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  • 1
    In: Blood, American Society of Hematology, Vol. 104, No. 11 ( 2004-11-16), p. 3334-3334
    Abstract: This is a retrospective analysis of 1084 patients who received an allogeneic HSCT in 10 Brazilian Centers, from February 1983 to March 2003, aiming to validate the EBMT risk score. Data from transplanted patients and donors regarding patients age, disease stage at transplantation, HLA full-match sibling donor or full-match unrelated donors, donor-recipient gender match and the interval from diagnosis to transplantation, were used as variables to calculate the EBMT risk score. This score was analyzed using Cox Proportional Hazards Model. The OS, DFS, TRM and relapse were analyzed using Kaplan-Meier and cumulative incidence, whenever appropriate. In all there were 647 (60%) males and 437 (40%) females, the median age was 32 years old (range 1 – 59); 898 (83%) were in chronic phase, 146 (13%) were in accelerated phase and 40 (4%) were in blast crisis; 151 (14%) were younger than 20 years old, 620 (57%) were between 20 and 40 and 313 (29%) were older than 40; 1025 (95%) received HLA full-match sibling transplant and only 59 (5%) received an unrelated transplant. Female donor to male recipient occurred in 283 (26%) transplants. The interval from diagnosis to transplantation was less than 12 months in 223 (21%) cases and greater in 861 (79%). The OS, DFS, TRM and, relapse were 49%, 50%, 45%, 25%, respectively. The risk score 0–1 occurred in 179 (17%), score 2 in 397 (37%), score 3 in 345 (32%), score 4 in 135 (12%), and score 5–6 in 28 (2%). The risk scores 0–1 and 2 did not show any difference in terms of OS (58% and 55%, respectively) but they were significantly better than scores 3 or more (score 3 – 44%, 4 – 36 % and, 5-6 - 27%, respectively) (P 〈 0.001). DFS and TRM beyond score 3 were 46%, 49%, respectively and the relapse rate beyond score 5–6 was 77%. Disease status had a negative impact on all outcomes (OS, DFS, TRM, and relapse). OS for female donor - male recipient was 40% compared to 52% for the other patients (P=0.004). DFS and TRM were significant for disease phase and female donor-male recipient (P 〈 0.001 and P 〈 0.003, respectively). In our experience, age and interval from diagnosis and transplant did not show any difference in terms of OS, DFS, TRM, and relapse rate. Our results confirm the usefulness of the EBMT risk score for point-decision in the Imatinib era.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2004
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  • 2
    In: Blood, American Society of Hematology, Vol. 104, No. 11 ( 2004-11-16), p. 5150-5150
    Abstract: Uncertainty still exists with the effects of allogeneic PBSCT on the clinical outcomes of patients with hematological malignancies. Our aim was analyzed retrospectively the clinical outcomes of 483 patients who underwent an allo PBSCT in 9 Brazilians centers from May 1994 to February 2004. The analyzes included patients with hematological malignancies who underwent PBSCT from HLA identical siblings donors treated with G-CSF at a dose of 10mgr/kg/day, 5 days. Median age was 34ys old (2–57), advanced disease was present in 58%, conditioning without irradiation was 85%; GVHD prophylaxis with MTX/CsA was 91%; CD34+ median was 4.7X106/kg (0.51–71.6); the median follow-up for surviving patients was 797 days (8–3420); median day for neutrophils and platelets engraftment was 15 and 14, respectively; cumulative incidence (CI) for ³ 2 aGVHD was 38%; extensive cGVHD 63%; CI for transplant relate mortality (TRM) 59%; CI for relapse 37%; the estimates of OS and DFS at 9 ys are 33% and 42, respectively. The following factors were significantly associated with better outcomes for engraftment, aGVHD, cGVHD, OS, DFS, relapse, and TRM in univariate analyzes, respectively: neutrophils and platelets engraftment: CD34+ cell dose & gt; 2.8X106/kg, GVHD prophylaxis other than MTX/CsA, and sex match other than female donor for male recipient; aGVHD: age & lt;43ys old, and CD34 dose & gt; 4.7X106/kg; cGVHD: age & lt; 25ys, sex match other than female donor for male recipient, advanced disease and CD3+ dose & lt; 170X106/kg; OS: early disease; DFS: early disease, CD34+ dose & gt; 4.7X106/kg; relapse: age & gt; 25ys, CD34+ cell dose & gt; 2.8X106/kg, and early disease; TRM: early disease. All the results remained significant in multivariate analyzes, but CD34+ dose and platelet engraftment; age and CD34+ dose in aGVHD; age and CD3+ in cGVHD, and age in relapse. In our experience, sex match, CD34+ dose, GVHD prophylaxis may influence the engrafment, and sex match and disease phase the cGVHD. Furthermore, advanced disease had a negative impact on OS and TRM;. CD34+ higher dose and early disease were associated with better DFS and lower relapse.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2004
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 3
    In: Blood, American Society of Hematology, Vol. 140, No. Supplement 1 ( 2022-11-15), p. 880-882
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2022
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 4
    In: Blood, American Society of Hematology, Vol. 108, No. 11 ( 2006-11-16), p. 598-598
    Abstract: Sixty-one consecutive patients with hematologic malignancies submitted to HLA-identical sibling allogeneic stem cell transplantation (allo-SCT) were followed in order to evaluate the relationship between the use of glutamine as part of parenteral nutrition (PN) and death/complications related to the procedure. Patients were randomly and blindly assigned to receive either glutamine enriched PN (group 1) or regular PN (group 2). The glutamine dipeptide (Dipeptiven® - Fresenius Kabi) was associated with parenteral nutrition in the first week following transplantation (D0−D+6). Infectious complications, acute GVHD, length of stay (LOS), deaths on D+100 and D+180 and, when possible, intestinal permeability as measured by urinary excretion of lactulosis and mannitol (on admission, D+6 and D+14) were the end-points. Eight patients were excluded from randomization because they refuse to take glutamine or glutamine was not available on D0, but were followed and analyzed as controls, so that group 1 comprised 27 patients and group 2 thirty-four (26+8). Demographics did not differ between groups (age - 37 ± 11 versus 36 ± 8.7, and gender - 14 versus 18 females). Diseases (CML n=37; AML n=12; ALL n=7; MDS n=4; MM n=1) were equally distributed between groups. Patients on group 1 received an average of 23.4g of glutamine/day, corresponding to 49% of the average protein delivery through PN (total 47.9g, against 50 g/day on group2, NS). They were allowed to eat ad libitum. Infection and acute GVHD incidences, and LOS median (36 versus 36.5) were similar on both groups. Intestinal permeability, which showed to be already affected on admission, was not affected by the use of glutamine, but consistently worsened throughout the study, from admission to D+14. Transplant-related mortality (TRM) rate was 29.5% on D+100 (18 deaths, 4 on group 1 and 14 on group 2) and 40.1% on D+180 (25 deaths, 7 on group 1 and 18 on group 2). Survival analysis showed statistical difference on univariate analysis, with a better survival for Group 1 both on D+100 (p= 0.02, log-rank) and D+180 (p=0.02). A Cox regression model was applied using variables that showed a p value of less than 0.2 (diagnosis-related risk, graft source - peripheral blood or bone marrow, conditioning regimen and use of glutamine). Use of glutamine, both on D+100 (HR 6.4; CI95% 1.81–22.44 - p=0.004) and D+180 (HR 4.9; CI95% 1.76–13.61 - p=0.002) was associated with a significantly higher chance of survival. Statistical significance is maintained if the cases excluded from randomization are also excluded from analysis. The results showed that glutamine dipeptide enriched PN plays a role on increasing short-term survival after allo-SCT. Benefits of glutamine dipeptide seems to be independent of mucosal damage/recovery, at least on short term, as intestinal permeability between admission and D +14 was not affected by its use.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2006
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 5
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 1136-1136
    Abstract: Hematopoietic stem cell transplantation is a valid alternative as post-remission therapy in ALL. Our aim was analyzed retrospectively the clinical outcomes of 97 ALL patients with HLA identical sibling donors who underwent an allo PBSCT. Median age was 24 ys (2–45), advanced disease was present in 74%, conditioning without irradiation was 56%; GVHD prophylaxis with MTX/CsA was 91%; CD34+ median was 4.6X106/kg (1.2–24); the median follow-up for surviving patients was 22 months (1.6–93). Median day for neutrophils and platelets engraftment was 15 and 13, respectively; no TBI conditioning, no MTX/CsA, were associated significantly with faster neutrophils engraftment; no MTX/CsA with platelets. Cumulative incidence (CI) for ≥ 2 aGVHD was 45%, extensive cGVHD 50%; aGVHD in patients who received TBI conditioning was 34% (P=0.04). The estimates of OS and DFS at 92 months was 21% and 31%, respectively; OS for patients & gt;36ys was 16% (P=0.04), for patients with aGVHD 11% (P=0.03); there was a trend towards better OS and DFS in patients with cGVHD (54%, 63%; P=0.07, P=0.06). CI for relapses was 60%; relapses for cGVHD patients were 36% (P= 0.05), and there was a trend towards higher relapses in advanced disease (66%, P=0.06). TRM was 64%; in those patients with aGVHD, 73% (P=0.008). In multivariate analyses no MTX/CsA was related with the speed of platelets engraftment (P=0.007); TBI conditioning was associated with less aGVHD and TRM (P=0.05, P=0.01); aGVHD had a negative impact on OS with higher TRM (P=0.02, P=0.02). Although not confirmed in the multivariate analyses, fewer relapses, and a trend towards better OS, and DFS were found in patients with extensive cGVHD. However, further follow up will be necessary to confirm these results.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
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