ALESSANDRA ARAUJO GOMES

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Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • article 3 Citação(ões) na Scopus
    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 de
    The 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.
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    Outcomes and Immune Reconstitution After T-Cell Replete Haploidentical Stem Cell Transplantation With Post-Transplantation Cyclophosphamide (PTCY) for Pediatric Patients with Primary Immunodeficiencies
    (2020) FERNANDES, Juliana Folloni; NICHELE, Samantha; ARCURI, Leonardo Javier; RIBEIRO, Lisandro; NETTO, Gabriele Zamperlini; LOTH, Gisele; RODRIGUES, Ana Luiza Melo; KUWAHARA, Cilmara; KOLISKI, Adriana; GARCIA, Julia Lopes; DAUDT, Liane Esteves; SEBER, Adriana; GOMES, Alessandra Araujo; HAMERSCHLAK, Nelson; BONFIM, Carmem
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    LONG TERM COMPLICATIONS IN CHILDREN TREATED FOR ADVANCED NEUROBLASTOMA
    (2012) HALLEY, Nathalia; CRISTOFANI, Lilian Maria; ALMEIDA, Maria Teresa Assis; MALUF-JUNIOR, Paulo Taufi; CORNACCHIONI, Ana Lucia Beltrati; TEIXEIRA, Roberto Augusto Plaza; ZAMPERLINI-NETO, Gabriele; GOMES, Alessandra Araujo; ODONE-FILHO, Vicente
    Purpose: Advanced neuroblastoma (stage 3 and 4) requires aggressive treatment, including surgery, chemo and radiotherapy and autologous bone marrow transplantation. Although long term survival rates are disappointing, those children who survive are prone to develop long term complications. Our aim is to report the long term complications rate and quality in children treated for stage 3 and 4 neuroblastoma. Methods: The charts of stage 3 and 4 children with neuroblastoma treated from January/1983 through October/2003 were reviewed and those surviving and with no evidence of disease for more than 5 years were selected. Late effects were classified as second malignancies, endocrinological, neuromotor, hepatic, sensorial, benign tumors, infectious diseases and psychiatric disease and others. Associations with treatment modalities were disclosed. Results: Among 263 children with stage 3 and 4 neuroblastoma, 40 (15%) are long term survivors. 20/40 (50%) present one or more complications, being 2 (10%) second malignant neoplasia, 4 (20%) endocrinological disturbances, 4 (20%) neuromotor, 5 (25%) hepatic, 4 (20%) sensorial, 3 (1.1%) benign tumors, and infertility, psychiatric disease and hepatitis C infection in 1 (5%) episode each. 10/20 (50%) of the children were less than 18 months at diagnosis, and 12/20 (60%) were stage 3 and 8/20 (40%) were stage 4. All children were submitted to chemotherapy and 7/20 (35%) to autologous bone marrow transplantation. In 10/20 (50%) patients radiotherapy was also included, and 4/10 (40%) presented functional lesions in the irradiated field. All endocrinologic sequelae were detected in the ABMT group. Second malignant neoplasia were not related to RDT(1 ALL and 1 thyroid carcinoma). Conclusion: Children surviving aggressive therapy for neuroblastoma are at risk of late effects, particularly endocrinological and neurological complications, requiring close observation to prompt intervention when necessary, avoiding impairments in quality of life or even life threatening situations. Second malignant neoplasia require special concern.
  • article 8 Citação(ões) na Scopus
    Oral mucositis in paediatric cancer patients undergoing allogeneic hematopoietic stem cell transplantation preventively treated with professional dental care and photobiomodulation: Incidence and risk factors
    (2022) MIRANDA-SILVA, Wanessa; FONSECA, Felipe Paiva da; GOMES, Alessandra Araujo; MAFRA, Ana Beatriz Bechara; ROCHA, Vanderson; FREGNANI, Eduardo Rodrigues
    Background Oral mucositis (OM) is an important side effect related to allogeneic hematopoietic stem cell transplantation (allo-HSCT), and it has been associated with a significative reduction of quality of life. A negative impact of this toxicity in paediatric patients could result in increased use of parenteral feeding and opioids, longer periods of hospitalization, and a higher risk of systemic infection. Aim To investigate the clinical features and clinical outcomes associated with OM development and severity in hematological cancer paediatric patients undergoing allo-HSCT who underwent professional dental care (PDC) and photobiomodulation (PBM) as prophylactic treatment. Design Medical data and OM presentation were retrieved retrospectively from all patients younger than 18 years who were submitted to allo-HSCT between 2013 and 2016. The incidence of OM was assessed and graded by two oral medicine specialists following the WHO guidelines, and it was correlated with clinical parameters. Results Forty-nine consecutive paediatric patients were included. OM was diagnosed in 73.5% of patients, and in 36.1% of patients, OM was classified as severe. Acute lymphoblastic leukemia as a primary diagnosis and the use of a myeloablative regimen were associated with OM development. The primary diagnosis and use of total body irradiation (TBI) were associated with aggressive OM. Neither the incidence nor the severity of OM affected the overall survival, whereas only the use of a myeloablative regimen and a high body mass index (BMI) were determinants of lower OM-free survival rates. Conclusions A myeloablative conditioning and a high BMI were observed to be independent prognostic determinants of a lower OMFS rate. The cluster analysis allowed us to outline patient profiles with greater susceptibility to the development and severity of oral mucositis, which seems to be a useful tool to determine the risk of OM in paediatric patients.
  • article 33 Citação(ões) na Scopus
    Outcomes after Haploidentical Stem Cell Transplantation with Post-Transplantation Cyclophosphamide in Patients with Primary Immunodeficiency Diseases
    (2020) FERNANDES, Juliana Folloni; NICHELE, Samantha; ARCURI, Leonardo Javier; RIBEIRO, Lisandro; ZAMPERLINI-NETTO, Gabriele; LOTH, Gisele; RODRIGUES, Ana Luiza Melo; KUWAHARA, Cilmara; KOLISKI, Adriana; TRENNEPOHL, Joanna; GARCIA, Julia Lopes; DAUDT, Liane Esteves; SEBER, Adriana; GOMES, Alessandra Araujo; FASTH, Anders; PASQUINI, Ricardo; HAMERSCHLAK, Nelson; ROCHA, Vanderson; BONFIM, Carmem
    Allogeneic hematopoietic stem cell transplantation (HCT) can cure primary immunodeficiency diseases (PID). When a HLA-matched donor is not available, a haploidentical family donor may be considered. The use of T cell-replete haploidentical HCT with post-transplantation cyclophosphamide (haplo-PTCy) in children with PID has been reported in few case series. A donor is usually readily available, and haplo-PTCy can be used in urgent cases. We studied the outcomes of 73 patients with PID who underwent haplo-PTCy, including 55 patients who did so as a first transplantation and 18 who did so as a salvage transplantation after graft failure of previous HCT. The median patient age was 1.6 years. Most of the children were male (n = 54) and had active infection at the time of transplantation (n = 50); 10 children had severe organ damage. The diagnosis was severe combined immunodeficiency (SCID) in 34 patients and non-SCID in 39 (Wiskott-Aldrich syndrome; n = 14; chronic granulomatous disease, n = 10; other PID, n = 15). The median duration of follow-up of survivors was 2 years. The cumulative incidence of neutrophil recovery was 88% in the SCID group and 84% in non-SCID group and was 81% for first transplantations and 83% after a salvage graft. At 100 days, the cumulative incidence of acute GVHD grade II-IV and III-IV was 33% and 14%, respectively. The majority of patients reached 200/mu L CD4(+) and 1000/mu L CD3(+) cell counts between 3 and 6 months. The estimated 2-year overall survival was 66%; it was 64% for SCID patients and 65% for non-SCID patients and 63% for first HCT and 77% for salvage transplantations. Twenty-five patients died, most of them due to infection early after transplantation (before 100 days). In conclusion, haplo-PTCy is a feasible procedure, can cure two-thirds of children with PID, and can be used as rescue treatment for previous graft failure. (C) 2020 American Society for Transplantation and Cellular Therapy.
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    T-Cell Replete Haploidentical Stem Cell Transplantation with Post-Transplantation Cyclophosphamide (PTCy) for Pediatric Patients with Primary Immunodeficiencies (PID) - a Survey of the Pediatric Transplantation Working Group of the Brazilian Society of Bone Marrow Transplantation (SBTMO)
    (2020) FERNANDES, Juliana Folloni; NICHELE, Samantha; RIBEIRO, Lisandro; LOTH, Gisele; NETTO, Gabriele Zamperlini; SEBER, Adriana; DAUDT, Liane Esteves; GOMES, Alessandra; KOLISKI, Adriana; RODRIGUES, Ana Luiza Melo; ARCURI, Leonardo Javier; HAMERSCHLAK, Nelson; BONFIM, Carmem
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    OUTCOMES FOLLOWING RELAPSE AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATION FOR CHILDREN WITH ALL: A SINGLE-CENTER EXPERIENCE
    (2022) MACHADO, Ana Rahal Guaragna; SANTOS, Camila Noronha; SION, Julia Loureiro; MORIKAWA, Karina Morikawa; ZAMPERLINI-NETTO, Gabriele; CRISTOFANI, Lilian; ODONE FILHO, Vicente; GOMES, Alessandra Araujo; FERNANDES, Juliana Folloni; GARCIA, Julia Lopes