VALERIA BUCCHERI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/31 - Laboratório de Genética e Hematologia Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/31 - Laboratório de Genética e Hematologia Molecular, Hospital das Clínicas, Faculdade de Medicina
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- Age, Blasts, Performance Status and Lenalidomide Therapy Influence the Outcome of Myelodysplastic Syndrome With Isolated Del(5q): A Study of 58 South American Patients(2022) AZEVEDO, R. S.; BELLI, C.; BASSOLLI, L.; FERRI, L.; PERUSINI, M. A.; ENRICO, A.; PEREIRA, T. D. M.; JUNIOR, W. F. S.; BUCCHERI, V; PINHEIRO, R. F.; MAGALHAES, S. M.; SCHUSTER, S.; CASTELLI, J. B.; TRAINA, F.; ROCHA, V; VELLOSO, E. D. R. P.This study analyzed the overall survival (OS) of patients with Myelodysplastic Syndrome (MDS) with isolated deletion 5q in South America. Age >75 years, ECOG >= 2 and Bone marrow (BM) blasts >2% at diagnosis is independently associated with worse OS. Lenalidomide treatment is the only factor that improves the OS. Background: Myelodysplastic Syndrome (MDS) with isolated deletion 5q is associated with a low risk to leukemic evolution and long overall survival (OS); it comprises 3%-4.5% of MDS cases in Latin America classified according to the World Health Organization 2008. This study aims to describe clinical, laboratory and the outcome of patients according to the newest World Health Organization 2016 proposal. Methods: We retrospectively reviewed patients from four Brazilian (BR) and four Argentinean (AR) centers diagnosed between 1999 and 2019. Results: The 58 patients (16-AR and 42-BR) presented a median age of 67 (IQR 61-75) years old, women predominance (70.7%) and transfusion dependency (62.5%) at diagnosis. Median hemoglobin level was 8.1g/dL, 27.5% and 44.4% presented thrombocytosis and neutropenia, respectively. Bone marrow (BM) was predominantly hypercellular (43.1%) with 66% showing dysplasia >1 lineage and 37.9% with >2% of blasts. Deletion 5q was mostly isolated (79.3%) and a variety of abnormalities were observed in remaining cases. Most patients were treated with erythropoietin-stimulating agents (ESA), 18 with lenalidomide and 15 with thalidomide. Median follow-up was 7.6 years, with a median OS of 3.5 years and an 8-years leukemic evolution rate of 18.4%. Multivariate analysis showed that age >75 years (HR 2.19), ECOG =2 (HR 5.76), BM blasts >2% (HR 2.92) and lenalidomide treatment (HR 0.25) independently influenced the OS. Conclusion: Older age, worse performance status and higher percentage of blasts, that can be easily assessed, were associated to a worse prognosis. Also, our results corroborate the protective influence of lenalidomide in terms of OS in this South American series.
- Treating Adult Acute Lymphoblastic Leukemia in Brazil-Increased Early Mortality Using a German Multicenter Acute Lymphoblastic Leukemia-based regimen(2018) SILVA JUNIOR, Wellington Fernandes da; MEDINA, Andrezza Bertolaci; YAMAKAWA, Patricia Eiko; BUCCHERI, Valeria; VELLOSO, Elvira D. R. P.; ROCHA, VandersonStudying adult acute lymphoblastic leukemia (ALL) in developing countries is essential, because few reports are available. We performed a retrospective medical record review of the adapted German Multicenter ALL regimen encompassing 59 patients treated in Brazil. A disappointing long-term survival rate of 15.3% was found, demonstrating that every regimen must be adjusted to a given population to avoid unacceptable toxicity. Background: Acute lymphoblastic leukemia (ALL) in adults is an invariably aggressive and rare disease. Its treatment is based on the use of multidrug regimens, which have been improved since the 1970s. Few published data are available on the results of adult ALL treatment in Latin America. Materials and Methods: We retrospectively analyzed the data from 59 patients with ALL treated from 2009 to 2015 at Hospital of Clinics of University of Sao Paulo, using an adapted German Multicenter ALL (GMALL) protocol (07/2003). Results: The median patient age was 35 years (range, 16-71 years), with 76% of new cases of B-cell lineage. Central nervous system involvement was present in 29%. Most patients were in the high-risk group, using the original GMALL criteria (68%). The early death rate was 17%, preventing early evaluation of the response in these patients. Despite a reasonable complete remission rate (76%), most patients eventually died of sepsis, especially during the induction phase and salvage regimens. The median overall survival was 17 months. Conclusion: Intensified chemotherapy protocols for adult ALL have succeeded in achieving better survival rates in adults, especially younger adults. The low overall survival found with GMALL in Brazil's public hospital denotes the importance of optimizing the adaptations of international protocols for treatment of ALL in nondeveloped countries and, in parallel, improving supportive care in public services.
- Consistency of FDG-PET Accuracy and Cost-Effectiveness in Initial Staging of Patients With Hodgkin Lymphoma Across Jurisdictions(2011) CERCI, Juliano J.; TRINDADE, Evelinda; BUCCHERI, Valeria; FANTI, Stefano; COUTINHO, Artur M. N.; ZANONI, Lucia; LINARDI, Camila C. G.; CELLI, Monica; DELBEKE, Dominique; PRACCHIA, Luis F.; PITELA, Felipe A.; SOARES JR., Jose; ZINZANI, Pier Luigi; MENEGHETTI, Jose C.Introduction: Two hundred ten patients with newly diagnosed Hodgkin's lymphoma (HL) were consecutively enrolled in this prospective trial to evaluate the cost-effectiveness of fluorine-18 ((18)F)-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) scan in initial staging of patients with HL. Methods: All 210 patients were staged with conventional clinical staging (CCS) methods, including computed tomography (CT), bone marrow biopsy (BMB), and laboratory tests. Patients were also submitted to metabolic staging (MS) with whole-body FDG-PET scan before the beginning of treatment. A standard of reference for staging was determined with all staging procedures, histologic examination, and follow-up examinations. The accuracy of the CCS was compared with the MS. Local unit costs of procedures and tests were evaluated. Incremental cost-effectiveness ratio (ICER) was calculated for both strategies. Results: In the 210 patients with HL, the sensitivity for initial staging of FDG-PET was higher than that of CT and BMB in initial staging (97.9% vs. 87.3%; P < .001 and 94.2% vs. 71.4%, P < 0.003, respectively). The incorporation of FDG-PET in the staging procedure upstaged disease in 50 (24%) patients and downstaged disease in 17 (8%) patients. Changes in treatment would be seen in 32 (15%) patients. Cumulative cost for staging procedures was $3751/patient for CCS compared to $5081 for CCS + PET and $4588 for PET/CT. The ICER of PET/CT strategy was $16,215 per patient with modified treatment. PET/CT costs at the beginning and end of treatment would increase total costs of HL staging and first-line treatment by only 2%. Conclusion: FDG-PET is more accurate than CT and BMB in HL staging. Given observed probabilities, FDG-PET is highly cost-effective in the public health care program in Brazil.
- Real-life Outcomes on Acute Promyelocytic Leukemia in Brazil - Early Deaths Are Still a Problem(2019) JR, Wellington F. da Silva; ROSA, Lidiane Ines da; MARQUEZ, Gabriel Lacerda; BASSOLLI, Lucas; TUCUNDUVA, Luciana; SILVEIRA, Douglas Rafaele Almeida; BUCCHERI, Valeria; BENDIT, Israel; REGO, Eduardo Magalhaes; ROCHA, Vanderson; VELLOSO, Elvira D. R. P.Real-life outcomes in acute promyelocytic leukemia are apparently worse than those reported by prospective studies. Retrospective data on 61 adult patients were reviewed. An early death rate of 20% was found, with a 5-year overall survival estimated at 59%. The results of real-life studies differ from prospective trials. Early actions and supportive care are needed, aiming to decrease toxicity, especially in developing countries. Introduction: Although a considerable improvement in survival of patients with acute promyelocytic leukemia (APL) has been seen over the past decades, real-life outcomes seem to be worse than those reported by prospective studies. We aim to describe clinical characteristics and outcomes of adult patients diagnosed with APL in an academic hospital from the University of Sao Paulo. Patients and Methods: We retrospectively reviewed the medical charts of 61 patients with APL diagnosed between January 2007 and May 2017. Baseline clinical features and follow-up data were collected, focusing on early toxicity variables such as infection, bleeding, and thrombosis in the first 30 days from diagnosis. Results: Among the 61 patients with APL, 54 received any chemotherapy. All patients also received alltrans retinoic acid (ATRA). Bleeding events were the main cause of death before receiving chemotherapy. Most patients belonged to the intermediate (43%) and high-risk (41%) groups, according to Sanz score. The '7 + 3 + ATRA' regimen was the most used regimen (n = 38). An early death rate of 20% was found, predominantly owing to sepsis. After a median follow-up of 5 years, only 1 relapse was diagnosed. The overall survival at 5 years was 59%. Discussion: In comparison with prospective trials with ATRA-based regimens, we found an inferior overall survival, mostly on account of a high early-death rate. Our results are in line with other real-life retrospective reports published in the past decades. Conclusion: Results of real-life studies differ from those found by prospective trials. Accordingly, early actions and supportive care are still needed, aiming to decrease toxicity, especially in developing countries.