Mauricio Ocqueteau T

Anemia en las embarazadas de la comuna de Puente Alto, Chile

Background: Micronutrient deficiencies, specially iron, render pregnant women as one of the most vulnerable groups to have anemia. Aim: To report the prevalence of anemia during pregnancy and its associated features in women attending public clinics in the Puente Alto County. Material and methods: We studied 1683 pregnant women aged 18 years old or more. Hemoglobin concentration was determined using the cianmetahemoglobin method. Anemia was defined using the 5th percentile cut-off for each week of gestational age as proposed by R Yip from the Centers of Disease Control, 1989. The influence of maternal age, parity, nutritional status classified using weight/height, diseases and smoking habits on hemoglobin concentration were analyzed using logistic regression with a stepwise procedure. Results: Thirteen percent of the study population was anemic. The single factor significantly associated with anemia was nutritional status. Twenty one percent of women with a low weight for height were anemic. Conclusions: These results support the concept that pregnant women with a low weight for height have the greatest risk for anemia and should be specially benefited with preventive or treatment programs to avoid this problem (Rev Med Chile 2003; 131: 520-525).

Leucemia de células natural killer: Caso clínico

Natural killer leukemia is a rare and highly aggressive neoplasm,is more common in young male patients and has a very poor prognosis, with a median survivalof few weeks. We report a 17 years old male patient who developed, after an acute upperrespiratory disease, a rapidly multiorganic failure with pancytopenia. Bone marrow aspirationand trephine biopsy showed an acute lymphoblastic leukemia. The immunophenotype andimmunohistochemistry revealed a natural killer acute leukemia. The disease progressed rapidlyand the patient died shortly after the diagnosis (Rev Med Chile 2005; 133: 457-60).(

Ajuste de intensidad para el trasplante hematopoyético alogénico en leucemia aguda

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 (n= 16). OS, 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.

Síndrome hemofagocítico adquirido: reporte de casos de cuatro pacientes adultos tratados con protocolo HLH 94-04 y revisión de la literatura

Hemophagocytic syndrome is a severe condition of excessive immune activation that has a high mortality in the absence of treatment. The syndrome is classified as primary if associated with congenital or hereditary problems, or secondary/acquired if associated with infectious, autoimmune or oncology diseases. We report four adult cases of the syndrome, one with viral, two with autoimmune and one with idiopathic causes who were successfully treated with HLH 94-04 chemotherapy protocol. Our experience shows that a high index of suspicion, early diagnosis and an opportune therapy are essential in the treatment of this disease.Hemophagocytic syndrome is a severe condition of excessive immune activation that has a high mortality in the absence of treatment. The syndrome is classified as primary if associated with congenital or hereditary problems, or secondary/acquired if associated with infectious, autoimmune or oncology diseases. We report four adult cases of the syndrome, one with viral, two with autoimmune and one with idiopathic causes who were successfully treated with HLH 94-04 chemotherapy protocol. Our experience shows that a high index of suspicion, early diagnosis and an opportune therapy are essential in the treatment of this disease.

Trasplante con precursores hematopoyéticos de cordón umbilical en adultos con neoplasias hematológicas en Chile: Serie clínica

Hematopoietic precursors transplantation is a therapeutic alternative for leukemia, some metabolic diseases and some immune deficiency syndromes. In its allogeneic variety leukemia eradication is based in the conditioning prior to transplantation and the allogran effect against leukemia. Umbilical cord blood is an alternative source of hematopoietic precursors when there are no HLA compatible relatives available. Between 2003 and 2007 we have performed five umbilical cord blood transplant in adult patients in a University hospital. All patients had malignant diseases. Conditioning protocols were ablative in all except in one patient and in all, more than one unit of umbilical cord blood was used. Hematopoietic engraftment was confirmed in all patients and the main complications registered were infectious and associated to immunosuppression.

Tratamiento de anemia aplásica severa adquirida en pacientes pediátricos con inmunosupresión y trasplante alogénico de precursores hematopoiéticos

Severe acquired aplastic anemia (SAA) is an uncommon disease of childhood. Patients with SAA receive supportive care with transfusions and timely treatment of opportunistic infections, along with specific therapies, which may be allogenic stem cell transplantation (SCT) from a matched sibling or immunosupressive therapy (IT). Aim: To report the experience in the management of SAA. Patients and methods: Twenty five children with acquired SAA were treated from July 1992 to September 2005. Patients with full matched sibling donors received allogenic SCT after conditioning with a cyclophosphamide containing regimen. The other patients received immune suppression with cyclosporine plus methylprednisolone (n= 18) plus ATG (n=17). All received supportive care until recovery of hematopoietic function. Those who had severe opportunistic infections at diagnosis or did not respond to two cycles of ATG were evaluated for unrelated donor SCT. Results: Seven patients received sibling donor SCT and 18 IT, which was repeated in six. Three patients received mismatched related (1) or unrelated (2) SCT. Nineteen patients survived with a median follow up time of 4 years, 14 with full hematologic recovery. Six patients died: four due to infections after IT or SCT, one due to intracranial hemorrhage and one with secondary myelodysplasia 12 years after IT. Conclusions: Most children with SAA can be treated successfully with sibling donor SCT or IT. Patients without a histocompatible sibling who fail to respond to IS have a worse prognosis

Resultados a largo plazo del tratamiento con quimioterapia y radioterapia en linfoma no Hodgking localizado, de grados intermedio y alto

Treatment of intermediate and high grade non-Hodgkin lymphoma (NHL) includes chemotherapy with or without radiotherapy, depending on theclinical stage. The standard treatment for advanced NHL is 8 cycles of combined chemotherapy,cyclophosphamide, adriamicin, vincristine and prednisone (CHOP). Patients presenting with localizeddisease are treated with fewer chemotherapy cycles and involved field radiotherapy, with good results.