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Triagem para o tratamento ambulatorial da neutropenia febril
Bellesso, Marcelo;Costa, Silvia Figueiredo;Chamone, Dalton Alencar Fischer;Llacer, Pedro Enrique Dorlhiac;
Revista Brasileira de Hematologia e Hemoterapia , 2010, DOI: 10.1590/S1516-84842010000500014
Abstract: febrile neutropenia is a frequent and potentially fatal adverse event of chemotherapy. nowadays, febrile neutropenia is considered an emergency and it is known that prompt infusion of antibiotics decreases mortality. several studies demonstrated that febrile neutropenia is a heterogeneous group of diseases and that factors such as outpatient status, no hypotension, no dehydration, no chronic obstructive pulmonary disease, no symptoms, no previous fungal infection and age < 60 years are protective factors against serious complications as demonstrated by the multinational association for supportive care in cancer (mascc). these data show that outpatient treatment and early discharge is safer and much research has shown lower costs for outpatient treatment in low-risk patients with febrile neutropenia. the aim of this work is to review and discuss tools (in particular the mascc index) for safe screening of febrile neutropenia for outpatient treatment in addition to demonstrate results of research.
Aspergillary bronchopneumonia: an unusual cause of atelectasis and asphyxia in a leukemic patient
Velloso, Elvira Deolinda Rodrigues Pereira;Martinez, Gracia Aparecida;Dorlhiac-Llacer, Pedro Enrique;Chamone, Dalton Alencar Fischer;
Sao Paulo Medical Journal , 1994, DOI: 10.1590/S1516-31801994000400004
Abstract: a 22-year-old man in his first relapse of t-acute lymphoblastic leukemia developed fever and a pulmonary infiltrate after 23 days of granulocytopenia. although having been under amphotericin b for 10 days, productive purulent cough ensued, with right lobe atelectasis and acute ventilatory failure that resolved after the elimination of a thick gelatinous bronchial plug. sputum cultures yielded candida albicans and staphylococcus epidermidis, and microscopic examination of the sputum plug disclosed aspergillus hyphae. the patient died 9 days after, of a disseminated aspergillus infection, confirmed by necropsy.
The Use of Imatinib Mesylate as a Lifesaving Treatment of Chronic Myeloid Leukemia Relapse after Bone Marrow Transplantation
Monika Conchon,Sabri S. Sanabani,Israel Bendit,Carla Luana Dinardo,Lucia Dias,Dalton de Alencar Fischer Chamone,Pedro Enrique Dorlhiac-Llacer,Frederico Luiz Dulley
Journal of Transplantation , 2009, DOI: 10.1155/2009/357093
Abstract: We describe the response of imatinib as lifesaving treatment of chronic myeloid leukemia (CML) relapse in seven patients who underwent allogeneic bone marrow transplantation (alloBMT) at our institution over a period of 4 years. Retrospective analysis of their medical records revealed that a mean age at transplant was 45.2 years. The median time to diagnosis was 7.4 years after transplant. At relapse, four, two, and one patients were classified as having hematologic, major molecular, and cytogenetic relapse, respectively. At imatinib initiation, five had CML in a chronic phase, while one patient was diagnosed as having accelerated phase and blast crisis. All these patients could be evaluated for the therapeutic efficacy. At a mean of follow-up of 1.9 years of therapy, all evaluable patients achieved major molecular response without compromising safety. Consistent with available data, our results indicate that imatinib is safe and effective treatment option for patients with relapse after BMT.
Hemolytic disease of the newborn due to anti-U
Novaretti, Marcia Cristina Zago;Jens, Eduardo;Pagliarini, Thiago;Bonifácio, Silvia Le?o;Dorlhiac-Llacer, Pedro Enrique;Chamone, Dalton de Alencar Fischer;
Revista do Hospital das Clínicas , 2003, DOI: 10.1590/S0041-87812003000600006
Abstract: anti-u is a rare red blood cell alloantibody that has been found exclusively in blacks. it can cause hemolytic disease of the newborn and hemolytic transfusion reactions. we describe the case of a female newborn presenting a strongly positive direct antiglobulin test due to an igg antibody in cord blood. anti-u was recovered from cord blood using acid eluate technique. her mother presented positive screening of antibodies with anti-u identified at delivery. it was of igg1 and igg3 subclasses and showed a titer of 32. monocyte monolayer assay showed moderate interaction of fc receptors with maternal serum with a positive result (3.1%). the newborn was treated only with 48 hours of phototherapy for mild hemolytic disease. she recovered well and was discharged on the 4th day of life. we conclude that whenever an antibody against a high frequency erythrocyte antigen is identified in brown and black pregnant women, anti-u must be investigated.
Comparison of catheter-related infection risk in two different long-term venous devices in adult hematology-oncology patients
Pracchia, Luís Fernando;Dias, Lúcia Cristina Santos;Dorlhiac-Llacer, Pedro Enrique;Chamone, Dalton de Alencar Fisher;
Revista do Hospital das Clínicas , 2004, DOI: 10.1590/S0041-87812004000500012
Abstract: purpose: infection is the leading complication of long-term central venous catheters, and its incidence may vary according to catheter type. the objective of this study was to compare the frequency and probability of infection between two types of long-term intravenous devices. methods: retrospective study in 96 onco-hematology patients with partially implanted catheters (n = 55) or completely implanted ones (n = 42). demographic data and catheter care were similar in both groups. infection incidence and infection-free survival were used for the comparison of the two devices. results: in a median follow-up time of 210 days, the catheter-related infection incidence was 0.2102/100 catheter-days for the partially implanted devices and 0.0045/100 catheter-days for the completely implanted devices; the infection incidence rate was 46.7 (ci 95% = 6.2 to 348.8). the 1-year first infection-free survival ratio was 45% versus 97%, and the 1-year removal due to infection-free survival ratio was 42% versus 97% for partially and totally implanted catheters, respectively (p <.001 for both comparisons). conclusion: in the present study, the infection risk was lower in completely implanted devices than in partially implanted ones.
Risk stratification for indolent lymphomas
Hallack Neto, Abrah?o Elias;Costa, Renata Oliveira;Atalla, Angelo;Dulley, Frederico Luiz;Chamone, Dalton Alencar Fischer;Pereira, Juliana;
Revista Brasileira de Hematologia e Hemoterapia , 2010, DOI: 10.1590/S1516-84842010000500015
Abstract: indolent b-cell lymphomas account for approximately 40% of all non-hodgkin lymphomas (nhls). advances in technology have contributed to improvements in the diagnosis and classification of indolent non-hodgkin lymphomas. follicular lymphomas are the most common although the frequency varies significantly throughout the world. the description of the follicular lymphoma international prognostic index (flipi) was an important step in identifying patient subgroups, but its use in the clinical practice has not been established yet. the use of a larger number of paraffin active monoclonal antibodies for immunohistochemistry, molecular cytogenetic studies including standard cytogenetics, multi-color fluorescence in-situ hybridization (fish), polymerase chain reaction and locus-specific fluorescence insitu hybridization as well as developments in high-resolution techniquesincluding microarray gene expression profiling allow more accurate diagnosis andprecise definition of biomarkers of value in risk stratification. the identification ofdiseasespecific gene lists resulting from expression profiling provides a number ofpotential protein targets that can be validated using immunohistochemistry. analysesof gene expression profiles or constitutive gene variations may also provide additional insight for prognostication in the near future. a comprehensive understanding of the biology of these distinct lymphoid tumors will allow us to identify novel diseaserelated genes and should facilitate the development of improved diagnosis, outcome prediction, and personalized approaches to treatment.
Busulfan and melphalan as conditioning regimen for allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia in first complete remission
Bueno, Nadjanara Dorna;Dulley, Frederico Luiz;Saboya, Rosaura;Amigo Filho, José Ulysses;Coracin, Fabio Luiz;Chamone, Dalton de Alencar Fischer;
Revista Brasileira de Hematologia e Hemoterapia , 2011, DOI: 10.5581/1516-8484.20110050
Abstract: background: allogeneic hematopoietic stem cell transplantation with hla-identical donors has been established for the treatment of acute myeloid leukemia patients for over 30 years with a cure rate of 50% to 60%. objectives: to analyze the overall survival of patients and identify factors that influence the outcomes of this type of transplant in patients in 1st complete remission who received a busulfan and melphalan combination as conditioning regimen. methods: twenty-five consecutive patients with acute myeloid leukemia were enrolled between 2003 and 2008. the median age was 34 years old (range: 16 - 57 years). all patients received cyclosporine and methotrexate for prophylaxis against graft-versus-host disease. median neutrophil engraftment time was 16 days (range: 7 - 22 days) and 17 days (range: 7 - 46 days) for platelets. sinusoidal obstructive syndrome was observed in three patients, seven had grade ii acute graft-versus-host disease and one extensive chronic graft-versus-host disease. results: the overall survival by the kaplan-meier method was 48% after 36 months with a plateau at 36 months after transplantation. intensive consolidation with high-dose arabinoside resulted in an improved survival (p-value = 0.0001), as did grade ii acute graft-versus-host disease (p-value = 0.0377) and mild chronic graft-versus-host disease (p-value < 0.0001). thirteen patients died, five due to infection within 100 days of transplant, two due to hemorrhages, one to infection and graftversus-host disease and three relapses followed by renal failure (one) and infection (two). the cause of death could not be determined for two patients. conclusion: the busulfan and melphalan conditioning regimen is as good as other conditioning regimens providing an excellent survival rate.
Disease progression after R-CHOP treatment associated with the loss of CD20 antigen expression
Bellesso, Marcelo;Xavier, Flavia Dias;Costa, Renata Oliveira;Pereira, Juliana;Siqueira, Sheila Aparecida Coelho;Chamone, Dalton Alencar Fischer;
Revista Brasileira de Hematologia e Hemoterapia , 2011, DOI: 10.5581/1516-8484.20110036
Abstract: a case of a follicular lymphoma transformed into a cd20+ is described which progressed with the loss of cd20 expression after 8 cycles of r-chop. this phenomenon is not a rare event and has shown poor prognosis. our purposes are to describe this event and suggest biopsy in relapsed or progressive disease.
Liver histology in co-infection of hepatitis C virus (HCV) and Hepatitis G virus (HGV)
STRAUSS, Edna;GAYOTTO, Luiz Carlos da Costa;FAY, Fabian;FAY, Oscar;FERNANDES, Helena Sabino;CHAMONE, Dalton de Alencar Fischer;
Revista do Instituto de Medicina Tropical de S?o Paulo , 2002, DOI: 10.1590/S0036-46652002000200003
Abstract: as little is known about liver histology in the co-infection of hepatitis c virus (hcv) and hepatitis g virus (hgv), hgv rna was investigated in 46 blood donors with hepatitis c, 22 of them with liver biopsy: co-infection hcv / hgv (n = 6) and hcv isolated infection (n = 16). besides staging and grading of inflammation at portal, peri-portal and lobular areas (brazilian consensus), the fibrosis progression index was also calculated. all patients had no symptoms or signs of liver disease and prevalence of hgv / hcv co-infection was 15.2%. most patients had mild liver disease and fibrosis progression index, calculated only in patients with known duration of infection, was 0.110 for co-infection and 0.130 for isolated hcv infection, characterizing these patients as "slow fibrosers". no statistical differences could be found between the groups, although a lesser degree of inflammation was always present in co-infection. in conclusion co-infection hcv / hgv does not induce a more aggressive liver disease, supporting the hypothesis that hgv is not pathogenic.
Significance of isolated hepatitis B core antibody in blood donors from S?o Paulo
ALMEIDA NETO, Cesar de;STRAUSS, Edna;SABINO, Esther Cerdeira;SUCUPIRA, Maria Cecília Araripe;CHAMONE, Dalton de Alencar Fischer;
Revista do Instituto de Medicina Tropical de S?o Paulo , 2001, DOI: 10.1590/S0036-46652001000400005
Abstract: the clinical significance of isolated anti-hbc is still a challenge. to elucidate the real importance of this finding in our blood donors, an investigation algorithm was tested. one hundred and twelve isolated anti-hbc seropositive blood donors underwent clinical evaluation and retesting of hbv markers. those who presented repeatedly reactive isolated anti-hbc, received a single dose of hepatitis b recombinant vaccine to verify anti-hbs early response. a hbv-dna determination by pcr was done for those who did not test positive to anti-hbs after vaccine. the level of anti-hbc was recorded as a ratio of the sample-to-cut-off values (s:c ratio) in 57 candidates at donation. comparing true and false-positive anti-hbc results, the different s:c ratios of them were statistically significant and when less than 2, implying in a false-positive result probability over 80%. a high percent of false-positive results (16.07%) was verified after anti-hbc retesting. hbv immunity was characterized in 49.11%, either by anti-hbs detection in retesting (15.18%), or after a single dose hbv vaccination (33.93%). hbv-dna was negative in all tested donors. in conclusion, this algorithm was useful to clarify the meaning of isolated anti-hbc in most of our blood donors.
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