300 pg/dL combinado com fósforo menor ou igual a 5,5 mg/dL, cálcio menor ou igual a 9,5 mg/dL e produto cálcio e fósforo (CaxP)<55 mg2/dL2. Neste último grupo, 38% tiveram prescrição de sevelamer sem outro QF. CONCLUSÃO: Os resultados mostram um elevado percentual de prescrição de sevelamer em pacientes em HD de manutenção em uma cidade brasileira, apesar do alto custo deste medicamento e ausência de contraindicação para QF à base de cálcio. Os resultados em pacientes com PTH<150 pg/mL e com PTH>300 pg/mL combinado com determinadas concentrações de cálcio, fósforo e CaxP indicam também a necessidade de avaliar as práticas de uso de QF e calcitriol.]]>

Background: Patients with hematological disease are 15 times more likely to develop sepsis than the general population. The patient with hematological disease and, mainly, those undergoing hematopoietic stem cell transplantation (HSCT), develop a severe secondary humoral immunodeficiency, with low serum levels of IgM, which may take more than a year to be restored. Materials and Methods: This is a retrospective, controlled and observational study that analyzed 51 patients with underlying hematological disease, who were diagnosed with sepsis or septic shock during the study period, to evaluate whether IgM-rich Ig replacement decreases the 30-day mortality. Results: Of the 51 patients, 35 patients received IgM-rich immunoglobulin (group A) and 16 (31%) received conventional therapy. Eleven (69%) patients in the control group were alive after 30 days compared to 11 (34%) patients in the intervention group, p= 0.013. Conclusion: There are no apparent benefits in the use of IgM-rich immunoglobulin in septic patients with hematological disease.

Recent improvements in the treatment of onco-hematologic disorders have significantly increased patient survival. Yet, hematopoietic stem cell transplantation (HSCT) may expose patients to opportunistic infections (OI) due to the high doses of chemotherapy, especially because of aplasia and the resulting immune suppression.

Background: Systemic hypertension (HTN) and diabetes mellitus (DM) are believed to be risk factors for adverse postoperative outcomes in patients undergoing surgical interventions, but evidence is lacking. This retrospective study evaluated the effects of HTN and DM, alone or in combination, on postoperative outcomes of elective noncardiac surgery in cancer patients. Methods: Patients (n = 844) with malignancies, who underwent elective surgery at a tertiary hospital, were categorised into healthy (group A, n = 339), hypertensive (group B, n = 357), diabetic (group C, n = 21), and hypertensive and diabetic (group D, n = 127) groups. Preoperatively, all patients had systolic blood pressure ≤ 160 mmHg and plasma glucose level ≤ 140 mg/dl. Postoperative in-hospital morbidity and mortality were compared among groups. Results: Postoperative complications occurred in 22 (6.5%), 21 (5.9%), 2 (9.5%), and 11 (8.7%) patients in groups A, B, C, and D, respectively (p = 0.712). HTN (p = 0.538), DM (p = 0.990), and HTN+DM (p = 0.135) did not impact the occurrence of adverse events. Patients with higher surgical risk (ASA III or IV) and those with longer surgical time had higher morbidity and mortality (p = 0.001, p < 0.001, respectively). In multiple logistic regression analysis, ASA status and surgical time were independent risk factors for postoperative complications (both p < 0.001). Conclusion: Cancer patients with preoperative comorbidities, such as HTN and DM, alone or in combination, regardless of other characteristics, do not have an increased risk of adverse postoperative outcomes.Trial registration: Retrospectively registered.

TXThalassemia, a hemoglobinopathy which is common in Asian descendants, in its severe forms, has a poor prognosis. Allogeneic stem cell transplantation (allo-SCT) in severe thalassemia patients is an only way to cure the disease, however available HLA-matched donors for the patients were hardly identified. We recently reported an alternative strategy, pre-transplant immunosuppression (PTIS), combination of fludarabine (Flu) and dexamethasone (Dxm), would immunosuppress the patients to facilitate engraftment when followed by a reduced-toxicity conditioning (RTC) regimen, antithymocyte globulin (ATG), Flu and IV busulfan (Bu), to prepare high risk thalassemia patients for allo-SCT. We explored the use of an alternative, mismatched related ("haplo-"), donor in thalassemia patients. We enrolled severe thalassemia patients including a high risk group, so called class 3 Lucarelli classification, aged more than 7 years old and had a liver size more than 5 cms below the costal margin. All patients received two courses of PTIS, 40 mg/m 2 /day of IV Flu and 25 mg/m 2 /day of IV Dxm on day -68 to -64 and day -40 to -36, followed by RTC regimen, 1.5 mg/kg/ day of ATG on day -12 to -10, 35 mg/m 2 /day of Flu on day -8 to -3 and 130 mg/m 2 /day of Bu on day -8 to -5, was administered followed by unmanipulated peripheral blood stem cell (PBSC) from haploidentical donors. Graft-versus-host disease (GVHD) prophylaxis consisted of 50 mg/kg/day of cyclophosphamide (PTCy) on day +3 and +4 and tacrolimus or sirolimus was started together with a short course of mycophenolate mofetil. Twenty five patients received haplo-SCT at the median age of 10 (2-20) years. Twenty one patients had beta-thalassemia/hemoglobin E while the rest of patients had homozygous beta-thalassemia. Twelve patients had class 3 disease, their median age at the time of haplo-SCT was 14 (10-20) years. One of the patients had haplo-SCT as a second transplant after a matched-related allo-HSCT complicated with primary graft failure with autologous reconstitution. Sixteen patients received PBSC from the mother while the rest received from the father, the median CD34+ cell dose at 11.6 (4.0-19.0) x 10 6 cells/kg of body weight of recipients. The median time of neutrophil engraftment and platelet engraftment were 14 (11-18) and 30 (20-45) days, respectively. Two patients who suffered from primary graft failure had anti-HLA antibodies. Nine patients developed grade II acute GVHD, while four patients developed mild reversible veno-occlusive disease. Only three patients developed limited chronic GVHD. One patient died of GVHD complications. The 2-year overall and thalassemia-free survival rates are 93% and 88%, respectively, at the median follow up time was 11 (6-30) months. We concluded our new program, PTIS followed by RTC regimen and PTCy-based GVHD prophylaxis, had rapid and durable engraftment, yet a low risk of serious GVHD in the severe thalassemia patients.Background: Allogeneic Hematopoietic Cell Transplantation (HCT) is currently the only treatment modality to res...