Subject(s)
COVID-19 Serological Testing , COVID-19/diagnosis , Cryptogenic Organizing Pneumonia/diagnosis , Graft vs Host Disease/diagnosis , Hematopoietic Stem Cell Transplantation , Myelodysplastic Syndromes/surgery , Tomography, X-Ray Computed , Aged , COVID-19/complications , COVID-19/virology , Cryptogenic Organizing Pneumonia/virology , Diagnostic Errors , Graft vs Host Disease/etiology , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Male , Myelodysplastic Syndromes/diagnosis , Predictive Value of Tests , Transplantation, Homologous , Treatment OutcomeSubject(s)
Betacoronavirus , Coronavirus Infections/blood , Hemostasis/physiology , Pneumonia, Viral/blood , Respiratory Distress Syndrome/blood , COVID-19 , Coronavirus Infections/complications , Disseminated Intravascular Coagulation/blood , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Interleukins/metabolism , Pandemics , Partial Thromboplastin Time , Pneumonia, Viral/complications , Prothrombin Time , Respiratory Distress Syndrome/etiology , Risk Factors , SARS-CoV-2 , Tumor Necrosis Factors/metabolismABSTRACT
It has been suggested that bridging therapy with intensive chemotherapy and/or hypomethylating agents followed by hematopoietic stem cell transplantation (HSCT) can be valuable in the treatment of patients with myelodysplastic syndromes (MDS). However, the influence of this approach on HSCT outcomes remains poorly defined. Therefore, our objective was to investigate the influence of treatment before HSCT in patients with MDS. We retrospectively analyzed data from the Latin American registry of 258 patients from 17 Latin American centers who underwent HSCT from 1988 to 2019. Our data showed that there was pre-HSCT. We detected no significant difference regarding the impact on overall survival of treated and untreated patients before HSCT. Despite these data, the type of previous treatment among treated patients showed a significant difference in overall survival. Treatment with hypomethylating agents together with pre-HSCT chemotherapy seems to result in better survival of the studied population. These data correspond to the first results obtained through cooperative work between various centers in Latin America comparing the different approaches to patients and reflecting their reality and challenges. Therefore, the selection of pretransplant bridge therapy should be analyzed and focus given primarily to those approaches that result in better survival of patients with MDS.
Subject(s)
Hematopoietic Stem Cell Transplantation , Myelodysplastic Syndromes , Hematopoietic Stem Cells , Humans , Latin America , Myelodysplastic Syndromes/therapy , Registries , Retrospective Studies , Transplantation, HomologousSubject(s)
Humans , Pneumonia, Viral/blood , Respiratory Distress Syndrome, Newborn/blood , Coronavirus Infections/blood , Betacoronavirus , Hemostasis/physiology , Partial Thromboplastin Time , Pneumonia, Viral/complications , Prothrombin Time , Respiratory Distress Syndrome, Newborn/etiology , Fibrin Fibrinogen Degradation Products/metabolism , Risk Factors , Interleukins/metabolism , Coronavirus Infections , Coronavirus Infections/complications , Tumor Necrosis Factors/metabolism , Disseminated Intravascular Coagulation/blood , PandemicsABSTRACT
OBJECTIVES: To evaluate the effects of epoetin (EPO) alfa treatment on overall survival, event-free survival and response duration in patients with myelodysplastic syndrome (MDS) who were treated at a haematological referral centre in northeastern Brazil. METHODS: This was a retrospective cohort study of 36 patients diagnosed with MDS and treated with EPO alfa at 30,000 to 60,000 IU per week. Clinical data were collected from medical records. The events assessed were non-response to treatment and progression to acute myeloid leukaemia (AML). Statistical analyses were performed using GraphPad Prism 7 and SPSS 24 software. RESULTS: The overall survival of patients who received EPO alfa treatment was 51.64%, with a median of 65 months of treatment, and the overall survival of this group was 100% during the first 24 months. We detected a 43.5-month median event-free survival, with a response rate of 80.5%. We observed responses from 25 to 175 months. Patients with transfusion dependence and those with a high-risk stratification, as determined by the International Prognostic Scoring System (IPSS), the Revised International Prognostic Scoring System (IPSS-R), the WHO classification-based Prognostic Scoring System (WPSS) and the WHO 2016, had a lower event-free survival than other patients. CONCLUSIONS: Despite the wide use of EPO alfa in the treatment of anaemia in patients with MDS, the median response duration is approximately only 24 months. Our data provide encouraging results concerning the benefits of using EPO alfa for the improvement of the quality of life, as patients treated with EPO showed higher overall survival, event-free survival rates and longer response durations than have been previously described in the literature.
Subject(s)
Epoetin Alfa/therapeutic use , Hematinics/therapeutic use , Myelodysplastic Syndromes/drug therapy , Myelodysplastic Syndromes/mortality , Aged , Aged, 80 and over , Blood Transfusion , Brazil , Disease Progression , Female , Hemoglobins/analysis , Humans , Kaplan-Meier Estimate , Karyotype , Male , Middle Aged , Platelet Count , Progression-Free Survival , Reference Values , Retrospective Studies , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND/AIM: Although risk stratification using the Prognostic Scores Systems (IPSS, WPSS and IPSS-R) incorporate key information about prognosis of patients with Myelodysplastic syndromes (MDS), patients classified as low-risk may evolve rapidly and aggressively, despite a "favorable" prognostic stratification. The aim of this study was to identify biomarkers for predicting prognosis, and for better stratification and management of these patients. MATERIALS AND METHODS: Expression of CD34 and p53 in megakaryocytes was examined by immunohistochemistry in 71 MDS patients classified as low-risk. RESULTS: CD34 staining in megakaryocytes was associated with p53 expression (p=0.0166). CD34 and p53 expression were associated to worse overall survival in patients (p=0.0281). CONCLUSION: The presence of CD34 in megakaryocytes is associated with p53 expression and an adverse prognosis for MDS patients.
Subject(s)
Antigens, CD34/genetics , Myelodysplastic Syndromes/genetics , Prognosis , Tumor Suppressor Protein p53/genetics , Adult , Aged , Aged, 80 and over , Female , Gene Expression Regulation, Neoplastic , Humans , Male , Megakaryocytes/metabolism , Megakaryocytes/pathology , Middle Aged , Myelodysplastic Syndromes/metabolism , Myelodysplastic Syndromes/pathology , Risk Assessment , Risk FactorsABSTRACT
OBJECTIVES: To evaluate the effects of epoetin (EPO) alfa treatment on overall survival, event-free survival and response duration in patients with myelodysplastic syndrome (MDS) who were treated at a haematological referral centre in northeastern Brazil. METHODS: This was a retrospective cohort study of 36 patients diagnosed with MDS and treated with EPO alfa at 30,000 to 60,000 IU per week. Clinical data were collected from medical records. The events assessed were non-response to treatment and progression to acute myeloid leukaemia (AML). Statistical analyses were performed using GraphPad Prism 7 and SPSS 24 software. RESULTS: The overall survival of patients who received EPO alfa treatment was 51.64%, with a median of 65 months of treatment, and the overall survival of this group was 100% during the first 24 months. We detected a 43.5-month median event-free survival, with a response rate of 80.5%. We observed responses from 25 to 175 months. Patients with transfusion dependence and those with a high-risk stratification, as determined by the International Prognostic Scoring System (IPSS), the Revised International Prognostic Scoring System (IPSS-R), the WHO classification-based Prognostic Scoring System (WPSS) and the WHO 2016, had a lower event-free survival than other patients. CONCLUSIONS: Despite the wide use of EPO alfa in the treatment of anaemia in patients with MDS, the median response duration is approximately only 24 months. Our data provide encouraging results concerning the benefits of using EPO alfa for the improvement of the quality of life, as patients treated with EPO showed higher overall survival, event-free survival rates and longer response durations than have been previously described in the literature.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Myelodysplastic Syndromes/mortality , Myelodysplastic Syndromes/drug therapy , Epoetin Alfa/therapeutic use , Hematinics/therapeutic use , Platelet Count , Reference Values , Time Factors , Blood Transfusion , Brazil , Hemoglobins/analysis , Retrospective Studies , Risk Factors , Treatment Outcome , Disease Progression , Kaplan-Meier Estimate , Karyotype , Progression-Free SurvivalABSTRACT
Wernick's Encephalopathy (WE) is an acute neuropsychiatric syndrome caused by thiamine deficiency post hematopoietic stem cell transplant (HSCT). WE is associated with high mortality and morbidity rates, but due to its rare occurrence, it is rarely considered in patients submitted to this procedure. Considering that, the manuscript reports the clinical characteristics and the possible factors that predisposed the occurrence of WE in a patient with non-Hodgkin's lymphoma post-Autologous HSCT. We conclude that WE should be considered in patients submitted to autologous HSCT associated with prolonged use of TPN and malnutrition.
Subject(s)
Hematopoietic Stem Cell Transplantation/adverse effects , Lymphoma, Non-Hodgkin/therapy , Thiamine Deficiency/complications , Wernicke Encephalopathy/etiology , Adult , Female , Humans , Risk Factors , Transplantation, Autologous , Wernicke Encephalopathy/diagnostic imagingABSTRACT
SUMMARY Wernick's Encephalopathy (WE) is an acute neuropsychiatric syndrome caused by thiamine deficiency post hematopoietic stem cell transplant (HSCT). WE is associated with high mortality and morbidity rates, but due to its rare occurrence, it is rarely considered in patients submitted to this procedure. Considering that, the manuscript reports the clinical characteristics and the possible factors that predisposed the occurrence of WE in a patient with non-Hodgkin's lymphoma post-Autologous HSCT. We conclude that WE should be considered in patients submitted to autologous HSCT associated with prolonged use of TPN and malnutrition.
