RESUMO
In adults with non-promyelocytic acute myeloid leukemia (AML), high-dose cytarabine consolidation therapy has been shown to influence survival in selected patients, although the appropriate doses and schemes have not been defined. We evaluated survival after calculating the actual dose of cytarabine that patients received for consolidation therapy and divided them into 3 groups according to dose. We conducted a single-center, retrospective study involving 311 non-promyelocytic AML patients with a median age of 36 years (16-79 years) who received curative treatment between 1978 and 2007. The 131 patients who received cytarabine consolidation were assigned to study groups by their cytarabine dose protocol. Group 1 (n=69) received <1.5 g/m2 every 12 h on 3 alternate days for up to 4 cycles. The remaining patients received high-dose cytarabine (≥1.5 g/m2 every 12 h on 3 alternate days for up to 4 cycles). The actual dose received during the entire consolidation period in these patients was calculated, allowing us to divide these patients into 2 additional groups. Group 2 (n=27) received an intermediate-high-dose (<27 g/m2), and group 3 (n=35) received a very-high-dose (≥27 g/m2). Among the 311 patients receiving curative treatment, the 5-year survival rate was 20.2% (63 patients). The cytarabine consolidation dose was an independent determinant of survival in multivariate analysis; age, karyotype, induction protocol, French-American-British classification, and de novo leukemia were not. Comparisons showed that the risk of death was higher in the intermediate-high-dose group 2 (hazard ratio [HR]=4.51; 95% confidence interval [CI]: 1.81-11.21) and the low-dose group 1 (HR=4.43; 95% CI: 1.97-9.96) than in the very-high-dose group 3, with no significant difference between those two groups. Our findings indicated that very-high-dose cytarabine during consolidation in adults with non-promyelocytic AML may improve survival.
Assuntos
Criança , Feminino , Humanos , Masculino , Transtorno do Deficit de Atenção com Hiperatividade/reabilitação , Terapia Cognitivo-Comportamental/métodos , Função Executiva/fisiologia , Inibição Psicológica , Assistência Ambulatorial , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtornos do Comportamento Infantil/psicologia , Memória de Curto Prazo/fisiologia , Metilfenidato/uso terapêutico , Projetos Piloto , Jogos e Brinquedos , Pais/psicologia , Reforço Psicológico , Resultado do Tratamento , Listas de Espera , Conduta ExpectanteRESUMO
The ABO blood group is the most important blood group system in transfusion medicine and organ transplantation. To date, more than 160 ABO alleles have been identified by molecular investigation. Almost all ABO genotyping studies have been performed in blood donors and families and for investigation of ABO subgroups detected serologically. The aim of the present study was to perform ABO genotyping in patients with leukemia. Blood samples were collected from 108 Brazilian patients with chronic myeloid leukemia (N = 69), chronic lymphoid leukemia (N = 13), acute myeloid leukemia (N = 15), and acute lymphoid leukemia (N = 11). ABO genotyping was carried out using allele specific primer polymerase chain reaction followed by DNA sequencing. ABO*O01 was the most common allele found, followed by ABO*O22 and by ABO*A103. We identified 22 new ABO* variants in the coding region of the ABO gene in 25 individuals with leukemia (23.2%). The majority of ABO variants was detected in O alleles (15/60.0%). In 5 of 51 samples typed as blood group O (9.8%), we found non-deletional ABO*O alleles. Elucidation of the diversity of this gene in leukemia and in other diseases is important for the determination of the effect of changes in an amino acid residue on the specificity and activity of ABO glycosyltransferases and their function. In conclusion, this is the first report of a large number of patients with leukemia genotyped for ABO. The findings of this study indicate that there is a high level of recombinant activity in the ABO gene in leukemia patients, revealing new ABO variants.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Alelos , Variação Genética , Leucemia/sangue , Sistema ABO de Grupos Sanguíneos/genética , DNA , Análise Mutacional de DNA , Genótipo , Leucemia/classificação , Reação em Cadeia da Polimerase , Polimorfismo Genético , Sistema ABO de Grupos Sanguíneos/classificaçãoRESUMO
Acute myelogenous leukemia (AML) blast cells show high-affinity degradation of low-density lipoprotein (LDL), suggesting an increased expression of cellular LDL receptors. LDE is a lipid microemulsion easily synthesized in vitro which is known to mimic the metabolic pathway of LDL. We used LDE as a carrier for daunorubicin and assayed the cytotoxicity of the complex using AML blast cells since RT-PCR analysis showed that AML cells express LDL receptor mRNA. The LDE:daunorubicin complex killed 46.7 percent of blast cells and 20.2 percent of normal bone marrow cells (P<0.001; Student t-test). Moreover, this complex destroyed AML blast cells as efficiently as free daunorubicin. Thus, LDE might be a suitable carrier of chemotherapeutic agents targeting these drugs to neoplastic cells and protecting normal tissues
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Antibióticos Antineoplásicos , Daunorrubicina , Leucemia Mieloide Aguda , Lipoproteínas LDL , Células-Tronco Neoplásicas , Células da Medula Óssea , Morte Celular , Ésteres do Colesterol , Células K562 , Leucemia Mieloide Aguda , Fosfolipídeos , Receptores de LDL , Reação em Cadeia da Polimerase Via Transcriptase Reversa , RNA MensageiroRESUMO
O teste ELISA ant-HTLVI/II foi introduzido na triagem sorlógica de doadores de sangue na Fundaçäo Pró-sangue Hemocentro de Säo Paulo (FPS/HSP) em julho de 1991. NO período compreendido entre julho de 1991 e julho de 1994 foram submetidos à triagem serológica 597.727 doadores. Destes, 7682 foram recusados por terem apresentado reatividade no teste ELISA anti-HTLVI/II. A positividade observada, para o referido teste, foi diminuindo com o correr do tempo: 2,12 por cento em 1991; 1,6 por cento em 1992; 0,8 por cento em 1993 e 1,0 por cento em 1994, sendo esse fato atribuido a melhora da especialidade e reprodutividade dos kits comerciais. Foi utilizado o teste suplementar de Western Blot para confirmar os resultados dos testes ELISA. Em 249 amostras de soros de doadores, com resultado repetidamente positivo (RRP) no teste ELISA (hemobio), o poder confirmatório do Western Blot (Cambridge Biotech) foi de 24.9 por cento (IC/90 por cento: 20,4 por cento-29,39 por cento). Baseados nesses dados, considera-se uma expectativa de prevalência de indivíduos infectados pelo HTLVI/II, na populaçäo de doadores de sangue da FPS/HSP de 0,142 por cento (IC/90 por cento; 0,116 por cento-0,167 por cento). Em 437 amostras de soro de doadores que retornaram ao Banco de Sangue, para confirmar o resultado inicial e apresentaram RRP no teste ELISA, o poder confirmatório do Western Blot foi de 34,55 por cento (IC/90 por cento: 30,82 por cento-38,28 por cento)...