Sérgio Costa Fortier

Faculdade de Ciências Médicas da Santa Casa de São Paulo

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Carlos Chiattone

Hospital Samaritano de São Paulo

Talita Silveira

Faculdade de Ciências Médicas da Santa Casa de São Paulo

Valéria Buccheri

Instituto do Câncer do Estado de São Paulo

Juliane Morando

Bristol-Myers Squibb (United States)

José Zanis Neto

Universidade Federal do Paraná

Carmem Bonfim

Hospital de Clínicas Universidade Federal do Paraná

Mihoko Yamamoto

Fundação de Apoio à Universidade Federal de São Paulo

Ricardo Pasqüini

Hospital de Clínicas Universidade Federal do Paraná

Verena Pfister

Universidade Federal de São Paulo

V.L.P. Figueiredo

Hospital do Servidor Público Municipal

Cooperative Institutions

D’Or Institute for Research and Education

Universidade Federal do Paraná

Universidade de São Paulo

Universidade Federal de São Paulo

Hospital de Clínicas Universidade Federal do Paraná

Hospital São Paulo

Faculdade de Ciências Médicas da Santa Casa de São Paulo

Universidade Federal do Rio de Janeiro

Inserm

Universidade Federal do Ceará

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Transplante de células-tronco hematopoéticas em crianças e adolescentes com leucemia aguda: experiência de duas instituições brasileiras

Revista Brasileira de Hematologia e Hemoterapia (2010)

Juliane Morando Marcos Augusto Mauad Sérgio Costa Fortier Flávia Zattar Piazera Mair Pedro de Souza

10.1590/s1516-84842010005000093

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Citations (2)

Lower access to risk stratification tests and drugs, and worse survival of chronic lymphocytic leukaemia patients treated in public as compared to private hospitals in Brazil: A retrospective analysis of the Brazilian registry of chronic lymphocytic leukaemia

eJHaem (2022)

Verena Pfister Fernanda de Morais Marques Flavia Parra Mihoko Yamamoto Matheus Vescovi Gonçalves

Abstract Chronic lymphocytic leukaemia (CLL) has a highly variable clinical course. In addition to biological factors, socioeconomic factors and health system characteristics may influence CLL outcome. Data from the Brazilian Registry of CLL were analyzed to compare clinical and treatment‐related characteristics in patients with CLL, from public or private institutions. A total of 3326 patients from 43 centres met the eligibility criteria, of whom 81% were followed up at public hospitals and 19% at private hospitals. The majority were male (57%), with a median age of 65 years. Comparing public and private hospitals, patients in public hospitals were older, had more advanced disease at diagnosis, and more frequently had elevated creatinine levels. All investigated prognostic markers were evaluated more often in private hospitals. First‐line treatment was predominantly based on chlorambucil in 41% of the cases and fludarabine in 38%. Anti‐CD20 monoclonal antibody was used in only 36% of cases. In public hospitals, significantly fewer patients received fludarabine‐based regimens and anti‐CD20 monoclonal antibodies. Patients from public hospitals had significantly worse overall survival (71% vs. 90% for private hospitals, p < 0.0001) and treatment‐free survival (32% vs. 40%, for private hospitals, p < 0.0001) at seven years. Our data indicate striking differences between patients followed in public and private hospitals in Brazil. A worse clinical condition and lack of accessibility to basic laboratory tests and adequate therapies may explain the worse outcomes of patients treated in public institutions.

Chlorambucil

10.1002/jha2.444

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Everolimus as a single agent in refractory or relapsed Hodgkin's lymphoma: the Brazilian Named Patient Program Experience

Revista Brasileira de Hematologia e Hemoterapia (2017)

Talita Silveira Sérgio Costa Fortier Thaís Fischer Guilherme Fleury Perini Rafael Dezen Gaiolla

Despite all the scientific progress that has been made on understanding the disease, prognosis for patients with relapsed and refractory Hodgkin's lymphoma remains poor and the treatment is palliative in the majority of the cases. Thus, the aim of this study was to present the results on the compassionate use of everolimus in a group of patients who were monitored at nine different centers in Brazil.A 10-mg oral dose of everolimus was given to each patient daily. Response time was evaluated from the beginning of medication use until loss of response, toxicity or medical decision to cease treatment.Thirty-three patients were evaluated. The median age at the beginning of medication administration was 29 years. Patients had received a median of five prior therapies. Overall response rate was 45.4%, with 13 patients achieving partial response, two achieved clinical response, 14 remained with stable disease, two had disease progression, and two were not evaluated. Patients received a median of 14 cycles. Progression-free survival was nine months, and overall survival was estimated to be 36 months. Three patients used the medication for more than four years. The most frequently reported adverse events were thrombocytopenia and hypercholesterolemia. Three patients had pulmonary toxicity. Grade III and IV adverse events occurred in 39% of the patients.Everolimus was found to provide a response in a group of patients with refractory or relapsed Hodgkin's lymphoma who had adequate tolerability to the drug.

Everolimus

Tolerability

Refractory (planetary science)

Progression-free survival

10.1016/j.bjhh.2017.03.008

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Toxoplasma Gondii Infection In 34 pts Submitted To Hematopoietic Stem Cell Transplantation: Analysis From A Single Institution

Biology of Blood and Marrow Transplantation (2010)

R. Vasconcelos Sérgio Costa Fortier Clóvis Arns da Cunha F.Z. Piazzera Juliane Morando

prophylaxis.Here we report the combined, updated results from a consecutive case-series of 58 patients with MDS who underwent RI-HCT from 2000 to 2008 and received either CSA/ MMF (n 5 29) or FK/SIR (n 5 29)-based GVHD prophylaxis.All patients received Flu 125 mg/m 2 and Mel 140 mg/m 2 followed by allogeneic HCT (PBSC: n 5 52, BM: n 5 6) from an HLA-identical sibling (SIB: n 5 21) or unrelated donor (MUD: n 5 37).For MUD transplants a short course of methotrexate was added to CSA/MMF or FK/SIR.The median age was 53.5 years (range: 20-71).Diagnoses at transplant were RA (n 5 21), RARS (n 5 1), and RAEB/RAEBT (n 5 36).Cytogenetic risk was low in 15, intermediate in 20, high in 23 patients.By IPSS criteria, two had low, 24 had int-1, 20 had int-2, and 12 had high-risk MDS.Fifteen patients had therapy-related MDS and 13 had a prior autologous HCT.The baseline patient and transplant characteristics were similar between CSA/MMF and FK/SIR except for more mismatch transplants in FK/SIR (34% vs. 10%, p 5 0.02).The median follow-up for surviving patients was 38 months (range: 24-68) for the CSA/MMF group and 16 months (range: 4-39) for the FK/SIR group.All but two patients engrafted with the median neutrophil recovery at 15 days (range: 11-39).The 2-year disease-free survival (DFS), relapse, and non-relapse mortality (NRM) for the entire cohort were 63% (54-70%), 12% (6-24%), and 26% (19-36%), respectively.By univariate analysis, there was a trend for improved DFS in FK/SIR (79% at 1 year) compared with CSA/MMF (55%, p 5 0.1).When adjusted for mismatch transplants in multivariate analysis, the use of FK/SIR was significantly associated with improved DFS ], p 5 0.01), attributable to reduced NRM with FK/SIR (HR 5 6.14 [CI: 1.5-26.1],P 5 0.01).While we observed no significant difference in grade II-IV acute GVHD between the two groups, there was a significant reduction in grade IV GVHD in FK/SIR (0% versus 26%, p\ 0.01).In conclusion, RI-HCT is associated with a promising long-term result in MDS with improved outcomes using FK/ SIR-based GVHD prophylaxis.

10.1016/j.bbmt.2009.12.356

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NKG2A Expression among CD8 Cells Is Associated with COVID-19 Progression in Hypertensive Patients: Insights from the BRACE CORONA Randomized Trial

Journal of Clinical Medicine (2022)

Renata Moll-Bernardes Sérgio Costa Fortier Andréa Silvestre de Sousa Renato D. Lópes Narendra Vera

Cardiovascular comorbidities and immune-response dysregulation are associated with COVID-19 severity. We aimed to explore the key immune cell profile and understand its association with disease progression in 156 patients with hypertension that were hospitalized due to COVID-19. The primary outcome was progression to severe disease. The probability of progression to severe disease was estimated using a logistic regression model that included clinical variables and immune cell subsets associated with the primary outcome. Obesity; diabetes; oxygen saturation; lung involvement on computed tomography (CT) examination; the C-reactive protein concentration; total lymphocyte count; proportions of CD4+ and CD8+ T cells; CD4/CD8 ratio; CD8+ HLA-DR MFI; and CD8+ NKG2A MFI on admission were all associated with progression to severe COVID-19. This study demonstrated that increased CD8+ NKG2A MFI at hospital admission, in combination with some clinical variables, is associated with a high risk of COVID-19 progression in hypertensive patients. These findings reinforce the hypothesis of the functional exhaustion of T cells with the increased expression of NKG2A in patients with severe COVID-19, elucidating how severe acute respiratory syndrome coronavirus 2 infection may break down the innate antiviral immune response at an early stage of the disease, with future potential therapeutic implications.

Immune Dysregulation

10.3390/jcm11133713

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Citations (8)

Comparison of Clinical and Laboratory Features, Drug Availability, and Outcomes of CLL Patients Treated in Public or in Private Hospitals in Brazil: A Retrospective Analysis of the Brazilian Registry of CLL

Blood (2020)

Verena Pfister Fernanda de Morais Marques Flavia Parra Mihoko Yamamoto Rodrigo Santucci Silva

10.1182/blood-2020-142520

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Citations (1)

Transplante de células-tronco hematopoéticas em crianças e adolescentes com leucemia aguda: experiência de duas instituições Brasileiras

Revista Brasileira de Hematologia e Hemoterapia (2010)

Juliane Morando Marcos Augusto Mauad Sérgio Costa Fortier Flávia Zattar Piazera Mair Pedro de Souza

O transplante de células-tronco hematopoéticas (TCTH) é o tratamento de escolha para leucemias agudas de alto risco. Apesar da melhora na sobrevida destes pacientes, a recidiva continua sendo a maior causa de óbito pós-transplante de células-tronco hematopoéticas. O objetivo deste trabalho foi analisar os resultados dos transplantes realizados em crianças com leucemia aguda em duas instituições brasileiras. Realizou-se estudo retrospectivo de 208 pacientes transplantados entre 1990-2007. Mediana de idade: 9 anos; 119 pacientes com leucemia linfoide aguda (LLA) e 89 com leucemia mieloide aguda (LMA). Doença precoce: CR1 e CR2. Doença avançada: >CR3, doença refratária ou recidivada. Noventa pacientes vivos entre 258-6.068 dias (M:1.438), com sobrevida global (SG) de 45% (3 anos) e a sobrevida livre de recaída (SLR) 39% (três anos). 14/195 pacientes tiveram falha primária de pega (8%). Não houve diferença na sobrevida global e sobrevida livre de recaída entre pacientes com leucemia linfoide aguda e leucemia mieloide aguda, entre transplantes aparentados e não aparentados, tampouco entre as fontes de células utilizadas. O desenvolvimento da doença do enxerto contra hospedeiro (DECH) aguda ou crônica também não influenciou a sobrevida global e sobrevida livre de recaída. Pacientes com leucemia linfoide aguda condicionados com irradiação corporal total (TBI) apresentaram melhor sobrevida global e sobrevida livre de recaída (p<0,001). Cento e dezoito pacientes morreram entre 1-1.654 dias pós-transplante de células-tronco hematopoéticas (M:160). Mortalidade relacionada a transplante (MRT) (dia+100): 16%. Incidência cumulativa de recaída: 40% (3 anos). Pacientes com doença avançada tiveram menor sobrevida global e sobrevida livre de recaída (três anos)(p<0,001). Na análise multivariada, o status da doença foi o principal fator associado ao aumento da sobrevida global e sobrevida livre de recaída. Nossos resultados mostram que é possível se atingir uma boa sobrevida para pacientes com doença precoce e também mostram a baixa eficácia naqueles com doença avançada.

10.1590/s1516-84842010000500006

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Citations (4)

Análise retrospectiva dos pacientes infectados por RSV na unidade de transplante de medula óssea RSV infection after allogeneic hematopoietic stem cell transplantation (HSCT): analysis of 59 patients transplanted in a single institution

DOAJ (DOAJ: Directory of Open Access Journals) (2009)

Flávia Zattar Piazera Sérgio Costa Fortier Juliane Morando Carmem Bonfim Rodney F. Silva

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New Insights on the Mechanisms of Myocardial Injury in Hypertensive Patients With COVID-19

Journal of Clinical Immunology (2023)

Renata Moll-Bernardes Juliana R. Ferreira Eduardo B. Schaustz Andréa Silvestre de Sousa João D. Mattos

Immune Dysregulation

CD4-CD8 Ratio

10.1007/s10875-023-01523-6

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Citations (3)

WITHDRAWN: Evaluation of C-reactive protein and its prognostic relationship in patients with Hodgkin's Lymphoma

Hematology Transfusion and Cell Therapy (2024)

E Negreiros Talita Silveira Sérgio Costa Fortier Carlos Chiattone

To assess the prognostic value of C-Reactive Protein (CRP), at diagnosis and during follow-up, of patients with Hodgkin´s Lymphoma treated at the Hematology Service of the Santa Casa de São Paulo Hospital, and to correlate serum CRP levels with disease stage and treatment response. A retrospective study involving review of 71 medical records of patients diagnosed with Hodgkin´s Lymphoma between February 2012 and January 2016 was performed. Three patients were subsequently excluded, giving a total of 68 patients for analysis. A level of CRP > 1mg/dl was considered elevated. Patients were predominantly male (61.8%) and mean age was 34 years. Fifty-three (78%) patients had advanced stage and (76.5%) had B symptoms. Elevated baseline CRP was associated with greater likelihood of B symptoms (p= 0.02) and of advanced stage (p= 0.015). Patients with Low CRP level after 5th and 6th cycles of chemotherapy was associated with complete response (p=0.04 and p=0.03, respectively). Treatment-refractory patients had greater risk of death (p=0.002). CRP is clinically important for follow-up of patients with Hodgkin´s Lymphoma, where high levels were associated with advanced disease and/or presence of B symptoms. CRP level was considered a predictor of treatment response. Persistence of high CRP values during treatment was associated with refractoriness.

Refractory (planetary science)

B symptoms

Medical record

Hematology

10.1016/j.htct.2023.11.011

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