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Medeiros GRDO, Funke VAM, Lima ACM, Mion ALV, Menezes I, Setubal DC, Sola CBDS, Tagliari G, Marchesini R, Nabhan SK, Pasquini R. The Role of Molecular or Cytogenetic Response as a Favorable Prognostic Factor Before Hematopoietic Stem Cell Transplantation for Chronic Myeloid Leukemia. Transplant Cell Ther 2024:S2666-6367(24)00293-8. [PMID: 38522578 DOI: 10.1016/j.jtct.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
Tyrosine kinase inhibitors (TKIs) have revolutionized therapy for patients with chronic myeloid leukemia (CML) over the last two decades. However, some patients still do not achieve an adequate response to these drugs, and hematopoietic stem cell transplantation (HSCT) is indicated in this scenario. We present the results of a 20-year follow-up study of 70 patients who underwent transplantation after TKI failure. The primary objective of this study was to evaluate overall survival (OS) and the secondary objective was to evaluate the outcomes of relapse-free survival (RFS), GVHD-free, relapse-free survival (GFRS) and the incidences of relapse (RI), non-relapse mortality (NRM), acute and chronic GVHD. Median survival was 11 years, with a 1-year OS of 70% (57.8 to 79.3) and a 5-year OS of 57.7% (45.1 to 68.5). The estimated 5-year OS was not different for CP1 (60%) versus advanced stages (45%); P = .60. The degree of response immediately before transplantation was directly associated with worse outcomes [HR 5.89 (1.19-29.16); P = .03] for patients with only a hematological response compared with patients with a cytogenetic or molecular response. This study corroborates the potential of HSCT in the scenario of therapeutic failure and highlights the role of molecular or cytogenetic response as a potential target to be achieved before transplantation.
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Affiliation(s)
| | - Vaneuza Araújo Moreira Funke
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | | | - Ana Lúcia Vieira Mion
- Molecular Biology in OncoHematological Diseases Laboratory, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Isabela Menezes
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Daniela Carinhanha Setubal
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Caroline Bonamin Dos Santos Sola
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Gláucia Tagliari
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Rafael Marchesini
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Samir Kanaan Nabhan
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Ricardo Pasquini
- Hematology and Bone Marrow Transplantation Center, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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Nichele S, Bonfim C, Junior LGD, Loth G, Kuwahara C, Trennephol J, Funke VAM, Marinho DE, Koliski A, Rodrigues AM, Mousquer RTG, Fasth A, Lima ACM, Calado RT, Pasquini R. Hematopoietic cell transplantation for telomere biology diseases: A retrospective single-center cohort study. Eur J Haematol 2023. [PMID: 37259830 DOI: 10.1111/ejh.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Telomere biology diseases (TBD) result from defective telomere maintenance, leading to bone marrow failure. The only curative treatment for aplastic anemia related to TBD is a hematopoietic cell transplant (HCT). Although reduced-intensity conditioning (RIC) regimens decrease transplant-related mortality, non-hematological phenotypes represent a major challenge and are associated with poor long-term follow-up outcomes. OBJECTIVE To describe the outcome of TBD patients transplanted for marrow failure. STUDY DESIGN This is a retrospective, single-center study describing the outcomes of 32 consecutive transplants on 29 patients between 1993 and 2019. RESULTS The median age at transplantation was 14 years (range, 3-30 years). Most patients received a RIC regimen (n = 28) and bone marrow (BM) from an unrelated donor (n = 16). Four patients received a haploidentical transplant. Chimerism was available for 27 patients with a median time to neutrophil recovery of 20 days (13-36 days). Primary graft failure occurred in one patient, whereas second graft failure occurred in two. Acute GVHD grade II-IV and moderate to severe chronic GVHD occurred in 22% of patients at risk. Fourteen patients were alive after HCT at the last follow-up (median, 6 years; 1.4-19 years). The 5-year overall survival was better after matched sibling donor (MSD) transplantation compared to other hematopoietic stem cell sources (88.9% vs. 47.7%; p = .05; CI = 95%). Overall, 15 patients died after HCT, most of them (n = 11) after the first year of transplant, due to non-hematological disease progression or complication of chronic GVHD. CONCLUSIONS Hematopoietic cell transplantation is a potentially curative treatment option for TBD, nonetheless the poor outcome reflects the progression of non-hematologic disease manifestations, which should be considered when transplantation is indicated.
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Affiliation(s)
- Samantha Nichele
- Clinical Hospital of Federal University of Paraná, Curitiba, Brazil
| | - Carmem Bonfim
- Clinical Hospital of Federal University of Paraná, Curitiba, Brazil
| | - Luiz G D Junior
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Gisele Loth
- Clinical Hospital of Federal University of Paraná, Curitiba, Brazil
| | | | | | | | | | - Adriana Koliski
- Clinical Hospital of Federal University of Paraná, Curitiba, Brazil
| | | | | | - Anders Fasth
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alberto C M Lima
- Clinical Hospital of Federal University of Paraná, Curitiba, Brazil
| | - Rodrigo T Calado
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ricardo Pasquini
- Clinical Hospital of Federal University of Paraná, Curitiba, Brazil
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Lima ACM, Getz J, do Amaral GB, Loth G, Funke VAM, Nabhan SK, Petterle RR, de Marco R, Gerbase-DeLima M, Pereira NF, Bonfim C, Pasquini R. Donor-specific HLA antibodies are associated with graft failure and delayed hematologic recovery after unrelated donor hematopoietic cell transplantation. Transplant Cell Ther 2023:S2666-6367(23)01298-8. [PMID: 37220839 DOI: 10.1016/j.jtct.2023.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Graft failure (GF) is one of the major concerns after allogeneic hematopoietic cell transplantation (allo-HCT) and remains a significant cause of morbidity and mortality. Although earlier reports have associated the presence of donor-specific HLA antibodies (DSAs) with increased risk of GF after unrelated donor allo-HCT, recent studies have failed to confirm this association. OBJECTIVE We sought to validate the presence of DSAs as a risk factor for GF and hematologic recovery in the unrelated donor allo-HCT setting. STUDY DESIGN We retrospectively evaluated 303 consecutive patients who underwent their first unrelated donor allo-HCT at our institution from January 2008 to December 2017. DSA evaluation was performed using 2 Single Antigen Beads (SAB) assays, DSA titration with 1:2, 1:8, and 1:32 dilutions, C1q-binding assay, and absorption/elution protocol to assess possible false-positive DSA reactivity. The primary endpoints were neutrophil and platelet recovery and GF, whereas the secondary endpoint was overall survival. Multivariable analyses were performed using Fine-Gray competing risks regression or Cox proportional hazards regression models. RESULTS The median patient age was 14 years (range, 0-61 years), 56.1% were male, and 52.5% were transplanted for nonmalignant diseases. Eleven patients (3.63%) were DSA-positive. Of them, 10 had preexisting DSAs, and one showed post-transplant de novo DSA. Nine patients had 1 DSA, 1 had 2 DSAs, and 1 had 3 DSAs, with a median MFI of 4334 (range, 588-20,456) and 3581 (range, 227-12,266) in LABScreen and LIFECODES SAB assays, respectively. Overall, 21 patients experienced GF. Of them, 12 had primary graft rejection, 8 had secondary graft rejection, and 1 had primary poor graft function. The cumulative incidences of GF at 28, 100, and 365 days were 4.0% (95% CI, 2.2%-6.6%), 6.6% (95% CI, 4.2%-9.8%), and 6.9% (95% CI, 4.4%-10.2%), respectively. In the multivariable analyses, DSA-positive patients had significantly delayed neutrophil (subdistribution hazard ratio [SHR] = 0.48; 95% CI, 0.29-0.81; P = .006) and platelet recovery (SHR = 0.51; 95% CI, 0.35-0.74; P = .0003) than patients without DSAs. In addition, only DSAs were significant predictors of primary GF at 28 days (SHR = 2.78; 95% CI, 1.65-4.68; P = .0001). The Fine-Gray regression also demonstrated that the presence of DSAs was strongly associated with a higher incidence of overall GF (SHR = 7.60; 95%CI, 2.61-22.14; P = .0002). DSA-positive patients with GF had significantly higher median MFI values than DSA-positive patients who achieved engraftment in LIFECODES SAB assay using neat serum (10,334 vs. 1250; P = .006) and in LABScreen SAB at 1:32 dilution (1627 vs. 61; P = .006). All 3 patients with C1q-positive DSAs failed to engraft. DSAs were not predictive of inferior survival (hazard ratio = 0.50; 95% CI, 0.20-1.26, P = .14). CONCLUSIONS Our results validate the presence of DSAs as a significant risk factor for GF and poor hematologic recovery after unrelated donor allo-HCT. Thus, careful pre-transplant DSA evaluation may optimize unrelated donor selection and improve allo-HCT outcomes.
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Affiliation(s)
- Alberto Cardoso Martins Lima
- Immunogenetics Laboratory - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil; Immunogenetics Institute (IGEN), Associação Fundo de Incentivo à Pesquisa, São Paulo, SP, Brazil.
| | - Joselito Getz
- Immunogenetics Laboratory - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Geovana Borsato do Amaral
- Immunogenetics Laboratory - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Gisele Loth
- Bone Marrow Transplantation Unit - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe, Hospital Pequeno Príncipe, Curitiba, PR, Brazil
| | - Vaneuza Araújo Moreira Funke
- Bone Marrow Transplantation Unit - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Samir Kanaan Nabhan
- Bone Marrow Transplantation Unit - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | | | - Renato de Marco
- Immunogenetics Institute (IGEN), Associação Fundo de Incentivo à Pesquisa, São Paulo, SP, Brazil
| | - Maria Gerbase-DeLima
- Immunogenetics Institute (IGEN), Associação Fundo de Incentivo à Pesquisa, São Paulo, SP, Brazil
| | - Noemi Farah Pereira
- Immunogenetics Laboratory - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Carmem Bonfim
- Bone Marrow Transplantation Unit - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe, Hospital Pequeno Príncipe, Curitiba, PR, Brazil
| | - Ricardo Pasquini
- Bone Marrow Transplantation Unit - Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
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Gutierrez-Rodrigues F, Munger E, Ma X, Groarke EM, Tang Y, Patel BA, Catto LFB, Clé DV, Niewisch MR, Alves-Paiva RM, Donaires FS, Pinto AL, Borges G, Santana BA, McReynolds LJ, Giri N, Altintas B, Fan X, Shalhoub R, Siwy CM, Diamond C, Raffo DQ, Craft K, Kajigaya S, Summers RM, Liu P, Cunningham L, Hickstein DD, Dunbar CE, Pasquini R, De Oliveira MM, Velloso EDRP, Alter BP, Savage SA, Bonfim C, Wu CO, Calado RT, Young NS. Differential diagnosis of bone marrow failure syndromes guided by machine learning. Blood 2023; 141:2100-2113. [PMID: 36542832 PMCID: PMC10163315 DOI: 10.1182/blood.2022017518] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/10/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
The choice to postpone treatment while awaiting genetic testing can result in significant delay in definitive therapies in patients with severe pancytopenia. Conversely, the misdiagnosis of inherited bone marrow failure (BMF) can expose patients to ineffectual and expensive therapies, toxic transplant conditioning regimens, and inappropriate use of an affected family member as a stem cell donor. To predict the likelihood of patients having acquired or inherited BMF, we developed a 2-step data-driven machine-learning model using 25 clinical and laboratory variables typically recorded at the initial clinical encounter. For model development, patients were labeled as having acquired or inherited BMF depending on their genomic data. Data sets were unbiasedly clustered, and an ensemble model was trained with cases from the largest cluster of a training cohort (n = 359) and validated with an independent cohort (n = 127). Cluster A, the largest group, was mostly immune or inherited aplastic anemia, whereas cluster B comprised underrepresented BMF phenotypes and was not included in the next step of data modeling because of a small sample size. The ensemble cluster A-specific model was accurate (89%) to predict BMF etiology, correctly predicting inherited and likely immune BMF in 79% and 92% of cases, respectively. Our model represents a practical guide for BMF diagnosis and highlights the importance of clinical and laboratory variables in the initial evaluation, particularly telomere length. Our tool can be potentially used by general hematologists and health care providers not specialized in BMF, and in under-resourced centers, to prioritize patients for genetic testing or for expeditious treatment.
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Affiliation(s)
- Fernanda Gutierrez-Rodrigues
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Eric Munger
- Department of Bioinformatics and Computational Biology, George Mason University, Fairfax, VA
| | - Xiaoyang Ma
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Emma M. Groarke
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Youbao Tang
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, NIH Clinical Center, Bethesda, MD
| | - Bhavisha A. Patel
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Luiz Fernando B. Catto
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Diego V. Clé
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Marena R. Niewisch
- Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch, National Cancer Institute (NCI), NIH, Bethesda, MD
| | | | - Flávia S. Donaires
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - André Luiz Pinto
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Gustavo Borges
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Barbara A. Santana
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Lisa J. McReynolds
- Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch, National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Neelam Giri
- Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch, National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Burak Altintas
- Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch, National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Xing Fan
- Translational Stem Cell Biology Branch, NHLBI, NIH, Bethesda, MD
| | - Ruba Shalhoub
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Christopher M. Siwy
- Department of Clinical Reseach Infomatics, NIH Clinical Center, Bethesda, MD
| | - Carrie Diamond
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Diego Quinones Raffo
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Kathleen Craft
- Translational and Functional Genomics Branch, National Human Genome Research Institute, NIH, Bethesda, MD
| | - Sachiko Kajigaya
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Ronald M. Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, NIH Clinical Center, Bethesda, MD
| | - Paul Liu
- Translational and Functional Genomics Branch, National Human Genome Research Institute, NIH, Bethesda, MD
| | - Lea Cunningham
- Translational and Functional Genomics Branch, National Human Genome Research Institute, NIH, Bethesda, MD
| | | | | | - Ricardo Pasquini
- Bone Marrow Transplantation Unit, Federal University of Parana, Curitiba, PR
| | | | - Elvira D. R. P. Velloso
- Hemotherapy and Cell Therapy Branch, Albert Einstein Hospital, São Paulo, Brazil
- Service of Hematology, Transfusion and Cell Therapy and Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31) HCFMUSP, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Blanche P. Alter
- Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch, National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Sharon A. Savage
- Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch, National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Carmem Bonfim
- Bone Marrow Transplantation Unit, Federal University of Parana, Curitiba, PR
- Instituto de Pesquisa Pele Pequeno Principe, Curitiba, PR
| | - Colin O. Wu
- Office of Biostatistics Research, NHLBI, NIH, Bethesda, MD
| | - Rodrigo T. Calado
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Neal S. Young
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
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Pillonetto DV, Piovezan BZ, Nichele S, Lima ACM, Pasquini R, Pereira NF, Bonfim C. Investigation of mutations in Fanconi anemia genes and malignancy predisposition in Brazilian patients. Int J Lab Hematol 2023; 45:82-89. [PMID: 36333938 DOI: 10.1111/ijlh.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION This study proposed to identify Fanconi anemia (FA) mutations in Brazilian patients and to investigate their impact on clinical manifestations and malignancies onset. METHODS A total of 116 patients were screened for nine mutations in FANCA, FANCC, FANCG. Those with no mutations were investigated by multiplex ligation-dependent probe amplification (MLPA) and Sanger sequencing for FANCA, FANCC, FANCE, FANCF, FANCG, FANCD1/BRCA2. RESULTS Genetic subtype was identified in 107/116 (78 FA-A, 8 FA-C, 13 FA-G, 8 FA-E), with only one mutation in 1/116, and no mutations in 9/116 patients. Before hematopoietic cell transplantation (HCT), malignancies were detected in 16/116 patients (14/78 FA-A, 01/08 FA-C, 01/08 FA-E), and 12 of them were hematological. Observed to expected ratio (O/E) of hematologic malignancy was 303.7 (95% CI = 148.6-458.7). CONCLUSION This study allowed the identification of biallelic mutations in 91.4% of patients. FANCG and FANCC mutations had significantly earlier bone marrow failure onset, and FANCG severe cytopenia at diagnosis. Despite the inherent limitations of the small number of malignancy events in each genetic subtype, the hematologic malignancies O/E ratio was very high. Cumulative incidence of malignancy before HCT was higher in the third and fourth decades of life, considering HCT and death as competing risks. The cumulative incidence of HCT increased during the first decade, competing with malignancy development.
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Affiliation(s)
| | - Bruno Zagonel Piovezan
- Immunogenetic's Laboratory - Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Samantha Nichele
- Bone Marrow Transplantation Service, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | | | - Ricardo Pasquini
- Bone Marrow Transplantation Service, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Noemi Farah Pereira
- Immunogenetic's Laboratory - Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Carmem Bonfim
- Bone Marrow Transplantation Service, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil.,Faculdades Pequeno Principe, Instituto de Pesquisa Pele Pequeno Principe, Curitiba, Brazil
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Azambuja AP, Beltrame MP, Schluga YC, Justus JLP, Malvezzi M, Bonfim C, Pasquini R. ANALYSIS OF B-LYMPHOCYTE MATURATION KINETICS WITH A 10-COLOR BCP-ALL MINIMAL RESIDUAL DISEASE DETECTION TUBE BY FLOW CYTOMETRY: A COMPARISON OF REGENERATING BONE MARROW BEFORE AND AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATION. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Azambuja AP, Schluga YC, Justus JLP, Beltrame MP, Funke VAM, Bonfim C, Malvezzi M, Pasquini R. IMPLANTAÇÃO DA PESQUISA DE DOENÇA RESIDUAL MÍNIMA POR CITOMETRIA DE FLUXO DE ALTA SENSIBILIDADE NAS LEUCEMIAS AGUDAS EM UM CENTRO ÚNICO NO BRASIL. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Lima ACM, Bonfim C, Getz J, do Amaral GB, Petterle RR, Loth G, Nabhan SK, de Marco R, Gerbase-DeLima M, Pereira NF, Pasquini R. Untreated Donor-Specific HLA Antibodies Are Associated With Graft Failure and Poor Survival After Haploidentical Transplantation With Post-Transplantation Cyclophosphamide in Pediatric Patients With Nonmalignant Disorders. Transplant Cell Ther 2022; 28:698.e1-698.e11. [DOI: 10.1016/j.jtct.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/10/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
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Graf CM, Nichele S, Siviero RB, Loth G, Trennepohl JP, Zinher MT, Grandinetti A, Pilonetto DV, Pasquini R, Ramos Moreira AT, Bonfim C. Ocular Manifestations in Patients with Fanconi Anemia: A Single-Center Experience Including 106 Patients. J Pediatr 2022; 242:228-234.e1. [PMID: 34774576 DOI: 10.1016/j.jpeds.2021.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To describe the prevalence of acquired ocular manifestations in patients with Fanconi anemia (FA) and to describe and correlate the congenital ocular malformations with the genetic subtypes of the disease. STUDY DESIGN This is a cross-sectional observational study of 106 consecutive patients with confirmed diagnosis of FA who were followed at the Hematopoietic Stem Cell Transplantation (HSCT) Service at the Federal University of Paraná, Curitiba, Parana, Brazil. Participants underwent a complete ophthalmologic evaluation and 84 patients underwent ocular ultrasound examination. This study was conducted between November 2014 and August 2017. RESULTS The patients ranged in age from 6 months to 43 years of age. Microphthalmia was the most common congenital ocular abnormality (95.2%). A decrease in anthropometric measurements was observed, including palpebral fissure length (78/103 patients [76.5%]), microcornea (48/103 patients [46.6%]), and ptosis (31/103 patients [30.1%]). We identified a new ophthalmic condition in 15 patients with FA, that is, epiretinal tissue on the optic disc. The genetic subtype was identified in 78 patients (79.6%), the FA-A subtype was most prevalent (50%). The most common acquired ocular manifestation (non-graft-versus-host disease [GVHD] related) in patients who did not undergo HSCT (n = 44) was limbal neovascularization (13.6%), whereas in patients who underwent HSCT (n = 62), the GVHD-related manifestation was ocular GVHD (51.6%). The most frequent symptom of ocular GVHD was keratoconjunctivitis sicca (29%). CONCLUSIONS Several ocular manifestations were identified in patients with FA.
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Affiliation(s)
- Christie Michelle Graf
- Ophthalmic Reference Center, Hospital De Clinicas, Federal University of Parana, Curitiba, Brazil.
| | - Samantha Nichele
- Bone Marrow Transplantation Service, Hospital De Clinicas, Federal University of Parana, Curitiba, Brazil
| | | | - Gisele Loth
- Bone Marrow Transplantation Service, Hospital De Clinicas, Federal University of Parana, Curitiba, Brazil
| | - Joanna Paula Trennepohl
- Bone Marrow Transplantation Service, Hospital De Clinicas, Federal University of Parana, Curitiba, Brazil
| | - Mariana Tosato Zinher
- Ophthalmic Reference Center, Hospital De Clinicas, Federal University of Parana, Curitiba, Brazil
| | | | | | - Ricardo Pasquini
- Bone Marrow Transplantation Service, Hospital De Clinicas, Federal University of Parana, Curitiba, Brazil
| | - Ana Tereza Ramos Moreira
- Ophthalmic Reference Center, Hospital De Clinicas, Federal University of Parana, Curitiba, Brazil
| | - Carmem Bonfim
- Bone Marrow Transplantation Service, Hospital De Clinicas, Federal University of Parana, Curitiba, Brazil
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Bonfim C, Nichele S, Loth G, Funke VAM, Nabhan SK, Pillonetto DV, Lima ACM, Pasquini R. Transplantation for Fanconi anaemia: lessons learned from Brazil. The Lancet Haematology 2022; 9:e228-e236. [DOI: 10.1016/s2352-3026(22)00032-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 12/11/2022]
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Moreira Funke VA, Lima ACM, Hamerschlak N, Rensi Colturato VA, De Souza MP, Vigorito AC, Teixeira GM, Rocha V, Barbosa Mariano LC, Lerner D, Arcuri LJ, Navarro Barros GM, Pasquini R, Paz A, Voltarelli CL, Tan BC, Neves HRA, Simione AJ, Silva CC, Flowers ME. DIPSS Score Validation As a Tool to Estimate Survival and Non-Relapse Mortality after Hematopoietic Stem Cell Transplant in a Brazilian Multicentric Cohort. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00322-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Azambuja AP, Oliveira MM, Cruvinel L, Bovo P, Bittencourt MA, Pasquini R, Malvezzi M. ANALYSIS OF BASELINE CHARACTERISTICS, DISEASE BURDEN AND LONG-TERM FOLLOW-UP OF 167 PATIENTS WITH BRAZILIAN PAROXYSMAL NOCTURNAL HEMOGLOBINURIA - ANOTHER NATURAL HISTORY. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Funke VAM, Lima ACM, Hamerschlak N, Colturato V, Souza MP, Vigorito AC, Teixeira GM, Rocha VG, Mariano LCB, Lerner D, Barros GMN, Pasquini R, Paz AA, Neves HRA, Simioni AJ, Silva CC, Martins V, Voltarelli CL, Tan BC, Flowers ME. ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT FOR MYELOFIBROSIS IN BRAZIL: FACING OUR CHALLENGES. Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Silva LG, Menezes I, Gallucci MC, Sola CB, Setubal DC, Nabhan SK, Oliveira MM, Pasquini R, Funke VAM. ANÁLISE DOS NÍVEIS DE BCR-ABL COMO PREDITOR DE RECAÍDA APÓS TRANSPLANTE ALOGÊNICO DE CÉLULAS TRONCO HEMATOPOIÉTICAS (TCTH) EM LEUCEMIA MIELÓIDE CRÔNICA NA ERA DOS INIBIDORES DE TIROSINA-QUINASE (ITQ). Hematol Transfus Cell Ther 2021. [DOI: 10.1016/j.htct.2021.10.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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de Azambuja AP, Oliveira MM, Bitencourt MA, Bonfim C, Malvezzi M, Pasquini R. Analysis of baseline characteristics, disease burden and long-term follow-up of 167 patients with Paroxysmal Nocturnal Hemoglobinuria at a single center in Brazil. Blood Cells Mol Dis 2021; 92:102605. [PMID: 34537447 DOI: 10.1016/j.bcmd.2021.102605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/31/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022]
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) can occur as a hemolytic form or small PNH clone found in a patient with bone marrow failure. METHODS Describe Brazilian retrospective PNH cohort and identify the impact of disease burden on long-term follow-up. RESULTS 167 patients, mean age at diagnosis 28.4 (7.1-71.2 years), four years mean interval between onset of cytopenia/aplasia diagnosis and PNH clone detection. Patients were divided into 15 Classic PNH, 55 Hemolytic PNH with bone marrow hypoplasia (PNH/AA), and 97 Subclinical PNH (sc-PNH). Hypocellular bone marrow was found in 89.2%; 55 had hemoglobinuria and 22 thrombosis during monitoring. WBC PNH clone correlated with RBC PNH clone, LDH and cytopenia. Subclinical patients had lower median lower RBC clone (2.0% vs 24.0% vs 57.8%) and WBC clone (11.7% vs 58.8% vs 81.2%) than PNH/AA and Classic PNH, respectively. PNH granulocyte clone was 89.1% in thrombotic patients. Ten-year overall survival 80.4% and mortality in transplanted patients 9.6%. Sepsis was mortality cause in subclinical PNH (16/18, 88.8%), and thrombosis in hemolytic PNH (11/13, 84.6%). CONCLUSION Large PNH clones and LDH burden were associated with increased hemolysis and thrombosis risks, while young patients were associated with small PNH clones and subclinical form of the disease. Knowledge of the patient profile, the low risk associated with HSCT, and the use of long-term IST may be instrumental in the clinical management of PNH in restricted-resources countries.
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Affiliation(s)
| | | | | | - Carmem Bonfim
- Hospital de Clínicas, Federal University of Paraná, UFPR, Brazil
| | | | - Ricardo Pasquini
- Hospital de Clínicas, Federal University of Paraná, UFPR, Brazil
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Langhi DM, Maiolino A, Chiattone CS, de Souza CA, Covas DT, Costa FF, Guerino Cunha RL, Pasquini R. The Brazilian association of hematology, hemotherapy and cellular therapy seeks the implementation of, and access to, the car-T cell treatment in Brazil. Hematol Transfus Cell Ther 2021; 43 Suppl 2:S1-S2. [PMID: 34326029 PMCID: PMC8606715 DOI: 10.1016/j.htct.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Dante Mário Langhi
- Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Angelo Maiolino
- Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Carlos Sérgio Chiattone
- Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Carmino Antônio de Souza
- Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Universidade Estadual de Campinas (UNICAMP), São Paulo, SP, Brazil.
| | - Dimas Tadeu Covas
- Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Instituto Butantan, São Paulo, SP, Brazil
| | - Fernando Ferreira Costa
- Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Universidade Estadual de Campinas (UNICAMP), São Paulo, SP, Brazil
| | - Renato L Guerino Cunha
- Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Ricardo Pasquini
- Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
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Kantarjian HM, Hughes TP, Larson RA, Kim DW, Issaragrisil S, le Coutre P, Etienne G, Boquimpani C, Pasquini R, Clark RE, Dubruille V, Flinn IW, Kyrcz-Krzemien S, Medras E, Zanichelli M, Bendit I, Cacciatore S, Titorenko K, Aimone P, Saglio G, Hochhaus A. Correction to: Long-term outcomes with frontline nilotinib versus imatinib in newly diagnosed chronic myeloid leukemia in chronic phase: ENESTnd 10-year analysis. Leukemia 2021; 35:2142-2143. [PMID: 34108614 DOI: 10.1038/s41375-021-01306-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Timothy P Hughes
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| | - Richard A Larson
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Dong-Wook Kim
- Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | | | | | | | - Carla Boquimpani
- Hemorio, Institute of Hematology, Rio de Janeiro, Brazil.,Oncoclínica Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Pasquini
- Universidade Federal do Paraná, Hospital de Clinicas, Curitiba, Paraná, Brazil
| | - Richard E Clark
- Royal Liverpool University Hospital, Liverpool, United Kingdom
| | | | - Ian W Flinn
- Sarah Cannon Research Institute, Nashville, TN, USA
| | - Slawomira Kyrcz-Krzemien
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland
| | - Ewa Medras
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Maria Zanichelli
- Instituto de Tratamento do Câncer Infantil, Instituto da Criança, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Israel Bendit
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Ksenia Titorenko
- Novartis Pharmaceuticals Corporation, Moscow, Russian Federation
| | | | - Giuseppe Saglio
- Division of Internal Medicine and Hematology, University of Turin, Turin, Italy
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Lima ACM, Bonfim C, Getz J, Dornelles LN, do Amaral GB, Petterle RR, Loth G, Nabhan SK, Pereira NF, Pasquini R. The impact of donor-specific anti-human leukocyte antigen antibodies in salvage haploidentical hematopoietic cell transplantation with posttransplant cyclophosphamide in patients with nonmalignant disorders. HLA 2021; 97:493-504. [PMID: 33886161 DOI: 10.1111/tan.14277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/08/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Abstract
The presence of donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) has been recognized as a major risk factor for graft failure (GF) after haploidentical hematopoietic cell transplantation with posttransplant cyclophosphamide (haplo-PTCy). However, the role of DSAs in salvage haplo-PTCy for rescuing patients with nonmalignant disorders (NMDs) has not yet been reported. The present study retrospectively analyzed 22 patients with NMDs who underwent salvage haplo-PTCy from January 2008 to December 2017. The median age at the time of the rescue haplo-PTCy was 9 years (range, 1-26 years). Median time from the first transplant to second haplo-PTCy was 56 days (range, 37-591 days). Among all patients, six (27.3%) had DSAs, with a median DSA strength (mean fluorescence intensity [MFI]) of 5201 (range, 1412-11,543) in the first DSA testing. In addition, the median DSA MFI was 2672 (range, 832-10,498) before the bone marrow infusion. Overall, GF occurred in 5 (25%) of the 20 assessable patients. Three of four (75%) patients with DSAs experienced GF versus 2 of 16 (12.5%) DSA-negative patients (P = 0.032). The median DSA MFI for patients with GF was 6437 (range, 1412-10,498) versus 1845 (range, 832-2672) for those who engrafted or had early death (P = 0.030). One-year event-free survival was significantly lower in DSA-positive patients than in those without DSAs (16.7% vs. 62.5%, P = 0.002). DSA-negative patients had an acceptable 1-year survival of 62.5%. In conclusion, this study suggests that DSAs may be associated with deleterious outcomes after salvage haplo-PTCy in patients with NMDs.
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Affiliation(s)
| | - Carmem Bonfim
- Bone Marrow Transplantation Unit, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Joselito Getz
- Immunogenetics Laboratory, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Luciana Nasser Dornelles
- Immunogenetics Laboratory, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Geovana Borsato do Amaral
- Immunogenetics Laboratory, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | | | - Gisele Loth
- Bone Marrow Transplantation Unit, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Samir Kanaan Nabhan
- Bone Marrow Transplantation Unit, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Noemi Farah Pereira
- Immunogenetics Laboratory, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Ricardo Pasquini
- Bone Marrow Transplantation Unit, Complexo Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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Moreira Funke VA, Hamerschlak N, Vigorito AC, Teixeira GM, Paz A, Silva CC, Nascimento VM, Voltarelli CL, Tan BC, Neves HRA, Petterle R, Pasquini R, Flowers ME. Allogeneic Hematopoietic Stem Cell Transplant for Myelofibrosis in Brazil: Facing Our Challenges. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00196-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Moreira Funke VA, Silva LG, Vieira Mion AL, Sola C, Setubal DC, Oliveira MM, Bitencourt M, Galucci MC, Nabhan S, Pasquini R. Analysis of BCR-ABL Levels As a Predictor of Relapse after Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) in Chronic Myeloid Leucemia (CML) in the Era of Tyrosine Kinase Inhibitors (ITQ). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00202-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Voltarelli C, Tan B, Costa L, Pasquini R, Funke V. SCOPULARIOSE INVASIVA EM PACIENTE IMUNOSSUPRIMIDO: RELATO DE CASO. Hematol Transfus Cell Ther 2020. [DOI: 10.1016/j.htct.2020.10.491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Arcuri LJ, Nabhan SK, Cunha R, Nichele S, Ribeiro AAF, Fernandes JF, Daudt LE, Rodrigues ALM, Arrais-Rodrigues C, Seber A, Atta EH, de Oliveira JSR, Funke VAM, Loth G, Junior LGD, Paz A, Calixto RF, Gomes AA, Araujo CES, Colturato V, Simoes BP, Hamerschlak N, Flowers ME, Pasquini R, Rocha V, Bonfim C. Impact of CD34 Cell Dose and Conditioning Regimen on Outcomes after Haploidentical Donor Hematopoietic Stem Cell Transplantation with Post-Transplantation Cyclophosphamide for Relapsed/Refractory Severe Aplastic Anemia. Biol Blood Marrow Transplant 2020; 26:2311-2317. [PMID: 32949751 DOI: 10.1016/j.bbmt.2020.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/08/2020] [Accepted: 09/14/2020] [Indexed: 12/31/2022]
Abstract
Severe aplastic anemia (SAA) is a life-threatening disease that can be cured with allogeneic cell transplantation (HCT). Haploidentical donor transplantation with post-transplantation cyclophosphamide (haplo-PTCy) is an option for patients lacking an HLA-matched donor. We analyzed 87 patients who underwent haplo-PTCy between 2010 and 2019. The median patient age was 14 years (range, 1 to 69 years), most were heavily transfused, and all received previous immunosuppression (25% without antithymocyte globulin). Almost two-thirds (63%) received standard fludarabine (Flu)/cyclophosphamide (Cy) 29/total body irradiation (TBI) 200 cGy conditioning, and the remaining patients received an augmented conditioning: Flu/Cy29/TBI 300-400 (16%), Flu/Cy50/TBI 200 (10%), or Flu/Cy50/TBI 400 (10%). All patients received PTCy-based graft-versus-host disease (GVHD) prophylaxis. Most grafts (93%) were bone marrow (BM). The median duration of follow-up was 2 years and 2 months. The median time to neutrophil recovery was 17 days. Primary graft failure occurred in 15% of the patients, and secondary or poor graft function occurred in 5%. The incidences of grade II-IV acute GVHD was 14%, and that of chronic GVHD was 9%. Two-year overall survival and event-free survival (EFS) were 79% and 70%, respectively. EFS was higher for patients who received augmented Flu/Cy/TBI (hazard ratio [HR], .28; P = .02), and those who received higher BM CD34 cell doses (>3.2 × 10E6/kg) (HR, .29; P = .004). The presence of donor-specific antibodies before HSCT was associated with lower EFS (HR, 3.92; P = .01). Graft failure (HR, 7.20; P < .0001) was associated with an elevated risk of death. Cytomegalovirus reactivation was frequent (62%). Haploidentical HCT for SAA is a feasible procedure; outcomes are improved with augmented conditioning regimens and BM grafts with higher CD34 cell doses.
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Affiliation(s)
- Leonardo Javier Arcuri
- Hospital Israelita Albert Einstein, Bone Marrow Transplantation Unit, Sao Paulo, Brazil.
| | - Samir Kanaan Nabhan
- Universidade Federal do Parana, Bone Marrow Transplantation Unit, Curitiba, Brazil
| | - Renato Cunha
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Bone Marrow Transplantation Unit, Ribeirao Preto, Brazil
| | - Samantha Nichele
- Universidade Federal do Parana, Bone Marrow Transplantation Unit, Curitiba, Brazil
| | | | - Juliana Folloni Fernandes
- Hospital Israelita Albert Einstein, Bone Marrow Transplantation Unit, Sao Paulo, Brazil; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Bone Marrow Transplantation Unit, Sao Paulo, Brazil
| | - Liane Esteves Daudt
- Hospital das Clinicas de Porto Alegre, Bone Marrow Transplantation Unit, Porto Alegre, Brazil
| | | | | | - Adriana Seber
- Hospital Samaritano, Bone Marrow Transplantation Unit, Sao Paulo, Brazil
| | - Elias Hallack Atta
- Instituto Nacional de Cancer, Bone Marrow Transplantation Unit, Rio de Janeiro, Brazil
| | | | | | - Gisele Loth
- Universidade Federal do Parana, Bone Marrow Transplantation Unit, Curitiba, Brazil
| | - Luiz Guilherme Darrigo Junior
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Bone Marrow Transplantation Unit, Ribeirao Preto, Brazil
| | - Alessandra Paz
- Hospital das Clinicas de Porto Alegre, Bone Marrow Transplantation Unit, Porto Alegre, Brazil
| | - Rodolfo Froes Calixto
- Real Hospital Portugues de Beneficencia em Pernambuco, Bone Marrow Transplantation Unit, Recife, Brazil
| | | | - Carlos Eduardo Sa Araujo
- Instituto de Cardiologia do Distrito Federal, Bone Marrow Transplantation Unit, Brasilia, Brazil
| | | | - Belinda Pinto Simoes
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Bone Marrow Transplantation Unit, Ribeirao Preto, Brazil
| | - Nelson Hamerschlak
- Hospital Israelita Albert Einstein, Bone Marrow Transplantation Unit, Sao Paulo, Brazil
| | | | - Ricardo Pasquini
- Universidade Federal do Parana, Bone Marrow Transplantation Unit, Curitiba, Brazil
| | - Vanderson Rocha
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Bone Marrow Transplantation Unit, Sao Paulo, Brazil; Rede D'or, Bone Marrow Transplantation Unit, Sao Paulo, Brazil
| | - Carmem Bonfim
- Universidade Federal do Parana, Bone Marrow Transplantation Unit, Curitiba, Brazil
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Fernandes JF, Nichele S, Arcuri LJ, Ribeiro L, Zamperlini-Netto G, Loth G, Rodrigues ALM, Kuwahara C, Koliski A, Trennepohl J, Garcia JL, Daudt LE, Seber A, Gomes AA, Fasth A, Pasquini R, Hamerschlak N, Rocha V, Bonfim C. Outcomes after Haploidentical Stem Cell Transplantation with Post-Transplantation Cyclophosphamide in Patients with Primary Immunodeficiency Diseases. Biol Blood Marrow Transplant 2020; 26:1923-1929. [PMID: 32653621 DOI: 10.1016/j.bbmt.2020.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/01/2020] [Accepted: 07/05/2020] [Indexed: 01/01/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (HCT) can cure primary immunodeficiency diseases (PID). When a HLA-matched donor is not available, a haploidentical family donor may be considered. The use of T cell-replete haploidentical HCT with post-transplantation cyclophosphamide (haplo-PTCy) in children with PID has been reported in few case series. A donor is usually readily available, and haplo-PTCy can be used in urgent cases. We studied the outcomes of 73 patients with PID who underwent haplo-PTCy, including 55 patients who did so as a first transplantation and 18 who did so as a salvage transplantation after graft failure of previous HCT. The median patient age was 1.6 years. Most of the children were male (n = 54) and had active infection at the time of transplantation (n = 50); 10 children had severe organ damage. The diagnosis was severe combined immunodeficiency (SCID) in 34 patients and non-SCID in 39 (Wiskott-Aldrich syndrome; n = 14; chronic granulomatous disease, n = 10; other PID, n = 15). The median duration of follow-up of survivors was 2 years. The cumulative incidence of neutrophil recovery was 88% in the SCID group and 84% in non-SCID group and was 81% for first transplantations and 83% after a salvage graft. At 100 days, the cumulative incidence of acute GVHD grade II-IV and III-IV was 33% and 14%, respectively. The majority of patients reached 200/μL CD4+ and 1000/μL CD3+ cell counts between 3 and 6 months. The estimated 2-year overall survival was 66%; it was 64% for SCID patients and 65% for non-SCID patients and 63% for first HCT and 77% for salvage transplantations. Twenty-five patients died, most of them due to infection early after transplantation (before 100 days). In conclusion, haplo-PTCy is a feasible procedure, can cure two-thirds of children with PID, and can be used as rescue treatment for previous graft failure. © 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
- Juliana Folloni Fernandes
- Hematopoietic Stem Cell Transplantation unit, Instituto de Tratamento do Câncer Infantil, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Hematology and Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil; Hematopoietic Stem Cell Transplantation Unit, Hospital 9 de Julho, São Paulo, Brazil.
| | - Samantha Nichele
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Pediatric Blood and Marrow Transplantation Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Leonardo Javier Arcuri
- Hematology and Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Lisandro Ribeiro
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Pediatric Blood and Marrow Transplantation Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Gabriele Zamperlini-Netto
- Hematology and Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Gisele Loth
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Hematopoietic Stem Cell Transplantation unit, Hospital Infantil Pequeno Príncipe, Curitiba, Brazil
| | - Ana Luiza Melo Rodrigues
- Hematopoietic Stem Cell Transplantation unit, Hospital Infantil Pequeno Príncipe, Curitiba, Brazil
| | - Cilmara Kuwahara
- Hematopoietic Stem Cell Transplantation unit, Hospital Infantil Pequeno Príncipe, Curitiba, Brazil
| | - Adriana Koliski
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - Joanna Trennepohl
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Pediatric Blood and Marrow Transplantation Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Julia Lopes Garcia
- Hematopoietic Stem Cell Transplantation unit, Instituto de Tratamento do Câncer Infantil, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Hematology and Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Liane Esteves Daudt
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Adriana Seber
- Pediatric Hematopoietic Cell Therapy Unit, Hospital Samaritano, São Paulo, Brazil
| | - Alessandra Araujo Gomes
- Hematopoietic Stem Cell Transplantation unit, Instituto de Tratamento do Câncer Infantil, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Hematopoietic Stem Cell Transplantation Unit, Hospital 9 de Julho, São Paulo, Brazil; Bone Marrow Transplantation Unit, Hospital Sírio Libanês, São Paulo, Brazil
| | - Anders Fasth
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ricardo Pasquini
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Pediatric Blood and Marrow Transplantation Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Nelson Hamerschlak
- Hematology and Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Vanderson Rocha
- Bone Marrow Transplantation Unit, Hospital Sírio Libanês, São Paulo, Brazil; Department of Hematology, Hospital das Clínicas da Universidade de São Paulo (LIM 31), São Paulo, Brazil
| | - Carmem Bonfim
- Pediatric Blood and Marrow Transplantation Unit, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil; Pediatric Blood and Marrow Transplantation Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil; Hematopoietic Stem Cell Transplantation unit, Hospital Infantil Pequeno Príncipe, Curitiba, Brazil
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Darrigo LG, Loth G, Kuwahara C, Vieira A, Colturato V, Rodrigues AL, Arcuri L, Fernandes J, Macedo A, Tavares R, Gomes A, Ribeiro L, Seber A, Zecchin V, de Souza M, Calixto R, Pasquini R, Flowers M, Rocha V, Bonfim C. Hematopoietic cell transplantation for Diamond Blackfan anemia: A report from the Pediatric Group of the Brazilian Bone Marrow Transplantation Society. Eur J Haematol 2020; 105:426-433. [PMID: 32525237 DOI: 10.1111/ejh.13463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/30/2020] [Accepted: 06/03/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The aim of this study was to analyze the outcomes of children with Diamond-Blackfan anemia (DBA) treated in Brazil with hematopoietic cell transplantation (HCT). METHODS We performed a retrospective analysis of 44 pediatrics patients transplanted between 1990 and 2018. The median age of patients was 5 years, and 57% were male. Twenty-five received their first HCT from an HLA-matched sibling donor (MSD), 12 from a HLA matched unrelated bone marrow donor (MUD 10/10, n = 12) and 7 other HLA mismatched donors (MMD). RESULTS After a median follow-up of 4 years, estimate 5-year overall survival (OS) for the entire cohort was 70%, 80% for MSD group, 73% for MUD, and 29% for MMD. Thirty-eight out of the 44 evaluable patients engrafted successfully. Primary and secondary graft failure was observed in five and three patients, respectively. Rates of grade II-IV and III-IV acute graft-versus-host disease (aGVHD) were 25% and 18%, respectively. Nine patients developed chronic GVHD (cGVHD). CONCLUSION Overall survival rates observed after HLA matched donors transplant for DBA were comparable to those reported from higher-income countries and international registries.
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Affiliation(s)
- Luiz Guilherme Darrigo
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Gisele Loth
- Universidade Federal do Paraná, Curitiba, Brazil
| | | | - Ana Vieira
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | - Antonio Macedo
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rita Tavares
- Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | | | | | | | - Victor Zecchin
- Instituto de Oncologia Pediátrica-Graacc-Unifesp, São Paulo, Brazil
| | | | | | | | - Mary Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Marinho DH, Ribeiro LL, Nichele S, Loth G, Koliski A, Mousquer RTG, Funke VAM, Page K, Fasth A, Pasquini R, Boguszewski MCDS, Bonfim C. The challenge of long-term follow-up of survivors of childhood acute leukemia after hematopoietic stem cell transplantation in resource-limited countries: A single-center report from Brazil. Pediatr Transplant 2020; 24:e13691. [PMID: 32246550 DOI: 10.1111/petr.13691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/30/2020] [Accepted: 02/18/2020] [Indexed: 11/28/2022]
Abstract
With the number of long-term HSCT survivors steadily increasing, attention needs to be focused on the late complications and quality of life. We therefore analyzed the outcome of 101 pediatric patients (<18 years old at the time of HSCT) transplanted for acute leukemia between 1981 and 2015 at Complexo Hospital de Clínicas, Federal University of Paraná, Brazil, and who survived at least two years after HSCT. The median follow-up was 5.9 years (2.0-29.0); median age at follow-up was 17.5 years (2.98-39.0). The 5-year cumulative incidence of relapse was 27.5% (95% CI 18.6%-36.4%). Two-year cumulative incidence of chronic GVHD was 21.8% (95% CI 13.7%-29.8%). Of the 101 patients, 72 patients (71.3%) presented with late effects. Those surviving longer after HSCT experienced more complications. Patients who received TBI-based regimen developed more late effects (P = .013) and more endocrinological complications (P = .024). Endocrinological complications were the most common late sequelae found in this study. For childhood survivors, quality of life was not influenced by age (at HSCT or at last visit), time from HSCT, gender, donor, or GVHD. For survivors that no longer were children, only age at last visit impacted financial domain measures, irrespective of gender, donor, or GVHD. The current study confirms the high burden late complications after pediatric HSCT have on the survivors and underlines the importance of extended follow-up.
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Affiliation(s)
| | | | - Samantha Nichele
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
| | - Gisele Loth
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
| | - Adriana Koliski
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
| | | | | | - Kristin Page
- Pediatric Transplant and Cellular Therapy, Duke University, Durham, NC, USA
| | - Anders Fasth
- Department of Pediatrics, Institute of Clinical Sciencies at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ricardo Pasquini
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
| | | | - Carmem Bonfim
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
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Bonfim C, Arcuri LJ, Nabhan S, Seber A, Nichele S, Funke VAM, Fernandes JF, Daudt LE, Darrigo LG, Rodrigues ALM, Cunha RLG, Arrais C, Ribeiro AF, Atta E, Oliveira JSR, Paz A, Calixto RF, Gomes A, Sá Araújo CE, Colturato VA, Flowers ME, Pasquini R. Haploidentical Hematopoietic Stem Cell Transplantation with Post-Transplant Cyclophosphamide for Severe Aplastic Anemia. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tavares R, Souza CAD, Paley C, Bouard C, Tiwari R, Pasquini R. A subgroup analysis of JUMP, a phase IIIb, expanded-access study evaluating the safety and efficacy of ruxolitinib in patients with myelofibrosis in a Brazilian cohort. Hematol Transfus Cell Ther 2020; 42:46-53. [PMID: 31235325 PMCID: PMC7031100 DOI: 10.1016/j.htct.2019.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/20/2018] [Accepted: 01/17/2019] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Ruxolitinib has been approved for the treatment of myelofibrosis (MF). In this study, we present safety and efficacy findings from an analysis of 104 patients with intermediate- and high-risk MF in a Brazilian cohort of the JUMP study who received treatment with ruxolitinib. METHODS JUMP is a single-arm, open-label, phase IIIb, expanded-access study. The primary endpoint was to evaluate the safety and tolerability (frequency, duration, and severity of adverse events [AEs]) of ruxolitinib. RESULTS All of the 104 patients received the treatment. Median duration of exposure was 35.8 months. The most common hematologic AEs were anemia (57.7), thrombocytopenia (38.5%), neutropenia (11.5%), and leukopenia (9.6%). Second malignancies (all grades) occurred in 19.2% of patients (n=20). Serious AEs were reported in 62.5% of patients (n=65). The proportions of patients with ≥50% reduction from baseline in palpable spleen length at weeks 24 and 48 were 62.7% and 69.2%, respectively. The mean change from the baseline in the Functional Assessment of Cancer Therapy (FACT)-Lymphoma total score was 10.8 [15.6%] at week 4, 12.6 [14.1%] at week 24, and 12.2 [14.3%] at week 48. The mean change from the baseline for the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale was 3.9 [42.8%] at week 4, 4.9 [29.9%] at week 24, and 4.7 [28%] at week 48. At week 48, the estimated progression-free survival, leukemia-free survival, and overall survival probabilities were 91%, 91% and 93%, respectively Overall, 21 deaths were observed in the present study. CONCLUSION Findings from this study suggest that ruxolitinib could be evaluated as a standard-of-care treatment for the MF population in need of a viable treatment option. NCT01493414.
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Affiliation(s)
- Renato Tavares
- Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil.
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Darrigo LG, Colturato V, de Souza MP, Loth G, Calixto R, Seber A, Zecchin VG, Esteves Daudt L, Tavares RB, Arcuri L, de Macedo AV, Vieira AK, Kuwahara C, Ribeiro L, Fernandes JF, Flowers ME, Pasquini R, Bonfim C. Allogeneic Bone Marrow Transplants for Pediatric Severe Aplastic Anemia: Real-world Data comparing Matched Related and Unrelated Donors in a Developing Country. Retrospective study on behalf of the Pediatric Hematopoietic Stem Cell Transplant Working Group of the Brazilian Bone Marrow Transplantation Society (SBTMO) and the Brazil-Seattle Consortium (Gedeco). Pediatr Transplant 2019; 23:e13552. [PMID: 31297928 DOI: 10.1111/petr.13552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/29/2019] [Accepted: 06/18/2019] [Indexed: 01/06/2023]
Abstract
In this study, we report on major MRD or URD BMT outcomes in pediatric patients with SAA in Brazil. This was a retrospective study, which included 106 patients ≤18 years old who received a first BMT for SAA. All patients received bone marrow as graft source from an MRD (n = 69) or a URD (n = 37). Conditioning regimen was non-myeloablative in 73.6% of cases, and GVHD prophylaxis comprised a calcineurin inhibitor plus methotrexate in 89.6% of patients. After a median follow-up of 4.5 years after BMT, 81 patients are alive, with a 4-year OS of 77% and no statistically significant difference between the MRD and URD groups (82% vs. 69%, respectively; P = .08). Grade III-IV aGVHD at 6 months and cGVHD at 2 years were observed in 8% and 14% of cases, respectively, and were not statistically different between the groups. Twenty-five (23%) patients died at a median of 2.9 months after BMT. Our study showed that 4-year OS after BMT was not statistically different between MRD and URD recipients. This study shows that the outcomes of pediatric patients transplanted for SAA with a URD in Brazil are approaching those of MRD transplants. In contrast, OS after MRD BMT was lower than we would expect based on previous reports. The wide range of preparatory regimens used by the study centers highlights the need for standardized protocols for these children. Our findings provide a benchmark for future studies focused on improving BMT outcomes in this setting in Brazil.
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Affiliation(s)
| | | | | | - Gisele Loth
- Universidade Federal do Paraná, Curitiba, Brazil
| | - Rodolfo Calixto
- Real Hospital Português de Beneficência, Recife - PE, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Mary E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Getz J, Goldenstein M, Bonfim C, Funke VM, Colturato V, Hamerschlak N, Torres M, Sayer D, Boldt A, Pasquini R, Pereira NF. Investigation of MHC gamma block C4A and C4B polymorphisms in unrelated hematopoietic stem cell transplantation. Hematol Transfus Cell Ther 2019; 42:221-229. [PMID: 31801701 PMCID: PMC7417459 DOI: 10.1016/j.htct.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/21/2019] [Accepted: 06/29/2019] [Indexed: 12/21/2022] Open
Abstract
Background Immunological life-threatening complications frequently occur in post-hematopoietic stem cell transplantation (HSCT), despite matching recipient and donor (R/D) pairs for classical human leukocyte antigens (HLA). Studies have shown that R/D non-HLA disparities within the major histocompatibility complex (MHC) are associated with adverse effects post-HSCT. Methods We investigated the impact of mismatches of single-nucleotide polymorphisms (SNPs) in C4A/C4B genes, for showing the highest diversity in the MHC gamma block, on 238 patients who underwent HLA 10/10 unrelated donor (URD) HSCT. The endpoints were acute graft-versus-host disease (aGVHD), chronic graft-versus-host disease (cGVHD) and mortality. One hundred and twenty-nine R/D pairs had 23 C4-SNPs typed by PCR-SSP (Gamma-Type™v.1.0), and 109 R/D pairs had these 23 SNPs identified by next-generation sequencing (NGS) using the Illumina platform. Results The percentage of patients who received HSC from HLA 10/10 donors with 1–7 mismatches was 42.9%. The R/D pairs were considered C4 mismatched when bearing at least one disparity. These mismatches were not found to be risk factors for aGVHD, cGVHD or mortality after unrelated HSCT when SNPs were analyzed together (matched or mm ≥ 1), independently or according to the percentage of incompatibilities (full match for 23 SNPs; 1–3 mm and >3 mm). An exception was the association between 1–3 mismatches at the composite of SNPs C13193/T14952/T19588 with the development of aGVHD (P = 0.012) and with grades III-IV of this disease (P = 0.004). Conclusion Our data are not consistent with the hypothesis that disparities in C4A/C4B SNPs increase the risks of post-HSCT adverse effects for the endpoints investigated in this study.
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Affiliation(s)
- Joselito Getz
- Hospital de Clínicas - Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil.
| | - Monica Goldenstein
- Hospital de Clínicas - Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil
| | - Carmem Bonfim
- Hospital de Clínicas - Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil
| | - Vaneuza Moreira Funke
- Hospital de Clínicas - Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil
| | | | | | - Margareth Torres
- Hospital Amaral Carvalho, Jaú, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Angelica Boldt
- Hospital de Clínicas - Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil; Genetics Department - Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Ricardo Pasquini
- Hospital de Clínicas - Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil; Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | - Noemi Farah Pereira
- Hospital de Clínicas - Universidade Federal do Paraná (HC-UFPR), Curitiba, PR, Brazil
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Costa HZ, Pereira NF, kaminski L, Pasquini R, Funke VAM, Mion ALV. Mutations in the breakpoint cluster region-Abelson murine leukemia 1 gene in Brazilian patients with chronic myeloid leukemia. Hematol Transfus Cell Ther 2018; 40:363-367. [PMID: 30370415 PMCID: PMC6200712 DOI: 10.1016/j.htct.2018.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/13/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Mutations in the breakpoint cluster region-Abelson murine leukemia 1 gene are the leading cause of resistance to treatment with tyrosine kinase inhibitors in chronic myeloid leukemia patients. Mutations have been detected throughout the extension of the kinase domain of this gene and it is important to investigate their positions because there may be a difference in clinical relevance. Objective To evaluate mutations in the transcripts of the BCR-ABL1 gene in Brazilian patients with chronic myeloid leukemia under tyrosine kinase inhibitor treatment in the Hospital de Clínicas of the Universidade Federal do Paraná. Methods This retrospective observational cross-sectional study analyzed mutation data of BCR-ABL1 gene transcripts. Three hundred and thirty peripheral blood samples from 193 patients were evaluated with the search for mutations being achieved by Sanger sequencing. Results Sixteen mutation types were identified in 48/193 (24.87%) patients with T315I (20.83%) being the most common. Furthermore, four polymorphisms (T240T, K247R, E275E and Y275Y) were identified. The highest incidence of mutations (19/53: 35.85%) occurred in the P-loop of the tyrosine kinase domain, whereas no mutation was found in the A-loop. In 43/48 (89.58%) patients only one mutation was found and more than one mutation was found in 5/48 (10.42%). The simultaneous presence of two mutations (E189G/V299L and E255K/T315I) was observed in 2/5 patients while the different mutations were seen in sequential samples of the other three patients (Y253Y/T315I, T315I/E255K and E255K/T315I). Conclusions This molecular characterization contributed to the identification of the resistance profile to tyrosine kinase inhibitors in Brazilian patients, thus enabling the use of adequate therapeutic strategies in a timely manner.
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Affiliation(s)
| | | | | | | | | | - Ana Lucia Vieira Mion
- Corresponding author at: Universidade Federal do Paraná, Complexo Hospital de Clínicas, Laboratório de Imunogenética, Rua Padre Camargo, 280 – Alto da Gloria, CEP 80060240, Curitiba, PR, Brazil. Tel.: +55 41 3360 1038.
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Padilha PH, Borges G, Santana BA, Medeiros LA, Nabhan SK, Pasquini R, Donaires FS, Calado RT. THPO gene variants in patients with acquired aplastic anemia. Hematol Transfus Cell Ther 2018. [PMCID: PMC6738484 DOI: 10.1016/j.htct.2018.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Pedro Henrique Padilha
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil
| | - Gustavo Borges
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil
| | - Barbara Amélia Santana
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil
| | | | | | | | - Flavia Sacilotto Donaires
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil
| | - Rodrigo Tocantins Calado
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil
- Corresponding author at: Faculdade de Medicina de Ribeirão Preto da USP, Laboratório de Hematologia, bloco G, subsolo, HCRP, Av. Bandeirantes, 3900, Ribeirão Preto, SP CEP 14049-900, Brazil.
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Quiroga M, Pereira NF, Bitencourt MA, Bonfim C, Monteiro MGDM, Pasquini R. Late chimerical status after bone marrow transplantation in severe aplastic anemia according to two different preparatory regimens. Hematol Transfus Cell Ther 2018; 40:112-119. [PMID: 30057984 PMCID: PMC6001926 DOI: 10.1016/j.htct.2017.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 11/29/2017] [Indexed: 11/26/2022] Open
Abstract
Background This study investigated the influence of two conditioning regimens on the chimerical status of 104 patients with acquired severe aplastic anemia. Methods Patients were monitored for at least 18 months after related bone marrow transplantation and reaching partial or complete hematologic recovery. Group I patients (n = 55) received 200 mg/kg cyclophosphamide alone and Group II (n = 49) received 120 mg/kg cyclophosphamide associated with 12 mg/kg busulfan. Patients were classified in three chimerism levels according to the percentage of donor cells in the peripheral blood. Results Chimerism ≤50% occurred in 36.4% of Group I and none of Group II; chimerism 51–90% was found in 20.0% of Group I and 10.2% of Group II; and chimerism >90% was found in 43.6% of Group I versus 89.8% of Group II. A significant association (p-value < 0.001) was found between conditioning type and chimerism levels. A higher number of infused cells was associated with higher levels of chimerism only in Group I (p-value = 0.013). Multivariate analysis showed that chimerism >90% is associated with the cyclophosphamide plus busulfan conditioning (p-value < 0.001) and higher number of infused cells (p-value = 0.009), suggesting that these factors are predictive of graft outcome. Regarding hematological recovery, higher chimerism levels were associated with higher neutrophil (p-value = 0.003) and platelet counts (p-value < 0.001) in Group I only. These results show that myeloablative conditioning favors full donor chimerism and non-myeloablative conditioning predisposes to mixed chimerism or autologous recovery of hematopoiesis. Conclusion These data show that autologous recovery depends on the intensity of immunosuppression and that the immunosuppressive function of cyclophosphamide alone can induce this type of hematopoietic recovery.
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Affiliation(s)
- Marcia Quiroga
- Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, PR, Brazil
| | - Noemi Farah Pereira
- Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, PR, Brazil
| | | | - Carmem Bonfim
- Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, PR, Brazil
| | | | - Ricardo Pasquini
- Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, PR, Brazil
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Hughes TP, Leber B, Cervantes F, Spector N, Pasquini R, Clementino NCD, Schwarer AP, Dorlhiac-Llacer PE, Mahon FX, Rea D, Guerci-Bresler A, Kamel-Reid S, Bendit I, Acharya S, Glynos T, Dalal D, Branford S, Lipton JH. Sustained deep molecular responses in patients switched to nilotinib due to persistent BCR-ABL1 on imatinib: final ENESTcmr randomized trial results. Leukemia 2017; 31:2529-2531. [PMID: 28862704 PMCID: PMC5668492 DOI: 10.1038/leu.2017.247] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- T P Hughes
- Division of Haematology, SA Pathology and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - B Leber
- Clinical Pathology, McMaster University, Hamilton, Ontario, Canada
| | - F Cervantes
- Department of Hematology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - N Spector
- Departamento de Clínica Médica/FM, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - R Pasquini
- Division of Hematology and Medical Oncology, Federal University of Paraná, Curitiba, Brazil
| | | | - A P Schwarer
- Department of Hematology, Alfred Hospital, Melbourne, Victoria, Australia
| | | | - F-X Mahon
- Laboratoire Hématopoïèse Leucémique et Cible Thérapeutique, Inserm U1035, Université Victor Ségalen, Bordeaux, France
| | - D Rea
- Unité de Thérapie Cellulaire et Clinique Transfusionnelle, Service des Maladies du Sang et EA3518, Hôpital Saint-Louis, Paris, France
| | - A Guerci-Bresler
- Department of Hematology, Brabois Hospital, Vandoeuvre-lès-Nancy, Vandoeuvre, France
| | - S Kamel-Reid
- Clinical Laboratory Genetics, Genome Diagnostics, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - I Bendit
- Hematology Unit, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - S Acharya
- Novartis Healthcare Pvt Ltd, Hyderabad, India
| | - T Glynos
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - D Dalal
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S Branford
- Leukaemia Unit, Centre for Cancer Biology, SA Pathology, University of South Australia and University of Adelaide, Adelaide, South Australia, Australia
| | - J H Lipton
- Blood and Marrow Transplant Service, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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Pilonetto DV, Pereira NF, Bonfim CMS, Ribeiro LL, Bitencourt MA, Kerkhoven L, Floor K, Ameziane N, Joenje H, Gille JJP, Pasquini R. A strategy for molecular diagnostics of Fanconi anemia in Brazilian patients. Mol Genet Genomic Med 2017; 5:360-372. [PMID: 28717661 PMCID: PMC5511800 DOI: 10.1002/mgg3.293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/20/2017] [Accepted: 03/24/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Fanconi anemia (FA) is a predominantly autosomal recessive disease with wide genetic heterogeneity resulting from mutations in several DNA repair pathway genes. To date, 21 genetic subtypes have been identified. We aimed to identify the FA genetic subtypes in the Brazilian population and to develop a strategy for molecular diagnosis applicable to routine clinical use. METHODS We screened 255 patients from Hospital de Clínicas, Universidade Federal do Paraná for 11 common FA gene mutations. Further analysis by multiplex ligation-dependent probe amplification (MLPA) for FANCA and Sanger sequencing of all coding exons of FANCA, -C, and -G was performed in cases who harbored a single gene mutation. RESULTS We identified biallelic mutations in 128/255 patients (50.2%): 89, 11, and 28 carried FANCA,FANCC, and FANCG mutations, respectively. Of these, 71 harbored homozygous mutations, whereas 57 had compound heterozygous mutations. In 4/57 heterozygous patients, both mutations were identified by the initial screening, in 51/57 additional analyses was required for classification, and in 2/57 the second mutation remained unidentified. We found 52 different mutations of which 22 were novel. CONCLUSION The proposed method allowed genetic subtyping of 126/255 (49.4%) patients at a significantly reduced time and cost, which makes molecular diagnosis of FA Brazilian patients feasible.
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Affiliation(s)
- Daniela V. Pilonetto
- Immunogenetics LaboratoryHospital de ClínicasUniversidade Federal do ParanáCuritibaPRBrazil
| | - Noemi F. Pereira
- Immunogenetics LaboratoryHospital de ClínicasUniversidade Federal do ParanáCuritibaPRBrazil
| | - Carmem M. S. Bonfim
- Bone Marrow Transplantation ServiceHospital de ClínicasUniversidade Federal do ParanáCuritibaPRBrazil
| | - Lisandro L. Ribeiro
- Bone Marrow Transplantation ServiceHospital de ClínicasUniversidade Federal do ParanáCuritibaPRBrazil
| | - Marco A. Bitencourt
- Bone Marrow Transplantation ServiceHospital de ClínicasUniversidade Federal do ParanáCuritibaPRBrazil
| | - Lianne Kerkhoven
- Department of Clinical GeneticsVU University Medical CenterAmsterdamThe Netherlands
| | - Karijn Floor
- Department of Clinical GeneticsVU University Medical CenterAmsterdamThe Netherlands
| | - Najim Ameziane
- Department of Clinical GeneticsVU University Medical CenterAmsterdamThe Netherlands
| | - Hans Joenje
- Department of Clinical GeneticsVU University Medical CenterAmsterdamThe Netherlands
| | - Johan J. P. Gille
- Department of Clinical GeneticsVU University Medical CenterAmsterdamThe Netherlands
| | - Ricardo Pasquini
- Bone Marrow Transplantation ServiceHospital de ClínicasUniversidade Federal do ParanáCuritibaPRBrazil
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Vieira-Mion AL, Pereira NF, Funke VAM, Pasquini R. Molecular response to imatinib mesylate of Brazilian patients with chronic myeloid leukemia. Rev Bras Hematol Hemoter 2017; 39:210-215. [PMID: 28830599 PMCID: PMC5568590 DOI: 10.1016/j.bjhh.2017.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/07/2017] [Accepted: 04/05/2017] [Indexed: 11/30/2022] Open
Abstract
Background Imatinib mesylate has revolutionized the treatment of chronic myeloid leukemia leading to significant reductions of BCR-ABL1 transcript levels in peripheral blood. Objective To evaluate the response to imatinib mesylate treatment (400 mg/day) in Brazilian patients in the chronic phase of chronic myeloid leukemia monitored by quantitative real time polymerase chain reaction. Methods Between October 2002 and October 2010, 3169 peripheral blood samples were collected from 1403 patients from 3 to 5 months, 6 to 11 months, 12 to 17 months, 18 to 23 months and ≥24 months after beginning imatinib treatment. Eighty-two patients had samples available and analyzed for all time intervals. BCR-ABL1 quantification was performed by quantitative real time polymerase chain reaction using the ABL1 gene as the control. Results of the BCR-ABL1 ratio as a percentage were reported by the international scale (IS) using the laboratory conversion factor (0.51). Results In the first interval, 80.8% of patients achieved the optimal response (BCR-ABL1IS ≤ 10%). In the second period, 69.1% achieved optimal response (BCR-ABL1IS ≤ 1%) and, between 12 and 17 months, 47.3% achieved major molecular response (BCR-ABL1IS ≤ 0.1%). Conclusions The results of this retrospective study show that the response to imatinib treatment (400 mg/day) of Brazilian patients in the chronic phase of chronic myeloid leukemia is within the expected profile when compared to patients reported in international prospective randomized studies.
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Bonfim C, Ribeiro L, Nichele S, Bitencourt M, Kuwahara C, Rodrigues ALM, Loth G, Pereira NF, Lima AC, Eapen M, Pasquini R. Haploidentical Bone Marrow Transplantation with Post-Transplant Cyclophosphamide for 41 Children and Adolescents with Bone Marrow Failures. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cavilha AM, Neves HRA, Manetti V, Bonfim C, Funke VAM, Nabhan S, Pasquini R. Improving Data Collection for Patients Who Developed Graft-Versus-Host Disease after Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bonfim C, Ribeiro L, Nichele S, Loth G, Bitencourt M, Koliski A, Kuwahara C, Fabro AL, Pereira NF, Pilonetto D, Thakar M, Kiem HP, Page K, Fuchs EJ, Eapen M, Pasquini R. Haploidentical Bone Marrow Transplantation with Post-Transplant Cyclophosphamide for Children and Adolescents with Fanconi Anemia. Biol Blood Marrow Transplant 2017; 23:310-317. [DOI: 10.1016/j.bbmt.2016.11.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/03/2016] [Indexed: 11/28/2022]
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Lange AP, Lima AS, Lucena-Araujo AR, Jácomo RH, Melo RA, Bittencourt RI, Pasquini R, Pagnano K, Fagundes EM, Chauffaille ML, Chiattone CS, Sanz MA, Lo-Coco F, Grimwade D, Rego EM. The experience of the International Consortium on Acute Promyelocytic Leukemia in monitoring minimal residual disease in acute promyelocytic leukaemia. Br J Haematol 2016; 180:915-918. [PMID: 28025822 DOI: 10.1111/bjh.14490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 10/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ana P Lange
- Haematology and Clinical Oncology Divisions, Department of Internal Medicine, University of Sao Paulo, Ribeirao Preto, Brazil.,Center for Cell Based Therapy, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Ana S Lima
- Haematology and Clinical Oncology Divisions, Department of Internal Medicine, University of Sao Paulo, Ribeirao Preto, Brazil.,Center for Cell Based Therapy, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | | | | | - Raul A Melo
- Fundação de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, PE, Brazil
| | - Rosane I Bittencourt
- Haematology Service, Federal University of Rio Grande do Sul University Hospital, Porto Alegre, Brazil
| | - Ricardo Pasquini
- Bone Marrow Transplantation Unit, Federal University of Parana University Hospital, Curitiba, Brazil
| | - Katia Pagnano
- Hemocentro, University of Campinas, Campinas, Brazil
| | - Evandro M Fagundes
- Haematology Service, Federal University of Minas Gerais University Hospital, Belo Horizonte, Brazil
| | | | | | - Miguel A Sanz
- Department of Haematology, Hospital Universitari i Politècnic La Fe and Departament de Medicina, Universitat de València, Valencia, Brazil
| | - Francesco Lo-Coco
- Department of Biomedicine and Prevention, University of Tor Vergata, and Santa Lucia Foundation, Rome, Italy
| | - David Grimwade
- Department of Medical & Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Eduardo M Rego
- Haematology and Clinical Oncology Divisions, Department of Internal Medicine, University of Sao Paulo, Ribeirao Preto, Brazil.,Center for Cell Based Therapy, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
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Bonfim C, Ribeiro L, Nichele S, Bitencourt M, Loth G, Koliski A, Funke VAM, Pilonetto DV, Pereira NF, Flowers MED, Velleuer E, Dietrich R, Fasth A, Torres-Pereira CC, Pedruzzi P, Eapen M, Pasquini R. Long-term Survival, Organ Function, and Malignancy after Hematopoietic Stem Cell Transplantation for Fanconi Anemia. Biol Blood Marrow Transplant 2016; 22:1257-1263. [PMID: 26976241 DOI: 10.1016/j.bbmt.2016.03.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/03/2016] [Indexed: 11/27/2022]
Abstract
We report on long-term survival in 157 patients with Fanconi anemia (FA) who survived 2 years or longer after their first transplantation with a median follow-up of 9 years. Marrow failure (80%) was the most common indication for transplantation. There were 20 deaths beyond 2 years after transplantation, with 12 of the deaths occurring beyond 5 years after transplantation. Donor chimerism was available for 149 patients: 112 (76%) reported > 95% chimerism, 27 (18%) reported 90% to 95% chimerism, and 8 (5%) reported 20% to 89% donor chimerism. Two patients have < 20% donor chimerism. The 10- and 15-year probabilities of survival were 90% and 79%, respectively. Results of multivariate analysis showed higher mortality risks for transplantations before 2003 (hazard ratio [HR], 7.87; P = .001), chronic graft-versus-host disease (GVHD) (HR, 3.80; P = .004) and squamous cell carcinoma after transplantation (HR, 38.17; P < .0001). The predominant cause of late mortality was squamous cell carcinoma, with an incidence of 8% and 14% at 10 and 15 years after transplantation, respectively, and was more likely to occur in those with chronic GVHD. Other causes of late mortality included chronic GVHD, infection, graft failure, other cancers, and hemorrhage. Although most patients are disease free and functional long term, our data support aggressive surveillance for long periods to identify those at risk for late mortality.
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Affiliation(s)
- Carmem Bonfim
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil.
| | - Lisandro Ribeiro
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
| | - Samantha Nichele
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
| | - Marco Bitencourt
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
| | - Gisele Loth
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
| | - Adriana Koliski
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
| | - Vaneuza A M Funke
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
| | | | - Noemi F Pereira
- Immunogenetics Laboratory, Federal University of Paraná, Curitiba, Brazil
| | - Mary E D Flowers
- Clinical Research Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Eunike Velleuer
- Clinic for Pediatric Oncology, Hematology and Clinical Immunology, Children's Hospital, University Hospital of Düsseldorf, Germany
| | - Ralf Dietrich
- Deutsche Fanconi-Anämie-Hilfe, Unna-Siddinghausen, Germany
| | - Anders Fasth
- Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden
| | | | - Paola Pedruzzi
- Oncology Department, Hospital Erasto Gaertner, Curitiba, Brazil
| | - Mary Eapen
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ricardo Pasquini
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
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Neves HRA, Kleina-Feitosa M, Muzi RT, Bonfim C, Moreira Funke VA, Nabhan S, Pasquini R. Strategies for Reducing Lost to Follow-up after Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hamerschlak N, de Souza C, Cornacchioni AL, Pasquini R, Tabak D, Spector N, Steagall M. Patients' perceptions about diagnosis and treatment of chronic myeloid leukemia: a cross-sectional study among Brazilian patients. SAO PAULO MED J 2015; 133:471-9. [PMID: 25388686 PMCID: PMC10496560 DOI: 10.1590/1516-3180.2014.0001306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/13/2014] [Accepted: 06/13/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVES Chronic myeloid leukemia (CML) requires strict daily compliance with oral medication and regular blood and bone marrow control tests. The objective was to evaluate CML patients' perceptions about the disease, their access to information regarding the diagnosis, monitoring and treatment, adverse effects and associations of these variables with patients' demographics, region and healthcare access. DESIGN AND SETTING Prospective cross-sectional study among CML patients registered with the Brazilian Lymphoma and Leukemia Association (ABRALE). METHODS CML patients receiving treatment through the public healthcare system were interviewed by telephone. RESULTS Among 1,102 patients interviewed, the symptoms most frequently leading them to seek medical care were weakness or fatigue. One third were diagnosed by means of routine tests. The time that elapsed between first symptoms and seeking medical care was 42.28 ± 154.21 days. Most patients had been tested at least once for Philadelphia chromosome, but 43.2% did not know the results. 64.8% had had polymerase chain reaction testing for the BCR/ABL gene every three months. 47% believed that CML could be controlled, but 33.1% believed that there was no treatment. About 24% reported occasionally stopping their medication. Imatinib was associated with nausea, cramps and muscle pain. Self-reported treatment adherence was significantly associated with normalized blood count, and positively associated with imatinib. CONCLUSIONS There is a lack of information or understanding about disease monitoring tools among Brazilian CML patients; they are diagnosed quickly and have good access to treatment. Correct comprehension of CML control tools is impaired in Brazilian patients.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Brazil
- Child
- Child, Preschool
- Cross-Sectional Studies
- Female
- Health Knowledge, Attitudes, Practice
- Health Services Accessibility
- Humans
- Imatinib Mesylate/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Medication Adherence
- Middle Aged
- Perception
- Philadelphia Chromosome
- Prospective Studies
- Socioeconomic Factors
- Statistics, Nonparametric
- Time Factors
- Young Adult
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Affiliation(s)
- Nelson Hamerschlak
- MD, PhD. Head of Bone Marrow Transplantation Unit, Hospital Israelita Albert Einstein (HIAE) and Associação Brasileira de Linfoma e Leucemia (ABRALE), São Paulo, Brazil
| | - Carmino de Souza
- MD, PhD. Titular Professor of Internal Medicine, Universidade Estadual de Campinas (Unicamp), Campinas and Associação Brasileira de Linfoma e Leucemia (ABRALE), São Paulo, Brazil
| | - Ana Lúcia Cornacchioni
- MD. Attending Physician, Instituto de Tratamento do Câncer Infantil (ITACI), Instituto da Criança (ICR), Hospital de Clínicas da Universidade de São Paulo (HC-USP) and Associação Brasileira de Linfoma e Leucemia (ABRALE), São Paulo, Brazil
| | - Ricardo Pasquini
- MD, PhD. Senior Professor, Postgraduate Program on Internal Medicine, Universidade Federal do Paraná (UFP), Paraná and Associação Brasileira de Linfoma e Leucemia (ABRALE), São Paulo, Brazil
| | - Daniel Tabak
- MD, PhD. Director, Centro de Tratamento Oncológico (Centron), São Paulo and Associação Brasileira de Linfoma e Leucemia (ABRALE), São Paulo, Brazil
| | - Nelson Spector
- MD, PhD. Titular Professor, Universidade Federal do Rio de Janeiro (UFRJ), and Head of the Hematology Service, Hospital Universitário Clementino Fraga Filho (HUCCFF), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro; and Associação Brasileira de Linfoma e Leucemia (ABRALE), São Paulo, Brazil
| | - Merula Steagall
- President, Associação Brasileira de Linfoma e Leucemia (ABRALE), São Paulo, Brazil
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Pagnano KBB, Bendit I, Boquimpani C, De Souza CA, Miranda ECM, Zalcberg I, Larripa I, Nardinelli L, Silveira RA, Fogliatto L, Spector N, Funke V, Pasquini R, Hungria V, Sérgio Chiattone C, Clementino N, Conchon M, Moiraghi EB, Lopez JL, Pavlovsky C, Pavlovsky MA, Cervera EE, Meillon LA, Simões B, Hamerschlak N, Bozzano AHM, Mayta E, Cortes J, Bengió 5 On Behalf Of Latin American Leukemia Net Lalnet RM. BCR-ABL Mutations in Chronic Myeloid Leukemia Treated With Tyrosine Kinase Inhibitors and Impact on Survival. Cancer Invest 2015:10.3109/07357907.2015.1065499. [PMID: 26279306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This is the largest Latin American study of BCR-ABL mutations in chronic myeloid leukemia (CML) patients, resistant to imatinib (IM). In 195/467 (41%) patients, mutations were detected. The most frequent mutation was T315I (n = 31, 16%). Progression-free (PFS) and overall survival (OS) at 5 years were lower in patients with BCR-ABL mutations (43% vs. 65%, p = 0.07 and 47% vs. 72%, p = 0.03, respectively) and in those with the T315I mutation (p = 0.003 and p = 0.03). OS and PFS were superior in subgroup who switched to second generation inhibitors (SGIs) after IM failure (OS: 50% vs. 39% p = 0.01; PFS: 48% vs. 30% p = 0.02). BCR-ABL mutations conferred a significant poor prognosis in CML patients.
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Pagnano KBB, Bendit I, Boquimpani C, De Souza CA, Miranda ECM, Zalcberg I, Larripa I, Nardinelli L, Silveira RA, Fogliatto L, Spector N, Funke V, Pasquini R, Hungria V, Chiattone CS, Clementino N, Conchon M, Moiraghi EB, Lopez JL, Pavlovsky C, Pavlovsky MA, Cervera EE, Meillon LA, Simões B, Hamerschlak N, Bozzano AHM, Mayta E, Cortes J, Bengió RM. BCR-ABL mutations in chronic myeloid leukemia treated with tyrosine kinase inhibitors and impact on survival. Cancer Invest 2015; 33:451-8. [PMID: 26288116 DOI: 10.3109/07357907.2015.1065499] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This is the largest Latin American study of BCR-ABL mutations in chronic myeloid leukemia (CML) patients, resistant to imatinib (IM). In 195/467 (41%) patients, mutations were detected. The most frequent mutation was T315I (n = 31, 16%). Progression-free (PFS) and overall survival (OS) at 5 years were lower in patients with BCR-ABL mutations (43% vs. 65%, p = 0.07 and 47% vs. 72%, p = 0.03, respectively) and in those with the T315I mutation (p = 0.003 and p = 0.03). OS and PFS were superior in subgroup who switched to second generation inhibitors (SGIs) after IM failure (OS: 50% vs. 39% p = 0.01; PFS: 48% vs. 30% p = 0.02). BCR-ABL mutations conferred a significant poor prognosis in CML patients.
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Affiliation(s)
| | - Israel Bendit
- b 2 Laboratório de Biologia Tumoral , University of São Paulo, São Paulo , São Paulo, Brazil
| | | | | | - Eliana C M Miranda
- a 1 Hemocentro-UNICAMP , University of Campinas, Campinas , São Paulo, Brazil
| | - Ilana Zalcberg
- d 4 Instituto Nacional do Câncer, Rio de Janeiro , Rio de Janeiro, Brazil
| | - Irene Larripa
- e 5 Instituto de Investigaciones Hematológicas, Academia Nacional de Medicina de Buenos Aires , Buenos Aires, Argentina
| | - Luciana Nardinelli
- b 2 Laboratório de Biologia Tumoral , University of São Paulo, São Paulo , São Paulo, Brazil
| | | | - Laura Fogliatto
- f 6 Hospital das Clínicas de Porto Alegre, Porto Alegre , Rio Grande do Sul, Brazil
| | - Nelson Spector
- g 7 Federal University of Rio de Janeiro , Rio de Janeiro , Rio de Janeiro, Brazil
| | - Vaneuza Funke
- h 8 Universidade Federal do Paraná , Curitiba, Paraná, Brazil
| | | | - Vania Hungria
- i 9 Santa Casa de São Paulo, São Paulo , São Paulo, Brazil
| | | | - Nelma Clementino
- j 10 Universidade Federal de Minas Gerais , Belo Horizonte , Minas Gerais, Brazil
| | - Monika Conchon
- k 11 Hospital Santa Marcelina , São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | - Belinda Simões
- q 17 University of São Paulo , Ribeirão Preto, São Paulo, Brazil
| | | | | | | | - Jorge Cortes
- u 21 MD Anderson Cancer Center , Houston, Texas, USA
| | - Raquel M Bengió
- e 5 Instituto de Investigaciones Hematológicas, Academia Nacional de Medicina de Buenos Aires , Buenos Aires, Argentina
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Bonfim C, Ribeiro L, Nichele S, Loth G, Kuwahara C, Koliski A, Bitencourt M, Scherer FF, Melo Rodrigues AL, Pilonetto D, Pasquini R. Excellent Outcome for Fanconi Anemia Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT) without Radiation: A Single Center Experience on 103 Patients. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bonfim C, Ribeiro L, Nichele S, Bitencourt M, Eapen M, Flowers ME, Loth G, Kuwahara C, Melo Rodrigues AL, Moreira Funke VA, Pasquini R. Long-Term Follow-up after Hematopoietic Stem Cell Transplantation for Patients with Fanconi Anemia: A Single Center Experience on 157 Patients Surviving 2 or More Years after Transplant. Biol Blood Marrow Transplant 2015. [DOI: 10.1016/j.bbmt.2014.11.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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de Azambuja AP, Malvezzi M, Bitencourt MA, Oliveira MM, Medeiros LA, Pasquini R. Paroxysmal nocturnal hemoglobinuria clone in 103 Brazilian patients: diagnosis and classification. Rev Bras Hematol Hemoter 2015; 37:90-7. [PMID: 25818818 PMCID: PMC4382579 DOI: 10.1016/j.bjhh.2015.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 11/26/2014] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Paroxysmal nocturnal hemoglobinuria is an acquired chronic hemolytic anemia, which often manifests as peripheral blood cytopenias and thrombosis. OBJECTIVE The aim of this study is to describe a Brazilian population of paroxysmal nocturnal hemoglobinuria patients. METHODS One hundred and three paroxysmal nocturnal hemoglobinuria cases were retrospectively reviewed and the clinical presentation, thrombosis, survival, and clone size were assessed. Diagnosis was established by flow cytometry. RESULTS Fifty-two male and 51 female patients with a median age of 24.1 years (5.5-62 years) were studied. Clinical symptoms included hemoglobinuria (18.4%), infection (46.6%) and thrombosis (16.5%), and 80.6% had pancytopenia. Patients were classified as classic paroxysmal nocturnal hemoglobinuria (10), paroxysmal nocturnal hemoglobinuria with aplastic anemia (39), and paroxysmal nocturnal hemoglobinuria with subclinical features and aplastic anemia (54). There were significant differences in terms of median age, size of clone, clinical symptoms, and peripheral blood cell counts between the three subcategories. The clone size in erythrocytes and granulocytes were respectively 0.04% (range: 0-18%) and 7.3% (range: 0.3-68.7%) in patients with subclinical features and aplastic anemia, 15.8% (range: 0-99.7%) and 63.0% (range: 1.7-99.8%) in patients with aplastic anemia alone, and 82.2% (range: 0-99.85%) and 98.0% (81.3-100.0%) in Classic disease. Statistical differences were identified for platelets (p-value=0.001), lactate dehydrogenase (p-value=0.002) and the clone size (p-value<0.001) in patients who suffered thrombotic events compared to those who did not. Overall survival was 81.7%, with patients with subclinical features and aplastic anemia having lower overall survival (76.5%). CONCLUSION This retrospective review of 103 patients over an 11-year period represents the largest collection of paroxysmal nocturnal hemoglobinuria cases from a single center in Brazil. Flow cytometry showed that a larger clone was associated with classical symptoms and increased risk of thrombosis, even in patients with bone marrow failure, whereas a smaller clone was associated with bone marrow aplasia.
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Westphal RJ, Bueno RRL, Galvão PBDA, Zanis Neto J, Souza JM, Guérios ÊE, Senegaglia AC, Brofman PR, Pasquini R, Cunha CLPD. Autologous transplantation of bone marrow adult stem cells for the treatment of idiopathic dilated cardiomyopathy. Arq Bras Cardiol 2015; 103:521-9. [PMID: 25590932 PMCID: PMC4290743 DOI: 10.5935/abc.20140164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 08/05/2014] [Indexed: 11/30/2022] Open
Abstract
Background Morbimortality in patients with dilated idiopathic cardiomyopathy is high, even
under optimal medical treatment. Autologous infusion of bone marrow adult stem
cells has shown promising preliminary results in these patients. Objective Determine the effectiveness of autologous transplantation of bone marrow adult
stem cells on systolic and diastolic left ventricular function, and on the degree
of mitral regurgitation in patients with dilated idiopathic cardiomyopathy in
functional classes NYHA II and III. Methods We administered 4,54 x 108 ± 0,89 x 108 bone marrow
adult stem cells into the coronary arteries of 24 patients with dilated idiopathic
cardiomyopathy in functional classes NYHA II and III. Changes in functional class,
systolic and diastolic left ventricular function and degree of mitral
regurgitation were assessed after 3 months, 6 months and 1 year. Results During follow-up, six patients (25%) improved functional class and eight (33.3%)
kept stable. Left ventricular ejection fraction improved 8.9%, 9.7% e 13.6%, after
3, 6 and 12 months (p = 0.024; 0.017 and 0.018), respectively. There were no
significant changes neither in diastolic left ventricular function nor in mitral
regurgitation degree. A combined cardiac resynchronization and implantable
cardioversion defibrillation was implanted in two patients (8.3%). Four patients
(16.6%) had sudden death and four patients died due to terminal cardiac failure.
Average survival of these eight patients was 2.6 years. Conclusion Intracoronary infusion of bone marrow adult stem cells was associated with an
improvement or stabilization of functional class and an improvement in left
ventricular ejection fraction, suggesting the efficacy of this intervention. There
were no significant changes neither in left ventricular diastolic function nor in
the degree of mitral regurgitation.
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Affiliation(s)
| | | | | | - José Zanis Neto
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | | | | | - Paulo Roberto Brofman
- Centro de Pesquisa, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Ricardo Pasquini
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Comar SR, Malvezzi M, Pasquini R. To follow or not to follow the recommendations regarding microscopic analysis of the Clinical and Laboratory Standards Institute H20-A2 to validate the criteria for blood smear review? Rev Bras Hematol Hemoter 2015; 37:69-70. [PMID: 25638773 PMCID: PMC4318853 DOI: 10.1016/j.bjhh.2014.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 09/20/2014] [Indexed: 11/24/2022] Open
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Comar SR, Malvezzi M, Pasquini R. Erratum to "Are the review criteria for automated complete blood counts of the International Society of Laboratory Hematology suitable for all hematology laboratories?" [Rev. Bras. Hematol. Hemoter. 2014;36(3):219-225]. Rev Bras Hematol Hemoter 2014; 36:381. [PMID: 25305174 PMCID: PMC4318374 DOI: 10.1016/j.bjhh.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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