Intermediate-dose cytarabine plus G-CSF as mobilization regimen for newly diagnosed multiple myeloma and heavily pre-treated patients with hematological and non-hematological malignancies.

BACKGROUND: Intermediate-dose cytarabine plus G-CSF has recently emerged as safe and effective mobilization regimen for heavily pre-treated patients with lymphoid malignancies. We prospectively tested this regimen in patients referred to our center in order to collect enough stem cells for hematopoietic rescue in autologous transplantation (auto-HSCT). STUDY DESIGN AND METHODS: cytarabine (1.6 g/m2) plus G-CSF (outpatient administration) was performed in 81 consecutive patients who underwent auto-HSCT. For analyses purposes patients were divided into Group A, consisted of 48 patients with newly diagnosed multiple myeloma (MM) and Group B with 33 heavily pre-treated patients (13 Hodgkin´s lymphoma, 7 non-Hodgkin´s lymphoma, 7 MM, 4 germ cell tumor, 2 non-promyelocytic acute myeloid leukemia). RESULTS: In the Group A, circulating CD34+ cells/µL was significantly higher, 90% started stem cell harvest on day 14, 98% collected ≥5.0 × 106 CD34+cells/kg and a single apheresis was sufficient in 92% of the cases. In the Group B, 85% started leukapheresis on day 14, 88% collected ≥2.0 × 106 CD34+cells/kg which was achieved with a single apheresis in 82% of the cases; a higher proportion of the patients (63.6% versus 33.3%) required platelet transfusions. Both groups exhibited few adverse events and the time to neutrophil and platelet recovery was similar between groups. CONCLUSION: Intermediate-dose cytarabine plus G-CSF mobilization is effective even for heavily pre-treated patients. The outpatient administration of G-CSF, the reliable prediction of the day to begin harvesting, the optimal CD34+ cell yield obtained with a single apheresis and the fewer occurrences of adverse events denoted the benefits of this regimen.

Trends in mortality of adult patients diagnosed with myeloid leukemia from 1994 to 2011 in southeastern Brazil.

OBJECTIVE: To evaluate trends in mortality among adults with myeloid leukemia in the Vale do Paraíba, State of São Paulo. METHODS: Data from the Brazilian National Health Service database DATASUS provided the number of deaths caused by myeloid leukemia and the number of inhabitants per year in the Regional Health Division XVII from 1994 to 2011. Registries were categorized according to gender into four age ranges (over 20 years, 20-49, 50-69 and over 70 years) for an estimation of the annual percent change for age-adjusted mortality rates. The percent changes were calculated using the Joinpoint regression analysis model. RESULTS: Overall, a significant decline per year was demonstrated for the entire sample (over 20 years) across the 18-year period studied (annual percent change: -5.59%; 95% CI: -8.5 to -2.5% for males; p-value<0.05 and -7.02%; 95% CI -11.2 to -2.8% for females; p-value<0.05) with no significant difference between genders. In an analysis using two Joinpoints, significant drops were observed from 1994 to 2001 (annual percent change: -21.22%; 95% confidence interval: -27.9 to -13.9%; p-value<0.05) and from 1994 to 2003 (annual percent change: -12.86%; 95% confidence interval -22.2 to -2.5%; p-value<0.05) for men and women, respectively. The declining trends were greatest for patients aged over 70 years with the age-adjusted mortality rates in younger groups declining non-significantly except for males aged 50-69 years old. CONCLUSION: Our data suggest a significant decline per year in age-adjusted mortality rates of adult patients diagnosed with myeloid leukemia from 1994 to 2011 in the Vale do Paraíba, State of São Paulo.

Prevalence of anemia in a sample of elderly southeastern Brazilians.

OBJECTIVE: To demonstrate the proportion of anemia and its association with demographic and clinical characteristics in a representative sample of elderly people from São José dos Campos, São Paulo. METHODS: Demographic data and blood samples were collected from 398 over 65-year-old male and female individuals. Anemia was defined as hemoglobin concentration <12g/dL in women and <13g/dL in men. Anemic and non-anemic groups were compared using the chi-squared test and a multiple logistic regression model. RESULTS: The prevalence of anemia was 18.6% (20.8% in men and 17.6% in women). The percentages of anemia rose significantly across the age groups >75-80, >85-90 and >90-95 years (p-value=0.0251). There were no significant differences in gender, ethnic background, place of residence, years of schooling, income, comorbidities and use of medications. According to gender, the mean hemoglobin concentration and mean corpuscular volume were 11.5g/dL (range: 8.4-11.9g/dL) and 90.7fL (range: 63.0-111.7fL) for women and 11.9g/dL (range: 8.6-12.8g/dL) and 92.1fL (range: 59.8-100.1fL) for men. The great majority of anemia cases were mild with less than 6% having hemoglobin concentrations below 10.9g/dL. Mean corpuscular volume was lower than 80fL in six cases (8%), between 80 and 100fL in 65 cases (88%) and higher than 100fL in three cases (4%). CONCLUSION: A total of 18.6% of elderly people from São José dos Campos had mild anemia with the majority being normocytic. The percentages of anemia rose as the age increased demonstrating an association between age and anemia.

Trends in mortality of adult patients diagnosed with myeloid leukemia from 1994 to 2011 in southeastern Brazil

Objective: To evaluate trends in mortality among adults with myeloid leukemia in the Vale do Paraíba, State of São Paulo. Methods: Data from the Brazilian National Health Service database DATASUS provided the number of deaths caused by myeloid leukemia and the number of inhabitants per year in the Regional Health Division XVII from 1994 to 2011. Registries were categorized according to gender into four age ranges (over 20 years, 20-49, 50-69 and over 70 years) for an estimation of the annual percent change for age-adjusted mortality rates. The percent changes were calculated using the Joinpoint regression analysis model. Results: Overall, a significant decline per year was demonstrated for the entire sample (over 20 years) across the 18-year period studied (annual percent change: −5.59%; 95% CI: −8.5 to −2.5% for males; p-value < 0.05 and −7.02%; 95% CI −11.2 to −2.8% for females; p-value < 0.05) with no significant difference between genders. In an analysis using two Joinpoints, significant drops were observed from 1994 to 2001 (annual percent change: −21.22%; 95% confidence interval: −27.9 to −13.9%; p-value < 0.05) and from 1994 to 2003 (annual percent change: −12.86%; 95% confidence interval −22.2 to −2.5%; p-value < 0.05) for men and women, respectively. The declining trends were greatest for patients aged over 70 years with the age-adjusted mortality rates in younger groups declining non-significantly except for males aged 50-69 years old. Conclusion: Our data suggest a significant decline per year in age-adjusted mortality rates of adult patients diagnosed with myeloid leukemia from 1994 to 2011 in the Vale do Paraíba, State of São Paulo. .

Prevalence of anemia in a sample of elderly southeastern Brazilians

Objective: To demonstrate the proportion of anemia and its association with demographic and clinical characteristics in a representative sample of elderly people from São José dos Campos, São Paulo. Methods: Demographic data and blood samples were collected from 398 over 65-year-old male and female individuals. Anemia was defined as hemoglobin concentration <12 g/dL in women and <13 g/dL in men. Anemic and non-anemic groups were compared using the chi-squared test and a multiple logistic regression model. Results: The prevalence of anemia was 18.6% (20.8% in men and 17.6% in women). The per- centages of anemia rose significantly across the age groups >75-80, >85-90 and >90-95 years (p-value = 0.0251). There were no significant differences in gender, ethnic background, place of residence, years of schooling, income, comorbidities and use of medications. Accord- ing to gender, the mean hemoglobin concentration and mean corpuscular volume were 11.5 g/dL (range: 8.4-11.9 g/dL) and 90.7 fL (range: 63.0-111.7 fL) for women and 11.9 g/dL (range: 8.6-12.8 g/dL) and 92.1 fL (range: 59.8-100.1 fL) for men. The great majority of ane- mia cases were mild with less than 6% having hemoglobin concentrations below 10.9 g/dL. Mean corpuscular volume was lower than 80 fL in six cases (8%), between 80 and 100 fL in 65 cases (88%) and higher than 100 fL in three cases (4%). Conclusion: A total of 18.6% of elderly people from São José dos Campos had mild anemia with the majority being normocytic. The percentages of anemia rose as the age increased demonstrating an association between age and anemia. .

Transplante autólogo de células-tronco hematopoéticas no Vale do Paraíba-SP: aspectos demográficos, clínicos e curvas de sobrevida / Autologous stem cell transplant in Vale do Paraiba, State of São Paulo: demographics and clinical aspects and survival curves

Demonstrar as características demográficas clínicas e taxas de sobrevida geral (SG) de pacientes tratados com transplante de células-tronco hematopoéticas (TCTH) autólogo no Vale do Paraíba-SP. Métodos - Análise retrospectiva de 129 pacientes atendidos no Hospital Pio XII de São José dos Campos entre 2005 e 2011. Coletaram-se registros de prontuário clínico, viabilidade das células CD34+ descongeladas,número de células CD34+ reinfundidas, reações adversas ao dimetilsulfóxido (DMSO), tempo de recuperação de contagem de neutrófilos (>0.5x109/L) e plaquetas (>20x109/L) e antimicrobianos prescritos. A SG 5 anos após o TCTH autólogo foi estimada para pacientes com mieloma múltiplo (MM), linfoma Hodgkin (LH) e linfoma não Hodgkin (LNH). Resultados - Foram selecionados 129 pacientes (67 homense 62 mulheres). A mediana das idades foi de 51 anos (18-70), 63 pacientes apresentavam MM, 25 LH, 24 LNH, 9 tumor germinativo, 7 leucemia mielóide aguda e 1 leucemia linfoblástica aguda. A mediana do número de células CD34+ reinfundidas foi de 6,02x106/kg (2,23-15,7) com viabilidade celular após descongelamento de 79% (62-93). O tempo para recuperação foi de 12 dias (9-18) para neutrófilose 13 dias (10-21) para plaquetas. Três pacientes apresentaram reações adversas ao DMSO. Trinta e três pacientes (25,6%) receberam antifúngico em associação aos antibióticos de amplo espectro de ação. As taxas de SG foram 57,7% (IC 33,8-71,5), 76,8% (IC 52,5-89,7) e 69,2% (IC 46,9-83,6) para MM, LH e LNH respectivamente. Conclusões - As características apresentadas demonstram que o TCTH autólogo é factível nesta região e as taxas de SG observadas em pacientes com MM, LH e LNH comparam-se favoravelmente com a literatura disponível...

To demonstrate the demographic and clinical aspects as well as the overall survival (OS) rates of patients treated with autologous stem cell transplantation (ASCT) in Vale do Paraíba-SP. Methods - Retrospective analysis of 129 patients from Pio XII Hospital of São José dos Campos that received treatment between 2005 and 2011. Data from the pronctuaries of the patients, number of CD34+ cells reinfused, viability of defrosted CD34+ cells, reactions induced by dimethylsulfoxide (DMSO), time to recover neutrophils and platelets count and antimicrobial agents prescribed were collected. Five-year OS was measured in patients with multiple myeloma (MM), Hodgkin´s lymphoma(HL) and non-Hodgkin´s lymphoma (NHL). Results - The median age was 51 years (18-70) among the 129 patients selected (67 male and 62 female). 63 had MM, 25 HL, 24 NHL, 9 germ cell tumors, 7 acute myeloid leukemia and 1 acute lymphoblastic leukemia. The median of number of CD34+ cells reinfused was 6.02 x 106/kg (2.23-15.7) with 79% (62-93%) of viable cells after defrost. Times to neutrophils and platelets count recovery were 12 (9-18) and 13 (10-21) days, respectively. Three patients showed DMSO-induced reactions. Thirty three patients(25.6%) were treated with antifungal in association with extended spectrum antibiotic. Five-year OS were 57.7% (CI 33.8-71.5) for MM patients, 76.8% (CI 52.5-89.7) for HL and 69.2% (CI 46.9-83.6) for NHL. Conclusions - The collected data provided evidence that the ASCT in Vale do Paraiba has favorable OS rates for patients with MM, HL and NHL in comparison to previously reported data from similar treatment in other regions...