Brazilian guidelines on hematopoietic stem cell transplantation in acute myeloid leukemia

INTRODUCTION/OBJECTIVES

Acute myeloid leukemia (AML) accounts for 90% of all cases of acute leukemia in adults. In Brazil, the mortality from myeloid leukemia is 1.74/100 000 men and 1.37/100 000 women. Our aim was to review and update guidelines of the Brazilian Society of Bone Marrow Transplantation on indications of hematopoietic stem cell transplantation (HSCT) for the treatment AML.

CONCLUSIONS

(i) Allo-HSCT is recommended for high-risk AML (IA); (ii) allo-HSCT is recommended for AML of intermediate risk (IA); (iii) allo-HSCT is recommended for AML relapsed/refractory (C4); (iv) auto-HSCT is recommended for AML after 1 consolidation (C4); (v) auto-HSCT is recommended for AML in CR1 (higher than QT in the Brazilian experience) (C4); (vi) auto-HSCT is accepted for AML M3 in second molecular complete remission (2B); (vii) peripheral blood instead of Bone Marrow HSC for advanced disease (2A); (viii) recommended conditioning protocols: Bu-Cy/Bu-Mel, Bu-Flu, TBI-Cy. In umbilical cord HSCT, consider ATG-based protocols (2A); (ix) allogeneic HSCT for the treatment of AML can be used in patients between 60 and 80 yr with good performance status and the absence of significant comorbidities (C4).

Abstract P1-07-19: Spatial analyses of breast cancer in women 15-49 years-old in Rio Grande do Sul, southern Brazil

Breast cancer (BC) rates under 50 years have been increasing over time in several countries. Although the exact impact of BC is not know in low and middle income countries, it's estimated that at least 20% of deaths caused by BC affect women under the ahe of 50 years. In Porto Alegre, the capital of Rio Grande do Sul (RS), Brazil's southernmost state, the incidence of BC in women aged 40-49 years is 165 cases per 100,000, while the mortality rate reaches 25 in 100,000 women. In order to understand BC profile in this age group in the entire state of RS, we established incidence, morbidity and mortality between 2002-2011 through crude and smoothed rates for each municipality. Furthermore, we perform the spatial analysis of these indicators. Incidence data were only available for the state capital, where the rate incidence was 19 and 160 cases per 100,000 women in the age groups of 15-39 and 40-49, respectively. Statewide mortality was 2 and 21 per 100,000 women in the age groups of 15-39 and 40-49, respectively. Hospitalar morbidity associated with BC was 0.6% and 2% in women 15-39 and 40-49 years, respectively. The distribution of morbidity and mortality showed regions with continuously high rates throughout this period with result above 3% and 20 deaths per 100,000 women. In the same areas we did not identified centers specialized in cancer treatment and care. Although there is specific epidemiological surveillance for cancer in Brazil, the coverage is insufficient, especially when it comes to incidence. Morbidity and mortality data showed regions continually affected by high rates, suggesting that specific measures as well as specialized care for women in these regions are necessary. This result is particularly important since current guidelines of the Ministry of Health in Brazil recommend mammographic screening starting at the age of 50 years. The expansion of coverage and access to appropriate treatment is essential for the recognition of risk factors, adoption of effective strategies and reduction of cases and deaths in this group of women. Knowledge of the age distribution of BC cases and BC related deaths is important for the definition of health care policies, which will likely be different in different regions of the world.

Citation Format: Vianna FSL, Vargas F, Gross LG, Nunes LN, Ashton-Prolla P, Camey SA. Spatial analyses of breast cancer in women 15-49 years-old in Rio Grande do Sul, southern Brazil. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-07-19.