RESUMO
Autologous stem cell transplantation (auto-HSCT) is an effective treatment strategy for hematological malignancies. The standard mode of handling hematopoietic progenitors for the autologous procedure (CRYO) consists on its collection and freezing with dimethyl sulfoxide (DMSO) and its subsequent thawing and re-infusion. This process is toxic and expensive. Non-cryopreserved (non-CRYO) is a less expensive mode of auto-HSCT. We designed a comparative study between both strategies performed in two different centers to analyze the short-term complications. In total 111 auto-HSCT were performed from January/2015 to October/2016 (42 non-CRYO and 74 CRYO). There were 74 males and 69 (62%) patients had the underlying diagnosis of multiple myeloma. No differences were seen on the characteristics of the apheresis products and their viability. Engraftment was significantly faster in the non-CRYO group (p = 0.001). Febrile neutropenia and severe mucositis were lower in the non-CRYO group (40% vs 92% p = 0.0001 and 11% vs 64%, p = 0.001, respectively). In addition, length of hospitalization was 5 days shorter in the non-CRYO group (p = 0.0001). Overall responses and transplantation outcomes were similar. Our data demonstrate a clear advantage of the non-CRYO over CRYO auto-HSCT with faster engraftment, lower incidence of febrile neutropenia and shorter hospital stay after the transplantation procedure. These data are especially relevant for centers with high transplant activity or with limited resources.
Assuntos
Criopreservação/métodos , Transplante de Células-Tronco Hematopoéticas/métodos , Condicionamento Pré-Transplante/métodos , Transplante Autólogo/métodos , Feminino , Humanos , Masculino , Resultado do TratamentoRESUMO
AIM: To isolate and characterize rhizobacteria from Theobroma cacao with antagonistic activity against Phytophthora palmivora, the causal agent of the black pod rot, which is one of the most important diseases of T. cacao. METHODS AND RESULTS: Among 127 rhizobacteria isolated from cacao rhizosphere, three isolates (CP07, CP24 and CP30) identified as Pseudomonas chlororaphis, showed in vitro antagonistic activity against P. palmivora. Direct antagonism tested in cacao detached leaves revealed that the isolated rhizobacteria were able to reduce symptom severity upon infection with P. palmivora Mab1, with Ps. chlororaphis CP07 standing out as a potential biocontrol agent. Besides, reduced symptom severity on leaves was also observed in planta where cacao root system was pretreated with the isolated rhizobacteria followed by leaf infection with P. palmivora Mab1. The production of lytic enzymes, siderophores, biosurfactants and HCN, as well as the detection of genes encoding antibiotics, the formation of biofilm, and bacterial motility were also assessed for all three rhizobacterial strains. By using a mutant impaired in viscosin production, derived from CP07, it was found that this particular biosurfactant turned out to be crucial for both motility and biofilm formation, but not for the in vitro antagonism against Phytophthora, although it may contribute to the bioprotection of T. cacao. CONCLUSIONS: In the rhizosphere of T. cacao, there are rhizobacteria, such as Ps. chlororaphis, able to protect plants against P. palmivora. SIGNIFICANCE AND IMPACT OF THE STUDY: This study provides a theoretical basis for the potential use of Ps. chlororaphis CP07 as a biocontrol agent for the protection of cacao plants from P. palmivora infection.
Assuntos
Antibiose , Cacau/microbiologia , Phytophthora/fisiologia , Doenças das Plantas/microbiologia , Pseudomonas/fisiologia , Rizosfera , Cacau/crescimento & desenvolvimento , Dados de Sequência Molecular , Doenças das Plantas/prevenção & controle , Raízes de Plantas/microbiologia , Pseudomonas/genética , Pseudomonas/isolamento & purificaçãoRESUMO
Most patients who require a sibling stem cell transplantation do not have a matched donor. In our experience, only 1/3 patients have a matched unrelated donor (MUD); therefore, the majority of the patients will require umbilical cord blood (UCB). Patients treated for hematologic diseases with UCB transplants were included. UCB selection and conditioning regimens were performed according to the Minnesota group. Graft-versus-host disease (GVHD) prophylaxis, infection prevention, and patient care were performed according to institutional guidelines. We analyzed patients and graft demography, neutrophil and platelet recovery, chimerism kinetics, GVHD incidence, overall (OS), progression-free survival (PFS) and transplant-related mortality (TRM). We included 29 patients with a median age of 34.8 years (range 15-55). Eighteen were male and the median weight was 72.6 kg (range 54-100). Nineteen patients had acute leukemia. Myeloablative (MA) conditioning was used in 27 patients. Seventeen received double UCB (DUCB) grafts. Median total nucleated cell (10(7)/kg) was 4.2 (range 3.9-4.9) and 4.4 (range 2.8-6.3) for single UCB (SUCB) and DUCB transplants, respectively. Median time for neutrophil engraftment was 24.7 (range 14-43) and 25.8 days (range 14-52) after SUCB and DUCB transplants, respectively. Median time for platelet engraftment was 147 (range 30-516) and 81 days (range 37-200) after SUCB and DUCB transplants, respectively. All the patients receiving MA conditioning had >95% chimerism shortly after transplant. Cumulative incidence of grades II-IV and III-IV acute GVHD was 41% and 20%, respectively. Localized chronic GVHD was seen in 14% of the patients. Median follow-up was 16.7 months (range 1-63). Five-year OS and PFS were 38% and 39%, respectively. One-year TRM was 42%. UCB transplantation is associated with potential cure of hematologic malignancies and our results are similar to other series. Studies are needed to decrease mortality and improve immune reconstitution.
Assuntos
Transplante de Células-Tronco de Sangue do Cordão Umbilical , Doenças Hematológicas/cirurgia , Adolescente , Adulto , Chile , Transplante de Células-Tronco de Sangue do Cordão Umbilical/efeitos adversos , Transplante de Células-Tronco de Sangue do Cordão Umbilical/mortalidade , Intervalo Livre de Doença , Feminino , Doença Enxerto-Hospedeiro/mortalidade , Doenças Hematológicas/sangue , Doenças Hematológicas/imunologia , Doenças Hematológicas/mortalidade , Humanos , Incidência , Estimativa de Kaplan-Meier , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos/imunologia , Contagem de Plaquetas , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Quimeras de Transplante , Resultado do Tratamento , Adulto JovemRESUMO
En las últimas décadas ha habido un aumento en la frecuencia de infecciones producidas por enterococcus sp., situándose entre los patógenos nosocomiales más comúnmente reportados. En forma simultánea se está reportando una mayor resistencia a los antimicrobianos, en especial a altos niveles de aminoglicósidos y a vancomicina. Entre marzo y julio de 1998 se recolectó en la ciudad de Valdivia, 34 cepas de enterococcus sp, aisladas de muestras clínica provenientes del Laboratorio Central del Hospital Clínico Regional de Valdivia y de un laboratorio privado, para determinarles altos niveles de resistencia a los aminoglicósidos (ANRA) por el método de dilución en agar y sensibilidad a vancomicina por el método de difusión en agar. El 23,8 por ciento de las cepas hospitalarias y el 7,7 por ciento de las extrahospitalarias presentaron ANR a estreptomicina. Para gentamicina se obtuvo un 4,8 por ciento de cepas de origen hospitalario con ANR, en cambio no se encontró cepas de origen extrahospitalario resistentes a este antibiótico. Todas fueron sensibles a vancomicina
Assuntos
Humanos , Enterococcus/isolamento & purificação , Infecção Hospitalar/microbiologia , Aminoglicosídeos/farmacologia , Resistência Microbiana a Medicamentos , Enterococcus/efeitos dos fármacos , Enterococcus/patogenicidade , Gentamicinas/farmacologia , Hospitais EstaduaisRESUMO
BACKGROUND: Refractoriness continues to be a major complication of platelet transfusion therapy in patients with multiple transfusions. Despite most cases are secondary to non-immune causes, the most serious is that associated to alloimmunization. The incidence and consequences of HLA and non-HLA (platelet specific) antibodies are unknown in our country. AIM: To prospectively determine the frequency and characteristics of post transfusion alloimmunization and the incidence of platelet specific antibodies. PATIENTS AND METHODS: Forty one adults and 24 children with a recently diagnosed malignancy and undergoing chemotherapy that required multiple transfusions were studied. Screening for antiplatelet antibodies (platelet membrane ELISA) was performed before the first transfusion, every four weeks or whenever the 1 hour corrected count increment for platelet transfusions was lower than 5000. Platelet specific antibodies were identified with a monoclonal antibody-specific immobilization of platelet antigens (MAIPA), with anti-GPIb, GPIIb/IIIa, GPIa/Iia and anti-HLA class I. RESULTS: Adult patients received an average of 10.2 +/- 5.5 units of red blood cells and 58.6 +/- 35.4 units of platelets. Children received 4.8 +/- 3.7 units of red blood cells and 9.6 +/- 6.7 units of platelets. HLA antibodies appeared in 7 of 41 adult patients (17%), platelet specific alloantibodies were found in two patients (one anti GP Ia/IIa and one anti GP Ib). Platelet refractoriness appeared in three alloimmunized patients. No child had detectable serum antibodies during follow up. CONCLUSIONS: Platelet transfusion refractoriness of immune origin occurs infrequently in our population and the presence of platelet antibodies does not mean that it will appear. The use of leukocyte depleted blood components to prevent refractoriness cannot be justified at this time.
Assuntos
Anemia Aplástica/imunologia , Anemia Aplástica/terapia , Antígenos de Plaquetas Humanas/imunologia , Antígenos HLA/imunologia , Isoanticorpos/imunologia , Transfusão de Plaquetas/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/imunologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Adolescente , Adulto , Idoso , Especificidade de Anticorpos/imunologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
We have analyzed the sequence of 40 VDJ rearrangements of the immunoglobulin heavy chain gene locus on 32 unselected children from Chile with precursor B cell ALL at diagnosis. Rearrangements were derived by PCR with VH gene family-specific primers and sequenced directly. The number of VDJ rearrangements, and the pattern of VH, DH and JH gene usage was identical to the one reported by groups from developed countries. CDR3 regions represented an unbiased repertoire; VH to JH joinings were in frame in 36% of cases. Absent N nucleotides in the DJ border, suggestive of fetal origin of ALL, were seen in 9/40 rearrangements but they did not correlate with younger age. More than one rearrangement was sequenced in six patients, representing independent events with no signs of clonal evolution. One patient was analyzed at first bone marrow relapse showing persistence of one rearrangement and evolution of a second one which conserved the DJ border. The subset of B cell precursors which suffer malignant transformation to ALL appear to be common in different parts of the world.
Assuntos
Rearranjo Gênico do Linfócito B , Genes de Imunoglobulinas , Cadeias Pesadas de Imunoglobulinas/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Adolescente , Sequência de Bases , Criança , Pré-Escolar , Chile , DNA Complementar , Feminino , Humanos , Região de Troca de Imunoglobulinas/genética , Lactente , Masculino , Dados de Sequência Molecular , Leucemia-Linfoma Linfoblástico de Células Precursoras/imunologia , Análise de Sequência de DNARESUMO
We report a 28 years old woman who consulted for diarrhea of two years and a thyroid nodule. A medullary thyroid carcinoma was diagnosed and a thyroidectomy performed. There was a local relapse two months later and distant metastases were found five months later. A MIBG-1131 scintigraphic image of the adrenals lead to the suspicion of a bilateral pheochromocytoma. The surgical resection of the adrenals confirmed the diagnosis. There was no response to chemotherapy and the patient continued with severe hypercalcemia, repeated infections, persistent diarrhea and cachexia, dying one year after the diagnosis. There was no family history of the disease. We conclude that this is a particularly aggressive presentation of a multiple endocrine neoplasia type 2A.
Assuntos
Carcinoma Medular/diagnóstico , Neoplasia Endócrina Múltipla Tipo 2a/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/secundário , Neoplasias das Glândulas Suprarrenais/terapia , Adulto , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Carcinoma Medular/terapia , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Neoplasia Endócrina Múltipla Tipo 2a/terapia , Feocromocitoma/diagnóstico , Feocromocitoma/secundário , Feocromocitoma/terapia , Neoplasias da Glândula Tireoide/terapiaRESUMO
The t(1;5)(q23;q33) is a rare genetic anomaly that was reported previously in two infants with a myeloproliferative disorder and eosinophilia and in one adult patient with acute nonlymphocytic leukemia (ANLL). A 13-year-old boy with high-risk early pre-B acute lymphoblastic leukemia (ALL) who presented to our institution carried the t(1;5)(q23;q33). He had an initial blast count of 230 X 10(9)/L and responded poorly to prednisone. Complete remission (CR) was achieved, and he had a bone marrow (BM) relapse 3 months after despite intensive consolidation therapy. He underwent allogeneic BM transplantation (BMT) from a human leukocyte antigen (HLA)-identical siblings in early relapse with total body irradiation (TBI) and cyclophosphamide conditioning. He had a short second CR with a central nervous system (CNS) relapse on day + 106 after BMT. Two of the previously reported patients also did not respond to chemotherapy. The t(1;5)(q23;q33) appears to be a rare lineage nonspecific anomaly related to hematologic malignancies that are resistant to current therapy.
Assuntos
Cromossomos Humanos Par 1 , Cromossomos Humanos Par 5 , Leucemia-Linfoma Linfoblástico de Células Precursoras B/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Translocação Genética , Adolescente , Humanos , MasculinoRESUMO
Lately, myeloprolipherative disorders are frequently reported as causes of portal vein thrombosis, probably due to the early detection of latent cases of this condition. We report two patients with portal vein thrombosis that presented with abdominal pain, nausea, vomiting and clinical consequences of portal hypertension such as variceal hemorrhage, splenomegaly and ascites. Diagnosis was made by a CAT scan in one patient and doppler ultrasound in the other. Both patients had high platelet counts and an essential thrombocytosis in the bone marrow.