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Objectives: To evaluate the results of the comprehensive geriatric assessment (CGA) before allogeneic hematopoietic stem cell (HSCT) transplantation in patients aged 60 years and over. Methods: We evaluated all consecutive patients undergoing CGA before HSCT between September 2011 and July 2018 in a private hospital in Brazil. We also evaluated the Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-SCI) and the Disease Risk Index (DRI). Results: During the study period, 61 patients were referred for transplant evaluation. After exclusions, we analyzed 40 patients, with a mean age of 67.6 years (60-76). The CGA detected vulnerability and frailty in 43% and 18.9% respectively according to the Fried Frailty Phenotype score; limitations across the domain of function and disability with handgrip test alterations in 65.8%. However, 36 (90%) were independent for instrumental activities of daily living (IADL). Cognitive and depression domain have shown abnormal with the clock test in 44.4%, and loss of memory complains in 37.5%. But the mini-mental test was normal in 89%. Geriatric Depression Scale (GDS) was normal in 82.5%. 30% were considered at risk for malnutrition. Half of the patients (50%) had a high Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) score. 32.5% needed ICU admission. The overall survival and non-relapse mortality at 2 years were 41.8% and 38.7% respectively. Conclusion: The CGA was feasible in detecting the patients' vulnerabilities in our population. More studies, multicentric and with a larger number of patients, are needed to evaluate the role of CGA in this context of allo-HCT in our population.

The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly was elaborated by nutritionists, nutrologists and hematologists physicians from 15 Brazilians reference centers in hematopoietic stem cell transplantation, in order to emphasize the importancy of nutritional status and the body composition during the treatment, as well as the main characteristics related to patient’s nutritional assessment. Establishing the consensus, we intended to improve and standardize the nutritional therapy during the hematopoietic stem cell transplantation. The Consensus was approved by the Brazilian Society of Bone Marrow Transplantation.

Hematopoietic stem cell transplantation (HSCT) is an important treatment option for children with severe and refractory sickle cell disease (SCD) with debilitating clinical complications. HSCT with cells from the bone marrow of a HLA-identical sibling used in SCD has a low mortality risk, high cure rate, and high event-free survival rate after a median follow-up of 5-6 years. However, matched donors are found in only about 20% of the patients. A boy aged 8 years with SCD had a sister, <2 years old, a fully compatible donor. The boy met all eligibility criteria to undergo HSCT, and he was suffering from cognitive and neurologic impairment due to ischemic events. A Bioethical Committee jointly discussed the ethical issues on this case after a pediatric evaluation released the very young sister for donation. The justification was that the sister would benefit from the donation too because of the greater likelihood of survival and cure and less suffering of her brother. The parents were informed about the risks and benefits for both children, and the family was psychologically evaluated. After their consent, HSCT was performed and the patient is cured from SCD. The complication for the donor was the need for blood transfusion.

No abstract

Retrospective study of consecutive patients with advanced cancer admitted to a tertiary care general hospital (April 2015-December 2016) and referred for the first time to an inpatient PC consultation team. Patients' demographics, clinical features, time from first consult to death or discharge, and outcomes on medication use, clinical interventions, and end-of-life preferences were retrieved. An analysis was performed before and after PC.ResultOne hundred eleven patients were included. Median age was 68; 72% had an Eastern Cooperative Oncology Group performance status ≥3. The median timing of PC access was 9 days (first interquartile = 3, third interquartile = 19). The use of analgesics (from 75% to 85%, p = 0.001) and opioids (from 50% to 73%, p < .001) increased. A lower proportion was receiving antibiotics (68% vs 48%, p < 0.001), thromboprophylaxis (44% vs 26%, p < 0.001), antihypertensives (28% vs 15%, p = 0.001), and antiemetic agents (64% vs 54%, p = 0.027). Chemotherapy use was lower (39-25%, p < 0.001). More patients had an end-of-life preference (39% to 25%, p < 0.001) and were not willing to receive intubation (32% vs 60%, p < 0.001), intensive care treatment (30% vs 55%, p < 0.001), cardiopulmonary resuscitation (35% vs 62%, p < 0.001), and artificial nutrition (22% vs 34%, p < 0.001).Significance of resultsAlthough PC referrals occurred exceedingly late during the cancer disease trajectory, positive changes were observed in medication profiles, clinical interventions use, and end-of-life preferences of patients with advanced cancer referred to a specialized inpatient PC consultation team in Brazil. Further efforts are needed to improve early palliative cancer care in developing countries.

BACKGROUND AND OBJECTIVES: There are very few publications on pain amplification syndrome in the elderly (PAS), in spite of its importance for them, because it may have multiple consequences during aging. This study aimed at reporting a case of PAS in the elderly represented by fibromyalgia (FM), describing its diagnostic approach and therapeutic management, and at presenting a literature review on the subject. CASE REPORT: Female patient, 73 years old, with moderate diffuse muscle pain, fleeting morning stiffness, anhedonia, sadness, anxiety, major fatigue and sleep disorders for four years. She was initially diagnosed as rheumatic polymyalgia and was under regular prednisone in spite of the progressive worsening of her functional capacity and quality of life (QL). One year ago her diagnosis was reviewed by our service and we confirmed it was PAS, spectrum of FM. Prednisone was then withdrawn and non-pharmacological therapy was indicated with pain self-management program; multimodal pharmacological therapy was also instituted with non-opioid (lysine clonixinate) and opioid (trama-Pain amplification syndrome in the elderly. Case report and literature review* Síndrome de amplificação dolorosa no idoso. Relato de caso e revisão da literatura

Autologous stem cell transplantation (ASCT) is a standard treatment strategy for consolidation of chemo sensitive, relapsed aggressive or indolent B-cell and Hodgkin lymphomas for transplant-eligible patients. In Kothari et al's retrospective study; both LEAM (Lomustine, etoposide, cytarabine and melphalan) and BEAM (BCNU, etoposide, cytarabine and melphalan) were associated with significant gastrointestinal toxicity. The LEAM regimen was associated with worse gastrointestinal toxicity compared with BEAM, there was no difference in rates of sepsis, engraftment or other transplantrelated parameters between the two cohorts. More patients conditioned with LEAM went to intensive care in the acute setting, but the difference was not significant and importantly, the non-relapse mortality was not statistically different between the two regimens. BEAM containing regimen is mostly used at many centers in our country. During the period BCNU was unavailable we substituted BEAM with LEAM that was developed in France. We retrospectively analyzed the early transplant data of 7 patients who were conditioned with LEAM (Lomustin 200 mg/ m2, etoposide 800 mg/m2 (in divided doses), cytarabine 1600 mg/m2 (in divided doses) and melphalan140mg/m2). The characteristics of the patients are 6 male, 1 female, mean age 58 (43-69) years. Diagnosis were; 3 large B cell lymphoma with chemo sensitive relapse, 3 manthle cell lymphoma in first remission and 1 lymphocyte predominant lymphoma with chemo sensitive relapse. Median neutrophil and thrombocyte engrafment was 11.1 days (10-13) and 13, 75 days (10-19). All patients tolerated lomustine well with no additional antiemetic treatment. All patients had grade 3-4 mucositis and diarrhea, but none of them was in need of total parenteral nutrition. And all patients had febrile attacks, one patient had septic shock and one died of pseudomonas sepsis. We did not have any grade 3-4 renal and hepatic toxicity. Median hospital days were 21days (15-27), not longer than patients conditioned with BEAM or TEAM in our center. In this small number of patients, we did not see any unexpected side affects due to use of lomustine. Since, there is no universally accepted gold-standard conditioning regimen for ASCT, LEAM conditioning which is not preferred often can be a comparable regimen in countries where lomustine is available and noticeably cheaper, which we can not ignore.