RESUMO
BACKGROUND: Acute myeloid leukemia (AML) is the most common leukemia in adults. Aim: To Describe our population of patients with AML and report the outcomes of our treatments. MATERIAL AND METHODS: Review of electronic clinical records of 114 patients with AML with a median age of 57 years (59% men). Results: Seventeen percent of patients were classified as low risk, 38% as intermediate risk and 33% as high risk. Seventy-six percent of patients were treated with intensive chemotherapy. Five years overall survival according to cytogenetic risk was 59, 41, and 12% in low, intermediate, and high-risk patients, respectively. The outcomes were better in patients under 60 years. The median survival of patients treated with intensive chemotherapy aged less than 60 years and 60 years and above was 3.4 and 1 year, respectively. CONCLUSIONS: Our results are comparable to those reported in developed countries. Improving the survival of patients 60 years and older is our main challenge.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Leucemia Mielomonocítica Aguda/genética , Leucemia Mielomonocítica Aguda/tratamento farmacológico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
We describe the management and follow-up of a 20-year-old male with acute myeloblastic leukemia with translocation (8; 21) [t (8; 21)]. A quantitative polymerase chain reaction for t(8; 21) in bone marrow was performed at diagnosis and after three consolidations with high doses of cytarabine. Currently, the management of this type of leukemias has been oriented towards the early detection of relapse. The concept of minimal or measurable residual disease, as the burden of leukemia cells that persist undetected, is an important tool in the therapeutic decision and follow-up of these patients.
Assuntos
Humanos , Masculino , Adulto , Adulto Jovem , Leucemia Mielomonocítica Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/genética , Translocação Genética , Medula Óssea , Seguimentos , Neoplasia ResidualRESUMO
The early events that drive myeloid oncogenesis are not well understood. Most studies focus on the cell-intrinsic genetic changes and how they impact cell fate decisions. We consider how chronic exposure to the proinflammatory cytokine, interleukin-1ß (IL-1ß), impacts Cebpa-knockout hematopoietic stem and progenitor cells (HSPCs) in competitive settings. Surprisingly, we found that Cebpa loss did not confer a hematopoietic cell-intrinsic competitive advantage; rather chronic IL-1ß exposure engendered potent selection for Cebpa loss. Chronic IL-1ß augments myeloid lineage output by activating differentiation and repressing stem cell gene expression programs in a Cebpa-dependent manner. As a result, Cebpa-knockout HSPCs are resistant to the prodifferentiative effects of chronic IL-1ß, and competitively expand. We further show that ectopic CEBPA expression reduces the fitness of established human acute myeloid leukemias, coinciding with increased differentiation. These findings have important implications for the earliest events that drive hematologic disorders, suggesting that chronic inflammation could be an important driver of leukemogenesis and a potential target for intervention.
Assuntos
Proteínas Estimuladoras de Ligação a CCAAT/metabolismo , Células-Tronco Hematopoéticas/metabolismo , Interleucina-1beta/metabolismo , Animais , Diferenciação Celular/fisiologia , Linhagem Celular , Linhagem da Célula/fisiologia , Expressão Gênica/fisiologia , Células HEK293 , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Inflamação/metabolismo , Leucemia Mielomonocítica Aguda/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Células Mieloides/metabolismoRESUMO
Abstract: Fusariosis is due to inhalation or direct contact with conidia. Clinical presentation depends on host's immunity and can be localized, focally invasive or disseminated. Given the severity of this infection and the possibility for the dermatologist to make an early diagnosis, we report six cases of patients with hematologic malignancies, who developed febrile neutropenia an skin lesions suggestive of cutaneous fusariosis. All patients had skin cultures showing growth of Fusarium solani complex, and they received amphotericin B and voriconazole. As this infection can quickly lead to death, dermatologists play a crucial role in diagnosing this disease.
Assuntos
Humanos , Pessoa de Meia-Idade , Adulto Jovem , Pele/microbiologia , Leucemia Mielomonocítica Aguda/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras B/complicações , Fusariose/complicações , Fusarium/isolamento & purificação , Mieloma Múltiplo/complicações , Antifúngicos/uso terapêutico , Pele/patologia , Evolução Fatal , Fusariose/patologia , Fusariose/prevenção & controle , Neutropenia/etiologiaRESUMO
Background: The intensity of conditioning chemotherapy and radiotherapy in hematopoietic stem cell transplantation (HSCT) varies according to several factors including the patients age, pre-existing conditions and performance status. Myeloablative conditioning (MA) increases transplant related mortality and reduces survival in older patients. Reduced intensity conditioning (RIC) is a good option for these patients. Aim: To report our experience with HSCT in patients of different ages with acute leukemia. Material and Methods: Retrospective analysis of 115 allogeneic HSCT performed in patients with acute myeloid or lymphoblastic leukemia. Results: We analyzed the cohort of patients in groups according to age at transplantation: younger than 40 years (n = 74), 41 to 50 years (n = 25) and older than 51 years of age (n = 16). Overall survival (OS), Disease free survival (DFS) and relapse at five years were similar in both groups of patients younger than 50 years (OS 40 and 44% respectively, DFS 38 and 42% respectively and relapse 40% and 34% respectively, p = NS). Patients over 51 years had a five years OS of 12%. However when we analyzed those patients by date and conditioning we found that patients who were treated with MA regimens in the first decade of the transplant program (before 2000) had lower OS compared to those treated after 2000 with RIC (five years OS 49% and 12% respectively, p < 0.01). No significant differences in terms of OS, recurrence or incidence of graft-versus-host disease were found when comparing groups under 40 years, between 41 and 50 years and older than 51 years treated only with RIC. Conclusions: RIC provides the possibility of HSCT in older patients with rates comparable to those obtained in younger patients successfully treated with MA conditioning.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Leucemia Mielomonocítica Aguda/cirurgia , Transplante de Células-Tronco Hematopoéticas/métodos , Condicionamento Pré-Transplante/métodos , Leucemia-Linfoma Linfoblástico de Células Precursoras/cirurgia , Recidiva , Transplante Homólogo/métodos , Transplante Homólogo/mortalidade , Análise de Sobrevida , Estudos Retrospectivos , Fatores Etários , Transplante de Células-Tronco Hematopoéticas/mortalidade , Intervalo Livre de Doença , Condicionamento Pré-Transplante/mortalidadeRESUMO
BACKGROUND/OBJECTIVE: Acute myeloid leukemia (AML) is the most common acute leukemia in adults. We documented the characteristics and results of treatment of patients with AML at a single reference center. METHODS: Patients diagnosed with AML between June 2003 and July 2011 at a university hospital in northeast Mexico were studied. Overall survival (OS) and event-free survival (EFS) were determined, and risk factors were analyzed with respect to their influence on prognosis. RESULTS: A total of 132 AML patients were included. Median age was 32 years. Complete remission (CR) was achieved by 55% of patients. CR was achieved by 65.1% of patients <60 years (n = 109), compared to 8.7% of those >60 years (n = 23; p < 0.001). In all, 39% of patients >60 years suffered an early death, compared to 14.7% of those <60 years (p < 0.001). OS for patients with AML was 35%, whereas EFS was 32%. On multivariate analysis, patients >60 years had a lower OS and EFS (p < 0.001). A total of 28% of patients received a transplant, and they had high er OS and EFS. Conclusions: Our patients were considerably younger and had remarkably lower survival rates than reported for other populations; those >60 years had a higher early death rate, and fewer of these patients achieved CR.
Assuntos
Leucemia Mieloide Aguda/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transfusão de Componentes Sanguíneos , Criança , Pré-Escolar , Terapia Combinada , Citarabina/administração & dosagem , Dexametasona/administração & dosagem , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Transplante de Células-Tronco Hematopoéticas , Hospitais Universitários , Humanos , Lactente , Infusões Intravenosas , Injeções Espinhais , Estimativa de Kaplan-Meier , Leucemia Mieloide Aguda/terapia , Leucemia Mielomonocítica Aguda/epidemiologia , Leucemia Mielomonocítica Aguda/terapia , Masculino , Metotrexato/administração & dosagem , México/epidemiologia , Pessoa de Meia-Idade , Mitoxantrona/administração & dosagem , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
Chronic myelomonocytic leukemia is a clonal stem cell disorder that is characterized mainly by absolute peripheral monocytosis. This disease can present myeloproliferative and myelodysplastic characteristics. According to the classification established by the World Health Organization, chronic myelomonocytic leukemia is inserted in a group of myeloproliferative/myelodysplastic disorders; its diagnosis requires the presence of persistent monocytosis and dysplasia involving one or more myeloid cell lineages. Furthermore, there should be an absence of the Philadelphia chromosome and the BCR/ABL fusion gene and less than 20% blasts in the blood or bone marrow. Phenotypically, the cells in chronic myelomonocytic leukemia can present myelomonocytic antigens, such as CD33 and CD13, overexpressions of CD56 and CD2 and variable expressions of HLA-DR, CD36, CD14, CD15, CD68 and CD64. The increase in the CD34 expression may be associated with a transformation into acute leukemia. Cytogenetic alterations are frequent in chronic myelomonocytic leukemia, and molecular mutations such as NRAS have been identified. The present article reports on a case of chronic myelomonocytic leukemia, diagnosed by morphologic and phenotypical findings that, despite having been suggestive of acute monocytic leukemia, were differentiated through a detailed analysis of cell morphology. Furthermore, typical cells of chronic lymphocytic leukemia were found, making this a rare finding.
Assuntos
Humanos , Idoso , Leucemia Linfocítica Crônica de Células B , Leucemia Mielomonocítica Aguda , Leucemia Mielomonocítica CrônicaRESUMO
JUSTIFICATIVA E OBJETIVOS: O acidente vascular encefálico (AVE) hemorrágico em pacientes jovens é potencialmente grave. Dentre as causas hematológicas, destaca-se a leucemia mieloide aguda, representada na maioria dos casos pela leucemia promielocítica aguda (M3), sendo escassos os relatos de AVE hemorrágicos como apresentação inicial em pacientes com leucemiamielo monocítica aguda (M4). O objetivo deste estudo foi relatar um caso de AVE hemorrágico como apresentação inicial de leucemia mielomonocítica em paciente jovem e discutir seus aspectos clínicos, evolutivos e terapêuticos. RELATO DO CASO: Paciente do sexo masculino, 19 anos,que apresentou diagnóstico de leucemia mielomonocítica aguda (M4) com hemorragia intraparenquimatosa cerebral, embora os níveis plaquetários fossem de 56.000/mm3. Foi submetido à drenagem do hematoma intraparenquimatoso. Recebeu tratamento quimioterápico com citarabina e idarrubicina em doses convencionais, evoluindo com distúrbios metabólicos, hidroeletrolíticose óbito no quinto dia de internação. CONCLUSÃO: A leucemia mieloide aguda deve fazer parte dos diagnósticos diferenciais da provável causa de AVE hemorrágico em jovens, inclusive naqueles com níveis plaquetários considerados relativamente "seguros", uma vez que este não é o único fator causal de sangramento.
BACKGROUND AND OBJECTIVES: The hemorrhagic stroke in young patients is potentially serious. Among the hematological causes, we highlight the acute myeloid leukemia, represented in most cases by acute promyelocytic leukemia, being few reports of hemorrhagic stroke as initial presentation in patients with acute myelomonocytic leukemia (M4). The objective of this study was to report a case of hemorrhagic stroke as the initial presentation of myelomonocytic leukemia in a young patient and discuss its clinical, evaluative and therapeutic aspects. CASE REPORT : Male patient, 19 years-old who had as initial presentation of acute myelomonocytic leukemia an intraparenchymal cerebral hemorrhage, with platelet levels of 56.000/mm3. The patient underwent drainage of hematomas. He received chemotherapy with idarubicin and cytarabine in conventional doses, evolving with metabolic disorders, acute renal failure and death on the fifth day of hospitalization. CONCLUSION : Acute myeloid leukemia should be part of the differential diagnosis of the probable cause of hemorrhagic strokein young patients, including those with platelet levels considered relatively "safe", since this is not the only causative factor forbleeding.
Assuntos
Humanos , Masculino , Adulto , Leucemia Mieloide Aguda , Leucemia Mielomonocítica Aguda , Acidente Vascular Cerebral , TrombocitopeniaRESUMO
The coexistence of acute myeloid leukemia and chronic lymphocytic leukemia in the same patient is rare. The majority of the cases correspond to patients that developed acute leukemia during the evolutionary course of a chronic lymphatic leukemia following treatment with chemotherapy drugs. We report a case of acute myelomonocytic leukemia concurrent with untreated B-cell chronic lymphocytic leukemia in which the use of flow cytometry analysis with a large panel of monoclonal antibodies, allowed the demonstration of different pathological populations and determine immunophenotyping patterns. Published cases of simultaneous chronic lymphocytic leukemia and acute leukemia are reviewed. The use of multiparametric flow cytometry to differentiate the populations demonstrates the utility of this technology in the diagnosis of these hematological malignancies.