JULIANA FOLLONI FERNANDES
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- Hematopoietic Stem Cell Transplantation for Chronic Granulomatous Disease in a Single Institution in Brazil. Reproducing Good Results with a Reduced Toxicity Regimen(2017) FERNANDES, Juliana Folloni; MANTOVANI, Luiz Fernando Alves Lima; VENANCIO, Angela Mandelli; DORNA, Mayra; PASTORINO, Antonio Carlos; VASCONCELOS, Dewton; NETO, Antonio Condino; MOURA, Ana Carla Augusto; COLLASSANTI, Maria Dulce; ZANICHELLI, Maria Aparecida; CARNEIRO-SAMPAIO, Magda; ROCHA, Vanderson G.; ODONE FILHO, Vicente
- Age-associated phenotypic imbalance in TCD4 and TCD8 cell subsets: comparison between healthy aged, smokers, COPD patients and young adults(2022) FERNANDES, Juliana Ruiz; PINTO, Thalyta Nery Carvalho; ARRUDA, Lia Barbara; SILVA, Cibele Cristine Berto Marques da; CARVALHO, Celso Ricardo Fernandes de; PINTO, Regina Maria Carvalho; DUARTE, Alberto Jose da Silva; BENARD, GilBackground COPD is associated with an abnormal lung immune response that leads to tissue damage and remodeling of the lung, but also to systemic effects that compromise immune responses. Cigarette smoking also impacts on innate and adaptative immune responses, exerting dual, pro- and anti-inflammatory effects. Previously, we showed that COPD patients presented accelerated telomere shortening and decreased telomerase activity, while, paradoxically, cigarette-smokers exhibited preserved telomerase activity and slower rate of telomere shortening. Results Here, we evaluated the naive, CM, EM and T-EMRA subsets of TCD4 and TCD8 cells according to the expression of CCR7/CD45RA. We compared age-matched COPD patients, cigarette-smokers without clinical-laboratory evidence of pulmonary compromise, and healthy individuals. They were additionally compared with a group of young adults. For each subset we analysed the expression of markers associated with late differentiation, senescence and exhaustion (CD27/CD28/CD57/KLRG1/PD1). We show that COPD patients presented a drastically reduced naive cells pool, and, paradoxically, increased fractions of naive cells expressing late differentiation, senescence or exhaustion markers, likely impacting on their immunocompetence. Pronounced phenotypic alterations were also evidenced in their three memory T-cell subsets compared with the other aged and young groups, suggesting an also dysfunctional memory pool. Surprisingly, our smokers showed a profile closer to the Healthy aged than COPD patients. They exhibited the usual age-associated shift of naive to EM TCD4 and TCD8 cells, but not to CM or T-EMRA T-cells. Nonetheless, their naive T-cells phenotypes were in general similar to those of the Youngs and Healthy aged, suggesting a rather phenotypically preserved subset, while the memory T-cells exhibited increased proportions of cells with the late-differentiation or senescence/exhaustion markers as in the Healthy aged. Conclusion Our study extends previous findings by showing that COPD patients have cells expressing a full range of late differentiated, senescent or exhausted phenotypes encompassing all TCD4 and TCD8 subsets, consistent with a premature immunosenescence phenotype. Surprisingly, the smokers group's results suggest that moderate to heavy chronic cigarette smoking did not accelerate the pace of immunosenescence as compared with the Healthy aged.
- Umbilical Cord Mesenchymal Stromal Cells for Steroid-Refractory Acute Graft-versus-Host Disease(2023) DONADEL, Camila Derminio; PIRES, Bruno Garcia; ANDRE, Nathalia Cristine; COSTA, Thalita Cristina Mello; ORELLANA, Maristela Delgado; CARUSO, Samia Rigotto; SEBER, Adriana; GINANI, Valeria Cortez; GOMES, Alessandra Araujo; NOVIS, Yana; BARROS, George Mauricio Navarro; VILELLA, Neysimelia Costa; MARTINHO, Glaucia Helena; VIEIRA, Ana Karine; KONDO, Andrea Tiemi; HAMERSCHLAK, Nelson; FILHO, Jayr Schmidt; XAVIER, Erick Menezes; FERNANDES, Juliana Folloni; ROCHA, Vanderson; COVAS, Dimas Tadeu; CALADO, Rodrigo Tocantins; GUERINO-CUNHA, Renato Luiz; SANTIS, Gil Cunha DeBackground: Steroid-refractory acute graft-vs.-host disease (SR-aGVHD) is a complication of allogeneic hematopoietic stem cell transplantation with a dismal prognosis and for which there is no consensus-based second-line therapy. Ruxolitinib is not easily accessible in many countries. A possible therapy is the administration of mesenchymal stromal cells (MSCs). Methods: In this retrospective study, 52 patients with severe SR-aGVHD were treated with MSCs from umbilical cord (UC-MSCs) in nine institutions. Results: The median (range) age was 12.5 (0.3-65) years and the mean +/- SD dose (x10(6)/kg) was 4.73 +/- 1.3 per infusion (median of four infusions). Overall (OR) and complete response (CR) rates on day 28 were 63.5% and 36.6%, respectively. Children (n = 35) had better OR (71.5% vs. 47.1%, p = 0.12), CR (48.6% vs. 11.8%, p = 0.03), overall survival (p = 0.0006), and relapse-free survival (p = 0.0014) than adults (n = 17). Acute adverse events (all of them mild or moderate) were detected in 32.7% of patients, with no significant difference in children and adult groups (p = 1.0). Conclusions: UC-MSCs are a feasible alternative therapy for SR-aGVHD, especially in children. The safety profile is favorable.
- Allogeneic Hematopoietic Stem Cell Transplantation for Children and Adolescents with Acute Myeloid Leukemia in Brazil: A Multicentric Retrospective Study(2020) RODRIGUES, Ana Luiza de Melo; BONFIM, Carmem; SEBER, Adriana; COLTURATO, Vergilio Antonio Rensi; ZECCHIN, Victor Gottardello; NICHELE, Samantha; DAUDT, Liane Esteves; FERNANDES, Juliana Folloni; VIEIRA, Ana Karine; DARRIGO JUNIOR, Luiz Guilherme; GOMES, Alessandra Araujo; ARCURI, Leonardo; LENZI, Luana; PICHARSKI, Gledson Luiz; RIBEIRO, Raul Correa; FIGUEIREDO, Bonald Cavalcante deThe survival rates of children with high-risk acute myeloid leukemia (AML) treated with hematopoietic stem cell transplant (HSCT) range from 60% to 70% in high-income countries. The corresponding rate for Brazilian children with AML who undergo HSCT is unknown. We conducted a retrospective analysis of 114 children with AML who underwent HSCT between 2008 and 2012 at institutions participating in the Brazilian Pediatric Bone Marrow Transplant Working Group. At transplant, 38% of the children were in first complete remission (CR1), 37% were in CR2, and 25% were in CR3+ or had persistent disease. The donors included 49 matched-related, 59 matched-unrelated, and six haploidentical donors. The most frequent source of cells was bone marrow (69%), followed by the umbilical cord (19%) and peripheral blood (12%). The 4-year overall survival was 47% (95% confidence interval [CI] 30%-57%), and the 4-year progression-free survival was 40% (95% CI 30%-49%). Relapse occurred in 49 patients, at a median of 122 days after HSCT. There were 65 deaths: 40 related to AML, 19 to infection, and six to graft versus host disease. In conclusion, our study suggests that HSCT outcomes for children with AML in CR1 or CR2 are acceptable and that this should be considered in the overall treatment planning for children with AML in Brazil. Therapeutic standardization through the adoption of multicentric protocols and appropriate supportive care treatment will have a significant impact on the results of HSCT for AML in Brazil and possibly in other countries with limited resources.
conferenceObject Development of BK Virus-Associated Hemorrhagic Cystitis (HC) Is Associated with Decreased Survival Post-Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT)(2012) BAUTZER, Vivien; SANTOS, Fernanda N. C.; OLIVEIRA, Erika A. F.; MACEDO, Erika Maria; KERBAUY, Fabio R.; KUTNER, Jose Mauro; FERNANDES, Juliana F.; RIBEIRO, Andreza Alice Feitosa; CAMPREGHER, Paulo Vidal; RODRIGUES, Morgani; SOBRINHO, Jairo; ODONE, Vicente; BOLLMANN, Patricia; HAMERSCHLAK, Nelson; SANTOS, Fabio P. S.- Radiological patterns of pulmonary fungal infection in pediatric hematology and oncology patients(2022) BAIN, Vera; BARRIENTOS, Anna Carlota Mott Galvão de Arruda; SUZUKI, Lisa; OLIVEIRA, Luiz Antonio Nunes de; LITVINOV, Nadia; PERON, Karina Rodrigues; FERNANDES, Juliana Folloni; MARQUES, Heloisa Helena de SousaAbstract Objective: To describe the radiological findings in pediatric patients with hematological or oncological diseases who also have an invasive fungal infection (IFI). Materials and Methods: This was a retrospective study of all patients with IFI admitted to a pediatric hematology and oncology hospital in Brazil between 2008 and 2014. Clinical and demographic data were collected. Chest computed tomography (CT) scans of the patients were reviewed by two independent radiologists. Results: We evaluated the chest CT scans of 40 pediatric patients diagnosed with an IFI. Twenty-seven patients (67.5%) had nodules with the halo sign, seven (17.5%) had cavities, two (5.0%) had nodules without the halo sign, and seven (17.5%) had consolidation. The patients with the halo sign and cavities were older (123 vs. 77 months of age; p = 0.03) and had less severe disease (34% vs. 73%; p = 0.04). Ten patients had a proven IFI: with Aspergillus sp. (n = 4); with Candida sp. (n = 5); or with Fusarium sp. (n = 1). Conclusion: A diagnosis of IFI should be considered in children and adolescents with risk factors and abnormal CT scans, even if the imaging findings are nonspecific.
- Haploidentical Donor Hematopoietic Stem Cell Transplantation with Post-Transplantation Cyclophosphamide for Relapsed/Refractory Severe Aplastic Anemia(2020) ARCURI, Leonardo Javier; NABHAN, Samir Kanaan; CUNHA, Renato; NICHELE, Samantha; RIBEIRO, Andreza Alice Feitosa; FERNANDES, Juliana Folloni; DAUDT, Liane Esteves; RODRIGUES, Ana Luiza Melo; ARRAIS-RODRIGUES, Celso; SEBER, Adriana; ATTA, Elias Hallack; OLIVEIRA, Jose Salvador Rodrigues de; FUNKE, Vaneuza Araujo Moreira; LOTH, Gisele; DARRIGO JUNIOR, Luiz Guilherme; PAZ, Alessandra; CALIXTO, Rodolfo Froes; GOMES, Alessandra Araujo; ARAUJO, Carlos Eduardo Sa; COLTURATO, Vergilio; SIMOES, Belinda Pinto; HAMERSCHLAK, Nelson; FLOWERS, Mary Evelyn; PASQUINI, Ricardo; ROCHA, Vanderson; BONFIM, CarmemSevere aplastic anemia (SAA) is a life-threatening disease that can be cured with allogeneic cell transplantation (HCT). Haploidentical donor transplantation with post-transplantation cyclophosphamide (haplo-PTCy) is an option for patients lacking an HLA-matched donor. We analyzed 87 patients who underwent haplo-PTCy between 2010 and 2019. The median patient age was 14 years (range, 1 to 69 years), most were heavily transfused, and all received previous immunosuppression (25% without antithymocyte globulin). Almost two-thirds (63%) received standard fludarabine (Flu)/cyclophosphamide (Cy) 29/total body irradiation (TBI) 200 cGy conditioning, and the remaining patients received an augmented conditioning: Flu/Cy29/TBI 300-400 (16%), Flu/Cy50/TBI 200 (10%), or Flu/Cy50/TBI 400 (10%). All patients received PTCy-based graft-versus-host disease (GVHD) prophylaxis. Most grafts (93%) were bone marrow (BM). The median duration of follow-up was 2 years and 2 months. The median time to neutrophil recovery was 17 days. Primary graft failure occurred in 15% of the patients, and secondary or poor graft function occurred in 5%. The incidences of grade II-IV acute GVHD was 14%, and that of chronic GVHD was 9%. Two-year overall survival and event-free survival (EFS) were 79% and 70%, respectively. EFS was higher for patients who received augmented Flu/Cy/TBI (hazard ratio [HR], .28; P = .02), and those who received higher BM CD34 cell doses (3.2 10E6/kg) (HR, .29; P = .004). The presence of donor-specific antibodies before HSCT was associated with lower EFS (HR, 3.92; P = .01). Graft failure (HR, 7.20; P < .0001) was associated with an elevated risk of death. Cytomegalovirus reactivation was frequent (62%). Haploidentical HCT for SAA is a feasible procedure; outcomes are improved with augmented conditioning regimens and BM grafts with higher CD34 cell doses. (C) 2020 American Society for Transplantation and Cellular Therapy.
- Associacao Brasileira de Hematologia, Hemoterapia e Terapia Celular Consensus on genetically modified cells. II: CAR-T cell therapy for patients with CD19+ acute lymphoblastic leukemia(2021) SEBER, Adriana; CASTRO JUNIOR, Claudio Galvao de; KERBAUY, Lucila N.; V, Alexandre Hirayama; BONFIM, Carmem; FERNANDES, Juliana Folloni; SOUZA, Mair; SCHAFELL, Rony; NABHAN, Samir; LOGGETTO, Sandra Regina; SIMOES, Belinda Pinto; ROCHA, Vanderson; LIMA, Marcos de; GUERINO-CUNHA, Renato L.; BITTENCOURT, HenriqueChimeric antigen receptor T (CAR-T) cell therapy is a novel therapeutic modality for acute lymphoblastic leukemia (ALL) with robust outcomes in patients with refractory or relapsed disease. At the same time, CAR-T cell therapy is associated with unique and potentially fatal toxicities, such as cytokine release syndrome (CRS) and neurological toxicities (ICANS). This manuscript aims to provide a consensus of specialists in the fields of Hematology Oncology and Cellular Therapy to make recommendations on the current scenario of the use of CAR-T cells in patients with ALL. (C) 2021 Published by Elsevier Espana, S.L.U. on behalf of Associacao Brasileira de Hematologia, Hemoterapia e Terapia Celular.