Mario Sérgio Fernandes

Estimated number of cases, regional distribution and survival of patients diagnosed with acute myeloid leukemia between 1996 and 2000 in Rio Grande do Sul, Brazil

Rio Grande do Sul (RS), in South Brazil, with about 10 million inhabitants, is known for its agricultural activities and consequent increased human exposure to toxic agents. Patients with de novo acute myeloid leukemia (AML) were included based on information retrieved from all referral hospitals in RS between 1996 and 2000. A total of 532 patients were registered. Median age at diagnosis was 42 years. The estimated annual incidence was 1.11 cases/100 000 inhabitants/year. There was an estimated incidence of 0.5 – 1 case per 100 000 inhabitants up to the age of 45 years, and of 3.5 cases per 100 000 inhabitants aged 70 years and older, with no geographical clusters. The mean 5-year survival rate was 17% for all cases. There was an increased number of M3 cases, as already described for individuals of Latin-American and the mortality rate was similar to that described in the literature.

Imunossupressão com ciclofosfamida e fludarabina, com suporte de células tronco hematopoéticas autólogas CD-34+, para tratamento de esclerose sistêmica severa

Immune ablation of T lymphocytes, key players in the physiopathogenic processes leading to autoimmune diseases, may arrest scleroderma progression even in some severely ill patients. High-dose chemotherapy followed by autologous stem cell reinfusion - sometimes named peripheral blood stem cell transplantation - has been an effective therapy for some autoimmune diseases, including scleroderma. In this paper the authors present a patient with the diffuse form of scleroderma who received immunosuppression with cyclophosphamide 0.5 g/m² and fludarabine followed by infusion of autologous CD-34+ cells without T lymphocyte purging. This patient was followed up with cutaneous score measures, imaging and laboratory tests, as well as a well-being questionnaire. After transplantation there were major positive responses on skin and gastrointestinal tract, with cessation of diarrhea and malabsorption syndrome. These clinical improvements did not last past 6 months. We observed transitory stem cell transfusion reaction and localized herpes zoster. The patient died 12 months after the procedure due to aspirative pneumonia and gastrointestinal complications. The immunosuppressive regimen, and not the autologous stem cell transplantation, could have been responsible for the observed transitory patient improvement.