Terapia alvo com mesilato de imatinibe : um estudo de 98 pacientes com leucemia mielóide crônica

Orientador: Ricardo PasquiniDissertaçao (mestrado) - Universidade Federal do Paraná, Setor de Ciencias da Saúde, Programa de Pós-Graduaçao em Medicina Interna. Defesa: Curitiba, 25/11/2005Inclui bibliografiaÁrea de concentraçao: Hematologi

Immune thrombocytopenia: clinical features and analysis of risk factors to response to the treatment

Introduction: Immune thrombocytopenia (ITP) is an acquired decrease of platelets, caused by autoantibodies against platelets, in the absence of an associated condition. ITP is associated to low morbidity and mortality, however there is reduced quality of life on the patients under treatment. This study has as objectives to describe the clinical features of the patients and the evaluation of risk factors related to the response to treatment. Methods: A retrospective analysis was achieved, regarding the medical records of 99 patients diagnosed with ITP and seen between May of 1992 and August of 2016 in a hospital.Results: 99 patients were analyzed, 71 female (71.7%). Mean age 39 years old to diagnosis (variation 2-84). 83.3% of the patients were chronic ITP and the mean follow up 49.2 months (0,1-289). 74.7% of patients presented bleeding to diagnosis. 76.7% of patients required treatment, and there was remission in 7 (30.4%) of the 23 patients who did not receive any treatment. 37 patients were submitted to splenectomy, 30 (81.1%) of those obtained partial or complete response and 18 (48.6%) presented loss of response. 30% of patients were submitted to posterior treatments. Only two patients had death related to ITP. In bivariate analysis of risk factors to response to the treatment, the only predictors of chronicity were initially the absence of corticosteroid dependence and absence of response to splenectomy, however in multivariate analysis those factors had their significance discarded. Conclusion: The presented results did not confirm a higher progression rate to chronicity in non corticosteroid-dependent patients and in those who did not present response to splenectomy. The clinical features, response pattern and survival of analyzed patients were similar to other studies reported.&nbsp

Accelerated phase chronic myeloid leukemia: evaluation of clinical criteria as predictors of survival, major cytogenetic response and progression to blast phase

AbstractBackgroundPublished criteria defining the accelerated phase in chronic myeloid leukemia are heterogeneous and little is known about predictors of poor outcome.MethodsThis is a retrospective study of 139 subjects in the accelerated phase of chronic myeloid leukemia treated with imatinib at a single center in Brazil. The objective was to identify risk factors for survival, major cytogenetic response and progression to blast phase in this population. The factors analyzed were: blasts 10–29%, basophils≥20%, platelets>1×106/μL or <1×105/μL and white blood cells>1×105/μL in the peripheral blood, as well as clonal evolution, splenomegaly, hemoglobin<10g/dL, time between diagnosis of chronic myeloid leukemia and imatinib treatment, and hematologic toxicity.ResultsRisk factors for poor survival in multivariate analysis were Grades 3–4 hematologic toxicity (p-value=0.001), blasts 10–29% (p-value=0.023), and hemoglobin<10g/dL (p-value=0.04). Risk factors for not achieving major cytogenetic response were blasts 10–29% (p-value=0.007), hemoglobin<10g/dL (p-value=0.001), and previous use of interferon (p-value=0.032). Risk factors for progression to the blast phase were hemoglobin<10g/dL (p-value=0.005), basophils≥20% (p-value=0.023), and time from diagnosis of chronic myeloid leukemia to imatinib treatment>12 months (p-value=0.030).ConclusionThese data indicate that patients with the above risk factors have a worse prognosis. This information can guide the therapy to be used

CAN NLR BE A BIOMARKER FOR MUCOSITIS AND GVHD IN PATIENTS UNDERGOING ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION?

Allogeneic hematopoietic stem cell transplantation (HSCT) is the treatment for many diseases, however can induce important complications such as Oral Mucositis (OM) and Graft-versus-Host Disease (GVHD). The neutrophil-lymphocyte ratio (NLR) is a peripheral biomarker of systemic inflammation and an independent prognostic factor in several inflammatory diseases. Objective: The aim of this study was to evaluate the association of NLR with OM and GVHD in patients undergoing allogeneic HSCT. Methods: Patients who underwent&nbsp; allogeneic HSCT at the Bone Marrow Transplant Service at the Hospital de Clínicas Complex of the Federal University of Paraná were included in the study. Sociodemographic data and blood count were collected from patients' medical records. NLR was calculated and associated with OM and GVHD. Results: 45 patients were included in the study. NLR was considerably higher in patients who had OM and oral GVHD when compared to patients who did not present these conditions, nonetheless no statistically significant difference was observed. Conclusion: Although both OM and GVHD are associated with inflammatory response as well as to the immune system, it was not associated with NLR. A further investigation considering other variables related to the HSCT might find possible association as it could favor patients management and prevention

Terapia alvo com mesilato de imatinibe : um estudo de 98 pacientes com leucemia mielóide crônica

Orientador: Ricardo PasquiniDissertaçao (mestrado) - Universidade Federal do Paraná, Setor de Ciencias da Saúde, Programa de Pós-Graduaçao em Medicina Interna. Defesa: Curitiba, 25/11/2005Inclui bibliografiaÁrea de concentraçao: Hematologi

Acute And Chronic Graft-versus-host Disease After Hematopoietic Stem Cell Transplantation

Graft-versus-host disease (GVHD) is one of the main complications of hematopoietic stem cell transplantation, affecting about 50% to 80% of the patients. Acute GVHD and its clinical manifestations are discussed in this article, as well as the new NIH criteria for the diagnosis and classification of chronic GVHD. Therapy for both chronic and acute GVHD is an important field of discussion, as there is no proven superiority for the majority of therapies used after primary treatment has failed. Hence, this review is meant to be a useful consultation tool for hematologists dealing with this complex transplantation procedure complication.621445