RESUMO Objetivo: O presente trabalho objetivou revisar as infecções fúngicas invasivas (IFIs) e as profilaxias antifúngicas utilizadas nos últimos 20 anos em pacientes transplantados, de forma a identificar as mudanças ocorridas nesse período e discutir as condutas mais atuais. Métodos: Trata-se de uma revisão sistemática em que se utilizou a base de dados PubMed, na qual foram selecionados artigos científicos dos últimos 20 anos, abrangendo ensaios clínicos, ensaios controlados randomizados, revisões sistemáticas da literatura e metanálises. Resultados: De acordo com o presente estudo, o posaconazol e o voriconazol parecem ser as drogas antifúngicas de escolha na profilaxia de IFI em transplante de células-tronco hematopoiéticas (TCTH). Entretanto, como não há disponibilidade do posaconazol no sistema público de saúde do Brasil, a opção mais viável continua sendo o voriconazol. Com relação à profilaxia de IFI em transplante de órgãos sólidos (TOS), observou-se que existem variações em função do órgão-alvo transplantado, sendo que no transplante renal (TR) nem há evidência da sua necessidade. Apesar dos azóis também serem os mais utilizados e trazerem benefícios evidentes nos transplantes de fígado (TF) e de pulmão (TP), alguns estudos atuais têm colocado as equinocandinas no mesmo patamar, encorajando mais seu uso para prevenção de IFI nesses pacientes. Conclusão: Uma vez que nos últimos 5 anos existe grande escassez de ensaios clínicos comparando diferentes profilaxias antifúngicas, novos estudos são necessários a fim de estabelecerem os protocolos mais adequados para cada condição e perfil de paciente transplantado. Objetivo IFIs (IFIs 2 transplantados Métodos Tratase Trata PubMed randomizados metanálises Resultados estudo célulastronco células tronco TCTH. TCTH . (TCTH) Entretanto Brasil TOS, TOS , (TOS) observouse observou órgãoalvo órgão alvo transplantado TR (TR necessidade TF (TF TP, TP (TP) patamar Conclusão (TCTH (TOS (TP

ABSTRACT Objective: The present work aimed to review the invasive fungal infections (IFIs) and antifungal prophylaxis used in the last 20 years in transplant patients to identify the changes that occurred in this period and discuss the most current conducts. Methods: This is a systematic review in which the PubMed database was used, in which scientific articles from the last 20 years were selected, covering clinical trials, randomized controlled trials, systematic reviews of the literature and meta-analyses. Results: According to the present study, posaconazole and voriconazole are the antifungal drugs of choice for IFI prophylaxis in hematopoietic stem cell transplantation (HSCT). However, as posaconazole is not available in the public health system in Brazil, the most viable option remains voriconazole. Regarding IFI prophylaxis in solid organ transplantation (SOT), it was observed that there are variations depending on the transplanted target organ, and there is no evidence of its need in kidney transplantation. Although azoles are also the most used and bring clear benefits in liver and lung transplantation, some current studies have placed echinocandins on the same level, encouraging their use to prevent IFI in these patients. Conclusion: In the last five years, there has been a great shortage of clinical trials comparing different antifungal prophylaxis. New studies are needed to establish the most appropriate protocols for each condition and profile of the transplanted patient. Objective IFIs (IFIs 2 conducts Methods selected metaanalyses. metaanalyses meta analyses. analyses meta-analyses Results study HSCT. HSCT . (HSCT) However Brazil SOT, SOT , (SOT) level Conclusion patient (HSCT (SOT

Objective: To demonstrate the proportion of anemia and its association with demographic and clinical characteristics in a representative sample of elderly people from São José dos Campos, São Paulo. Methods: Demographic data and blood samples were collected from 398 over 65-year-old male and female individuals. Anemia was defined as hemoglobin concentration <12 g/dL in women and <13 g/dL in men. Anemic and non-anemic groups were compared using the chi-squared test and a multiple logistic regression model. Results: The prevalence of anemia was 18.6% (20.8% in men and 17.6% in women). The per- centages of anemia rose significantly across the age groups >75-80, >85-90 and >90-95 years (p-value = 0.0251). There were no significant differences in gender, ethnic background, place of residence, years of schooling, income, comorbidities and use of medications. Accord- ing to gender, the mean hemoglobin concentration and mean corpuscular volume were 11.5 g/dL (range: 8.4-11.9 g/dL) and 90.7 fL (range: 63.0-111.7 fL) for women and 11.9 g/dL (range: 8.6-12.8 g/dL) and 92.1 fL (range: 59.8-100.1 fL) for men. The great majority of ane- mia cases were mild with less than 6% having hemoglobin concentrations below 10.9 g/dL. Mean corpuscular volume was lower than 80 fL in six cases (8%), between 80 and 100 fL in 65 cases (88%) and higher than 100 fL in three cases (4%). Conclusion: A total of 18.6% of elderly people from São José dos Campos had mild anemia with the majority being normocytic. The percentages of anemia rose as the age increased demonstrating an association between age and anemia.

Objective: To evaluate trends in mortality among adults with myeloid leukemia in the Vale do Paraíba, State of São Paulo. Methods: Data from the Brazilian National Health Service database DATASUS provided the number of deaths caused by myeloid leukemia and the number of inhabitants per year in the Regional Health Division XVII from 1994 to 2011. Registries were categorized according to gender into four age ranges (over 20 years, 20-49, 50-69 and over 70 years) for an estimation of the annual percent change for age-adjusted mortality rates. The percent changes were calculated using the Joinpoint regression analysis model. Results: Overall, a significant decline per year was demonstrated for the entire sample (over 20 years) across the 18-year period studied (annual percent change: −5.59%; 95% CI: −8.5 to −2.5% for males; p-value < 0.05 and −7.02%; 95% CI −11.2 to −2.8% for females; p-value < 0.05) with no significant difference between genders. In an analysis using two Joinpoints, significant drops were observed from 1994 to 2001 (annual percent change: −21.22%; 95% confidence interval: −27.9 to −13.9%; p-value < 0.05) and from 1994 to 2003 (annual percent change: −12.86%; 95% confidence interval −22.2 to −2.5%; p-value < 0.05) for men and women, respectively. The declining trends were greatest for patients aged over 70 years with the age-adjusted mortality rates in younger groups declining non-significantly except for males aged 50-69 years old. Conclusion: Our data suggest a significant decline per year in age-adjusted mortality rates of adult patients diagnosed with myeloid leukemia from 1994 to 2011 in the Vale do Paraíba, State of São Paulo.

Objetivo: Identificar como centros de hematologia brasileiros trataram e diagnosticaram os casos de leucemia mieloide aguda no ano de 2009. Métodos: Estudo epidemiológico, observacional, multicêntrico de 11 centros brasileiros cadastrados para tratamento de leucemia mieloide aguda e transplante de medula óssea. Os dados foram coletados a partir de prontuários de pacientes com leucemia mieloide aguda tratados nos centros citados entre os anos de 2005 e 2009. Foi avaliada a disponibilidade para realização de exames de imunofenotipagem e citogenética nos centros estudados. Resultados: Foram diagnosticados 345 casos novos de leucemia mieloide aguda no ano de 2009. Observaram-se diferenças na realização de exames entre pacientes que iniciaram o tratamento no centro em relação àqueles referenciados para tratamento. Dos centros participantes, 72% realizaram algum tipo de pesquisa molecular em leucemia mieloide aguda ao diagnóstico. Conclusão: O tratamento da leucemia mieloide aguda no Brasil apresenta resultados muito inferiores quando comparado a outros centros mundiais.

Objective: To identify how the Brazilian hematology centers treated and diagnosed cases of acute myeloid leukemia in 2009. Methods: An epidemiological observational multicenter study of 11 listed Brazilian centers that treat acute myeloid leukemia and perform bone marrow transplantation. Data were collected from clinical charts of patients with acute myeloid leukemia treated at the said centers between 2005 and 2009. The availability for immunophenotyping and cytogenetic tests was assessed. Results: During 2009, a total of 345 new cases of acute myeloid leukemia were diagnosed. Differences were noted in the tests performed between patients who initiated treatment at the center and those referred for treatment. Of the participating centers, 72% conducted some type of molecular study in acute myeloid leukemia upon diagnosis. Conclusion: Treatment for acute myeloid leukemia in Brazil shows significantly inferior results when compared to other centers worldwide.

BACKGROUND: Based on the necessity of detailed information that supports effective strategies to improve cancer outcomes in the different regions of Brazil, the aims of this study were to report demographic aspects and to calculate the prevalence and incidence rates of oncohematological diseases in the region of Vale do Paraíba. METHODS: This is a multicentric prospective study carried out from October 2009 to March 2010. A total of 500 over 19-year-old patients were enrolled. Data such as type of healthcare insurance, gender, age, ethnic classification, place of residence, schooling, income, body mass index, new cases and the period between the first symptoms and a definite diagnosis were collected. The prevalence and incidence rates were calculated according to an estimated number of 1,319,800 inhabitants. RESULTS: The prevalence and incidence rates per 100,000 inhabitants in the period of six months were, respectively: acute myeloid leukemia 1.5 and 0.7; acute lymphoblastic leukemia 0.5 and 0.1; chronic lymphocytic leukemia 2.4 and 0.4; chronic myeloid leukemia 6.2 and 0.8; Hodgkin's lymphoma 2.9 and 0.9; non-Hodgkin lymphoma 9.8 and 4.3; multiple myeloma 5.7 and 0.7; myelodysplastic syndromes 2.1 and 0.2 and myeloproliferative syndromes 5.1 and 0.3. CONCLUSION: Giving the paucity of data in this field of investigation, our data may be useful for comparisons with those of other regions of Brazil and will assist in the implementation of treatment programs of oncohematological diseases in this region.

CONTEXTO E OBJETIVO: Variações geográficas têm sido demonstradas na leucemia mielóide aguda (LMA). No Brasil poucos estudos têm sido publicados nesta área. O objetivo foi demonstrar a alta prevalência do subtipo FAB M1 em adultos com LMA de novo em São José dos Campos, São Paulo. TIPO DE ESTUDO E LOCAL: Análise retrospectiva, no Hospital Pio XII de São José dos Campos, instituição pública e não ligada a universidade. MÉTODOS: Registros de 39 pacientes consecutivos com LMA de novo foram analisados de janeiro de 2002 até setembro de 2004. Lâminas de sangue periférico e da medula óssea sem identificação prévia foram analisadas por cinco hematologistas e classificadas de acordo com os critérios FAB. Taxas de remissão, de recaída, de mortalidade, de mortalidade de acordo com o período de tratamento, de sobrevivência e de sobrevivência livre de leucemia foram calculadas. RESULTADOS: A prevalência de cada categoria determinada por consenso entre os observadores foi M0: 0, M1: 43,6%, M2: 30,7%, M3: 12,8%, M4: -5,1%, M5: 2,6%, M6: 2,6% and M7: 2,6%. As taxas de remissão e de recaída foram de 82% e 41% respectivamente. A taxa de mortalidade foi de 69% (indução da remissão 7/39, 17.9%, pós-indução 10/32, 31,2% e de recaída 10/16, 62,5%). A taxa de sobrevivência foi de 30% e a taxa de sobrevivência livre de leucemia foi de 33%. CONCLUSÕES: O estudo demonstrou alta prevalência do subtipo FAB M1 em adultos com LMA de novo em São José dos Campos. Nossos resultados sugerem a ocorrência de diferentes prevalências de subtipos FAB nas regiões do Brasil.

CONTEXT AND OBJECTIVE: Geographical variations have been described in acute myelogenous leukemia (AML). In Brazil, few studies have been published on this. The aim of this study was to demonstrate the high prevalence of French-American-British (FAB) M1 subtype in adults with de novo AML in São José dos Campos, State of São Paulo, Brazil. DESIGN AND SETTING: Retrospective analysis, at Hospital Pio XII in São José dos Campos, a public non-teaching institution. METHODS: Records from 39 consecutive adult patients with de novo AML referred to Hospital Pio XII between January 2002 and September 2004 were reviewed. Peripheral blood and blood marrow smears were reviewed blindly by five hematologists and classified according to FAB criteria. The rates of remission, relapse, mortality according treatment phase, survival and leukemia-free survival were calculated. RESULTS: The prevalence of each category as determined via a consensus among five observers was M0: 0%; M1: 43.6%; M2: 30.7%; M3: 12.8%; M4: 5.1%; M5: 2.6%: M6: 2.6%; and M7: 2.6%. The remission and the relapse rates were 82% and 41% respectively. The mortality rate was 69% (induction of remission: 7/39, 17.9%; post induction: 10/32, 31.2%; and relapse: 10/16, 62.5%). The survival rate was 30% and leukemia-free survival was 33%. CONCLUSIONS: The study demonstrated a high prevalence of FAB M1 subtype in adults with de novo AML in São José dos Campos. Our data suggest the occurrence of different regional prevalences of FAB AML categories in Brazil.

Neste relato é apresentado um caso de LA bilineal, com expressão rara de marcadores da LLA comum e pré T, sendo descritos os aspectos clínicos citogenéticos e imunofenotípicos de um paciente masculino com 38 anos de idade.

In this case report the case of bilineal acute leukemia with a rare expression of common ALL and pre-T markers is presented. The cytogenetic and immunophenotypic clinical aspects of a 38-year-old male patient are described.

As reações transfusionais agudas ocorrem durante ou em um período de até 24 horas após a transfusão de hemocomponentes. O objetivo deste estudo foi descrever as principais reações transfusionais agudas em um serviço de hemoterapia brasileiro. Através de um formulário próprio contendo a idade e o sexo dos receptores, os hemocomponentes solicitados, as especialidades médicas envolvidas e os sinais e sintomas relacionados, os transfusionistas registraram os eventos durante a transfusão e até quatro horas após seu término. Colheram-se dados de 30 hospitais e clínicas atendidos pelo Serviço de Hematologia e Hemoterapia de São José dos Campos em um período de 90 dias. As reações agudas foram definidas como febril não hemolítica, alérgica, sobrecarga volêmica, TRALI, anafilática e metabólica. Em um total de 8378 transfusões, 46 reações foram registradas (5,5 por 1000 unidades transfundidas) sendo 28 do tipo febril não hemolítica, 12 do tipo alérgica, 5 do tipo anafilática 1 do tipo sobrecarga volêmica. Reações do tipo TRALI não foram observadas. 27 reações foram associadas com a transfusão de concentrado de hemácias, 11 com a transfusão de concentrado de plaquetas, 6 com a transfusão de plasma fresco congelado e 2 com a transfusão de concentrado de hemácias para recém-nascidos. Dentre os receptores com reações, a mediana das idades foi de 43 anos (3 meses a 83 anos) sendo 23 do sexo masculino e 23 do sexo feminino. 12 reações (26,1%) foram provenientes do setor de Oncologia, 12 (26,1%) do setor Clínica Médica e 7 do setor Unidade de Terapia Intensiva. Este estudo descreve as reações transfusionais agudas registradas em um período de tempo específico provenientes de um serviço de hemoterapia brasileiro.

Acute transfusion reactions have been found to occur during or within 24 hours of transfusion. The aim of this work is to describe the main characteristics of acute reactions reported in a Brazilian transfusion service. A preprinted report form was used to evaluate the age and sex of the transfusion recipients, blood component requested, medical specialty involved and transfusion-related signs and symptoms, transfusionists performed a direct observation during the transfusion and in a period of four hours following transfusion. Data were prospectively collected for 90 days from 30 hospitals and health facilities supplied by the the Service of Hematology and Hemotherapy of São José dos Campos. Acute reactions were recognized as febrile nonhemolytic, allergic, fluid overload, transfusion-related acute lung injury (TRALI), anaphylatic and metabolic reactions. In a total of 8,378 transfusions, 46 acute reactions were recorded (5.5 per 1000 units transfused, 28 febrile nonhemolytic, 12 allergic, 5 anaphylatic and 1 fluid overload). TRALI and metabolic reactions were not detected. The majority (27) was associated with RBCs followed by PLTs 11, FFP 6 and partial units 2. The median age of the recipients was 43 years (3 months to 83 years, 23 males and 23 females). Overall, 12 (26.1%) events were recorded in oncology, 12 (26.1%) in medicine and 7 in intensive care unit departments. This study provides baseline acute transfusion reaction information for a specific period of time in a Brazilian transfusion service.