Conventional chemotherapy for acute myeloid leukemia: a Brazilian experience

CONTEXT: Young patients affected by acute myeloid leukemia (AML) achieve complete remission (CR) using conventional chemotherapy in about 55-85%. However, 30% of patients fail to achieve CR and the remission duration is often only about 12 months. More intensive treatment after CR seems to be necessary in order to maintain CR and obtain a definitive cure. In Brazil, few reports have been published on this important subject. OBJECTIVE: The aim of this study was to describe a Brazilian experience in the treatment of de novo acute myeloid leukemia (AML) in younger adult patients (age < 60 years). DESIGN: Retrospective analysis. SETTING: University Hospital, Hematology and Hemotherapy Center, State University of Campinas, Brazil. PARTICIPANTS: Newly diagnosed cases of de novo AML in the period from January 1994 to December 1998 were evaluated retrospectively, in relation to response to treatment, overall survival (OS) and disease free survival (DFS). Cases with acute promyelocytic leukemia (APL) were also included in this analysis. RESULTS: On the basis of an intention to treat, 78 cases of AML, including 17 cases of APL, were evaluated. The overall median follow-up was 272 days. The complete remission (CR) rate was 63.6% in the AML group (excluding APL) and 78% in the APL group. The 5-year estimated disease-free survival (DFS) was 80% for the APL group and 34% for the AML group (P = 0.02). The 5-year estimated overall survival (OS) was 52% for the APL group and 20.5% for the AML group, respectively (P = NS). Relapse was observed in 12/39 (30.7%) patients with AML and 1/11 (9%) with APL. CONCLUSIONS: These results are similar to those reported in the literature. However, relapse and mortality rates remain high, and a search for more aggressive strategies in order to prevent relapse is recommended.CONTEXTO: Pacientes adultos com diagnóstico de leucemia mielóide aguda (LMA) obtém remissão completa (RC) com quimioterapia convencional em cerca de 55-85% dos casos, e a sua duração é de aproximadamente 12 meses. Cerca de 30% dos pacientes não atingem a RC. Para manter a RC e obter cura definitiva parece ser necessário intensificar o tratamento após a RC. No Brasil, há um pequeno número de artigos publicados a esse respeito. OBJETIVO: Descrever a experiência brasileira no tratamento de leucemia mielóide aguda de novo em jovens e adultos com idade inferior a 60 anos. TIPO DE ESTUDO: Análise retrospectiva. LOCAL: Hospital das Clínicas e Hemocentro da Universidade Estadual de Campinas. PARTICIPANTES: Foram estudados, retrospectivamente, casos novos de LMA entre 1994 e 1998, com relação à resposta ao tratamento de quimioterapia, sobrevida global e sobrevivência livre de doença. RESULTADOS: Entraram no estudo 78 pacientes de LMA, incluindo 17 casos de leucemia promielocítica (LPM). A média de seguimento foi de 272 dias. A taxa de RC foi de 63,6% nos pacientes com LMA excluindo-se os pacientes com LPM, e 78% nos pacientes com LPM. A sobrevida livre de doença em 5 anos foi de 80% nos pacientes com LPM e 34% para os pacientes com LMA (P=0,01). A sobrevida global foi de 52% e 20,5% para os pacientes com LPM e LMA respectivamente (P=NS). Recidiva foi observada em 12/39 (30,7%) dos pacientes com LMA e 1/11 (9%) na LPM. CONCLUSÕES: Esses resultados são semelhantes aos encontrados na literatura, entretanto, o número de recidivas e a mortalidade mantém-se alta, recomendando-se pesquisa de estratégias mais agressivas para prevenir recidivas.17317

Validation Of The Ebmt Risk Score In Chronic Myeloid Leukemia In Brazil And Allogeneic Transplant Outcome.

The management of chronic myeloid leukemia (CML) has changed radically since the introduction of imatinib therapy. The decision of whether to offer a patient a hematopoietic stem cell transplant (HSCT) must be based on the probability of success of the procedure. The aim of this retrospective analysis of 1,084 CML patients who received an allogeneic HSCT in 10 Brazilian Centers between February 1983 and March 2003 was to validate the EBMT risk score. The study population comprised 647 (60%) males and 437 (40%) females, with a median age of 32 years old (range 1 - 59); 898 (83%) were in chronic phase, 146 (13%) were in accelerated phase and 40 (4%) were in blast crisis; 151 (14%) were younger than 20 years old, 620 (57%) were between 20 and 40 and 313 (29%) were older than 40; 1,025 (94%) received an HLA fully matched sibling transplant and only 59 (6%) received an unrelated transplant. In 283 cases (26%) a male recipient received a graft from a female donor. The interval from diagnosis to transplantation was less than 12 months in 223 (21%) cases and greater in 861 (79%). The overall survival, disease-free survival, transplant-related mortality and relapse incidence were 49%, 50%, 45% and 25%, respectively. Of the 1084 patients, 179 (17%) had a risk score of 0 or 1, 397 (37%) had a score of 2, 345 (32%) had a score of 3, 135 (12%) had a score of 4 and 28 (2%) a score of 5 or 6. The overall survival (OS) rate in patients with risk scores 0-1 and 2 was similar (58% and 55%, respectively) but significantly better than that in patients with scores 3 or more (score 3 - 44%, 4 - 36 % and 5-6 - 27%, respectively) pp<0.001). Disease-free survival (DFS) and transplant related mortality (TRM) in a patients with a score of 3 or more were 46% and 49%, respectively and the relapse rate beyond score 5-6 was 77%. Disease status had a negative impact on all outcomes (OS, DFS, TRM, and relapse). The OS rate for male recipients of a graft from a female donor was 40% compared to 52% among the other donor-recipient pairs (p=0.004). DFS and TRM were significant for disease phase and female donor-male recipient (p<0.001 and p<0.003, respectively). In our experience, age and interval between diagnosis and transplant did influence OS, DFS, TRM, and relapse rate. Our results validate the EBMT risk score in the context of a developing country and confirm its usefulness for making point decisions in the imatinib era.90232-

Microdureza e rugosidade superficial do esmalte submetido ao clareamento: uma revisão de literatura

The increasing importance of aesthetic in the Dentistry for the patients and the consumers brought a constant rise in the number of products and procedures to facilitate the confection of the dental bleaching. Concomitantly, thone was a sudden increase in the number of research and publications, in vitro and in vivo, about its possible adverse reactions. Through literature revision this study aims to verify the possible morphologic alterations of the submitted enamel and dentine with different bleaching agents making critical analysis of the results of the current research with relation to the study of the microhardness and superficial roughness.A importância crescente da estética na Odontologia para os pacientes e consumidores levou a constante elevação no número de produtos e procedimentos para facilitar a confecção do clareamento dental. Concomitantemente, houve aumento repentino no número de pesquisas e publicações, in vitro e in vivo, a respeito das suas possíveis reações adversas. Através de revisão de literatura, este trabalho tem por objetivo verificar as possíveis alterações morfológicas do esmalte e dentina submetidos ao clareamento com diversos agentes clareadores, fazendo análise crítica dos resultados das pesquisas atuais com relação ao estudo da microdureza e rugosidade superficial

Bcr-abl1 Transcript Levels At 3 And 6 Months Are Better For Identifying Chronic Myeloid Leukemia Patients With Poor Outcome In Response To Second-line Second-generation Tyrosine Kinase Inhibitors After Imatinib Failure: A Report From A Single Institution

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Early reduction of BCR-ABL1 transcript levels has been associated with improved outcome in chronic myeloid leukemia (CML) treatment. We evaluated 54 chronic-phase CML patients treated with imatinib who switched therapy to dasatinib (n = 33) or nilotinib (n = 21). BCR-ABL1 transcript levels were measured in peripheral blood using real-time quantitative PCR (RQ-PCR) every 3 months from the start of second-line treatment. Patients with BCR-ABL transcript levels > 10% at 3 months and >1% at 6 months had significantly inferior progression-free (PFS) and event-free survival (EFS) than patients with RQ-PCR 1% at 6 months also had inferior PFS and EFS than patients with RQ-PCR <10% at 3 months and <1% at 6 months (48 vs. 100%, p = 0.002, and 25 vs. 73%, p < 0.0001, respectively). Two measurements of BCR-ABL levels were better than a single one to stratify chronic-phase CML patients as failure after second-line therapy. (C) 2015 S. Karger AG, Basel1344248254Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Hematology and Hemotherapy Center, University of Campinas - UNICAMP, Campinas, BrazilFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Conventional chemotherapy for acute myeloid leukemia: a Brazilian experience

CONTEXT: Young patients affected by acute myeloid leukemia (AML) achieve complete remission (CR) using conventional chemotherapy in about 55-85%. However, 30% of patients fail to achieve CR and the remission duration is often only about 12 months. More intensive treatment after CR seems to be necessary in order to maintain CR and obtain a definitive cure. In Brazil, few reports have been published on this important subject. OBJECTIVE: The aim of this study was to describe a Brazilian experience in the treatment of "de novo" acute myeloid leukemia (AML) in younger adult patients (age < 60 years). DESIGN: Retrospective analysis. SETTING: University Hospital, Hematology and Hemotherapy Center, State University of Campinas, Brazil. PARTICIPANTS: Newly diagnosed cases of "de novo" AML in the period from January 1994 to December 1998 were evaluated retrospectively, in relation to response to treatment, overall survival (OS) and disease free survival (DFS). Cases with acute promyelocytic leukemia (APL) were also included in this analysis. RESULTS: On the basis of an intention to treat, 78 cases of AML, including 17 cases of APL, were evaluated. The overall median follow-up was 272 days. The complete remission (CR) rate was 63.6% in the AML group (excluding APL) and 78% in the APL group. The 5-year estimated disease-free survival (DFS) was 80% for the APL group and 34% for the AML group (P = 0.02). The 5-year estimated overall survival (OS) was 52% for the APL group and 20.5% for the AML group, respectively (P = NS). Relapse was observed in 12/39 (30.7%) patients with AML and 1/11 (9%) with APL. CONCLUSIONS: These results are similar to those reported in the literature. However, relapse and mortality rates remain high, and a search for more aggressive strategies in order to prevent relapse is recommended

Free Recall of Word Lists under Total Sleep Deprivation and after Recovery Sleep

Study Objectives: One task that has been used to assess memory effects of prior total sleep deprivation (TSD) is the immediate free recall of word lists; however, results have been mixed. A possible explanation for this is task impurity, since recall of words from different serial positions reflects use of distinct types of memory (last words: short-term memory; first and intermediate words: episodic memory). Here we studied the effects of 2 nights of TSD on immediate free recall of semantically unrelated word lists considering the serial position curve.Design: Random allocation to a 2-night TSD protocol followed by one night of recovery sleep or to a control group.Setting: Study conducted under continuous behavioral monitoring.Participants: 24 young, healthy male volunteers.Intervention: 2 nights of total sleep deprivation (TSD) and one night of recovery sleep.Measurements and Results: Participants were shown five 15 unrelated word-lists at baseline, after one and 2 nights of TSD, and after one night of recovery sleep. We also investigated the development of recall strategies (learning) and susceptibility to interference from previous lists. No free recall impairment occurred during TSD, irrespective of serial position. Interference was unchanged. Both groups developed recall strategies, but task learning occurred earlier in controls and was evident in the TSD group only after sleep recovery.Conclusion: Prior TSD spared episodic memory, short-term phonological memory, and interference, allowed the development of recall strategies, but may have decreased the advantage of using these strategies, which returned to normal after recovery sleep

Quality Of Life In Patients Randomized To Receive A Bone Marrow Or A Peripheral Blood Allograft.

Quality of life (QOL) is an important clinical end-point to be considered in the late follow-up of patients treated with allogeneic bone marrow (BM) or peripheral blood progenitor cell (PBPC) transplantation. To assess the QOL in a group of survivors of hematologic malignancies who had been enrolled in a prospective randomized trial comparing allogeneic BM with PBPC. Sixty randomized patients had been enrolled in a study comparing BM with PBPC graft during 1995-99. At the time of this QOL study, 30 were alive and 26 (13 BM and 13 PBPC) were eligible. Clinical and demographic data were collected and psychometric instruments (WHOQOL-100 and the Hospital Anxiety and Depression Scale HAD) were used. Non-parametric and univariate analyses were performed. The PBPC recipients had more chronic graft-versus-host disease (p=0.03) and were on immunosuppressive treatment for a longer period (p=0.02). The WHOQOL-100 analysis demonstrated significant differences between groups with more favorable results in the BM group in the facets of Pain and Discomfort (p=0.03), Mobility (p=0.02) and Daily Living Activities (p=0.03). According to the patients' spontaneous responses, 8 individuals (6 in the PBPC group) believed that their QOL had worsened. With the limitations of a small randomized study, these findings suggest a lower QOL in recipients of allogeneic PBPC than in recipients of BM grafts, probably due to the frequency and severity of chronic graft-versus-host disease. This need to be confirmed in a large international trial.871281-