ABSTRACT
BACKGROUND: Published criteria defining the accelerated phase in chronic myeloid leukemia are heterogeneous and little is known about predictors of poor outcome.METHODS: This is a retrospective study of 139 subjects in the accelerated phase of chronic myeloid leukemia treated with imatinib at a single center in Brazil. The objective was to identify risk factors for survival, major cytogenetic response and progression to blast phase in this population. The factors analyzed were: blasts 10-29%, basophils ≥ 20%, platelets > 1 × 106/µL or <1 × 105/µL and white blood cells > 1 × 105/µL in the peripheral blood, as well as clonal evolution, splenomegaly, hemoglobin < 10 g/dL, time between diagnosis of chronic myeloid leukemia and imatinib treatment, and hematologic toxicity.RESULTS: Risk factors for poor survival in multivariate analysis were Grades 3-4 hematologic toxicity (p-value = 0.001), blasts 10-29% (p-value = 0.023), and hemoglobin < 10 g/dL (p-value = 0.04). Risk factors for not achieving major cytogenetic response were blasts 10-29% (p-value = 0.007), hemoglobin < 10 g/dL (p-value = 0.001), and previous use of interferon (p-value = 0.032). Risk factors for progression to the blast phase were hemoglobin < 10 g/dL (p-value = 0.005), basophils ≥ 20% (p-value = 0.023), and time from diagnosis of chronic myeloid leukemia to imatinib treatment > 12 months (p-value = 0.030).CONCLUSION: These data indicate that patients with the above risk factors have a worse prognosis. This information can guide the therapy to be used.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Prognosis , Leukemia, Myeloid, Accelerated Phase , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Mortality , Imatinib MesylateABSTRACT
Art and Medicine often mingle in the most unexpected ways. One can often find in pictorial art the representation of many medical conditions. The same can happen with sculptures; however, the finding of an urban sculpture in a public space with features of parkinsonism is unique. We reported how “The Shaking Man”, an urban sculpture located in the Yerba Buena Gardens in San Francisco, USA, is a contemporary representation of parkinsonism and compared it with other art works in different media that also present such thing to laymen.
Arte e Medicina frequentemente interagem das mais inusitadas maneiras. Muitas condições médicas podem ser encontradas em pinturas acadêmicas. O mesmo pode ocorrer com esculturas; no entanto, encontrar uma escultura em um espaço público exibindo sinais clínicos de parkinsonismo é um achado único. Relatou-se como “The Shaking Man”, que é uma estátua urbana localizada no Yerba Buena Gardens em São Francisco, EUA, pode ser uma representação contemporânea de parkinsonismo e foram realizadas comparações com outras obras de arte em diferentes mídias, as quais também demonstram parkinsonismo para o público leigo.