Treatment Outcome of Acute Promyelocytic Leukemia with Modified Aida Protocol

We analyzed the outcome of a series of 19 newly diagnosed patients with acute promyelocytic leukemia treated with AIDA modified protocol, using mitoxantrone in place of idarubicin. Eleven patients achieved morphologic CR (58%). The remaining 8 patients had induction failure due to death during induction. Ten of eleven patients in CR achieved molecular remission after induction therapy and all the 8 patients had molecular remission after consolidation. Eight patients completed the three consolidation courses as scheduled and then proceeded to maintenance therapy. After a median follow up of 52 months, no molecular or hematological relapse has occurred. The 4-year disease-free survival is 82%. The study showed the antileukemic efficacy of mitoxantrone and that it could be used as a reasonable option in anthracycline-based strategies in APL

A influência dos inibidores de checkpoint imunológico na sobrevida do paciente com cancer / The influence of checkpoint inhibitors on cancer patient survival

Introdução: Os mecanismos de controle do crescimento celular são regulados por fatores estimulantes e inibidores. A quebra desses mecanismos é capaz desenvolver um estímulo de crescimento efetivo, sem que haja regulação inibitória, relacionado aos processos iniciais da carcinogênese. Como os tumores malignos apresentam incidência e mortalidade elevadas em todo o mundo, o desenvolvimento de terapias capazes de prolongar a sobrevida do paciente é matéria de constante interesse clínico. A imunoterapia com inibidores de checkpoints imunológicos pode melhorar o prognóstico do melanoma maligno, carcinoma renal, linfoma, câncer pulmonar de células não pequenas, assim como do câncer de bexiga, de cabeça e pescoço, intestinal, hepático e gástrico. Entretanto, essa terapia pode causar diversos efeitos colaterais no corpo humano, ainda pouco compreendidos. Objetivo: Analisar diferentes artigos em que foram abordados os inibidores do checkpoint imunológico e sua relação com a sobrevida do paciente com câncer. Método: As pesquisas para esta revisão integrativa foram realizadas nos meses de maio e junho de 2020. As bases de dados utilizadas foram SciELO, Pubmed e Sistema Online de Busca e Análise de Literatura Médica (MEDLINE). Foram selecionados oito artigos, 2 na língua portuguesa e 6 na língua inglesa, que discutem a eficácia dos inibidores do checkpoint imunológico e seus efeitos colaterais. Resultados: Todos os resultados dos artigos demonstraram que os medicamentos pembrolizumab, avelumab e nivolumab têm efeitos positivos ao prolongar a sobrevida do paciente com câncer.  Por sua vez, estudos com inibidores de checkpoint imunológico são desenvolvidos com o objetivo melhorar a performance farmacológica desses medicamentos. Conclusão: Apesar dos resultados promissores, ainda são necessários maiores investimentos em pesquisa e ensaios clínicos para que os inibidores dos checkpoints imunológicos sejam adotados como terapia definitiva e com menos efeitos colaterais no tratamento dos tumores malignos.

Management of chronic myeloid leukemia during pregnancy: a retrospective analysis at a single center

We analyzed the management and outcomes of pregnancies of patients with chronic myeloid leukemia at a single center over fifteen years. Among the 203 CML female patients, there were ten pregnancies in seven women, all of them not planned. In three cases, the chronic myeloid leukemia diagnosis was made during pregnancy. Five patients received tyrosine kinase inhibitors in the first weeks of pregnancy and the drug was interrupted until delivery. One patient lost complete cytogenetic response, and two patients lost the hematological response. A patient with a stable major molecular response had two successful pregnancies without loss of response. There were four premature births. There were no maternal adverse events, fetal malformation or death. All patients received Interferon-alpha during gestation, and two received hydroxyurea for a short period. Leukapheresis was performed in two patients for hyperleukocytosis control. One patient with sickle cell disease died from disease progression six months after delivery. Conclusions: The tyrosine kinase inhibitors ministration should be interrupted during pregnancy. Patients should be advised to achieve a stable and deep molecular response if they plan to conceive, to avoid the risk of disease progression. Keywords: Chronic myeloid leukemia, Pregnancy, Imatinib, Interferon-alpha, Hydroxyurea, Dasatini

Characteristics of follicular and mantle cell lymphoma in Brazil: prognostic impact of clinical parameters and treatment conditions in two hospitals

Objective: Follicular and mantle cell lymphoma are low-grade B-cell malignancies that lack good responses to chemoimmunotherapy. This study aimed to assess retrospectively clinicopathological features and to determine independent prognostic factors for follicular and mantle cell lymphoma patients treated at two Brazilian medical centers: the Hematology and Hemotherapy Center of the Universidade Estadual de Campinas (Unicamp), a public university hospital, and AC. Camargo Cancer Center, a specialized cancer center. Methods: Two hundred and twenty-seven follicular and 112 mantle cell lymphoma cases were diagnosed between 1999 and 2016. Archived paraffin blocks were retrieved and reviewed. Corresponding demographics and clinical data were recovered from medical charts. Outcome analyses considered both overall and event-free survival. Results: For follicular lymphoma treated with the R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, prednisone) and R-CVP (rituximab, cyclophosphamide, vincristine sulfate, prednisone) regimens, both B-symptoms (p-value < 0.01 for overall and event-free survival) and high-risk Follicular Lymphoma International Prognostic Index (p-value < 0.01 for overall survival) were independently associated to worse prognosis. Maintenance with rituximab improved the prognosis (p-value < 0.01 for overall survival). For mantle cell lymphoma, B-symptoms (p-value = 0.03 for overall survival and event-free survival) and bone marrow infiltration (p-value = 0.01 for overall survival) independently predicted reduced survival, and rituximab at induction increased both event-free and overall survival (p-value < 0.01 in both analyses). Combinations of these deleterious features could identify extremely poor prognostic subgroups. The administration of rituximab was more frequent in the AC. Camargo Cancer Center, which was the institution associated with better overall survival for both neoplasias. Conclusion: This study represents the largest cohort of follicular and mantle cell lymphoma in South America thus far. Some easily assessable clinical variables were able to predict prognosis and should be considered in low-income centers. In addition, the underuse of rituximab in the Brazilian public health system should be reconsidered in future health policies. Keywords: Follicular lymphoma, Mantle cell lymphoma, Histopathology, Prognosi