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Abstract: The aim of the present study was to analyze the relationship of OM with possible risk factors such as oral health condition, immunological status and IL-1β profile in patients submitted to hematopoietic stem cell transplantation (HSCT). Fifty-four individuals submitted to HSCT were included. All patients received previous dental treatment and photobiomodulation (PBM) as the institutional OM preventive protocol. OM scores, immune status, and IL-1β levels were determined during the conditioning period and at D+3 and D+8 after HSC infusion. IL-1β gene polymorphism was also analyzed during conditioning. Possible associations of OM with risk factors were analyzed using conditional Fisher's exact test. OM was observed in 34 patients (62.9%) classified as Grade 1 (13 patients/24.1%), Grade 2 (14 patients/25.9%), Grade 3 (3 patients/5.5%), and Grade 4 (4 patients/7.4%). Allogeneic HSCT individuals exhibited a higher OM grade than autologous subjects. Moreover, an association was observed between severe OM and severe gingivitis (p = 0.01), neutropenia (p = 0.03), and leukopenia (p = 0.04). A significant association between OM and lower IL-1β levels was detected at three time points, i.e., conditioning (p = 0.048), D+3 (p = 0.01), and D+8 (p = 0.005). The results showed that IL-1β gene polymorphism was not associated with OM. Our study provided important insights into the scope of OM risk factors in the setting of HSCT. Patients submitted to HSCT with severe gingivitis prior to chemotherapy and with severe neutropenia and leukopenia exhibited a higher OM grade. Further investigation will be necessary to better understand the exact role of IL-1β in the context of OM pathobiology and to validate cytokine analysis in larger cohorts.

https://doi.org/10.1590/1807-3107bor-2022.vol36.0016

Managing patients with multiple myeloma during the COVID-19 pandemic: recommendations from an expert panel - ABHH monoclonal gammopathies committe
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Hungria, Vania

; Garnica, Marcia

; Crusoé, Edvan de Queiroz

; Magalhaes Filho, Roberto Jose Pessoa de

; Martinez, Gracia

; Bittencourt, Rosane

; Farias, Danielle Leão Cordeiro de

; Braga, Walter Moises

; Pinto Neto, Jorge Vaz

; Ribeiro, Glaciano Nogueira

; Maiolino, Angelo

Hematology, Transfusion and Cell Therapy

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Set 2020, Volume 42 Nº 3 Páginas 200 - 205

Resumo: En | Texto: En | PDF: En

ABSTRACT Since the World has been facing the COVID-19 pandemic, special attention has been taken concerning cancer patients; related to their immunosuppression status, adding risk for more aggressive COVID-19 and mortality, but also concerns about the access and the quality of care in cancer therapy. The COVID-19 pandemic impacts the number of infected, its related mortality, as well as the care of cancer patients. Multiple myeloma patients are a particular group with several important aspects to be considered during pandemic times. In essence, they are immunosuppressed in different intensities during their treatment. Most of them are elderly and all of them require long-term therapy, with prolonged contact with the health care system, possibly including a stem cell transplant during the treatment. A panel of experts in multiple myeloma and infectious diseases discusses pieces of evidence and the lack of the same in the scenario of COVID-19 in myeloma patients, while also exposing what is expected for the next phases of the COVID-19 pandemic.

https://doi.org/10.1016/j.htct.2020.05.001 547 downloads

Superiority of the triple combination of bortezomib, cyclophosphamide and dexamethasone versus cyclophosphamide, thalidomide and dexamethasone in patients with newly diagnosed multiple myeloma, eligible for transplantation
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Crusoe, Edvan De Queiroz

; Higashi, Fabiana

; Martinez, Gracia

; Bittencourt, Rosane

; Pinto Neto, Jorge Vaz

; Sousa, Lais

; Santucci, Rodrigo

; Magalhães, Roberto José Pessoa

; Colli, Gilberto

; Nunes, Renata Ferreira Marques

; Ribeiro, Glaciano

; Nicacio, Jandir

; Zanella, Karla Richter

; Kutner, Jose Mauro

; Magalhaes, Andre

; Leao, Danielle

; Hallack Neto, Abrahão Elias

; Braga, Walter

; Souza, Emanuella G

; Guimaraes, Antonio Julio A.M.

; Durigon, Giovanna Steffenello

; Laks, Dani

; Maiolino, Angelo

; Hungria, Vania Tietsche de Moraes

Hematology, Transfusion and Cell Therapy

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Jun 2020, Volume 42 Nº 2 Páginas 118 - 124

Resumo: En | Texto: En | PDF: En

ABSTRACT Background: The treatment of multiple myeloma (MM) has evolved significantly in the past decade, and new drug combinations have improved the response rates and prolonged survival. Studies comparing different induction chemotherapy regimens have shown that triple combinations have better results than double combinations. However, comparisons among different triple combinations are rare in the literature. Methods: We retrospectively compared two triple combinations comprising bortezomib, cyclophosphamide and dexamethasone (VCD) versus thalidomide, cyclophosphamide and dexamethasone (CTD), and aimed at identifying which of the two combinations would yield better response rates following four induction cycles prior to hematopoietic cell transplantation in patients with untreated multiple myeloma. Results: We retrospectively reviewed the medical records of 311 patients from 24 different centers.The VCD regimen was used as induction therapy by 117 (37.6%) patients, whereas 194 (62.4%) patients received the CTD regimen. After four cycles of induction on an intention-to-treat basis, 54% of the patients in the VCD group achieved at least very good partial response versus 42.8% in the CTD group (p = 0.05). We observed no difference in neuropathy or thrombotic events rates among the two regimens. Conclusion: Our results corroborate the superiority of the triple combination regimes containing bortezomib over the triple combination with thalidomide as pre ASCT induction therapy in MM.

https://doi.org/10.1016/j.htct.2019.05.004 283 downloads

New proteasome inhibitors in the treatment of multiple myeloma
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Hungria, Vania Tietsche de Moraes

; Crusoé, Edvan de Queiroz

; Bittencourt, Rosane Isabel

; Maiolino, Angelo

; Magalhães, Roberto José Pessoa

; Nascimento Sobrinho, Jairo do

; Pinto, Jorge Vaz

; Fortes, Ricardo Coutinho

; Moreira, Eloisa de Sá

; Tanaka, Paula Yurie

Hematology, Transfusion and Cell Therapy

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Mar 2019, Volume 41 Nº 1 Páginas 76 - 83

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Abstract The treatment of patients with relapsed and/or refractory multiple myeloma has improved considerably in the last 15 years, after the introduction of proteasome inhibitors and immunomodulatory drugs. The first clinical trials with new proteasome inhibitors have produced exciting results, particularly those comparing triplet regimens with standard doublet regimens, with a gain in progression-free survival accompanied by an acceptable safety profile and either similar or better health-related quality of life. New proteasome inhibitors hold the potential to fill unmet needs in multiple myeloma management regarding improvement of clinical outcomes, including delayed progression of disease in high-risk patients. This review summarizes the main pharmacological properties and clinical outcomes of these agents, and discusses their potential to change the whole multiple myeloma therapeutic landscape.

https://doi.org/10.1016/j.htct.2018.07.003 1337 downloads

Guidelines on the treatment of acute myeloid leukemia: Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular
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Bittencourt, Rosane

; Bortolheiro, Teresa Cristina

; Chauffaille, Maria de Lourdes Lopes Ferrari

; Fagundes, Evandro Maranhão

; Pagnano, Katia Borgia Barbosa

; Rego, Eduardo Magalhães

; Bernardo, Wanderley Marques

Revista Brasileira de Hematologia e Hemoterapia

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Fev 2016, Volume 38 Nº 1 Páginas 58 - 74

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1016/j.bjhh.2016.01.001 2201 downloads

Guidelines on the diagnosis and treatment for acute promyelocytic leukemia: Associacao Brasileira de Hematologia, Hemoterapia e Terapia Celular Guidelines Project: Associacao Medica Brasileira - 2013
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Pagnano, Katia Borgia Barbosa

; Rego, Eduardo Magalhaes

; Rohr, Sandra

; Chauffaille, Maria de Lourdes

; Jacomo, Rafael Henriques

; Bittencourt, Rosane

; Firmato, Ana Beatriz

; Fagundes, Evandro Maranhao

; Melo, Raul Antonio Moraes

; Bernardo, Wanderley

Revista Brasileira de Hematologia e Hemoterapia

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Jan 2014, Volume 36 Nº 1 Páginas 71 - 92

Resumo: En | Texto: En | PDF: En

https://doi.org/10.5581/1516-8484.20140018 2966 downloads

Philadelphia-negative chronic myeloproliferative neoplasms
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Bittencourt, Rosane Isabel

; Vassallo, Jose

; Chauffaille, Maria de Lourdes Lopes Ferrari

; Xavier, Sandra Guerra

; Pagnano, Katia Borgia

; Nascimento, Ana Clara Kneese

; De Souza, Carmino Antonio

; Chiattone, Carlos Sergio

Revista Brasileira de Hematologia e Hemoterapia

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2012, Volume 34 Nº 2 Páginas 140 - 149

Resumo: En | Texto: En | PDF: En

Chronic myeloproliferative diseases without the Philadelphia chromosome marker (Ph-), although first described 60 years ago, only became the subject of interest after the turn of the millennium. In 2001, the World Health Organization (WHO) defined the classification of this group of diseases and in 2008 they were renamed myeloproliferative neoplasms based on morphological, cytogenetic and molecular features. In 2005, the identification of a recurrent molecular abnormality characterized by a gain of function with a mutation in the gene encoding Janus kinase 2 (JAK2) paved the way for greater knowledge of the pathophysiology of myeloproliferative neoplasms. The JAK2 mutation is found in 90-98% of polycythemia vera and in about 50% essential thrombocytosis and primary myelofibrosis. In addition to the JAK2 mutation, other mutations involving TET2 (ten-eleven translocation), LNK (a membrane-bound adaptor protein); IDH1/2 (isocitrate dehydrogenase 1/2 enzyme); ASXL1 (additional sex combs-like 1) genes were found in myeloproliferative neoplasms thus showing the importance of identifying molecular genetic alterations to confirm diagnosis, guide treatment and improve our understanding of the biology of these diseases. Currently, polycythemia vera, essential thrombocytosis, myelofibrosis, chronic neutrophilic leukemia, chronic eosinophilic leukemia and mastocytosis are included in this group of myeloproliferative neoplasms, but are considered different situations with individualized diagnostic methods and treatment. This review updates pathogenic aspects, molecular genetic alterations, the fundamental criteria for diagnosis and the best approach for each of these entities.

https://doi.org/10.5581/1516-8484.20120034 4020 downloads

The expression of CD56 antigen is associated with poor prognosis in patients with acute myeloid leukemia
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Alegretti, Ana Paula

; Bittar, Christina Matzenbacher

; Bittencourt, Rosane

; Piccoli, Amanda Kirchner

; Schneider, Laiana

; Silla, Lúcia Mariano

; Bó, Suzane Dal

; Xavier, Ricardo Machado

Revista Brasileira de Hematologia e Hemoterapia

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Jun 2011, Volume 33 Nº 3 Páginas 202 - 206

Resumo: En | Texto: En | PDF: En

BACKGROUND: The expression of CD56 is considered a bad prognostic factor for overall survival, lower rates or short complete remission and extramedullary invasion but the results are controversial. The importance of validating new prognostic parameters in acute leukemias was the reason to investigate the CD56 expression in blast cells of patients with acute myeloid leukemia. METHODS: A cohort of 48 patients treated at Hospital de Clinicas de Porto Alegre and diagnosed with acute myeloid leukemia as classified by the French-American-British group (FAB) criteria using cell morphology, cytochemistry and flow cytometry were evaluated. RESULTS: Eight cases (16.7%) were CD56 positive without correlation to age or gender. The highest incidence of CD56 positivity was in FAB subtypes M4 and M5. The death rate during induction was not significantly different between patients with and without CD56 expression (62.5% vs. 27.5%; p-value = 0.097). However, patients that expressed CD56 had significantly lower overall survival than those who did not (mean 4.0 months vs. 14.5 months; p-value = 0.03). CONCLUSIONS: The data suggest that expression of CD56 in acute myeloid leukemia may be indicative of poor prognosis because it is associated with a shorter overall survival. The death rate during induction was not significantly different despite an apparent difference in proportions between groups.

https://doi.org/10.5581/1516-8484.20110054 3155 downloads Citado 1 vez em SciELO

10.

Transplante de células-tronco hematopoéticas em linfoma Hodgkin
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Bittencourt, Rosane I.

; Fogliato, Laura

; Paz, Alessandra

; Souza, Mair P.

; Lerner, Decio

Revista Brasileira de Hematologia e Hemoterapia

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Mai 2010, Volume 32 Supl. 1 Páginas 97 - 105

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

O linfoma Hodgkin(LH) é uma malignidade hematológica que conta com um armamentário terapêutico selecionado de acordo com o estadiamento e a classificação prognóstica de cada doente. A sobrevida dos pacientes tratados para o LH clássico vem aumentando significativamente, com taxas de cura entre 80%-85%. Entretanto, 20%-25% são refratários aos tratamentos iniciais e cerca de 30% recaem após ter alcançado resposta completa. Os pacientes considerados com falha à terapia de primeira linha ainda têm uma segunda chance de cura se apresentarem quimiossensibilidade aos esquemas de salvamento, seguido por uma das modalidades de transplante de células-tronco hematopoéticas (TCTH). O TCTH autólogo representa uma estratégia atrativa para os pacientes com LH que falham ao tratamento convencional de primeira linha. Os resultados em termos de sobrevidas livre de doença e global são superiores aos esquemas de salvamento com quimioterapia convencional. Este procedimento tem finalidade curativa para 50% dos pacientes em segunda remissão quimiossensíveis e pode levar a remissões duráveis naqueles com mais de duas linhas de terapia. Atualmente, o TCTH alogênico, basicamente com condicionamento de intensidade reduzida (RIC), está indicado em pacientes com recaída precoce após o TCTH autólogo ou em pacientes bastante jovens com refratariedade a mais de duas linhas de tratamento convencional.

Hodgkin's Lymphoma is a hematologic malignancy with a wide range of therapeutic options that must be chosen according to the stage and the prognostic classification of each patient. The overall survival of patients treated for classic Hodgkin's Lymphoma is increasing significantly, with current cure rates being between 80% and 85%. Nevertheless, 20% to 25% are refractory to the initial treatment and about 30% relapse after having reached a complete response. Patients that have failed standard therapy still have a second chance of cure if they present chemosensitivity to cure schemes, followed by one type of hematopoietic stem cell transplantation (TCTH). Autologous TCTH is an attractive strategy for Hodgkin's Lymphoma patients that fail in the conventional standard therapy. The results in terms of overall survival and disease-free survival are higher than the cure schemes with conventional chemotherapy. This procedure addresses the cure in 50% of chemosensitive patients in second remission, and can lead to lasting remissions for those with more than two lines of treatment. Today, allogeneic TCTH, basically with reduced intensity conditioning (RIC) is indicated for patients with premature relapse after autologous TCTH or for young patients refractory to one or more lines of conventional treatment.

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11.

Transplante de células-tronco hematopoéticas em gamopatias monoclonais
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Maiolino, Angelo

; Solza, Cristiana

; Barros, José Carlos

; Coelho, Erika

; Magalhães, Roberto

; Bittencourt, Rosane

; Atalla, Angelo

; Carnevalli, Ellen

; Roithmann, Sergio

; Hungria, Vânia

Revista Brasileira de Hematologia e Hemoterapia

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Mai 2010, Volume 32 Supl. 1 Páginas 115 - 124

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

O transplante de células-tronco hematopoéticas (TCTH) é um procedimento de fundamental importância na estratégia terapêutica das gamopatias monoclonais. No mieloma múltiplo, em particular, o TCTH autólogo está indicado como estratégia de primeira linha para pacientes até 70 anos de idade. Nesta capítulo serão discutidas as indicações, estratégias e recomendações envolvendo o TCTH em gamopatias monoclonais, amiloidose e POEMS, frutos da Reunião de Consenso da Sociedade Brasileira de Transplante de Medula Óssea.

Hematopoietic stem cell transplantation (HSCT) is an important strategy in the treatment of monoclonal gammopathies. For multiple myeloma, in particular, autologous HSCT is indicated as first line therapy for under 70-year-old patients. In this chapter we will discuss indications, strategies and recommendations involving HSCT for monoclonal gammopathies from the Consensus Meeting of the Brazilian Society of Bone Marrow Transplantation.

4060 downloads Citado 1 vez em SciELO

12.

Trombocitose essencial: o que é essencial saber
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Bittencourt, Rosane I.

; Poncelet, Karin

; Almeida, Antonio Carlos C.

; Fassina, Katia

; Onsten, Tor G.

Revista Brasileira de Hematologia e Hemoterapia

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2010, Volume 32 Nº 2 Páginas 162 - 170

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

A trombocitose essencial (TE) faz parte do grupo de síndromes mieloproliferativas (SMP) cromossomo Philadelphia(Ph) negativas. Caracteriza-se pela hiperproliferação megacariocítica com consequente trombocitose periférica, favorecendo fenômenos trombo-hemorrágicos. Esta entidade estava esquecida até meados de 2005, quando as recentes publicações sobre as alterações moleculares na atividade da enzima tirosina quinase, JAK2, desencadeou um novo interesse sobre a patogenia, aspectos clínicos e terapêuticos da TE. A identificação das mutações de JAK2 e do gene MPL W515K, W515L e S505N impulsionou a nova proposta da Organização Mundial de Saúde (OMS) para reformular os critérios diagnósticos, reduzindo o número de plaquetas para 450x10(9)/L. O alicerce do tratamento são agentes redutores das contagens plaquetárias: hidroxiureia, anagrelide ou interferon associados à prevenção das complicações trombo-hemorrágicas. Não há um tratamento curativo para a TE, mas despontam perspectivas de que terapias alvo, bloqueadoras da mutação JAK2, possam incrementar o desfecho da doença. Inibidores de JAK2, específicos e inespecíficos, estão sendo estudados em fase I e II e parecem promissores num futuro próximo.

Essential thrombocythemia (ET) is an acquired myeloproliferative Philadelphia negative disorder characterized by megakaryocytic hyperproliferation and persistent peripheral thrombocytosis with a tendency of thrombosis and hemorrhages. This entity was forgotten until 2005, when the recent identification of somatic mutations such as JAK2V617F and MPL W515L/K triggered off interest in the molecular pathogenesis, clinical aspects and therapeutic approach of ET. The presence of molecular mutations changed the diagnostic criteria proposed by the World Health Organization, and nowadays the platelet count for which ET should be considered has dropped to 450 X 10(9) /L. Treatment is given according to risk stratification: in cases with high risk platelet reduction, therapy using drugs such as hydroxyurea, interferon or anagrelide is chosen. There is no drug known to cure ET and the current therapy is either to prevent thrombohemorrhagic events or reductions in the platelet count. The identification of the JAK2V617F mutation has opened an opportunity to develop new therapeutic target. JAK2 inhibitors are promising for the treatment of ET in the near future.

49662 downloads Citado 1 vez em SciELO

13.

Leucemia mielóide aguda: o olhar dos anos 2000 no Serviço de Hematologia do Hospital de Clínicas de Porto Alegre-RS
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Bittencourt, Rosane I.

; Fernandes, Flavo B.

; Paz, Alessandra A.

; Fogliatto, Laura

; Astigarraga, Cláudia C.

; Friederich, João R.

; Leugheur, Denise S.

; Silla, Lucia M. R.

Revista Brasileira de Hematologia e Hemoterapia

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2008, Volume 30 Nº 3 Páginas 202 - 207

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

A leucemia mielóide aguda (LMA) representa uma preocupação para os especialistas, porque perfaz um percentual alto das leucemias no adulto e o sucesso terapêutico ainda é insatisfatório. A partir do ano 2000, o Serviço de Hematologia do Hospital de Clínicas de Porto Alegre definiu estratégias para diagnóstico, tratamento e seguimento das LMAs, de acordo com o subtipo FAB, idade, citogenética e performance status (ECOG). Todos os casos de LMA "de novo"não promielocítica, em adultos (15 a 65 anos) foram acompanhados prospectivamente, desde outubro de 2001, data da implantação do protocolo c,ompreendendo três fases de tratamento: indução com o tradicional "7+3", citarabina 100 mg/m²/dia em infusão contínua em 7d, e daunorrubicina 60 mg/m²/dia em 3d e citarabina intratecal no D1 nas LMA M4 e M5. Após a recuperação medular, segue a consolidação idêntica à indução e posteriormente a intensificação com dois ou três ciclos de altas doses de citarabina 6 g/m²/dia por três dias. Foram diagnosticados, entre outubro/01 e dezembro/05, 69 pacientes portadores de LMA e destes, 39 com LMA "de novo"e idade entre 15 e 65 anos. Neste grupo foram analisadas a taxa de remissão, a taxa de recaída, a refratariedade e o tempo de sobrevida global. No final da observação foram encontrados: a taxa de indução de remissão 75%; aconteceram 12 (40%) recaídas, 7 (19%) foram refratários ao tratamento. A sobrevida global foi 37% em 56 meses, representando um incremento aos resultados obtidos no Serviço na década passada.

Acute myeloid leukemia (AML) is still a concern for hematologists as it represents a significant percentage of adult leukemias and the therapeutic success rates are unsatisfactory. In 2000, the Hematology Department of Hospital de Clínicas de Porto Alegre defined strategies for the diagnosis, treatment and follow up of AML patients according to the FAB subtype classification, age, cytogenetic tests and performance status (ECOG). Patients with promyelocytic leukemia are treated using the AIDA (GIMEMA) protocol with those older than 65 years receiving palliative therapy using hydroxyurea, oral etoposide, thalidomide, subcutaneous cytarabine or an association of drugs. Since October 2001 all our "de novo"AML patients aged 15 to 65 years with non-promyelocytic acute leukemia were prospectively followed up. At diagnosis we start a three phase treatment protocol: induction with a classical "7+3"therapy regimen, that is continuous infusion of 100 mg/m²/day cytarabine for 7 days, 60 mg/m²/day daunorubicin for 3 days and on day 1 an intrathecal cytarabine in AML M4 and M5 cases. After bone marrow recovery, if complete remission is achieved, follow ups involve an identical "7+3"consolidation phase followed by two or three high dose cycles of 6 g/m²/day cytarabine for 3 days. A group of 39 patients diagnosed between October 2001 and December 2005 was followed up until June 2006. Our objectives were to evaluate the effectiveness of the protocol for remission, relapse rates and overall survival. The rate of complete remission was 75%. Relapse occurred in 12/29 (40%) patients and the overall survival rate at 56 months was 37%, showing an improvement on our results of previous decades.

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14.

O papel da terapia de manutenção no Mieloma Múltiplo
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Bittencourt, Rosane

Revista Brasileira de Hematologia e Hemoterapia

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Mar 2007, Volume 29 Nº 1 Páginas 54 - 59

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

O papel da terapia de manutenção para os pacientes com mieloma múltiplo(MM) após a obtenção de resposta completa ou resposta parcial quase completa ainda é um assunto controverso. As altas doses de quimioterapia seguidas pelo transplante autólogo de células hematopoéticas podem prolongar significativamente a sobrevida, embora não seja curativo, propiciando a alternativa da terapia de manutenção, como uma possibilidade de manter por períodos mais prolongados a fase de estabilização, onde a doença está clinicamente inativa (plateau). A manutenção pode ainda agir na doença residual mínima, capaz de converter taxas de resposta parcial em resposta completa. Há mais de duas décadas a terapia de manutenção antimieloma vem sendo proposta e suscitando discussões. Desde os anos 80, o interferon-alfa, os corticóides, incluindo a dexametasona e a prednisona, e, mais recentemente, os antiangiogênicos talidomida e seus derivados, junto às combinações destes vários agentes são alvos de estudos como terapia de manutenção. Para cada um destes agentes, os ensaios clínicos apontam vantagens e desvantagens em termos de sobrevida livre de doença, sobrevida global e toxicidades. Na avaliação geral faltam evidências que justifiquem um inequívoco benefício na sobrevida global para a maioria dos pacientes. No momento atual, em que novas terapias para o MM estão despontando como promissoras, o mais racional é individualizar a necessidade da terapia de manutenção considerando os fatores de riscos prognósticos apresentados por cada indivíduo.

The use of maintenance therapy for patients with multiple myeloma (MM) and complete or almost complete remission is still under discussion. Although not curative, high dose chemotherapy followed by autologous bone marrow transplantation significantly prolongs overall survival time. The addition of maintenance therapy seems to be a valuable alternative aiming at longer inactive disease periods (plateau) or even as an effective therapy for minimal residual disease. It may also bring higher rates of complete response to patients with an initial partial response. Over more than two decades, maintenance therapy for MM has been discussed and proposed. Since then various drugs and their combinations have been studied for this purpose, such as interferon-alpha, glucocorticoids - including dexamethasone and prednisone - and the more recently antiangiogenic drugs including thalidomide and its analogs. Clinical trials with each of these agents have shown advantages and, sometimes, disadvantages in terms of disease-free survival, overall survival and toxicity. A general review of these studies draws attention to the lack of evidence favoring unequivocal benefits in overall survival. In a time when novel and promising therapies arrive we shall emphasize the need of individual therapeutic approaches in terms of maintenance therapy, considering the prognosis and risk factors of each patient.

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Possibilidades de atuação do psicólogo no programa saúde da família: a experiência de Bonito-MS
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Bittencourt, Rosane Aparecida do Amaral

; Mateus, Marina Lopes Fontoura

Psicologia: Ciência e Profissão

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Jun 2006, Volume 26 Nº 2 Páginas 328 - 343

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

O trabalho resulta de estudo realizado junto aos participantes do Programa de Saúde da Família - PSF, no município de Bonito, no Estado de Mato Grosso do Sul, no ano de 2003. O estudo objetivou identificar as possibilidades de atuação do psicólogo nas equipes de PSF, por meio da opinião dos profissionais e usuários. Trata-se de um estudo descritivo com abordagem qualitativa, utilizando-se de questionários para a coleta dos dados. Os resultados apontaram que a atuação do psicólogo junto à equipe, orientando ou atendendo a demanda por saúde mental, proporciona atendimento integral e resolutividade nos serviços ofertados, por meio de ações interdisciplinares. Destaca-se a promoção da integração entre os membros da equipe e, desta com a comunidade. Tem uma importante contribuição na promoção da saúde, desenvolvendo ações educativas/preventivas; além disso, favorece a humanização do atendimento, por ser um profissional que ouve e orienta os profissionais, os indivíduos e, as famílias.

This paper is the result of a study conducted among the family health's program participants, in the city of Bonito, Mato Grosso do Sul state, in the year 2003. The aim of the study was to identity the psychologist intervention possibilities in the PSF program through the opinions of the professionals and the program users. It is a descriptive study with a qualitative approach, using a questionnaire as an instrument to collect data. The results point out that the intervention of the psychologist in mental health helps to provide full attention at the offered health services beyond multidisciplinary actions. We also point out the integration among the health team members, and with the community. It has a great contribution to health promotion because allows developing educative/preventive actions and, besides, contributes to humanize the attention to the patient and their families.

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