


Assuntos
Cromossomo Filadélfia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Benzamidas , Transplante de Medula Óssea/fisiologia , Criança , Humanos , Mesilato de Imatinib , Piperazinas/administração & dosagem , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Inibidores de Proteínas Quinases/administração & dosagem , Pirimidinas/administração & dosagem
10.
Hematología (B. Aires) ; 5(1): 18-23, ene.-abr. 2001. ilus
Artigo em Espanhol | LILACS | ID: lil-317818

RESUMO

La pielosis es una rara entidad, de teología poco clara: tóxica, infecciosa relacionada a inmunodepresión (enfermedades consuntivas) inflamatoria o vascular, caracterizada por la presencia de espacios quísticos múltiples, con secuestro hemático, que hasta puede llegar a producir trastornos de la hemostasia, induciendo una extrema fragilidad y por ende la ruptuta facial o espontánea del órgano, a veces sin aumentar el volúmen del mismo. Mucho más rara es su asociación con la leucemia mioelomonocítica crónica (LMMC) sindrome mieloproliferativo crónico de diagnóstico controvertido. Habiendo estudiado en detalle de médula ósea, el baso y la citogenética, concluimos que se trata de una verdadera mieloproloiferación. Sugerimos además un estricto control clínico-hematológico y por imágenes para evaluar adecuadamente a aquellas patologías que se acompañan de grandes esplenomegalias en algún momento de su evolución


Assuntos
Humanos , Ruptura Esplênica , Leucemia Mielomonocítica Crônica/diagnóstico , Leucemia Mielomonocítica Crônica/terapia
11.
Hematología [B. Aires] ; 5(1): 18-23, ene.-abr. 2001. ilus
Artigo em Espanhol | BINACIS | ID: bin-7686

RESUMO

La pielosis es una rara entidad, de teología poco clara: tóxica, infecciosa relacionada a inmunodepresión (enfermedades consuntivas) inflamatoria o vascular, caracterizada por la presencia de espacios quísticos múltiples, con secuestro hemático, que hasta puede llegar a producir trastornos de la hemostasia, induciendo una extrema fragilidad y por ende la ruptuta facial o espontánea del órgano, a veces sin aumentar el volúmen del mismo. Mucho más rara es su asociación con la leucemia mioelomonocítica crónica (LMMC) sindrome mieloproliferativo crónico de diagnóstico controvertido. Habiendo estudiado en detalle de médula ósea, el baso y la citogenética, concluimos que se trata de una verdadera mieloproloiferación. Sugerimos además un estricto control clínico-hematológico y por imágenes para evaluar adecuadamente a aquellas patologías que se acompañan de grandes esplenomegalias en algún momento de su evolución (AU)


Assuntos
Humanos , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/terapia , Leucemia Mielomonocítica Crônica/diagnóstico , Leucemia Mielomonocítica Crônica/terapia
12.
Rev. med. Plata (1955) ; 34(1): 20-7, mayo 2000. tab
Artigo em Espanhol | LILACS | ID: lil-261313

RESUMO

La enfermedadd de Behcet es un desórden inflamatorio crónico, multisisté-rnico, de etiología desconocida, caracterizado por úlceras aftosas orales recu-rrentes, úlceras genitales y uveítis. Se trata de una patología de muy rara frecuencia y su patogenia sería autoinmune, mediada por hiperactividad de poli-morfonucleares (PMNs) y linfocitos T. Una de las causas de muerte más fre-cuentemente asociada a la Enfermedad de Behcet es la afectación oclusiva del sistema circulatorio, arterial y venoso, que está intimamente ligada a un estado de hipercoagulabilidad, ocasionada por activación del endotelio vascular y activación plaquetaria. El tratamiento anticoagulante oral (curnarínicos), aso-ciado al tratamiento específico, puede ayudar a la prevención de fenórnenos tromboembólicos y mejorar el pronóstico de la enfermedad, sobre todo te-niendo en cuenta que en muchos casos la misma tiende a autolímitarse.


Assuntos
Humanos , Feminino , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamento farmacológico , Síndrome de Behçet/terapia , Trombofilia
13.
Rev. med. Plata [1955] ; 34(1): 20-7, mayo 2000. tab
Artigo em Espanhol | BINACIS | ID: bin-12667

RESUMO

La enfermedadd de Behcet es un desórden inflamatorio crónico, multisisté-rnico, de etiología desconocida, caracterizado por úlceras aftosas orales recu-rrentes, úlceras genitales y uveítis. Se trata de una patología de muy rara frecuencia y su patogenia sería autoinmune, mediada por hiperactividad de poli-morfonucleares (PMNs) y linfocitos T. Una de las causas de muerte más fre-cuentemente asociada a la Enfermedad de Behcet es la afectación oclusiva del sistema circulatorio, arterial y venoso, que está intimamente ligada a un estado de hipercoagulabilidad, ocasionada por activación del endotelio vascular y activación plaquetaria. El tratamiento anticoagulante oral (curnarínicos), aso-ciado al tratamiento específico, puede ayudar a la prevención de fenórnenos tromboembólicos y mejorar el pronóstico de la enfermedad, sobre todo te-niendo en cuenta que en muchos casos la misma tiende a autolímitarse. (AU)


Assuntos
Humanos , Feminino , /diagnóstico , /tratamento farmacológico , /terapia , Trombofilia
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