Hepatitis B virus infection among oncohematologic disease patients in Central Brazil: prevalence, risk factors and immunization

ABSTRACT Introduction: Carriers of oncohematological diseases are at high risk for hepatitis B virus (HBV) infection. Objective and method: To investigate the epidemiology of HBV infection in Goiânia, Central Brazil, 322 individuals with oncohematological diseases (leukemias, Hodgkin lymphoma and non-Hodgkin lymphoma) were interviewed and blood samples were collected for the detection of serological markers of HBV-DNA by polymerase chain reaction (PCR). Medical records of participants were also reviewed. Results: Non-Hodgkin's lymphomas (n = 99) and chronic myeloid leukemia (n = 108) were the most frequent oncohematological diseases. The overall prevalence of HBV was 13.97% (45/322). Of the total participants, 8.69% (28/322) presented isolated positivity for anti-HBs, suggesting low vaccine coverage. HBV-DNA was detected in 25% (1/4) of HBsAg positive samples and in 25% (3/12) of anti-HBc isolated, suggesting HBV occult infection. All samples were identified as subgenotype A1. Entries in patient records and the findings of this investigation suggest anti-HBc seroconversion during oncologic treatment. Age 50 years or over and use of a central catheter during therapy were associated with HBV exposure. Conclusion: The low frequency of hepatitis B immunized individuals, detection of HBV DNA in HBsAg negative samples, and the suggestion of HBV exposure during treatment evidenced the potential for health-related viral dissemination in people with oncohematological diseases in our region, reinforcing the importance of serological monitoring, vaccination against hepatitis B, and adoption of strict infection control measures in these individuals.

Invasive fungal infection in patients with hematologic disorders in a Brazilian tertiary care hospital

ABSTRACT INTRODUCTION: Invasive fungal infections (IFIs) are an important complication in immunocompromised individuals, particularly neutropenic patients with hematological malignancies. In this study, we aimed to verify the epidemiology and diagnosis of IFIs in patients with hematologic problems at a tertiary hospital in Goiânia-GO, Brazil. METHODS: Data from 117 patients, involving 19 cases of IFIs, were collected. The collected data included diagnosis methods, demographics, clinical characteristics, and in vitro susceptibility to different antifungal agents. Among the 19 cases, 12 were classified as proven IFI and 7 as probable invasive aspergillosis with detection of galactomannan in blood and presence of lung infiltrates in radiographic images. Logistic regression analysis showed that the proven and probable IFIs were associated with increased risk of death. Statistical analysis demonstrated that age, sex, and underlying disease were not independently associated with risk of death in IFI patients. RESULTS: Most bloodstream isolates of Candida spp. exhibited low minimum inhibitory concentrations (MICs) to all antifungal agents tested. Voriconazole and amphotericin had the lowest MICs for Aspergillus spp. and Fusarium spp., but Fusarium spp. showed the least susceptibility to all antifungals tested. Amphotericin B, fluconazole, and itraconazole were found to be inactive in vitro against Acremonium kiliense; but this fungus was sensitive to voriconazole. CONCLUSIONS: Considering the high number of IFI cases, with crude mortality rate of 6%, we could conclude that IFIs remain a common infection in patients with hematological malignancies and underdiagnosed ante mortem. Thus, IFIs should be monitored closely.

Thymoma followed by aplastic anemia: two different responses to immunosuppressive therapy

Aplastic anemia is an uncommon complication of thymoma and is extremely infrequent after the surgical removal of a thymic tumor. Aplastic anemia is a result of marrow failure and is characterized by peripheral pancytopenia and severely depressed marrow cellularity; it may be an autoimmune manifestation of thymoma. As thymoma-associated hematological dyscrasias, which include pure red cell aplasia, aplastic anemia and myasthenia gravis, are supposed to be of immunologic origin, two cases of very severe aplastic anemia following the resection of lymphocytic thymomas treated with immunosuppression are herein presented.

Transplante autólogo de células-tronco em linfoma de Hodgkin: análise de uma opção terapêutica / Autologous stem-cell transplantation in Hodgkin's lymphoma: analysis of a therapeutic option

Objective: To report the clinical progress of patients with Hodgkin’slymphoma treated with autologous transplantation after failure or relapse of first-line treatment with chemotherapy and/or radiation therapy. Methods: The results of a retrospective analysis of 31 patients submitted to autologous transplantation as second-line treatment, between April 2000 and December 2008, were analyzed. Fourteen men and seventeen women, with a median age of 27 years, were submitted to autologous transplantation for relapsed (n = 21)or refractory (n = 10) Hodgkin’s lymphoma. Results: Mortality related to treatment in the first 100 days after transplant was 3.2%. With a mean follow-up period of 18 months (range: 1 to 88 months), the probability of global survival and progression-free survival in 18 months was 84 and 80%, respectively. The probability of global survival and progression-free survival at 18 months for patients withchemosensitive relapses (n = 21) was 95 and 90%, respectively, versus 60 and 45% for patients with relapses resistant to chemotherapy(n = 10) (p = 0.001 for global survival; p = 0.003 for progressionfreesurvival). In the multivariate analysis, absence of disease or pretransplantdisease < 5 cm were favorable factors for global survival (p= 0.02; RR: 0.072; 95%CI: 0.01-0.85) and progression-free survival(p= 0.01; RR: 0.040; 95%CI: 0.007-0.78). Conclusion: Autologoustransplantation of stem-cells is a therapeutic option for Hodgkin’slymphoma patients after the first relapse. Promising results were observed in patients with a low tumor burden at transplant.

Objetivo: Relatar a evolução dos pacientes com linfoma de Hodgkintratados com transplante autólogo após falha ou recidiva do tratamentode primeira escolha com quimioterapia e/ou radioterapia. Métodos: Foram analisados os resultados de uma análise retrospectiva em 31 pacientes submetidos a transplante autólogo como terapia de segunda escolha, entre Abril de 2000 e Dezembro de 2008. Quatorzehomens e dezessete mulheres, com idade mediana de 27 anos, foram submetidos a transplante autólogo por linfoma de Hodgkin após recidiva (n = 21) ou por refratariedade (n = 10). Resultados: A mortalidade relacionada ao tratamento nos primeiros 100 dias pós transplante foi de 3,2%. Com um acompanhamento médio de 18 meses(variação: 1 a 88), a probabilidade de sobrevida global e sobrevida livre de progressão em 18 meses foi de 84 e 80%, respectivamente. A probabilidade de sobrevida global e sobrevida livre de progressão aos 18 meses para pacientes com recidivas quimiossensíveis (n = 21) foi de 95 e 90%, respectivamente, versus 60 e 45% para os pacientes com recidiva resistente à quimioterapia (n = 10) (p = 0,001 para sobrevida global; p = 0,003 para sobrevida livre de progressão). Na análise multivariada, a ausência de doença ou doença pré-transplante < 5 cm foi um fator favorável para a sobrevida global (p= 0,02; RR: 0,072; IC95%: 0,01-0,85) e sobrevida livre de progressão (p= 0,01;RR: 0,040; IC95%: 0,007-0,78). Conclusão: O transplante autólogode células-tronco constitui uma opção terapêutica para pacientes com linfoma de Hodgkin após uma primeira recaída. Resultados promissores foram observados em pacientes com baixa carga tumoral ao transplante.

Transplante de células-tronco hematopoéticas e leucemia mieloide aguda: diretrizes brasileiras / Hematopoietic stem cells transplantation and acute myeloid leukemia: Brazilian guidelines

O objetivo deste trabalho foi definir diretrizes para a indicação do transplante de células-tronco hematopoéticas (TCTH) no tratamento da leucemia mieloide aguda (LMA) no Brasil. O papel do TCTH no tratamento da LMA foi discutido pelosautores e apresentado para a Sociedade Brasileira de Transplante de Medula Óssea na reunião sobre Diretrizes Brasileiras para o TCTH, que o ratificou. Este consenso foi baseado na revisão da literatura internacional e na experiência brasileira em TCTH para o tratamento da LMA. O tratamento ideal para leucemia mieloide aguda em primeira remissão completa (1RC) ainda não está definido. Há consenso na indicação do TCTH alogênico, com condicionamento mieloablativo, para pacientes que apresentem alterações citogenéticas consideradas de alto risco. O TCTH alogênico não está indicado na 1RC para pacientes de baixo risco citogenético e, aparentemente, o TCTH alogênico, autólogo ou a quimioterapia de consolidação são equivalentes para os pacientes de risco intermediário.

The objective of this work was to define guidelines for the indication of hematopoietic stem cells transplantation (HSCT) in the treatment of acute myeloid leukemia (AML) in Brazil. The role of HSCT in the treatment of AML was discussed by the authors and presented to the Brazilian Society of Bone Marrow Transplantation in a meeting to formulate and ratify the Brazilian Guidelines on HSCT. This consensus was based on a review of international publications and on the Brazilian experience in HSCT for the treatment of AML. The optimal treatment for AML in first complete remission (1CR) has not been defined yet. There is consensus on the indication of allogeneic HSCT with myeloablative conditioning for patients who present high risk cytogenetic changes. Allogeneic HSCT is not indicated for low cytogenetic risk 1RC patients and, apparently, allogeneic and autologous HSCT and consolidation chemotherapy are similar for intermediate risk patients.

Axoval neuropathy as initial manifestation of primary amyloidosis: report of a case submitted to bone marrow transplantation

A amiloidose é uma síndrome caracterizada pela deposição no meio extracelular de material protéico altamente insolúvel e que pode afetar vários órgãos. Pode ocorrer como doença generalizada e pode ser idiopática (amiloidose primária). Descrevemos o caso de mulher de 48 anos com neuropatia axonal associada a proteinúria na qual a investigação final resultou no diagnóstico de amiloidose primária (AL). Foi submetida a transplante autólogo de medula óssea sem complicações. Discutiremos aspectos relacionados ao diagnóstico da neuropatia e do tratamento atual da AL.