Respuesta inmunológica a la vacunación y riesgo de COVID-19 en adultos con neoplasias hematológicas / Immunological response to vaccination and risk of COVID-19 in adults with hematological malignancies

Los pacientes con malignidades hematológicas tienen un riesgo más alto de hospitalización, admisión a cuidado crítico y muerte cuando contraen COVID-19. En este grupo se ha propuesto la vacunación y los refuerzos para disminuir el riesgo de complicaciones. Sin embargo, es posible ver una pobre respuesta humoral y celular a las vacunas. En esta revisión se presenta la evidencia sobre la respuesta a la vacunación, poniendo de presente algunas patologías y tratamientos que pueden disminuirla de forma significativa. Los pacientes con neoplasias hematológicas se deben considerar en riesgo de complicaciones, incluso después de haber sido vacunados de forma completa y haber recibido los refuerzos. Se debe mantener la vigilancia de forma estrecha después de haber sido vacunados y evaluar la posibilidad de otras estrategias (medicamentos, anticuerpos monoclonales) para la prevención o el manejo de COVID-19.

Patients with hematological malignancies have a higher risk of hospital admission, critical care and death when they suffer from COVID-19. In this group of patients, vaccination and boosters have been proposed to mitigate the risk of complications. However, it is possible to observe a diminished rate of humoral and cellular response. In this review, evidence is shown about the response to COVID-19 vaccination, considering some specific pathologies and treatments that can affect such response in a significant account. Patients with malignant neoplasm must be considered at risk of COVID-19 complications, even after a complete vaccine schedule and boosters. Surveillance must be maintained after vaccination over these patients and other strategies must be considered (drugs, monoclonal antibodies) for prevention and management of COVID-19.

Clinical Characteristics and Treatment of Blastic Plasmacytoid Dendritic Cell Neoplasm / 中国实验血液学杂志

OBJECTIVE@#To explore the clinical manifestations, diagnosis, treatment and prognosis of blastic plasmacytoid dendritic cell neoplasm(BPDCN).@*METHODS@#The clinical features, bone marrow morphology and immunophenotyping, treatment and prognosis of 4 patients with BPDCN were analyzed retrospectively.@*RESULTS@#4 patients had bone marrow， spleen and lymph nodes involvement， 2 patients had skin lesions， and 3 patients had central nervous system infiltration． Tailing phenomenon of abnormally cells could be seen in bone marrow. The immunophenotyping showed that CD56, CD4 and CD123 expression was observed in 4 patients， and CD304 in 3 patients． One patient refused chemotherapy and died early. Both patients achieved complete remission after the initial treatment with DA+VP regimen, 1 of them achieved complete remission after recurrence by using the same regimen again． One patient failed to respond to reduced dose of DA+VP chemotherapy, and then achieved complete remission with venetoclax+azacitidine.@*CONCLUSION@#The malignant cells in BPDCN patients often infiltrate bone marrow, spleen and lymph nodes, and have specical phenotypes, with poor prognosis. The treatment should take into account both myeloid and lymphatic systems. The treatment containing new drugs such as BCL-2 inhibitors combined with demethylation drugs is worth trying.

Research Progress and Application of Daratumumab in Non-Multiple Myeloma--Review / 中国实验血液学杂志

Daratumumab is the first CD38 monoclonal antibody drug approved for the treatment of patients with multiple myeloma. It can bind to CD38 expressed by tumor cells, inhibit tumor cell growth and induce myeloma cell apoptosis through a variety of immune-related mechanisms. Meanwhile, CD38 is also expressed in other cells, including regulatory T cells, regulatory B cells and myeloid-derived suppressor cells, which provides a theoretical basis for the treatment of hematological tumor diseases other than non-multiple myeloma diseases. This article reviews the research progress and application of this part.

Application of PROTACs in Hematological Malignancies--Review / 中国实验血液学杂志

Proteolysis-targeting chimeras (PROTACs) are heterobifunctional small molecules by utilizing the ubiquitin proteasome system (UPS) to degrade proteins of interest. PROTACs have exhibited unprecedented efficacy and specificity in degrading various oncogenic proteins because of their unique mechanism of action, ability to target "undruggable" and mutant proteins. A series of PROTACs have been developed to degrade multiple key protein targets for the treatment of hematologic malignancy. Notably, PROTACs that target BCL-XL, IRAK4, STAT3 and BTK have entered clinical trials. The known PROTACs that have the potential to be used to treat various hematological malignancies are systematically summarized in this review.

Perfil de liberación de biomarcadores miocárdicos en pacientes con enfermedades hemato-oncológicas que reciben trasplante de progenitores hematopoyéticos / Profile or myocardial biomarkers release in patients with hemato-oncological diseases who receive hematopoietic stem cell transplantation / Perfil de liberação de biomarcadores miocárdicos em pacientes com doenças hemato-oncológicas que recebem transplante de células-tronco hematopoéticas

Introducción: las enfermedades cardiovasculares (CV) son la primera causa de muerte en quienes sobreviven al cáncer. Aunque el trasplante de progenitores hematopoyéticos (TPH) se asocia con grados variables de cardiotoxicidad, estas complicaciones han sido escasamente caracterizadas. Objetivo: analizar el perfil de liberación de biomarcadores miocárdicos como potenciales indicadores subclínicos de cardiotoxicidad en pacientes sometidos a TPH. Material y método: estudio descriptivo, analítico, prospectivo transversal y unicéntrico, reclutando pacientes derivados a la policlínica de cardio-oncología, con indicación de TPH en octubre de 2018-marzo de 2020. Se realizaron controles clínicos, ECG, bioquímicos (troponina I TnI y péptido natriurético del tipo BBNP) e imagenológicos según algoritmo de seguimiento. Las variables discretas se presentan como n (%) y las continuas mediante media ± DE o mediana RIQ. Los valores evolutivos de biomarcadores séricos se compararon mediante test de Friedman. La fracciónde eyección del VI (FEVI) basal se comparó con la de los 3 meses del TPH mediante test de Wilcoxon. Resultados: se incluyeron 19 pacientes, 37% mujeres, de 43,8 ± 15,7 años. No se detectaron modificaciones significativas de la FEVI en los controles evolutivos. En ningún caso se observó aumento de la TnI. Los valores de BNP aumentaron en 6 pacientes (32%), con diferencias significativas al mes postrasplante (basal: 13,6 1;6,1-30,9 vs. primer mes: 38,9 16,3-120,0 pg/ml, p = 0,036); con una mayor elevación en aquellos pacientes que recibieron antimetabolitos vs. otros fármacos (basal: 13,6 1;6,1-30,9 vs. al primer mes: 67,0 ;21,3-174,9 pg/ml, p = 0,039). El aumento de BNP no se asoció con el riesgo CV. Conclusión: la liberación de BNP posterior al TPH es un fenómeno frecuente (32% de los pacientes), alcanza un máximo al mes, independientemente de la FEVI. El subgrupo de pacientes que recibió antimetabolitos presentó una mayor liberación precoz de BNP.

Introduction: cardiovascular (CV) diseases are the leading cause of death in those who survive cancer. Although hematopoietic stem cell transplantation (HSCT) is associated with diverse grades of cardiotoxicity, these complications have been poorly characterized. Objective: to analyze the release profile of myocardial biomarkers as a potential subclinical marker of cardiotoxicity in patients undergoing HSCT. Material and method: descriptive, analytical, prospective, cross-sectional, single-center study, recruiting patients referred to the cardio-oncology polyclinic, with indication for HSCT in October 2018-March 2020. Clinical, ECG, biochemical and imaging controls were performed according to the algorithm of follow-up. The evolutionary values of serum biomarkers were compared using the Friedman test. Baseline LVEF was compared with that of 3 months after HSCT using the Wilcoxon test. Results: 19 patients were included, 37% women, aged 43.8 ± 15.7 years. No changes in LVEF were detected. In no case was an increase in TnI observed. BNP values increased in 6 patients (32%), with significant differences one month after transplantation (baseline: 13.6 ;6.1-30.9 vs. first month: 38.9 ;16.3-120.0, p = 0.036), detecting a greater elevation in those patients who received antimetabolites vs. other rugs (baseline: 13.6 ;6.1-30.9 vs. at the first month: 67.0 21.3-174.0, p = 0.039). The increase in BNP was not associated with CV risk. Conclusion: BNP release after HSCT is frequent (32% of our patients), reaching a maximum at one month, regardless of LVEF. The subgroup of patients who received antimetabolites had a greater early release of BNP.

Introdução: as doenças cardiovasculares (CV) são a principal causa de morte em pessoas que sobrevivem ao câncer. Embora o transplante de células-tronco hematopoéticas (TCTH) esteja associado à diverso grado de cardiotoxicidade, essas complicações têm sido mal caracterizadas. Objetivo: analisar o perfil de liberação de biomarcadores miocárdicos como potenciais marcadores subclínicos de cardiotoxicidade em pacientes submetidos ao TCTH. Material e método: estudo descritivo, analítico, prospectivo, transversal, unicéntrico, com recrutamento de pacientes encaminhados à policlínica de cardio-oncologia, com indicação de TCTH de outubro de 2018 a março de 2020. Foram realizados controles clínicos, eletrocardiográficos, bioquímicos e de imagem de acordo com o algoritmo de acompanhamento. Os valores evolutivos dos biomarcadores séricos foram comparados pelo teste de Friedman. A FEVE basal foi comparada com a de 3 meses após o TCTH usando o teste de Wilcoxon. Resultados: foram incluídos 19 pacientes, 37% mulheres, com idade de 43,8 ± 15,7 anos. Nenhuma mudança na LVEF foi detectada. Em nenhum caso foi observado um aumento de TnI. Os valores de BNP aumentaram um mês após o transplante (linha de base: 13,6 6,1-30,9; vs. primeiro mês: 38,9 16,3-120,0, p = 0,036), se detectou uma maior elevação nos pacientes que receberam antimetabólitos vs. outros medicamentos (linha de base: 13,6 ;6,1-30,9; vs. no primeiro mês: 67,0 ;21,3-174,0;, p = 0,039). O aumento do BNP não foi associado ao risco CV. Conclusão: a liberação do BNP após o TCTH é frequente (32% de nossos pacientes), podendo chegar a no máximo um mês, independente da FEVE. O subgrupo de pacientes que recebeu antimetabólitos apresentou maior liberação precoce de BNP.

Avaliação da qualidade de vida em pacientes com malignidades hematológicas / Assessment of quality of life in patients with hematological malignancies

As malignidades hematológicas formam um grupo heterogêneo de cânceres que afetam o sangue, a medula óssea e o sistema linfático. Objetivo: Avaliar a qualidade de vida relacionada à saúde em um grupo de pacientes com malignidades hematológicas. Método: Estudo transversal analítico com abordagem quantitativa. O grupo de estudo foi formado por pacientes selecionados em um serviço privado de Hematologia e Oncologia, em Goiânia-GO. Os instrumentos utilizados foram um questionário contendo dados clínicos e sociodemográficos e o European Organization for Research and Treatment of Câncer Quality of Life Questionnaire Core (EORTC QLQ-C30). Foi realizada estatística inferencial e descritiva. Resultados: A amostra foi composta por 56 pacientes. O sexo feminino apresentou mais náuseas e vômito, pacientes com LMC, LH, LMA apresentaram pior desempenho da função cognitiva, pacientes com maior tempo de tratamento com quimioterapia apresentaram maior dificuldade financeira. A análise de correlação evidenciou que quanto maior o número de sintomas, pior é a QV em relação às dimensões física e desempenho da escala funcional. Quanto maior o número de preocupações no tratamento, pior é a QV em relação às dimensões cognitivo e social também da escala funcional. Quanto maior o número de sintomas no tratamento, maiores são os sintomas de fadiga, dor, dispneia e perda de apetite. Quanto maior o número de preocupações no tratamento, maiores são os sintomas de fadiga e de constipação. Conclusão: O presente estudo acerca da QVRS de pacientes com malignidades hematológicas em tratamento quimioterápico apresentou um perfil muito bem delineado dos participantes, como sendo de idosos, acometidos de LNH e MM, com um período longo de tratamento com quimioterapia

Hematological malignancies form a heterogeneous group of cancers that affect the blood, bone marrow and lymphatic system. Objective: To assess health-related quality of life in a group of patients with hematological malignancies. Method: Analytical cross-sectional study with a quantitative approach. The study group was formed by selected patients in a private service of Hematology and Oncology, in Goiânia-GO. The instruments used were a questionnaire containing clinical and sociodemographic data and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30). Inferential and descriptive statistics were performed. Results: The sample consisted of 56 patients. Females had more nausea and vomiting, patients with CML, HL, AML had worse cognitive function performance, patients with longer chemotherapy treatment had greater financial difficulties. The correlation analysis showed that the greater the number of symptoms, the worse the QoL in relation to the physical and performance dimensions of the functional scale. The greater the number of concerns in the treatment, the worse the QoL in relation to the cognitive and social dimensions of the functional scale as well. The greater the number of symptoms in the treatment, the greater the symptoms of fatigue, pain, dyspnea and loss of appetite. The greater the number of concerns in the treatment, the greater the symptoms of fatigue and constipation. Conclusion: The present study on the HRQoL of patients with hematological malignancies undergoing chemotherapy treatment presented a very well-defined profile of the participants, as being elderly, affected by NHL and MM, with a long period of chemotherapy treatmen

Resignificación de la vida por parte de jóvenes sobrevivientes al cáncer hematológico / Resignification of Life by Young People Survivors of Hematologic Cancer

Introducción: Los jóvenes con enfermedades oncológicas enfrentan dificultades durante los períodos de diagnóstico, tratamiento y recuperación. Estos procesos complejos cargados de experiencias vitales inusitadas producen la transformación de su conciencia y los lleva a construir nuevos significados en la manera de comprender, relacionarse y actuar en el mundo que los rodea. Objetivo: Comprender el (re)significado de la vida a partir de la experiencia de los jóvenes que sobrevivieron al cáncer hematológico. Métodos: Estudio cualitativo, que utilizó la Teoría Fundamentada en Datos como metodología y el referencial de la Teoría de la Complejidad de Morin. Se realizaron entrevistas en profundidad a 12 adolescentes sobrevivientes de cáncer hematológico. El tamaño de muestra fue determinado al alcanzar nivel de saturación. El análisis fue simultáneo durante la recolección de los datos, mediante codificación abierta, axial y selectiva según lo señalan Strauss y Corbin. Resultados: Emergieron dos categorías: Reorganizando su vida por medio de cambios y aprendizajes para vencer al cáncer y, Asumiendo una mejor comprensión y compromiso con los demás y consigo mismo. Conclusiones: Las experiencias vividas por jóvenes sobrevivientes que padecen de cáncer modifican su forma de vivir y se tornan más comprensivos con el sufrimiento que ocasiona la enfermedad. Esta situación los hace más solidarios y comprometidos con su contexto social sobre todo con su familia y con pacientes oncológicos(AU)

Introduction: Young people with oncological diseases face difficulties during the periods of diagnosis, treatment and recovery. These complex processes loaded with unusual life experiences produce the transformation of their consciousness and lead them to construct new meanings in the way that they understand, relate and act in the world around them. Objective: To understand the (re)signification of life from the experience of young survivors of hematological cancer. Methods: A qualitative study was carried out, using the data driven theory as the methodology and Morin's complexity theory as the referent. In-depth interviews were conducted with twelve adolescent hematologic cancer survivors. The sample size was determined by reaching the saturation level. The analysis was simultaneous during data collection, using open, axial and selective coding according to Strauss and Corbin. Results: Two categories emerged: 1. reorganizing their life through changes and learning to overcome cancer and 2. assuming a better understanding and commitment to others and to themselves. Conclusions: The experiences lived by young cancer survivors modify their way of living as they become more understanding of the suffering caused by the disease. This situation makes them more supportive and committed to their social context, especially with their family and with cancer patients(AU)

Analysis of Agranulocytosis Time and Its Influencing Factors in Patients with Hematological Malignancies Treated with rhIL-11 combined rhG-CSF / 中国实验血液学杂志

OBJECTIVE@#To explore the intervention effect of recombinant human interleukin-11 (rhIL-11) and recombinant human granulocyte-colony stimulating factor (rhG-CSF) on the duration and severity of agranulocytosis in patients with hematological malignancies after chemotherapy, and to analyze the influencing factors.@*METHODS@#The data of hematological malignancy patients treated with rhIL-11 and rhG-CSF after chemotherapy in the hematology department of The First Hospital of Lanzhou University from July 2017 to July 2020 were collected retrospectively. The duration and differences of agranulocytosis in differeent groups were compared by univariate analysis, and the influencing factors of agranulocytosis duration were further analyzed by multiple regression analysis.@*RESULTS@#The duration of agranulocytosis in 97 patients was 6.47±2.93 days. The results of univariate analysis showed that there were no statistical differences in the duration of agranulocytosis among patients with different sex, age, height, weight, body surface area, body mass index (BMI), dose of rhG-CSF, dose of rhIL-11, spontaneous bleeding after administration of rhG-CSF and rhIL-11, and the duration of agranulocytosis in patients with different red blood cell count (RBC), hemoglobin(HGB) level, platelet count (PLT) and absolute neutrophil count (ANC), before administration of rhG-CSF and rhIL-11. There were significant differences in agranulocytosis time among patients with different disease types, chemotherapy cycle, fever after rhG-CSF and rhIL-11 administration, and different white blood cell count (WBC) baseline level before rhG-CSF and rhIL-11 administration (P＜0.05). Compared with patients with acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL), patients with acute myeloid leukemia (AML) had the longest duration of agranulocytosis, which was 7.07±3.05 d. Compared with patients with chemotherapy cycles of 4－6 and ≥7, patients with total chemotherapy cycle of 1－3 had the shortest duration of agranulocytosis, which was 5.25±2.48 d. Compared with patients without fever, patients with fever within 1 day after administration of cytokines and patients with fever within 2-5 days after administration of cytokines, the duration of agranulocytosis was the longest in patients with fever 6 days after administration of cytokines, which was 8.85±2.85 d. Compared with patients with WBC baseline <1.0×109/L, (1.0－1.9)×109/L and (2.0－3.9)×109/L, patients with WBC baseline ≥4.0×109/L had the shortest duration of agranulocytosis, which was 4.50±2.56 d. Multiple linear regression analysis showed that chemotherapy cycle, different fever after administration of rhG-CSF and rhIL-11, diagnosis of ALL and NHL, and WBC baseline level before administration of rhG-CSF and rhIL-11 were the influencing factors of the duration of agranulocytosis (P＜0.001).@*CONCLUSION@#The risk of prolonged agranulocytosis is higher in patients diagnosed with AML, with more chemotherapy cycles, lower WBC baseline before cytokines administration and fever later after cytokines administration, which should be paid more attention to.

Impact of Coronavirus Disease 2019 on Prognosis and Treatment Strategies in Patients with Hematological Malignancy--Review / 中国实验血液学杂志

Coronavirus disease 2019 (COVID-19) has spread rapidly worldwide since outbreak in December 2019, and become a global public health crisis. Patients with hematological malignancy concurrently infected with COVID-19 are often associated with severe even fatal complications, due to low basic immune function, high intensity of chemotherapy and radiotherapy, and slow immune reconstruction post hematopoietic stem cell transplantation, and their treatment strategies, such as anti-infective therapy, blood transfusion, and the use of granulocyte colony stimulating factor need to be adjusted. The characteristics of patients, chemotherapy, hematopoietic stem cell transplantation, and other clinical factors may affect the prognosis of patients with hematological malignancy concurrently infected with COVID-19. Herein, the latest research progress is reviewed.

CAR T cells redirected against tumor-specific antigen glycoforms: can low-sugar antigens guarantee a sweet success? / 医学前沿

Immune-based therapies have experienced a pronounced breakthrough in the past decades as they acquired multiple US Food and Drug Administration (FDA) approvals for various indications. To date, six chimeric antigen receptor T cell (CAR-T) therapies have been permitted for the treatment of certain patients with relapsed/refractory hematologic malignancies. However, several clinical trials of solid tumor CAR-T therapies were prematurely terminated, or they reported life-threatening treatment-related damages to healthy tissues. The simultaneous expression of target antigens by healthy organs and tumor cells is partly responsible for such toxicities. Alongside targeting tumor-specific antigens, targeting the aberrantly glycosylated glycoforms of tumor-associated antigens can also minimize the off-tumor effects of CAR-T therapies. Tn, T, and sialyl-Tn antigens have been reported to be involved in tumor progression and metastasis, and their expression results from the dysregulation of a series of glycosyltransferases and the endoplasmic reticulum protein chaperone, Cosmc. Moreover, these glycoforms have been associated with various types of cancers, including prostate, breast, colon, gastric, and lung cancers. Here, we discuss how underglycosylated antigens emerge and then detail the latest advances in the development of CAR-T-based immunotherapies that target some of such antigens.

Poor Oral Health Increases the Physical Pain, Psychological Discomfort and Social Incapacity of Individuals with Oncohaematological Diseases / La Mala Salud Oral Aumenta el Dolor Físico, el Malestar Psicológico y la Incapacidad Social de las Personas con Enfermedades Oncohematológicas

The objective of this study was to evaluate the relationship between oral health status and its impact on quality of life, and to suggest dental management strategies in patients undergoing antineoplastic therapy for onco-hematological diseases. A retrospective study including 33 individuals (age 9-79 yr) was conducted. It was observed that the dimensions related to physical pain, psychological discomfort, and social incapacity had statistically significant values. The most frequently performed dental treatments were periodontal treatment (45.45 %), dental restoration (36.36 %), tooth extractio n (33.33 %), and endodontic treatment (24.24 %). Thus, poor oral health directly affects the quality of life. Dental management should consider the aspects of the disease and antineoplastic treatment while aiming for safe and effective dental care.

El objetivo de este estudio fue evaluar la relación entre el estado de salud oral y su impacto en la calidad de vida, y sugerir estrategias de manejo odontológico en pacientes sometidos a terapia anti-neoplásica por enfermedades onco-hematológicas. Se realizó un estudio retrospectivo que incluyó a 33 personas (de 9 a 79 años de edad). Se observó que las dimensiones relacionadas con dolor físico, malestar psicológico e incapacidad social tuvieron valores estadísticamente significativos. Los tratamientos dentales realizados con mayor frecuencia fueron el tratamiento periodontal (45,45 %), la restauración dental (36,36 %), la extracción dentaria (33,33 %) y el tratamiento endodóntico (24,24 %). Así, la mala salud oral afecta directamente la calidad de vida. El tratamiento dental debe tener en cuenta los aspectos de la enfermedad y el tratamiento antineoplásico mientras se busca una atención dental segura y eficaz.

Research Advances in the Mechanisms of BRD4 and Its Inhibitors in Hematologic Malignancies--Review / 中国实验血液学杂志

Bromodomain-containing protein 4 (BRD4) is one of the most important members in the bromodomain and extra terminal domain(BET) family, it plays an important role in cellular physiology in human body, such as cell cycles, cell proliferation, and immune response. Recent studies have shown that BRD4 is associated with occurrence and development of acute myeloblastic leukemia, multiple myeloma and lymphoma. The mechanisms of BRD4 in hematologic malignancies including the regulation of c-Myc expression, and participation of the composition of super-enhancer, etc. At present, many kinds of inhibitors have been developed to target inhibit BRD4 for therapy in hematologic malignancies, and some of BRD4 inhibitors have entered phase Ⅱ clinical trials, which suggested that BRD4 inhibitors are expected to become new therapeutic agents for hematologic malignancies. In this review, the research advance of BRD4 and BRD4 inhibitors in hematologic malignancies was summarized briefly.

Pediatric expert consensus on the application of intravenous immunoglobulin in children with hematological/neoplastic diseases / 中国当代儿科杂志

Intravenous immunoglobulin (IVIG) has been widely used in chemotherapy for hematological malignancies, targeted therapy, and hematopoietic stem cell transplantation; however, there are still no available guidelines or consensus statements on the application of IVIG in pediatric hematological/neoplastic diseases at present in China and overseas. This consensus is developed based on the research advances in the application of IVIG in pediatric hematological/neoplastic diseases across the world and provides detailed recommendations for the clinical application of IVIG in pediatric hematological/neoplastic diseases and the prevention and treatment of related adverse reactions.

Single Center Analysis of Bloodstream Infection Clinical Characteristics and Prognosis in Patients with Hematological Malignancies in the Tropics / 中国实验血液学杂志

OBJECTIVE@#To analyze the characteristics, prognosis and risk factors of bloodstream infection in patients with hematological malignancies in the tropics, so as to provide evidence for the prevention and treatment of bloodstream infection.@*METHODS@#The clinical features, blood culture results and prognosis of patients with bloodstream infection in patients with hematological malignancies admitted to Hainan Hospital of PLA General Hospital were retrospectively studied.@*RESULTS@#The most common primary infection site of the 81 patients with hematological malignancies was lung (46.91%), followed by PICC (11.11%). The detection rate of Gram-positive bacteria and Gram-negative bacteria in the blood culture was 60.98% and 30.02%, respectively. Coagulase-negative staphylococci was the most common Gram-positive bacteria resulting in bloodstream infection in our study. Of the Gram-negatives, Klebsiella pneumoniae (34.38%) was predominant, followed by Escherichia coli (18.75%) and Pseudomonas aeruginosa (18.75%). Gram-positive bacteria was highly sensitive (100%) to vancomycin, linezolid and tigecycline. Study showed that Gram-negative bacteria had low sensitive to quinolones, in particular, the resistance rate of Escherichia coli to quinolones was as high as 83.33%. In terms of overall survival (OS), the 30-days OS of patients with Gram-negative and Gram-positive septicemia was 77.42% and 92.00%, respectively. There was no statistically significant difference between the two groups. Multivariate analysis revealed that septic shock (P=0.001, RR=269.27) was an independent risk factor for 30-day mortality, and remission status (P=0.027, RR=0.114) was an independent predictor of a favourable outcome of bloodstream infection in patients with hematological malignancies.@*CONCLUSION@#Gram-positive bacteria are the main pathogens causing bloodstream infections in patients with hematological malignancies in the tropics. Improving the care of PICC is an important measure to reduce the incidence of bloodstream infection in patients with hematological malignancies in the tropics. A correct treatment relieving disease and effective prevention and treatment of septic shock can reduce mortality of patients with bloodstream infection in patients with hematological malignancies in the tropics.

Sintomas de Fadiga e Força Muscular Respiratória de Pacientes Onco-hematológicos em Quimioterapia / Fatigue Symptoms and Respiratory Muscle Strength of Onco-hematological Patients in Chemotherapy / Síntomas de Fatiga y Fuerza de los Músculos Respiratorios de Pacientes Onco-hematológicos en Quimioterapia

Introdução: Quando exposto à quimioterapia, o paciente onco-hematológico está suscetível a várias complicações físicas e respiratórias, associadas aos efeitos colaterais dessas substâncias. Objetivo: Avaliar o impacto de força muscular respiratória quando comparada com os níveis de normalidade e sintomatologia de fadiga, durante recebimento do tratamento quimioterapêutico de pacientes onco-hematológicos. Método: Pesquisa observacional do tipo transversal, realizada por meio de questionário referente aos dados sociodemográficos e de manovacuometria com dispositivo analógico. Resultados: A pesquisa foi constituída por uma população composta de 19 pessoas, 57,9% mulheres e 42,9% homens. A idade média foi de 51,3 anos. A predominância diagnóstica foi leucemia, seguida por linfoma e mieloma. Entre as queixas, a dispneia esteve presente em 31,6% dos casos, sendo a quimioterapia o protocolo escolhido para todos os participantes. Durante a avaliação, 52,6% relataram cansaço e, entre eles, 70% relataram sentir-se melhor quando em repouso, seguidos por 50% impedidos de realizar suas atividades diárias. Ex-fumantes representaram 70% da população pesquisada e 84,2% não praticavam atividades físicas. Na amostra, 62,4% apresentaram frequência respiratória normal, predominando o padrão respiratório apical e o tórax longilíneo. Foram observados resultados significativos na diminuição de Pimáx e Pemáx, com valores estatisticamente conclusivos de p<0,001 nas duas variáveis. Conclusão: O quadro da doença, os tratamentos utilizados e as internações a que essa população foi submetida provocaram a diminuição da força muscular respiratória e o aumento dos sintomas de fadiga.

Introduction: When exposed to chemotherapy, the onco-hematological patient is susceptible to several physical and respiratory complications, associated with side effects of these substances. Objective: Evaluate the impact on respiratory muscle strength when compared to the levels of normality and symptoms of fatigue of onco-hematological patients during chemotherapy treatment. Method: Observational cross-sectional study performed trough a social demographic questionnaire and manovacuometry with analogical device. Results: The study population consisted of 19 subjects, 57.9% women and 42.9% men. The average age was 51.3 years old. The predominant diagnoses were leukemia, followed by lymphoma and myeloma. Among the complaints, dyspnea was present in 31.6% of the cases, chemotherapy was the protocol of choice for all the participants. During the evaluation, 52.6% reported tiredness, and among them, 70%, claimed they feel better when at rest, followed by 50% precluded from performing their daily activities. Ex-smokers represented 70% of the study population and 84.2% did not practice physical activities. 62.4 % of the sample presented normal respiratory frequency, with the apical breathing pattern and predominant slender thorax. Significant results were observed in decreasing MIP and MEP with statistically conclusive values of p<0.001 for the two variables. Conclusion: The disease, the treatments and the hospitalizations this population was submitted provoked the reduction of the respiratory muscle strength and increase of the fatigue symptoms

Introducción: Cuando se expone a quimioterapia, el paciente oncohematológico es susceptible a diversas complicaciones físicas y respiratorias, asociadas a los efectos secundarios de estas sustancias. Objetivo: Evaluar el impacto de la fuerza de los músculos respiratorios en comparación con los niveles de normalidad y síntomas de fatiga, mientras reciben tratamiento de quimioterapia de pacientes oncohematológicos. Método: Investigación observacional transversal, realizada mediante un cuestionario referente a datos sociodemográficos y realizando manovacuometría con dispositivo analógico. Resultados: La investigación consistió en una población compuesta por 19 personas, 57,9% mujeres y 42,9% hombres. La edad media fue de 51,3 años. El predominio diagnóstico fue la leucemia, seguida del linfoma y el mieloma. Entre las quejas, la disnea estuvo presente en el 31,6% de los casos, siendo la quimioterapia el protocolo elegido para todos los participantes. Durante la evaluación, el 52,6% refirió cansancio y, entre ellos, el 70% refirió sentirse mejor en reposo, seguido del 50% incapaz de realizar sus actividades diarias. Los exfumadores representaron el 70% de la población encuestada y el 84,2% no practicaba actividad física. En la muestra, el 62,4% tenía frecuencia respiratoria normal, con predominio de patrón respiratorio apical y tórax longilineal. Se observaron resultados significativos en la disminución de Pimax y Pmax, con valores estadísticamente concluyentes de p<0,001 en ambas variables. Conclusión: Debido a la enfermedad, los tratamientos utilizados y las hospitalizaciones a las que esta población fueron sometidos provocaron la disminución de la fuerza de los músculos respiratorios y aumento de los síntomas de fatiga

Differences between the oral changes presented by patients with solid and hematologic tumors during the chemotherapeutic treatment

Abstract Objective: This study sought to identify the differences between the oral changes presented by patients with solid and hematologic tumors during chemotherapeutic treatment. Methodology: This is an observational, prospective and quantitative study using direct documentation by follow-up of 105 patients from 0 to 18 years using the modified Oral Assessment Guide (OAG). Of the 105 patients analyzed, 57 (54.3%) were boys with 7.3 years (±5.2) mean age. Hematologic neoplasms accounted for 51.4% of all cases. Results: Voice, lips, tongue, and saliva changes were not significantly different (p>0.05) between patients with solid or hematologic tumors and during the follow-up. From the 6th until the 10th week of chemotherapeutic treatment alterations in swallowing function, in the mucous membrane (buccal mucosa and palate), in the labial mucosa, and in the gingiva occurred and were distributed differently between the two tumors groups (p<0.05). The main alterations were observed in patients with hematologic tumors. Conclusion: It was concluded that the oral changes during the chemotherapeutic treatment occurred especially in swallowing function, in the mucous membrane, in the labial mucosa and in the gingiva, and these alterations were found mainly in patients with hematologic tumors.

Quimioterapia intratecal: percepções e significados atribuídos por pacientes com câncer hematológico / Intrathecal chemotherapy: perceptions and meanings attributed by patients with hematological cancer / Quimioterapia intratecal: percepciones y signficados atribuidos por pacientes com cáncer hematológico

Objetivo: analisar os significados e as percepções dos pacientes submetidos à quimioterapia intratecal sobre esse tratamento. Método: estudo descritivo de abordagem quantiqualitativa, desenvolvida com 13 participantes atendidos em uma central de quimioterapia de um hospital universitário do interior de Minas Gerais, entre os anos de 2015 a 2016, cujos dados, obtidos por meio de entrevistas, foram submetidos à análise do discurso do sujeito coletivo. Aprovado pelo Comitê de Ética em Pesquisa da instituição campo do estudo. Resultados: dos dados codificados emergiram cinco discursos: desconhecimento do tratamento, dor, ansiedade, fé e esperança. Conclusão: a quimioterapia intratecal é desconhecida pelos pacientes em tratamento, causando ansiedade, dor e reações adversas as quais trazem prejuízo para a qualidade de vida desses indivíduos. Com isso criam-se mecanismos de enfrentamento da doença por meio da fé e da esperança.

Objective: analyze the meanings and perceptions of patients undergoing intrathecal chemotherapy about this treatment Method: qualitative and descriptive study carried out with 13 participants attended at a Chemotherapy Center of a University Hospital in the interior of Minas Gerais, from 2015 to 2016, whose data were submitted to the analysis of the collective subject discourse. Approved by the Research Ethics Committee of the study development institution. Results: the information obtained through the interviews was coded and five discourses emerged: lack of treatment, pain, anxiety, faith and hope. Conclusion: intrathecal chemotherapy is unknown to patients undergoing treatment, causing anxiety, pain and adverse reactions that impair their quality of life. This creates mechanisms for coping with the disease through faith and hope.

Objetivo: analizar los significados y las percepciones de los pacientes sometidos a quimioterapia intratecal sobre este tratamiento. Método: estudio de enfoque cuantitativo y descriptivo desarrollado con 13 participantes atendidos en un Centro de Quimioterapia de un Hospital Universitario en el interior de Minas Gerais, entre 2015 y 2016, cuyos datos fueron sometidos al análisis del discurso del sujeto colectivo. Aprobado por el Comité de Ética en Investigación de la institución de desarrollo del estudio. Resultados: la información obtenida a través de las entrevistas fue codificada y surgieron cinco discursos: falta de tratamiento, dolor, ansiedad, fe y Esperanza. Conclusión: la quimioterapia intratecal es desconocida para los pacientes sometidos a tratamiento, lo que causa ansiedad, dolor y reacciones adversas que deterioran su calidad de vida. Esto crea mecanismos para hacer frente a la enfermedad a través de la fe y la esperanza.

Neoplasia de células dendríticas plasmocitoides blásticas con respuesta inicial a quimioterapia y recaída en sistema nervioso central: caso clínico / Blastic plasmacytoid dendritic cell neoplasm with complete clinical remission with chemotherapy and central nervous system relapse: report of one case

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, clinically aggressive hematologic malignancy that most commonly manifests as cutaneous lesions with or without bone marrow involvement and leukemic dissemination. The demonstration of tumor cells with the characteristic immunophenotype with expression of CD56, generally CD4 and dendritic cell antigens (CD123, cyTCL-1, HLA-DR), in the absence of myeloid or lymphoid lineage markers is required for the diagnosis. Responses to chemotherapy are initially satisfactory, with frequent systemic and central nervous system relapses. We report a 24 year-old male with BPDCN, initially diagnosed and treated as non-Hodgkin CD4+ T-cell lymphoma, with initial complete remission who evolved with early central nervous system relapse. A second attempt of chemotherapy failed and the patient died two months later.

Implementing a clinical pharmacy service in hematology / Implementação de um serviço farmacêutico clínico em hematologia

ABSTRACT Objective: To implement a clinical pharmacy service focused on the comprehensive review of antineoplastic drugs used in therapy of hematological diseases. Methods: An interventional study was conducted in a Brazilian tertiary teaching hospital in two different periods, with and without a clinical pharmacy service, respectively. This service consisted of an antineoplastic prescription validation (analysis of patients' characteristics, laboratory tests, compliance with the therapeutic protocol and with pharmacotechnical parameters). When problems were detected, the pharmacist intervened with the physician or another health professional responsible for the patient. Inpatients and outpatients with hematological diseases were included. Results: We found an increased detection of drug-related problem by 106.5% after implementing the service. Comparing the two periods, an increase in patients' age (26.7 years versus 17.6 years), a predominance of outpatients (54% versus 38%), and an increase in multiple myeloma (13% versus 4%) and non-Hodgkin lymphoma (16% versus 3%) was noted. The most commonly found problems were related to dose (33% versus 25%) and cycle day (14% versus 30%). With regard to clinical impact, the majority had a significant impact (71% versus 58%), and in one patient from the second period could have been fatal. The main pharmaceutical interventions were dose adjustment (35% versus 25%) and drug withdrawal (33% versus 40%). Conclusion: The pharmacy service contributed to increase the detection and resolution of drug-related problems, and it was an effective method to promote the safe and rational use of antineoplastic drugs.

RESUMO Objetivo: Implementar um serviço farmacêutico clínico centrado na revisão completa dos antineoplásicos utilizados no tratamento de doenças hematológicas. Métodos: Estudo intervencional conduzido em um hospital universitário terciário brasileiro em dois períodos distintos, com base na ausência e na presença do serviço farmacêutico clínico, respectivamente. O referido serviço consistiu na validação farmacêutica de prescrição de medicamentos antineoplásicos (análise de características do paciente, exames laboratoriais, conformidade com o protocolo terapêutico e parâmetros farmacotécnicos). Após a detecção dos problemas, o farmacêutico interveio junto ao médico ou outro profissional de saúde responsável pelo paciente. Foram incluídos pacientes internados e ambulatoriais com doenças hematológicas. Resultados: Observou-se um aumento de 106,5% na detecção de problemas relacionados com medicamentos após a implementação do serviço. Comparando-se os dois períodos, verificou-se aumento na idade dos pacientes (26,7 anos versus 17,6 anos), predomínio de pacientes ambulatoriais (54% versus 38%) e aumento de mieloma múltiplo (13% versus 4%) e linfoma não Hodgkin (16% versus 3%). Os problemas mais comumente encontrados foram relacionados à dose (33% versus 25%) e ao dia do ciclo (14% versus 30%). Quanto ao impacto clínico, a maioria apresentou impacto significante (71% versus 58%) e um poderia ter sido fatal no segundo período. As principais intervenções farmacêuticas realizadas foram ajuste de dose (35% versus 25%) e suspensão de medicamento (33% versus 40%). Conclusão: O serviço farmacêutico contribuiu para o aumento da detecção e resolução de problemas relacionados com medicamentos, tratando-se de um método efetivo para promover o uso seguro e racional de medicamentos antineoplásicos.