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Arch. argent. pediatr ; 119(5): e550-e553, oct. 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1292810


Las leucemias son las neoplasias malignas más frecuentes en la infancia; la leucemia linfoblástica aguda (LLA) es la más frecuente. Desde principios de los 80, la adición de metotrexato intratecal a los esquemas de quimioterapia ha sido beneficiosa para prevenir la recidiva en el sistema nervioso central y evitar el uso de radioterapia. Su mecanismo de acción es la inhibición de la enzima dihidrofolato reductasa, por lo que posee múltiples efectos adversos (neurotoxicidad aguda, subaguda o crónica) después de la infusión intratecal o de dosis altas por vía intravenosa.Se presenta un paciente de 11 años con diagnóstico de LLA de línea T (LLA-T), que presenta hemiparesia faciobraquial y afasia de expresión de instauración aguda 8 días después de la administración intratecal de metotrexato. Luego de excluir otras patologías más frecuentes de origen vascular y la evolución típica del cuadro, con resolución espontánea ad integrum de los síntomas, se arribó al diagnóstico de encefalopatía subaguda reversible por metotrexato.

Leukemias are the most frequent malignant neoplasms in childhood; acute lymphoblastic leukemia (ALL) is the most frequent. The addition of intrathecal methotrexate to chemotherapy regimens has been beneficial in preventing relapse to the central nervous system and avoiding the use of radiation therapy. Due to its mechanism of action, by inhibiting the enzyme dihydrofolate reductase, when it is used systemically, it has multiple expected adverse effects such as mucositis, myelosuppression and it has also been observed after intrathecal administration or high intravenous doses, acute, subacute neurotoxicity where stroke like syndrome is found. We present an 11-year-old patient diagnosed with T-ALL, who manifested after 8 days of intrathecal administration of methotrexate, faciobrachial hemiparesis and acute onset expression aphasia. The diagnosis of subacute encephalopathy reversible by methotrexate was reached by excluding other more frequent pathologies and the typical evolution, with spontaneously ad integrum resolution of the symptoms

Humans , Child , Stroke/chemically induced , Neurotoxicity Syndromes , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Methotrexate/adverse effects , Antimetabolites, Antineoplastic/adverse effects
Article in Chinese | WPRIM | ID: wpr-880138


OBJECTIVE@#To retrospective analyze the reason of death in children with acute lymphoblastic leukemia (ALL) treated with CCLG-ALL 2008 protocol, and the experience was summarized in order to reduce the mortality.@*METHODS@#916 children diagnosed as ALL and accepted CCLG-ALL 2008 protocol from April 2008 to April 2015 in our hospital were enrolled, the dead cases in them were analyzed retrospectively.@*RESULTS@#169 children died, including 111 (65.7%) males and 58 (34.3%) females. Recurrence was the main reason of death. 150 (88.7%) children died due to recurrence, among them, 86 (57.3%) cases gave up directly. The second reason of death was infection. The main clinical sites of infection were concentrated in respiratory system and digestive system. Bacterial infection was most common (Gram-negative was common).@*CONCLUSION@#Enough finance and improving family compliance can decrease the mortality in children with ALL. Early rational use of antibiotics can reduce infection-related mortality in children with ALL.

Antineoplastic Combined Chemotherapy Protocols , Child , Disease-Free Survival , Female , Humans , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Prognosis , Retrospective Studies
Article in Chinese | WPRIM | ID: wpr-880130


OBJECTIVE@#To analyze the efficacy of CCLG-ALL-2008 protocol and the related factors of treatment failure in children with acute lymphoblastic leukemia (ALL).@*METHODS@#The clinical data of 400 children newly-diagnosed ALL in Children's Hospital of Soochow University from March 1, 2008 to December 31, 2012 was retrospectively analyzed. All the children accepted CCLG-ALL-2008 protocol, and were followed-up until October 2019. The dates of relapse, death and causes of death were recorded. Treatment failure was defined as relapse, non-relapse death, and secondary tumor.@*RESULTS@#Following-up for 10 years, there were 152 cases relapse or non-relapse death, the treatment failure rate was 38%, including 122 relapse (80.3%), 30 non-relapse deaths (19.7%) which included 7 cases (4 cases died of infection and 3 cases died of bleeding) died of treatment (23.3% of non-relapse deaths), 8 cases died of minimal residual disease (MRD) continuous positive (26.7% of non-relapse deaths) and 15 cases died of financial burden (50% of non-relapse deaths). According to the relapse stage, 37 cases (30%) in very early stage, 38 cases (31%) in early stage, and 47 cases (39%) in late stage, while according to the relapse site, 107 cases relapsed in bone marrow, 3 cases in testis, 3 cases in central nervous system (CNS), 5 cases in bone marrow plus testis and 4 cases in bone marrow plus CNS. Bone marrow relapse was the main cause of death in 89 cases, followed by nervous system. Initially diagnosed WBC count (≥50×10@*CONCLUSION@#Relapse is the main cause of treatment failure in children with ALL. The initially diagnosed WBC count, immunophenotype and MRD at week 12 were the independent prognostic factors for relapse of the patients. Financial burden accounts for a large proportion of non-relapse death.

Antineoplastic Combined Chemotherapy Protocols , Child , Disease-Free Survival , Humans , Male , Neoplasm, Residual , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Prognosis , Recurrence , Retrospective Studies , Treatment Failure , Treatment Outcome
Article in English | WPRIM | ID: wpr-888789


Brucea javanica oil emulsion (BJOE) has been used to treat tumor in China for more than 40 years. However, its components and effectiveness in the treatment of acute lymphocytic leukemia (ALL) and its mechanism of anti-cancer activity remain unknown. In the current study, high-performance liquid chromatography-evaporative light scattering detector (HPLC-ELSD) was used to analyze the components of BJOE. Then, the anti-leukemia effects of BJOE were examined both in vitro and in vivo using ALL Jurkat cells and the p388 mouse leukemia transplant model, respectively. The primary ALL leukemia cells were also used to confirm the anti-leukemia effects of BJOE. The apoptotic-related results indicated that BJOE induced apoptosis in Jurkat cells and were suggestive of intrinsic apoptotic induction. Moreover, BJOE inhibited Akt (protein kinase B) activation and upregulated its downstream targets p53 and FoxO1 (forkhead box gene, group O-1) to initiate apoptosis. The activation of GSK3β was also involved. Our findings demonstrate that BJOE has anti-leukemia effects on ALL cells and can induce apoptosis in Jurkat cells through the phosphoinositide3-kinase (PI3K) /Akt signaling pathway.

Animals , Apoptosis , Brucea/chemistry , Glycogen Synthase Kinase 3 , Humans , Jurkat Cells , Mice , Phosphatidylinositol 3-Kinases/genetics , Plant Oils/pharmacology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Proto-Oncogene Proteins c-akt/genetics , Seeds/chemistry , Signal Transduction
Article in English | WPRIM | ID: wpr-888490


OBJECTIVES@#To study the clinical features and prognosis of children with acute leukemias of ambiguous lineage (ALAL) under different diagnostic criteria.@*METHODS@#A retrospective analysis was performed on the medical data of 39 children with ALAL who were diagnosed and treated from December 2015 to December 2019. Among the 39 children, 34 received treatment. According to the diagnostic criteria for ALAL by World Health Organization and European Group for the Immunological Characterization of Leukemias, the 39 children were divided into two groups: ALAL group (@*RESULTS@#The 34 children receiving treatment had a 3-year event-free survival (EFS) rate of 75%±9% and an overall survival rate of 88%±6%. The children treated with acute myeloid leukemia (AML) protocol had a 3-year EFS rate of 33%±27%, those treated with acute lymphoblastic leukemia (ALL) protocol had a 3-year EFS rate of 78%±10%, and those who had no remission after induction with AML protocol and then received ALL protocol had a 3-year EFS rate of 100%±0% (@*CONCLUSIONS@#ALL protocol has a better clinical effect than AML protocol in children with ALAL, and positive MRD after induction therapy suggests poor prognosis. Hyperleukocytosis and adverse genetic changes are not observed in children with myeloid expression, and such children tend to have a good prognosis, suggesting that we should be cautious to take it as ALAL in diagnosis and treatment.

Acute Disease , Child , Disease-Free Survival , Humans , Neoplasm, Residual , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Prognosis , Retrospective Studies
Journal of Experimental Hematology ; (6): 1710-1713, 2021.
Article in Chinese | WPRIM | ID: wpr-922322


OBJECTIVE@#To explore the effect of posaconazole in the primary prevention of invasive fungal disease (IFD) in the induction therapy of childhood acute lymphoblastic leukemia (ALL).@*METHODS@#From August 2018 to November 2020, 144 pediatric patients with ALL treated in Department of Pediatrics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University were selected, 88 cases received fluconazole as IFD prophylaxis (fluconazole prophylaxis group), 56 cases received posaconazole as IFD prophylaxis (posaconazole prophylaxis group). The incidence of IFD and treatment-related adverse reactions between the two groups were compared, and the safety of posaconazole was evaluated.@*RESULTS@#The incidence of IFD in the fluconazole prophylaxis group was 20.4% (18/88), and in the posaconazole prophylaxis group was 7.1% (4/56). The incidence of IFD between the two groups was statistically significant different(P=0.030). There was no serious adverse reactions in the two groups. The incidence of mild adverse reactions in the posaconazole prophylaxis group (23.2%) was lower than that in the fluconazole prophylaxis group(39.8%), and the difference was statistically significant (P=0.039). There were 12 cases died in the fluconazole prophylaxis group and 4 in the posaconazole prophylaxis group, while no significant difference in the overall survival rate between the two groups (P=0.281).@*CONCLUSION@#The effect of posaconazole in the primary prophylaxis of IFD is better and incidence of adverse reactions is lower than fluconazole. Posaconazole can be tolerated, and expected to become the first-line primary prophylaxis drug for IFD during the induction remission therapy of childhood ALL.

Antifungal Agents/therapeutic use , Child , Humans , Induction Chemotherapy , Mycoses/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Primary Prevention , Triazoles
Clinics ; 75: e2011, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133363


OBJECTIVE: The occurrence of cryptic Philadelphia (Ph) chromosome translocation is rare in BCR-ABL1-positive acute lymphoblastic leukemia (BCR-ABL1+ ALL) and is of unknown significance in the tyrosine kinase inhibitor (TKI) era. METHODS: We retrospectively studied a series of adult patients receiving TKI-based therapy to evaluate the prognostic impact of the normal karyotype (NK) (n=22) in BCR-ABL1+ ALL by comparison with the isolated Ph+ karyotype (n=54). RESULTS: There were no statistically significant differences in clinical characteristics and complete remission rate between the two groups. Compared with the isolated Ph+ group, the NK/BCR-ABL1+ group had a higher relapse rate (55.0% versus 29.4%, p=0.044). Overall survival (OS) and disease-free survival (DFS) were significantly shorter in the NK/BCR-ABL1+ group than in the isolated Ph+ group [median OS: 24.5 versus 48.6 (months), p=0.013; median DFS: 11.0 (months) versus undefined, p=0.008]. The five-year OS and DFS for patients with NK/BCR-ABL1+ were 19.2% and 14.5%, respectively; those for patients with isolated Ph+ were 49.5% and 55.7%, respectively. Thirty-four (44.7%) patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in this study. Among the patients who received allo-HSCT, the median OS and DFS in the NK/BCR-ABL+ group (n=9) were 35.5 and 27.5 months, respectively, while those in the isolated Ph+ group (n=25) were undefined. There was a trend of significant statistical difference in the OS between the two subgroups (p=0.066), but no significant difference in the DFS. Multivariate analysis revealed that NK was independently associated with worse OS and DFS in BCR-ABL1+ ALL patients [Hazard ratio (HR) 2.256 (95% confidence interval (CI), 1.005-5.066), p=0.049; HR 2.711 (95% CI, 1.319-5.573), p=0.007]. CONCLUSION: Our results suggest that the sub-classification of an NK could be applied in the prognostic assessments of BCR-ABL1+ ALL. In addition, allo-HSCT should be actively performed to improve prognosis in these patients.

Humans , Adult , Hematopoietic Stem Cell Transplantation , Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Prognosis , Retrospective Studies , Fusion Proteins, bcr-abl/genetics , Protein Kinase Inhibitors/therapeutic use , Karyotype
Article in Chinese | WPRIM | ID: wpr-879771


OBJECTIVE@#To study the pharmacokinetic characteristics, clinical effect, and safety of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) in children with acute lymphoblastic leukemia (ALL).@*METHODS@#A prospective study was performed on children with ALL who cyclophosphamide, cytarabine, and 6-mercaptopurine were used for consolidation therapy. PEG-rhG-CSF (PEG-rhG-CSF group) or rhG-CSF (rhG-CSF group) was injected after chemotherapy. The plasma concentration of PEG-rhG-CSF was measured, and clinical outcome and safety were observed for both groups.@*RESULTS@#A total of 17 children with ALL were enrolled, with 9 children in the PEG-rhG-CSF group and 8 children in the rhG-CSF group. In the PEG-rhG-CSF group, the peak concentration of PEG-rhG-CSF was 348.2 ng/mL (range 114.7-552.0 ng/mL), the time to peak was 48 hours (range 12-72 hours), and the half life was 14.1 hours (range 11.1-18.1 hours). The plasma concentration curve of PEG-rhG-CSF was consistent with the mechanism of neutrophil-mediated clearance. Compared with the rhG-CSF group, the PEG-rhG-CSF group had a significantly shorter median time to absolute neutrophil count (ANC) recovery (P0.05).@*CONCLUSIONS@#The pharmacokinetic characteristics of PEG-rhG-CSF in children with ALL receiving consolidation chemotherapy are consistent with the mechanism of neutrophil-mediated clearance, with a short half life and fast recovery of ANC, and there are no significant differences in safety between PEG-rhG-CSF and rhG-CSF.

Child , Granulocyte Colony-Stimulating Factor/therapeutic use , Humans , Neutropenia , Polyethylene Glycols , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Prospective Studies , Recombinant Proteins
Rev. Salusvita (Online) ; 38(4): 987-1000, 2019.
Article in Portuguese | LILACS | ID: biblio-1117694


Introdução: O câncer merece destaque entre as doenças que causam transtornos em adultos e crianças, pois continua sendo um diagnóstico dos mais temidos da atualidade. Vincula-se a um estigma de sofrimento, mutilação e morte, envolvendo uma série de ameaças e dificuldades, que afetam não só a criança, mas sua família como um todo, ao longo do processo de diagnóstico e tratamento Objetivo: Comparar os comportamentos de crianças durante a quimioterapia endovenosa antes e após a aplicação do brinquedo terapêutico instrucional (BTI). Materiais e Métodos: Pesquisa não controlada do tipo "antes e depois", realizada na oncopediatria de um hospital público. Foram avaliadas 10 crianças submetidas a quimioterapia endovenosa. Na coleta de dados, utilizou-se um questionário com questões sociodemográficas, clínicas, comportamentais e reações esboçadas durante o tratamento, antes e após a sessão de BTI. A análise de dados foi feita no programa SPSS, sendo realizado o teste de Mc Nemar, considerando um intervalo de confiança de 95%. Resultados: O câncer infantil mais frequente foi a Leucemia Linfoide Aguda (40%). Dos comportamentos analisados, percebeuse redução significativa após o uso do BTI do comportamento "postura retraída". Conclusão: O BTI representou uma ferramenta importante no controle da ansiedade e sofrimento gerado pelo tratamento quimioterápico endovenoso.

Introduction: Cancer plays a notable role among diseases that afflict adults and children. Its diagnosis is still much feared and connects to a stigma of suffering, mutilation and death. It is related to difficulties and treats that affects not only the child but also his whole family during the long process of diagnosis and treatment. Objective: to compare the behaviors of children during intravenous chemotherapy before and after the application of therapeutic instructional toy (BTI). Materials and methods: Uncontrolled search such as "before and after", held in oncopediatria of a public hospital. Ten children were evaluated, subjected to intravenous chemotherapy. For collection, it was used a questionnaire asking for sociodemographic, clinical and behavioral questions, as well as issues and reactions outlined during treatment, before and after the session of BTI. The data analysis was done in SPSS program, being carried out the Mc Nemar test, assuming a confidence interval of 95%. Results: the most frequent childhood cancer was Acute Lymphoblastic leukemia (40%). Among the behaviors examined, it was significantly reduced after the use of BTI "retracted posture" behavior. Conclusion: the BTI represented an important tool in the control of anxiety and suffering generated by intravenous chemotherapy treatment.

Humans , Male , Female , Child, Preschool , Child , Play and Playthings , Child, Hospitalized/psychology , Drug Therapy/psychology , Emotions , Neoplasms/drug therapy , Ovarian Neoplasms/drug therapy , Infusions, Intravenous/psychology , Leukemia, Myeloid, Acute/drug therapy , Punctures/psychology , Child Behavior/psychology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Kidney Neoplasms/drug therapy
Arch. argent. pediatr ; 116(4): 500-507, ago. 2018. graf, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-950042


Introducción: Los niños con síndrome de Down (SD) tienen mayor frecuencia de leucemia linfoblástica aguda (LLA) y menor supervivencia que pacientes sin síndrome de Down (NSD). Analizamos las características clínicas, demográficas-biológicas y respuestas al tratamiento en SD-LLA versus NSD-LLA. Pacientes y métodos: Pacientes (0-19 años) con LLA desde enero de 1990 a noviembre de 2016. Se compararon características demográficas biológicas y respuestas al tratamiento con chi cuadrado y Wilcoxon rank sum. La supervivencia global y el intervalo libre de eventos (ILE) se analizaron con Kaplan-Meier y el test log-rank. Resultados: Se incluyeron 1795 pacientes, 54 con SD. Los SD-LLA presentaron edad mayor (p= 0,0189). T odos inmuno fenotipo precursor-B, con menor incidencia de anomalías recurrentes (p < 0,0001). Demostraron mejor tasa de respuesta a prednisona (p= 0,09) y mayor mortalidad en inducción y remisión completa (p < 0,0001). Todas las muertes de los SD-LLA fueron relacionadas con el tratamiento. La sobrevida libre de eventos en niños SD-LLA vs.NSD-LLA fue 47 (± 8)% vs. 73 (± 1)% (p= 0,006) y el ILE de los SD-LLA vs. NSD-LLA fue 54 (± 9)% vs. 75 (± 1)% (p= 0,0297). La tasa de recaídas fue similar en ambos grupos (p= 0,6894). El ILE de los SD-LLA fue menor en el grupo de 6-9 años: 39 (± 19)% (p= 0,7885). Conclusiones: Los niños de 6-9 años con SD-LLA años presentó menor sobrevida. Aunque estos niños presentaron una mejor respuesta temprana, la sobrevida libre de eventos e ILE fueron menores debido a la mortalidad relacionada con el tratamiento.

Introduction. Children with Down syndrome (DS) more commonly have acute lymphoblastic leukemia (ALL) and a lower survival rate than those without Down syndrome (WDS). We analyzed the clinical, demographic, and biological characteristics and treatment response of children with DS-ALL versus those WDS-ALL. Patients and methods: Patients with ALL between January 1990 and November 2016. The demographic and biologic characteristics and treatment response were compared using the χ² and Wilcoxon rank-sum tests. The overall survival and event-free interval (EFI) were analyzed using the Kaplan-Meier and log-rank tests. Results. 1795 patients were included; 54 had DS. Patients with DS-ALL were older (p= 0.0189). All had B-cell precursor immunophenotype and a lower incidence of recurrent abnormalities (p < 0.0001). They showed a better response rate to prednisone (p= 0.09) and a higher mortality in induction and complete remission (p < 0.0001). All deaths of patients with DS-ALL were treatment-related. The event-free survival (EFS) was 47% (± 8%) versus 73% (± 1%) (p= 0.006) and the EFI was 54% (± 9%) versus 75% (± 1%) (p= 0.0297) among patients with DS-ALL versus those WDS-ALL, respectively. The rate of relapse was similar in both groups (p= 0.6894). The EFI of patients with DS-ALL was lower in the group aged 6-9 years: 39% (± 19%) (p= 0.7885). Conclusions. A lower survival was observed among children aged 6-9 years with DS-ALL. Although these children showed a better early response, their EFS and EFI were lower due to treatment-related mortality.

Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Prednisone/administration & dosage , Down Syndrome/complications , Antineoplastic Agents, Hormonal/administration & dosage , Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology , Recurrence , Remission Induction , Survival Rate , Retrospective Studies , Age Factors , Statistics, Nonparametric , Disease-Free Survival , Kaplan-Meier Estimate , Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
Rev. méd. Chile ; 146(7): 846-853, jul. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-961470


Background: Metformin has antineoplastic and cancer protective effects in vitro, sensitizing leukemia cells to chemotherapeutic agents, inducing apoptosis and cell cycle arrest. Aim: To assess the effect of metformin on the induction stage in patients with ALL and its impact on overall survival and relapse. Material and Methods. We included 123 patients treated with metformin and without metformin. The dose used was 850 mg PO at 8 h intervals. The survival analysis was used by Kaplan-Meier method, the difference between the distinct groups was performed using the log Rank test. Results. The overall survival at a median follow up of 700 days of follow-up was 43%, with a disease-free survival of 47%. Regarding the treatment groups, patients with metformin had a lower rate of relapse compared to the group receiving only chemotherapy (6.5% vs 17.1%, p = 0.006). Conclusions. The addition of metformin to the conventional treatment of ALL was associated with an improvement in survival, this association being independent of the type of biological risk at diagnosis.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Metformin/therapeutic use , Recurrence , Acute Disease , Survival Rate , Risk Factors , Apoptosis , Disease-Free Survival
Rev. méd. Chile ; 146(6): 802-807, jun. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-961462


Intrathecal chemotherapy may be complicated with the development of myelopathies or toxic radiculopathies. This myeloradicular involvement, of toxic character, is unpredictable, since these patients have repeatedly received Intrathecal chemotherapy with the same drugs without apparent injury. The toxic effect should be mainly attributed to Cytarabine and not to methotrexate, since the central nervous system lacks Cytidine deaminase, the enzyme that degrades Cytarabine. We report two patients, an 18-year-old woman and a 16 years old male, who received systemic and intrathecal chemotherapy (methotrexate, cytarabine) for the treatment of an acute lymphoblastic leukemia and developed, in relation to this procedure, a spinal subacute combined degeneration. They had a proprioceptive and motor alteration of the lower extremities and neuroimaging showed selective rear and side spinal cord hyper intensity produced by central axonopathy. Two weeks later the woman developed a quadriplegia and the young man a flaccid paraplegia due to added root involvement.

Humans , Female , Adolescent , Methotrexate/adverse effects , Cytarabine/adverse effects , Subacute Combined Degeneration/chemically induced , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Antimetabolites, Antineoplastic/adverse effects , Injections, Spinal , Magnetic Resonance Imaging , Methotrexate/administration & dosage , Fatal Outcome , Cytarabine/administration & dosage , Subacute Combined Degeneration/diagnostic imaging , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Antimetabolites, Antineoplastic/administration & dosage
Arch. argent. pediatr ; 116(3): 459-462, jun. 2018. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-950027


La necrólisis epidérmica tóxica y el síndrome de StevensJohnson son enfermedades mucocutáneas raras que están asociadas a una evolución prolongada y a un desenlace potencialmente mortal. Principalmente están inducidas por fármacos y las tasas de mortalidad son muy elevadas. Aunque la piel es la más comprometida, también pueden estar afectados múltiples aparatos o sistemas como el cardiovascular, pulmonar, gastrointestinal y urinario. En este artículo, describimos el caso de un paciente con síndrome de Stevens-Johnson asociado al tratamiento con metotrexato, quien desarrolló insuficiencia cardíaca aguda y hemorragia gastrointestinal además de las manifestaciones en la piel. El paciente recibió un tratamiento satisfactorio con metilprednisolona e inmunoglobulina por vía intravenosa y continuó la quimioterapia con metotrexato.

Toxic epidermal necrolysis and Stevens-Johnson syndrome are rare mucocutaneous diseases which are associated with a prolonged course and potentially lethal outcome. They are mostly drug induced and mortality rates are very high. Although mostly skin is involved, multiple organ systems such as cardiovascular, pulmonary, gastrointestinal, and urinary systems may be affected. Here, we report a case of StevensJohnson Syndrome associated with methotrexate treatment who developed acute cardiac failure and gastrointestinal hemorrhage beside skin findings. He had been treated with intravenous immunglobulin and methylprednisolone succesfully and continued chemotherapy with methotrexate treatment again.

Humans , Male , Child , Methotrexate/adverse effects , Stevens-Johnson Syndrome/etiology , Antimetabolites, Antineoplastic/adverse effects , Methylprednisolone/administration & dosage , Methotrexate/administration & dosage , Stevens-Johnson Syndrome/diagnosis , Stevens-Johnson Syndrome/drug therapy , Immunoglobulins, Intravenous/administration & dosage , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Heart Failure/chemically induced , Gastrointestinal Hemorrhage/chemically induced , Antimetabolites, Antineoplastic/administration & dosage
São Paulo; s.n; s.n; 2018. 170 p. ilus, tab, graf.
Thesis in Portuguese | LILACS | ID: biblio-946740


A enzima L-Asparaginase (ASNase) é um biofámaco utilizado no tratamento da leucemia linfoblástica aguda, no entanto, a evolução da produção da ASNase como um medicamento desde o final da década de 1970 resultou em apenas quatro alternativas disponíveis no mercado farmacêutico, com relatos de graves reações imunogênicas e toxicidade. Desse modo, a nanotecnologia é uma plataforma que pode ser explorada para administração dessa enzima diminuindo a exposição da mesma a proteases e aumentando a sua meia-vida aparente. Os polimerossomos (PL) são opções que pela nanoestrutura vesicular poderiam encapsular a ASNase em seu core aquoso e pela presença de uma membrana polimérica, são mais robustos que os lipossomos. Assim, neste trabalho objetivou-se desenvolver PL para encapsulação da ASNase como uma alternativa às formulações deste biofármaco existentes. Foram desenvolvidos PL de PEG-PLA, PMPC-PDPA, PEG-PDPA e Pluronic® L-21. Foram estudados fatores relacionados à composição dos copolímeros (fração hidrofílica, responsividade a fatores externos tais como pH e temperatura) e métodos de elaboração (hidratação do filme polimérico, troca de pH e temperatura) bem como foi feita a caracterização dos PL obtidos (tamanho, índice de polidispersão, espessura de membrana, formação de excessivo bulk polimérico, obtenção de micelas). Também foi feito um planejamento racional para encapsulação da ASNase (hidratação direta do filme polimérico e encapsulação por eletroporação, autoagregação com encapsulação por troca de pH ou de temperatura). Para os PL preparados com PEG-PLA, a extrusão resultou em distribuição de tamanhos mais estreitos correspondentes aos valores de PDI de 0,345, 0,144 e 0,081 para PEG45-PLA69, PEG114-PLA153 e PEG114-PLA180, respectivamente. Foi demonstrado que copolímeros com menor fração hidrofóbica resultam em maior eficiência de encapsulação para proteínas, já que possuem volumes aquosos maiores. Com o PMPC25-PDPA72 foi possível encapsular em média três unidades de ASNase por vesículas através da eletroporação ou troca de pH, sendo que no primeiro método houve formação de túbulos e no último método as micelas não foram completamente removidas. Para PEG100-PDPA80, grandes agregados permaneceram após a purificação levando a um PDI alto, mas não foi observada a formação de túbulos, já a troca de pH para este copolímero resultou em maior perda de copolímeros como bulk polimérico precipitado. Para o copolimero tribloco Pluronic® L-121, foi observado que as vesículas eram estáveis durante uma semana à temperatura ambiente, contrariando o que era descrito na literatura. Nesses sistemas, quando preparados por hidratação do filme, a encapsulação da ASNase foi realizada por eletroporação mas a proteína não foi detectada dentro das vesículas. Atribuímos a não-encapsulação à organização da bicamada Pluronic® L-121 sem conformação definida das cadeias poliméricas, dificultando a reorganização do bloco hidrofílico na porção interna do poro durante eletroporação. Por troca de temperatura, cerca de 5 % de ASNase foi encapsulada e o método resultou em total recuperação da atividade da enzima. Desse modo foram obtidos diferentes PL com diferentes características nanoestruturais de acordo com os copolímeros utilizados para carreamento da ASNase

The enzyme L-Asparaginase (ASNase) is a biopharmaceutical used in the treatment of acute lymphoblastic leukemia, still the industrial production of ASNase as a marketable drug since the late 1970s has resulted in only four alternatives available in the pharmaceutical market, with reports of severe immunogenic reactions and toxicity. In this sense, nanotechnology is a platform that can be exploited to administer this enzyme by decreasing its exposure to proteases and increasing its apparent half-life. Polymerosomes (PL) are interesting routes which by its intrinsically vesicular nanostructure could encapsulate the ASNase in its aqueous core and by the presence of a polymeric membrane, being more robust than the liposomes. Thus, in this work it was intended to develop PL for ASNase encapsulation as an alternative to existing formulations of this biopharmaceutical. PL of PEG-PLA, PMPC-PDPA, PEG-PDPA and Pluronic® L-21 were developed. It was studied the copolymers composition (i.e. hydrophilic fraction, responsiveness to external factors such as pH and temperature), PL design (i.e. polymer film hydration, pH change and temperature) and PL characterization (i.e. size, polydispersity index - PDI, membrane thickness, formation of excessive polymer bulk, micelles production). A suitable experimental planning for ASNase encapsulation (i.e. direct hydration of the polymeric film and encapsulation by electroporation, self-aggregation with encapsulation by pH or temperature change) was also performed. For the PL prepared with PEG-PLA, the extrusion resulted in narrower size distribution corresponding to the PDI values of 0.345, 0.144 and 0.081 for PEG45-PLA69, PEG114-PLA153 and PEG114-PLA180, respectively. It has been shown that copolymers with lower hydrophobic fraction result in higher encapsulation efficiency for proteins, since they have larger aqueous volumes. With PMPC25-PDPA72 PL, it was possible to encapsulate three units of ASNase per vesicles through electroporation or pH change. In the first method, tubules were formed and in the latter one the micelles were not completely removed. For PEO100-PDPA80 PL, large aggregates remained after purification leading to a high PDI value, nevertheless no tubule formation was observed, since the pH change for this copolymer resulted in greater loss of copolymers as a precipitated polymer bulk. For the Pluronic® L-121 triblock copolymer PL, it was observed that the vesicles were stable for one week at room temperature, contrary to what was described in the literature. These PLs were prepared by film hydration method and ASNase encapsulation was performed by electroporation, nonetheless the protein was not detected within the vesicles. It is attributed the non-encapsulation to the organization of the Pluronic® L-121 bilayer without defined conformation of the polymer chains, making it difficult to reorganize the hydrophilic block in the internal portion of the pore during electroporation. By temperature change, about 5% of ASNase was encapsulated and the method resulted in complete recovery of enzyme activity. In conclusion, several PLs with a vast range of differential nanostructural characteristics were obtained according to the copolymers used for ASNase loading

Asparaginase/analysis , Nanostructures/classification , Capsules , Electroporation , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
São Paulo; s.n; s.n; 2018. 86 p. graf, tab.
Thesis in Portuguese | LILACS | ID: biblio-913209


O tratamento para a Leucemia Linfoblástica Aguda LLA utiliza, entre outros fármacos, a enzima L-asparaginase (ASNase) proveniente da bactéria Escherichia coli. Reações imunológicas estão entre os problemas do tratamento com ASNase, e a formação de anticorpos contra essa proteína pode impedir o sucesso no tratamento. Duas cisteíno proteases lisossomais estão relacionadas com a degradação de ASNase nos seres humanos, a Catepsina B (CTSB) e Asparagina Endopeptidase (AEP). Em estudos prévios do nosso grupo obteve-se mutantes de ASNase resistentes a degradação por CTSB e/ou AEP in vitro. Nesse trabalho avaliamos essas mutantes quanto a sua citotoxicidade em linhagens celulares de leucemia e conduzimos estudos in vivo, aplicando as proteoformas de ASNases em camundongos Balb C para avaliar a atividade asparaginase sérica das enzimas ao longo do tempo, bem como obter informações sobre a formação de anticorpos contra essas proteoformas. Nos ensaios de citotoxicidade, duas das proteoformas testadas tiveram efeito citotóxico semelhante a forma selvagem, enquanto uma outra proteoforma tem a citotoxicidade sensivelmente reduzida. Já nos ensaios in vivo, uma proteoforma demonstrou meia vida sérica maior da atividade asparaginásica, e duas proteoformas causaram reduzida formação de anticorpos. Juntos, esses resultados colaboram para a obtenção de uma nova geração de ASNases com melhor biodisponibilidade, e efeitos adversos reduzidos, gerando a possibilidade de menores doses e frequência de aplicações

The Treatment for Acute Lymphoblastic Leukemia (ALL) includes the biopharmaceutical L-asparaginase (ASNase) from Escherichia coli. Immunological reactions are among the problems of treatment using ASNase, and the antibodies formation protein may prevent success in treatment. Lysosomal cysteine proteases are related to ASNase degradation, Cathepsin B (CTSB) and Asparagine Endopeptidase (AEP). In previous studies, ASNase mutants resistant to CTSB and / or AEP degradation in vitro were obtained. In this work, mutants were evaluated in cytotoxicity in ALL cell lines and, in vivo studies, applying doses of the wild and mutant ASNases in Balb C mice to evaluate serum asparaginase activity of the enzymes over time, as well as to obtain information on the formation of antibodies against these proteoforms. Regarding to the cytotoxicity, two proteoforms among the tested had similar cytotoxicity than the wild-type. While another proteoform had the cytotoxicity severely reduced. One proteoform have demonstrated greater serum half-life of asparaginase activity, while two other mutants caused reduced antibody formation. Together, these results collaborate to obtain a new generation of ASNases with increased bioavailability and reduced side effects, generating the possibility of lower doses and frequency of applications

Animals , Male , Female , Mice , Disease Resistance , Asparaginase/adverse effects , Biological Products/pharmacokinetics , Cathepsin B , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
São Paulo; s.n; s.n; 2018. 120 p. tab, graf, ilus.
Thesis in English | LILACS | ID: biblio-905963


The L-asparaginase (ASNase) obtained from yeasts species has been poorly studied and a new yeast ASNase could be an alternative to minimize the side effect in the treatment of lymphoblastic leukemia. The Antarctic ecosystems have a great potential to obtain novel enzymes produced from psychrophilic and psychrotolerant microorganisms. Yeasts isolated from samples collected in the Antarctic Peninsula by the PROANTAR expedition team were tested for the production of ASNase and L-glutaminase (GLNase). From this screening, the strain Leucosporidium scottii L115 presented the highest ASNase activity (6.24 U g-1 of dried cell weight (dcw)) with a combination of low GLNase activity (0.41 U g-1 dcw). The ASNase belonging to L. scottii L115 (LsASNase) was purified 227 fold with a specific activity of 137.01 U mg-1 at 37 ºC, and with 0.93 U mg-1 for GLNase. Moreover, the maximum activity was observed at pH 7.5 at 55 ºC. The enzyme is a multimer presenting a single band of 54.5 kDa of molecular weight in reduced conditions and 462 kDa by size exclusion chromatography. The LsASNase is a glycosylated enzyme that presented a band lower at 25 kDa when was treated with PGNase F. The enzymatic kinetic reveals an allosteric regulation of the enzyme and the kinetic parameters were determined at 37º C, pH 7.0 as K0.5 = 233 µM, kcat = 54.7 s-1 and nH = 1.52 demonstrating a positive cooperativity by the enzyme and the substrate. The ASNase production by L. scottii L115 was improved by applying DoE for the culture medium development. The PB and CDD designs were used to optimize the ASNase production providing the nutrient values of 6.15 g L-1 of proline, 28.34 g L-1 sucrose, and 15.61 g L-1 of glycerol for a maximal production. The synthetic medium containing the optimized quantities was added with the salts: KCl, 0.52 g L-1; MgSO4.7H2O, 0.52 g L-1; CuNO3.3H2O, 0.001 g L-1; ZnSO4.7H2O, 0.001 g L-1; FeSO4.7H2O, 0.001 g L-1.The optimized medium produces a 23.75 ULh-1 of ASNase in shake flask culture. Furthermore, L. scottii is characterized as an oleaginous yeast that accumulates lipids with a suitable fatty acid profile. The production of ASNase and lipids were scaled up in the 1 L bioreactor to evaluate the initial cell concentration, carbon source, and oxygen transfer rate (kLa).The experiments were performed at 15ºC in the bioreactor BIOSTAT®Q plus (Sartorius Stedim, Germany) in batch mode, using 0.5 L of the optimized medium culture in phosphate buffer 50 mM pH 7.0. The initial cell concentration was evaluated at 1%, 3%, and 5% (v/v). Sucrose and glycerol were tested alone to examine if the combination of both is mandatory to produce ASNase. All these assays were carried in duplicate. The kLa was assessed through a CCD design in the range of 1.42 - 123.0 h-1. The performance in bioreactor showed the productivity of 36.95 ULh-1of ASNase under the optimized conditions (growth temperature 15º C, X0: 5 g L-1, pH 7.0, 48 h, kLa 89-92 h-1). The cultivation of L. scottii L115 at 15ºC in sucrose and glycerol as carbon sources generate an interesting lipid profile, where it presents monounsaturated and polyunsaturated lipids

A L-asparaginase (ASNase) obtida a partir de espécies de leveduras tem sido pouco estudada e uma nova ASNase de levedura pode ser uma alternativa para minimizar os efeitos adversos no tratamento da leucemia linfoblástica. Os ecossistemas Antárticos têm um grande potencial para obter novas enzimas produzidas a partir de microorganismos psicrofílicos e psicotrolerantes. As leveduras isoladas de amostras coletadas na Península Antártica pela equipe de expedição do PROANTAR foram testadas para a produção de ASNase e L-glutaminase (GLNase). A partir desta triagem, a cepa Leucosporidium scottii L115 apresentou a maior atividade de ASNase (6,24 U g-1 dcw) com uma combinação de baixa atividade de GLNase (0,41 U g-1 dcw). A ASNase pertencente a L. scottii L115 (LsASNase) foi purificada 227 vezes com uma atividade específica de 137,01 U mg-1 a 37 ºC e com 0,93 U mg-1 de GLNase. A atividade máxima foi observada a pH 7,5 a 55 ºC. A enzima é um multímero que apresenta uma banda única de 54,5 kDa de peso molecular em condições redutoras e 462 kDa por cromatografia de exclusão molecular. A LsASNase é uma enzima glicosilada que apresentou uma banda menor a 25 kDa quando tratada com PGNase F. A cinética enzimática revela uma regulação alostérica da enzima e os parâmetros cinéticos foram determinados a 37º C, pH 7,0 como K0,5 = 233 µM, kcat = 54,7 s-1 e nH = 1,52 demonstrando uma cooperatividade positiva pela enzima e o substrato. A produção de ASNase por L. scottii L115 foi melhorada aplicando DoE para o desenvolvimento do meio de cultura. Os desenhos experimentais de PB e CDD forma usados para otimizar a produção de ASNase e forneceram os valores de nutrientes de 6,15 gL-1 de prolina, 28,34 gL-1 de sacarose e 15,61 gL-1 de glicerol para uma produção máxima. O meio sintético contendo as quantidades otimizadas foi adicionado com os sais: : KCl, 0.52 g L-1; MgSO4.7H2O, 0.52 g L-1; CuNO3.3H2O, 0.001 g L-1; ZnSO4.7H2O, 0.001 g L-1; FeSO4.7H2O, 0.001 g L-1.O meio otimizado produz 23.75 ULh-1 de ASNase em cultivo em frasco agitado. Além disso, L. scottii é caracterizada como uma levedura oleaginosa que acumula lipídios com um perfil adequado de ácidos graxos. A produção de ASNase e lipídios foi ampliada no biorreator de 1 L para avaliar a concentração celular inicial, fonte de carbono e taxa de transferência de oxigênio (kLa). Os experimentos foram realizados a 15ºC no biorreator BIOSTAT®Q plus (Sartorius Stedim) em modo batelada, utilizando 0,5 L da cultura de meio otimizado em tampão fosfato 50 mM pH 7,0. A concentração celular inicial foi avaliada em 1%, 3% e 5% (v / v). Sacarose e glicerol foram testados isoladamente para examinar se a combinação de ambos é obrigatória para produzir ASNase. Todos esses ensaios foram realizados em duplicado. O kLa foi avaliado através de um planejamento CCD na faixa de 1,42-123,0 h-1. O desempenho no biorreator mostrou a produtividade de 36,95 ULh-1 de ASNase sob condições otimizadas (temperatura de crescimento 15º C, X0: 5 g L-1, pH 7,0, 48 h, kLa 89-92 h-1). O cultivo de L. scottii L115 a 15ºC em sacarose e glicerol como fontes de carbono gera um perfil lipídico interessante, onde apresenta lipídios monoinsaturados e poliinsaturados

Antarctic Regions/ethnology , Asparaginase/analysis , Yeasts , Bioreactors , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
São Paulo; s.n; s.n; 2018. 108 p. tab, graf, ilus.
Thesis in Portuguese | LILACS | ID: biblio-906092


A L-Asparaginase (L-ASNase) é uma enzima tetramérica bacteriana, utilizada em sessões de quimioterapia. Essa enzima depleta os aminoácidos asparagina (Asn) e glutamina (Gln), transformando-os em aspartato (Asp) ou glutamato (Glu), respectivamente, e em amônia. Contudo, a L-ASNase pode induzir resposta imune, levando à produção de anticorpos antiasparaginase, uma causa importante de resistência ao medicamento. Uma L-ASNase ideal seria aquela com alta atividade e estabilidade e baixo potencial imunogênico, porém, as L-ASNases utilizadas na terapêutica não reúnem essas características simultaneamente. Por essa razão, o presente trabalho utilizou técnicas de mutagênese randômica, a fim de criar uma nova proteoforma de L-ASNase de E. chrysanthemi com uma melhor atividade e estabilidade. Além disso, foram estudadas condições de cultivo em agitador metabólico, visando à otimização de condições de produção. Foi criada uma biblioteca com 1.056 clones, e desses, 19 foram selecionados por apresentarem atividade superior ou igual à enzima selvagem quando dosada em extrato bruto. Dentre eles, dois mutantes se destacaram por apresentarem a atividade específica glutaminásica diferente da enzima selvagem. Análises in silico indicam que o mutante 9-6D apresentou diminuição de desordem estrutural e epítopos imunogênicos. O mutante 9-5F demonstrou uma diminuição da porcentagem da atividade glutaminásica quando comparada a enzima selvagem. O estudo de produção do mutante 9-5F indicou que a temperatura de indução, seguida da concentração do indutor, são os parâmetros mais relevantes para a otimização da produção de L-ASNase de E. chrysanthemi mutante

L-Asparaginase (L-ASNase) is a bacterial tetrameric enzyme used in chemotherapy sessions that deplete asparagine (Asn) and glutamine (Gln), transforming them into Aspartate (Asp) or glutamate (Glu), respectively, and ammonia. However, L-ASNase can induce immune response leading to the production of anti-asparaginase antibody, an important cause of drug resistance. Ideally, L-ASNase would be one with high activity, high stability and low immunogenic potential, but the L-ASNases commercially available today do not present these characteristics simultaneously. For this reason, this study used techniques of random and site-directed mutagenesis in order to create a new proteoform of E. chrysanthemi L-ASNase with improved activity and stability. In addition, culture conditions were studied in a metabolic shaker, aiming at the optimization of production conditions. A library with 1,056 clones was created, and of these clones, 19 were selected because they had activity superior or equal to the wild-type enzyme in crude protein extract. Among them, 2 mutants stood out for having different glutaminase specific activity in relation to wild-type enzyme. The 9-6D mutant also showed decreased structural disorder and immunogenic epitopes. The 9-5F mutant demonstrated a decrease in percentage of glutaminase activity when compared to the wild-type enzyme. The production study of 9-5F mutant indicated that the induction temperature followed by the inductor concentration are the most relevant parameters for the production optimization of E. chrysanthemi mutant L-ASNase

Asparaginase/analysis , Dickeya chrysanthemi/classification , Clone Cells , Mutation , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
Cuad. Hosp. Clín ; 59(2): 19-28, 2018. ilus.
Article in Spanish | LILACS, LIBOCS | ID: biblio-986443


INTRODUCCIÓN: La leucemia linfoblástica aguda es la neoplasia más común en pediatría. Hasta la fecha no se estudiaron los aspectos clínicos y resultados del tratamiento de este trastorno en Bolivia. OBJETIVO: Describir los resultados de la inducción a la remisión en un grupo de niños con leucemia linfoblástica aguda. MÉTODOS: Estudio descriptivo de una serie de casos tratados en el Hospital del Niño "Ovidio Aliaga Uría", durante el periodo 2013-2015. RESULTADOS: Se incluyeron en el análisis 25 casos, con una edad promedio de 5,8 años, el 60% correspondía al sexo femenino. Las manifestaciones clínicas frecuentes al diagnóstico fueron la palidez, fiebre y la anorexia con 68%, 64% y 60% respectivamente. El 100% de los casos correspondía al fenotipo B, con un 96% para subtipo B común. Al finalizar la inducción con el protocolo institucional (Total Therapy XV modificado) el 92% alcanzó remisión completa, la mortalidad durante la inducción fue del 4%. La complicación más frecuente durante la inducción fue la toxicidad hematológica, seguida de la morbilidad infecciosa. El 92% requirió apoyo transfusional durante el tratamiento. La SG y la SLE estimada a los 2 años fue del 95% y 56% respectivamente. CONCLUSIÓN: La respuesta terapéutica a la inducción a la remisión con el protocolo institucional es comparable a estudios previos. La SLE es menor a datos reportados previamente, siendo el abandono de tratamiento un factor clave asociado a este hallazgo.

INTRODUCTION: Acute lymphoblastic leukemia is the most common neoplasm in pediatrics. To date, the clinical aspects and results of the treatment of this disorder in Bolivia have not been studied. OBJECTIVE: To describe the results of induction to remission in a group of children with acute lymphoblastic leukemia. METHODS: Descriptive, cross-sectional and analytical study of a case series treated at Hospital del Niño "Ovidio Aliaga Uría" during the period 2013-2015. RESULTS: Twenty-five cases, with an average age of 5.8 years, were included in the analysis, 60% of which were female. The common clinical manifestations at the diagnosis were pallor, fever and anorexia with 68%, 64% and 60% respectively. 100% of the cases corresponded to phenotype B, with 96% for common B subtype. At the end of the induction with the institutional protocol (Total Therapy XV modified), 92% achieved complete remission, the mortality during induction was 4%. The most frequent complication during induction was haematological toxicity, followed by infectious morbidity. 92% required transfusion support during treatment. The OS and EFS estimated at 2 years was 95% and 56%, respectively. CONCLUSION: Therapeutic response to induction of remission with the institutional protocol is comparable to previous studies. SLE is lower than previously reported data, with treatment abandonment being a key factor associated with this finding.

Humans , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Leukemia
Arch. argent. pediatr ; 115(2): e92-e95, abr. 2017. ilus, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-838345


La gangrena gaseosa, o mionecrosis clostridial, es una de las enfermedades infecciosas más graves, y se caracteriza por la rápida y progresiva destrucción de los tejidos blandos profundos y la producción de gas dentro de los tejidos. Presentamos un caso de gangrena gaseosa espontánea mortal causada por Clostridium perfringens en un paciente con leucemia linfocítica aguda durante la fase de quimioterapia de inducción de la remisión.

Gas gangrene, clostridial myonecrosis, is one of the most serious infectious diseases, characterized by rapidly progressive destruction of deep soft tissues and production of gas within the tissues. We presented a case of fatal spontaneous gas gangrene due to Clostridium perfringens in a patient with acute lymphoblastic leukemia during remission induction chemotherapy phase.

Humans , Male , Adolescent , Gas Gangrene/complications , Anemia, Hemolytic/etiology , Fatal Outcome , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
Lima; s.n; mar. 2017. ilus.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-848199


INTRODUÇÃO: Antecedentes: El presente dictamen expone la evaluación de tecnología de la eficacia y seguridad del uso de L-asparaginasa Erwinia y L-asparaginasa E. coli pegilada para el tratamiento de pacientes con leucemia linfoblástica aguda que presentan hipersensibilidad a L-asparaginasa E. coli nativa. Aspectos Generales: La leucemia es el tipo de cáncer más común en niños, representando aproximadamente el 30% de todos los tipos de cáncer diagnosticados en niños; siendo la leucemia linfoblástica aguda (LLA) uno de los dos tipos de leucemias más comunes. Adicionalmente, alrededor del 60% de todos los casos de LLA ocurre en pacientes menores de 20 años. Así, LLA es un tipo de leucemia de alta importancia dentro de población joven. Tecnología Sanitaria de Interés: Las células neoplásicas en la leucemia linfoblástica aguda (LLA) no sintetizan las cantidades necesarias del aminoácido L-asparagina; por lo que requieren de funtes externas (i.e., L-asparagina extracelular). La L-asparaginasa, es una enzima que cataliza la conversión de L-asparagina más agua, en ácido aspártico y amoniaco, ocasionando que los niveles de L-asparagina extracelular disminuyan; y que por los tanto las células d ela LLA no cuenten con L-asparagina extracelular. Así, estas células neoplásicas se quedan sin fuentes de L-asparagina, y no pueden sintetizar proteínas de gran imporancia para su supervivencia, ocasionando su muerte. METODOLOGÍA: Estrategia de Búsqueda: Se realizó una búsqueda de la literatura a la eficacia y seguridad del uso de L-asparaginasa Erwinia y L-asparaginasa E. coli pegilada para el tratamiento de pacientes niños y adultos con leucemia linfoblástica aguda que presentan hipersensibilidad a L-asparaginasa E. coli nativa. Esta búsqueda se realizó utilizando los meta-buscadores: Translating Research into Practice (TRIPDATABASE) Y National Library of Medicine (Pubmed-Medline). RESULTADOS: Sinopsis de la Evidencia: Se realizó la búsqueda bibliográfica y de evidencia científica hasta marzo del 2017 para el sustento del uso de L-asparaginasa Erwinia en el tratamiento de leucemia linfoblástica aguda en pacientes niños y adultos que presentan hipersensibilidad a L-asparaginasa E. coli nativa. Se presente la evidencia disponible según el tipo de publicación priorizada en los criterios de inclusión (i.e., GP, ETS, RS y ECA fase III), siendo los ensayos de fase III o en su defecto ensayos controlados y aleatorizados la principal considerada. CONCLUSIONES: El presente dictamen evaluó la mejor evidencia disponible hasta marco 2017 en relación al uso de L-asparaginasa Erwinia y L-asparaginasa E. coli pegilada para el tratamiento de pacientes niños, adolescentes, y adultos con leucemia linfoblástica aguda, que presentan hipersensibilidad a L-asparaginasa E. coli nativa. El Instituto de Tecnologías Sanitarias-IETSI, aprueba el uso de L-asparaginasa Erwinia como parte del esquema quimioterápico utilizada para el tratamiento de pacientes niños, adolescentes, y adultos con leucemia linfoblástica aguda, que presentan hipersensibilidad grado 2 o más a L-asparaginasa E. coli nativa. La vigencia de este dictamen preliminar es de dos años a partir de la fecha de publicación. Asimismo, el Instituto de Tecnologías Sanitarias-IETSI, no aprueba el uso de L-asparaginasa E. coli pegilada en el tratamiento de pacientes niños, adolescentes, y adultos con leucemia linfoblástica aguda, que presentan hipersensiblidad grado 2 o más a L-asparaginasa E. coli nativa.

Humans , Asparaginase/administration & dosage , Asparagine/analogs & derivatives , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Treatment Outcome , Cost-Benefit Analysis , Erwinia/immunology , Escherichia coli/immunology