Current treatment preferences in acute myeloid leukemia: a survey in Brazil

ABSTRACT Introduction:: Most adults with acute myeloid leukemia (AML) will eventually relapse from their disease. The combination of 7-day cytarabine and an anthracycline on days 1-3 (the so called "7 + 3" regimen) can be considered standard of care of younger patients with AML. However, the treatment of the elderly ineligible for intensive chemotherapy remains a challenge. Low-dose of subcutaneous cytarabine or hypomethylating agents (HMA) have been studied this group. There are no studies investigating physician practice variation in treating AML in Brazil. Methods:: We developed a survey with ten questions in order to explore the approach to AML in Brazil. Results:: The sample size comprised 100 hematologists. Most reported regular (63%) or occasional (29%) treatment of AML patients. Karyotype analysis and polymerase chain reaction were available in 88% and 71% of institutions, respectively. Next generation sequencing analysis was used in 7% of instituitions. Younger patients receive the "7 + 3" protocol with continuous infusion of cytarabine and anthracycline in 98% of cases. The preferred anthracycline is daunorubicin (64%), followed by idarubicin (34%). The most prescribed daunorubicin dose was 60 mg/m2 (56%). Consolidation after CR with high cytarabine doses (HIDAC) was indicated by 84% of hematologists and 70% use 3 g/m2 twice a day for 3 days. Elderly and unfit patients received HMA (47%) as the preferred treatment. Conclusion:: We showed that the most prevalent AML treatments were according to current guidelines. There is room to improve on the availability of diagnostic tools and the capacity to perform bone marrow transplantation.

Expression of Epstein-Barr virus in patients with Hodgkin's disease: report of 64 cases from Rio de Janeiro, Brazil

O vírus Epstein-Barr (EBV) tem sido implicado na fisiopatogenia da doença de Hodgkin (DH) e a associação deste vírus com a DH está relacionada com as condições socioeconômicas da população estudada, com a idade e com o subtipo histológico celularidade mista (CM). A prevalência do EBV na DH é muito variável. Este estudo foi realizado com o objetivo de determinar a prevalência do EBV na DH em uma população brasileira. Foram estudados 64 casos de DH oriundos do Hospital Universitário utilizando-se o método de imunoistoquímica com anticorpo monoclonal contra a proteína latente da membrana (LMP1). O vírus foi encontrado em 35 dos 64 casos estudados (55 por cento) e sua presença correlacionou-se de maneira significativa com o subtipo histológico CM (OR = 9; IC 95 por cento = 1,66 - 66; p = 0,0015). Estes resultados confirmam que o EBV está relacionado com a DH em uma população brasileira.