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
5 resultados
Resultados de Busca
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- Quality-of-life analysis of pembrolizumab vs brentuximab vedotin for relapsed/refractory classical Hodgkin lymphoma(2022) ZINZANI, Pier Luigi; RAMCHANDREN, Radhakrishnan; SANTORO, Armando; PASZKIEWICZ-KOZIK, Ewa; GASIOROWSKI, Robin; JOHNSON, Nathalie A.; OLIVEIRA, Jose S. R. de; BUCCHERI, Valeria; PERINI, Guilherme Fleury; DICKINSON, Michael; MCDONALD, Andrew; OZCAN, Muhit; SEKIGUCHI, Naohiro; ZHU, Ying; RAUT, Monika; SARETSKY, Todd L.; NAHAR, Akash; KURUVILLA, JohnKEYNOTE-204 (NCT02684292) demonstrated a progression-free survival advantage for pembrolizumab over brentuximab vedotin (BV) in patients who had relapsed or refractory classical Hodgkin lymphoma (R/R cHL) following, or who were ineligible for, autologous stem cell transplantation (ASCT). Health-related quality of life (HRQoL), measured by patient-reported outcomes (PROs) from KEYNOTE-204, are reported from patients who received >= 1 dose of study treatment and completed >= 1 PRO assessment. The EORTC QoL Questionnaire Core 30 (QLQ-C30) and EuroQoL EQ-5D were administered at baseline, every 6 weeks until week 24, and every 12 weeks thereafter. Prespecified end points included least squares mean (LSM) changes from baseline to week 24 and time to true deterioration (TTD; >= 10-point decline from baseline). Comparisons were evaluated using 2-sided P values uncontrolled for multiplicity. High compliance at baseline (>90%) and through week 24 (>80%) was demonstrated across treatment groups (PRO analysis set: pembrolizumab, n = 146; BV, n = 150). The EORTC QLQ-C30 global health status (GHS)/quality of life (QoL) score improved from baseline to week 24 on pembrolizumab and worsened on BV and demonstrated significant LSM differences at 24 weeks (GHS/QoL: 8.60 [95% confidence interval, 3.89-13.311; P = .0004). Significant improvements were observed in each QLQ-C30 domain except emotional and cognitive functioning. Compared with BV, pembrolizumab prolonged TTD for GHS/QoL (hazard ratio, 0.40 [95% CI, 0.22-0.741; P = .003) and each QLQ-C30 domain except cognitive functioning. In conclusion, pembrolizumab demonstrated overall improvements in PROs of HRQoL measures over BV in the KEYNOTE-204 study. These data and previously reported efficacy results support pembrolizumab as the preferred treatment option for patients with RJR cHL who are ineligible for or experience relapse after ASCT.
- 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.
- Salvage treatment for refractory or relapsed acute myeloid leukemia: a 10-year single-center experience(2020) SILVA, Wellington Fernandes da; ROSA, Lidiane Ines da; SEGURO, Fernanda Salles; SILVEIRA, Douglas Rafaele Almeida; BENDIT, Israel; BUCCHERI, Valeria; VELLOSO, Elvira Deolinda Rodrigues Pereira; ROCHA, Vanderson; REGO, Eduardo M.OBJECTIVES: The outcomes of refractory and relapsed acute myeloid leukemia (AML) patients in developing countries are underreported, even though the similar classic regimens are widely used. METHODS: We conducted a retrospective comparison of ""MEC"" (mitoxantrone, etoposide, and cytarabine) and ""FLAG-IDA"" (fludarabine, cytarabine, idarubicin, and filgrastim) in adults with first relapse or refractory AML. RESULTS: In total, 60 patients were included, of which 28 patients received MEC and 32 received FLAG-IDA. A complete response (CR) rate of 48.3% was observed. Of the included patients, 16 (27%) died before undergoing bone marrow assessment. No statiscally significant difference in CR rate was found between the two protocols (p=0.447). The median survival in the total cohort was 4 months, with a 3-year overall survival (OS) rate of 9.7%. In a multivariable model including age, fms-like tyrosine kinase 3 (FLT3) status, and stem-cell transplantation (SCT), only the last two indicators remained significant: FLT3-ITD mutation (hazard ratio [HR] =4.6, p< 0.001) and SCT (HR=0.43, p=0.01). CONCLUSION: In our analysis, there were no significant differences between the chosen regimens. High rates of early toxicity were found, emphasizing the role of supportive care and judicious selection of patients who are eligible for intensive salvage therapy in this setting. The FLT3-ITD mutation and SCT remained significant factors for survival in our study, in line with the results of previous studies.
- 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.
- Impact of baseline and interim quantitative PET parameters on outcomes of classical Hodgkin Lymphoma(2024) SANTOS, Fernanda Maria; MARIN, Jose Flavio Gomes; LIMA, Marcos Santos; SILVA-JUNIOR, Wellington Fernandes; ALVES, Lucas Bassolli O.; MOREIRA, Frederico R.; VELASQUES, Rodrigo Dolphini; ATANAZIO, Marcelo Junqueira; MAIA, Ana Carolina Arrais; BUCHPIGUEL, Carlos A.; BUCCHERI, Valeria; ROCHA, VandersonCurrently, analysis of interim PET (iPET) according to the Deauville score (DS) is the most important predictive factor in Hodgkin lymphoma (HL); however, there is room for improvement in its prognostic power. This study aimed to evaluate the prognostic value of quantitative PET analysis (maximum standard uptake value [SUVmax], total metabolic tumor volume [TMTV] and total lesion glicolysis [TLG]) at baseline (PET0) and iPET in a retrospective cohort of newly diagnosed classical HL. For positive iPET (+ iPET), the reduction of quantitative parameters in relation to PET0 (Delta SUVmax, Delta TMTV and Delta TLG) was calculated. Between 2011 and 2017, 234 patients treated with ABVD were analyzed. Median age was 30 years-old, 59% had advanced stage disease, 57% a bulky mass and 25% a + iPET (DS 4-5). At baseline, high TLG was associated with an increased cumulative incidence of failure (CIF) (p = 0.032) while neither SUVmax, TMTV or TLG were associated with overall survival (OS) or progression-free survival (PFS). In multivariate analysis, only iPET was associated with CIF (p < 0.001). Among Delta SUVmax, Delta TMTV and Delta TLG, only a Delta SUVmax >= 68.8 was significant for PFS (HR: 0.31, CI95%: 0.11-0.86, p = 0.024). A subset of patients with improved PFS amongst + iPET was identified by the quantitative (Delta SUVmax >= 68.8%) analysis. In this real-world Brazilian cohort, with prevalent high-risk patients, quantitative analysis of PET0 did not demonstrate to be prognostic, while a dynamic approach incorporating the Delta SUV(max )to + iPET succeeded in refining a subset with better prognosis. These findings warrant validation in larger series and indicate that not all patients with + iPET might need treatment intensification.