Brazilian experience using high dose sequential chemotherapy followed by autologous hematopoietic stem cell transplantation for malignant lymphomas

OBJECTIVE: To evaluate the use of high-dose sequential chemotherapy in a Brazilian population. METHODS: High-dose cyclophosphamide followed by autologous hematopoietic stem cell transplantation is an effective and feasible therapy for refractory/relapsed lymphomas; this regimen has never before been evaluated in a Brazilian population. All patients (106 with high-grade non-Hodgkin lymphoma and 77 with Hodgkin's lymphoma) submitted to this treatment between 1998 and 2006 were analyzed. Chemotherapy consisted of the sequential administration of high-dose cyclophosphamide (4 or 7 g/m²) and granulocyte-colony stimulating factor (300 µg/day), followed by peripheral blood progenitor cell harvesting, administration of etoposide (2g/m²) and methotrexate (8 g/m² only for Hodgkin's lymphoma) and autologous hematopoietic stem cell transplantation. RESULTS: At diagnosis, non-Hodgkin lymphoma patients had a median age of 45 (range: 8-65) years old, 78% had diffuse large B-cell lymphoma and 83% had stage III/IV disease. The Hodgkin's lymphoma patients had a median age of 23 (range: 7-68) years old, 64.9% had the nodular sclerosis subtype and 65% had stage III/IV disease. Nine Hodgkin's lymphoma patients (13%) and 10 (9%) non-Hodgkin lymphoma patients had some kind of cardiac toxicity. The overall survival, disease-free survival and progression-free survival in Hodgkin's lymphoma were 29%, 59% and 26%, respectively. In non-Hodgkin lymphoma, these values were 40%, 49% and 31%, respectively. High-dose cyclophosphamide-related mortality was 10% for Hodgkin's lymphoma and 5% for non-Hodgkin lymphoma patients. High-dose cyclophosphamide dosing had no impact on toxicity or survival for both groups. CONCLUSIONS: Despite a greater prevalence of poor prognostic factors, our results are comparable to the literature. The incidence of secondary neoplasias is noteworthy. Our study suggests that this approach is efficient and feasible, regardless of toxicity-related mortality

Incidence and risk factors for agranulocytosis in Latin American countries - the Latin study

Purpose LATIN is a multinational case-control study designed to identify risk factors for agranulocytosis and to estimate the incidence rate of the disease in some Latin American countries. Methods Each study site in Brazil, Argentina and Mexico conducted an active search of agranulocytosis patients in hematology clinics and looked for possible associations with drug use. Results The overall incidence rate was 0.38 cases per 1 million inhabitant-years. Agranulocytosis patients more often took medications already associated with agranulocytosis than controls (p=0.01), mainly methimazole (OR 44.2, 95% CI 6.8 to infinity). The population attributable risk percentage (etiologic fraction) was 56%. The use of nutrient supplements was more frequent among patients than controls (p=0.03). Conclusions Agranulocytosis seems to be very rare in Latin America. The lower than expected number of cases identified during the study period precluded estimation of the risk associated to individual drugs, with the exception of methimazol. However, this is the longest series of agranulocytosis cases ever gathered in Latin America, and information on drug exposures was collected prospectively. The conclusion is that drug-induced agranulocytosis does not seem to be a major public health problem in the study regions

Chronic lymphocytic leukemia in Brazil: A retrospective analysis of 1903 cases

Univ Fed São Paulo, UNIFESP, EPM, São Paulo, BrazilHosp Sirio Libanes, São Paulo, BrazilUniv Estadual Campinas, Campinas, BrazilHemope, Hemoctr Pernambuco, Recife, PE, BrazilSanta Casa de Misericordia São Paulo, São Paulo, BrazilHosp Samaritano, São Paulo, BrazilHosp Brigadeiro, Hosp Transplantes Euryclides de Jesus Zerbini, São Paulo, BrazilHosp Amaral Carvalho, Jau, BrazilUniv Fed Minas Gerais, Belo Horizonte, MG, BrazilHosp Israelita Albert Einstein, São Paulo, BrazilHosp Servidor Publ Estadual, São Paulo, BrazilCasa Saude Santa Marcelina, São Paulo, BrazilUniv Fed Goias, Goiania, Go, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilInst Canc São Paulo, São Paulo, BrazilUniv Fed Parana, Curitiba, Parana, BrazilHosp Sao Vicente de Paulo, Passo Fundo, BrazilUniv Fed São Paulo, UNIFESP, EPM, São Paulo, BrazilWeb of Scienc

Chronic lymphocytic leukemia in Brazil: A retrospective analysis of 1903 cases

Univ Fed São Paulo, UNIFESP, EPM, São Paulo, BrazilHosp Sirio Libanes, São Paulo, BrazilUniv Estadual Campinas, Campinas, BrazilHemope, Hemoctr Pernambuco, Recife, PE, BrazilSanta Casa de Misericordia São Paulo, São Paulo, BrazilHosp Samaritano, São Paulo, BrazilHosp Brigadeiro, Hosp Transplantes Euryclides de Jesus Zerbini, São Paulo, BrazilHosp Amaral Carvalho, Jau, BrazilUniv Fed Minas Gerais, Belo Horizonte, MG, BrazilHosp Israelita Albert Einstein, São Paulo, BrazilHosp Servidor Publ Estadual, São Paulo, BrazilCasa Saude Santa Marcelina, São Paulo, BrazilUniv Fed Goias, Goiania, Go, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilInst Canc São Paulo, São Paulo, BrazilUniv Fed Parana, Curitiba, Parana, BrazilHosp Sao Vicente de Paulo, Passo Fundo, BrazilUniv Fed São Paulo, UNIFESP, EPM, São Paulo, BrazilWeb of Scienc