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Please use this identifier to cite or link to this item: https://tedebc.ufma.br/jspui/handle/tede/tede/3141
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dc.creatorSANTOS, Khalil Lima da Costa Maia dos-
dc.creator.Latteshttp://lattes.cnpq.br/8420195617192722por
dc.contributor.advisor1OLIVEIRA, Raimundo Antonio Gomes-
dc.contributor.advisor1Latteshttp://lattes.cnpq.br/1633053684617759por
dc.contributor.referee1OLIVEIRA, Raimundo Antonio Gomes-
dc.contributor.referee1Latteshttp://lattes.cnpq.br/1633053684617759por
dc.contributor.referee2ÁVILA, Elda Pereira Noronha-
dc.contributor.referee2Latteshttp://lattes.cnpq.br/9711847705518162por
dc.contributor.referee3ANDRADE, Marcelo Sousa de-
dc.contributor.referee3Latteshttp://lattes.cnpq.br/2293647808814594por
dc.contributor.referee4CARTAGENES, Socorro-
dc.contributor.referee4Latteshttp://lattes.cnpq.br/3013333572719007por
dc.date.accessioned2021-01-25T13:52:40Z-
dc.date.issued2020-02-27-
dc.identifier.citationSANTOS, Khalil Lima da Costa Maia dos. Avaliação da resposta a prednisona no dia 8 da fase de indução do tratamento de leucemias linfoblástica aguda: enfoque na determinação do percentual de blastos residuais por citometria de fluxo e valor preditivo de prognóstico. 2020. 74f. Dissertação (Programa de Pós-Graduação em Saúde do Adulto e da Criança/CCBS) - Universidade Federal do Maranhão, São Luís, 2020.por
dc.identifier.urihttps://tedebc.ufma.br/jspui/handle/tede/tede/3141-
dc.description.resumoIntrodução: As leucemias linfoides agudas (LLA) são as neoplasias mais comuns na infância contando com 25 a 30% dos casos nessa faixa etária de 1 a 9 anos. Contudo em adultos representa cerca de 20%. É caracterizada pelo bloqueio maturativo e proliferação de células precursoras da linhagem linfóide após sofrerem alterações genético-moleculares específicas. Os pacientes são submetidos a protocolos de tratamento que determinam como estratificação de risco: a resposta a prednisona do Dia 8 (D8) do tratamento, avaliado pela citomorfologia, doença residual mínima (DRM) no D15 e D35 do tratamento, avaliados por imunofenotipagem por citometria de fluxo(CMF). Pacientes com < 1.000 blastos/mm3 (valor absoluto) em sangue periférico (SP) no D8 são considerados como bons respondedores. Da mesma forma são considerados como bons respondedores quando doença residal mínima (DRM) em medula óssea (MO) < 0,01% de blastos nos D15 e D35 do tratamento. O objetivo deste estudo foi avaliar se a quantificação relativa de células leucêmicas (percentual de blastos) no SP no D8 de tratamento de pacientes com LLA tem associação com DRM no D15, D35, recaída e sobrevida global (SG). Material e métodos: setenta e quatro pacientes diagnosticados com LLA, no período de 2014 a 2019, oriundos do centro de referência em oncologia do estado do Maranhão foram incluídos neste estudo. Foram coletados os dados clínicos, laboratoriais e imunofenotípicos e cadastrados em um banco de dados para posterior análises de correlação. No D8 de tratamento realizou-se hemograma automatizado, avaliação citomorfológica e imunofenotipagem por CMF para determinação do valor absoluto (por mm3 ) e relativo de blastos em sangue periférico. Estabeleceu-se como ponto de coorte do valor relativo 5% de blastos em SP para as análises comparativas. Foram analisadas as sobrevidas globais (SG), em 48 meses, pelo método de Kaplan-Meier e diferenças entre os grupos foram comparadas pelo teste de log-rank. Um p valor < 0,05 foi considerado como estatisticamente significante. Resultados:85,1% atingiram uma contagem de blastos no dia 8 de tratamento ≤1.000/mm3 . Observou-se que grande parte dos pacientes (73%) não foram bons respondedores a quimioterapia no D15 do tratamento, os quais apresentaram DRM >0,01%. No dia 35 ou 33 de tratamento, 44,6% responderam a terapia (DRM negativos) e 47,3%, não (DRM > 0,01%). Dos 74 pacientes analisados 22 foram a óbito (29,7%) e 11 (14,9%) recidivaram. A correlação do percentual de blastos no D8 determinado por citomorfologia e CMF foi satisfatória (r = 0.66, p< 5% SG maior (78,9%) (p = 0,01). Conclusão: O percentual relativo de blastos determinado por CMF deve ser levado em consideração no D8, principalmente no grupo de pacientes considerados bom respondedores (<1.000 blastos/mm3 ) onde observou-se que o valor relativo (acima de 5% de blastos) demonstrou influenciar na sobrevida global de forma significativa.por
dc.description.abstractIntroduction: Acute lymphoid leukemias (ALL) are the most common neoplasms in childhood, accounting for 25 to 30% of cases in the age group from 1 to 9 years. However, in adults it represents about 20%. It is characterized by the maturation block and proliferation of precursor cells of the lymphoid lineage after undergoing specific genetic-molecular changes. Patients are submitted to treatment protocols that determine how risk stratification: the response to prednisone on Day 8 (D8) of treatment, assessed by cytomorphology, minimal residual disease (DRM) on D15 and D35 of treatment, assessed by cytometry immunophenotyping flow (CMF). Patients with <1,000 blasts / mm3 (absolute value) in peripheral blood (SP) at D8 are considered to be good responders. Likewise, they are considered as good responders when minimal residual disease (DRM) in bone marrow (OM) <0.01% of blasts in D15 and D35 of treatment. The aim of this study was to assess whether the relative quantification of leukemic cells (percentage of blasts) in SP at D8 for treatment of ALL patients is associated with DRM at D15, D35, relapse and overall survival (SG). Material and methods: seventy-four patients diagnosed with ALL, from 2014 to 2019, from the oncology reference center in the state of Maranhão were included in this study. Clinical, laboratory and immunophenotypic data were collected and registered in a database for further correlation analysis. In the treatment D8, automated blood count, cytomorphological evaluation and immunophenotyping by CMF were performed to determine the absolute (per mm3) and relative value of blasts in peripheral blood. It was established as a cohort point of the relative value of 5% of blasts in SP for comparative analysis. Overall survival (SG) at 48 months was analyzed using the Kaplan-Meier method and differences between groups were compared using the log-rank test. A p value <0.05 was considered to be statistically significant. Results: 85.1% reached a blast count on day 8 of treatment ≤1,000 / mm3, which corresponds to 63 patients. It was observed that most of the patients (73%) were not good responders to chemotherapy in the D15 of the treatment, who presented DRM> 0.01%. On day 35 or 33 of treatment, 44.6% responded to therapy (negative DRM) and 47.3% did not (DRM> 0.01%). Of the 74 patients analyzed, 22 died (29.7%) and 11 (14.9%) relapsed. The correlation of the percentage of blasts in D8 determined by cytomorphology and CMF was satisfactory (r = 0.66, p<0.001.) There was no association of absolute values (<1,000 blasts / mm3 and ≥ 1,000 blasts / mm3) and relative (<5% blasts and ≥5% blasts), identified both by cytomorphology and CMF, on D8, with DRM on D15, DRM on D35 and relapse. It was observed in the total cohort that it influenced the SG by stratification 1,000 blasts / mm3 and ≥1,000 blasts / mm3 and by the 5% blast cohort point determined only by CMF. SG of 44.4% for <1,000 blasts / mm3 and 73.4% for ≥1,000 blasts / mm3 (p = 0.03). For patients with <5% of blasts at D8, SG was 74.7% and for those with ≥ 5%, SG was 53.3% (p = 0.03). In the group of patients with <1,000 blasts / mm3, it was observed that patients with ≥ 5% of blasts had a lower SG (50.0%) and patients with <5% greater SG (78.9%) (p = 0,01). Conclusion: The relative percentage of blasts determined by CMF should be taken into account in D8, especially in the group of patients considered to be good responders (<1,000 blasts / mm3), where it was observed that the relative value (above 5% of blasts) demonstrated to significantly influence overall survival.eng
dc.description.provenanceSubmitted by Daniella Santos (daniella.santos@ufma.br) on 2021-01-25T13:52:40Z No. of bitstreams: 1 KhalilSantos.pdf: 529130 bytes, checksum: fbda5a351b6fffc23302e87d2e912e20 (MD5)eng
dc.description.provenanceMade available in DSpace on 2021-01-25T13:52:40Z (GMT). No. of bitstreams: 1 KhalilSantos.pdf: 529130 bytes, checksum: fbda5a351b6fffc23302e87d2e912e20 (MD5) Previous issue date: 2020-02-27eng
dc.formatapplication/pdf*
dc.languageporpor
dc.publisherUniversidade Federal do Maranhãopor
dc.publisher.departmentDEPARTAMENTO DE FARMÁCIA/CCBSpor
dc.publisher.countryBrasilpor
dc.publisher.initialsUFMApor
dc.publisher.programPROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE DO ADULTO E DA CRIANÇA/CCBSpor
dc.rightsAcesso Abertopor
dc.subjectLeucemias linfoblasticas agudapor
dc.subjectProtocolo de tratamentopor
dc.subjectCitometria de fluxopor
dc.subjectOitavo diapor
dc.subjectAcute lymphoblastic leukemiaseng
dc.subjectTreatment protocoleng
dc.subjectFlow cytometryeng
dc.subjectEighth dayeng
dc.subject.cnpqCiências da Saúdepor
dc.titleAvaliação da resposta a prednisona no dia 8 da fase de indução do tratamento de leucemias linfoblástica aguda: enfoque na determinação do percentual de blastos residuais por citometria de fluxo e valor preditivo de prognósticopor
dc.title.alternativeEvaluation of the response to prednisone on day 8 of the induction phase of the treatment of acute lymphoblastic leukemias: focus on determining the percentage of residual blasts by flow cytometry and predictive value of prognosiseng
dc.typeDissertaçãopor
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