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Papers by Angela Peña

Automática y Robótica en Latinoamérica. Aportes desde la Academia, 2021

Context: Tyrosine kinase inhibitors (TKIs) dramatically changed outcomes in CML; achieving and ma... more Context: Tyrosine kinase inhibitors (TKIs) dramatically changed outcomes in CML; achieving and maintaining treatment milestones is highly dependent on adherence. Colombia subscribes a principle of universal health coverage; however, there is significant difference in access to high-cost drugs between different insurance types (Subsidized [SS] vs Contributory [SC]). Objective: To describe the current patient management and outcomes of CML in Colombia and possible factors associated with outcomes. Design: ACHO’s hematological disease registry (RENEHOC) is a multicenter study that has collected information on CML patients since 2019. Setting: RENEHOC is a real-world registry that captures information from 16 academic and general community centers in 5 cities in Colombia. Patients or Other Participants: Adult CML patients. Interventions: Due to its observational nature, all treatment decisions depend on treating investigator preferences. Main Outcomes Measures: RENEHOC is an online data...

Blood, 2021

Introduction Acute lymphoblastic leukemia (ALL) is a clonal hematopoietic disorder that originate... more Introduction Acute lymphoblastic leukemia (ALL) is a clonal hematopoietic disorder that originates from B or T lymphoid progenitors and has well validated prognostic and predictive factors that influence outcomes. One of the strongest prognostic factors is the detection of minimal residual disease (MRD) which measures residual cell population after treatment when a morphologic complete response has been achieved. MRD positivity is associated with a higher risk of relapse and poor response to chemo or radiotherapy Objectives The aim of the study was to assess the prognostic impact of post-induction MRD status in a cohort of ALL Colombian patients in terms of relapse-free survival (RFS) and overall survival (OS). Methods This is a retrospective observational study conducted at a Colombian university hospital and included a cohort of ALL patients diagnosed between 2013 and 2020 treatment according to protocol PETHEMA (Spanish Program for Hematology Treatments). MRD was measured with 8-...

Acta Médica Colombiana, 2015

Introducción: la complicación más grave de los pacientes con hemofilia es el desarrollo de anticu... more Introducción: la complicación más grave de los pacientes con hemofilia es el desarrollo de anticuerpos inhibidores; hasta un 30% de los pacientes con hemofilia A severa los desarrollan. Para erradicarlos, la inducción de tolerancia inmune es el tratamiento de elección; cuando persisten, los tratamientos profilácticos con agentes de puente como el concentrado de complejo de protrombina activado CCPa (FEIBA®) o rFVIIa (Novoseven®) ofrecen una alternativa terapéutica para reducir los sangrados y la artropatía hemofílica. Para evaluar la eficacia de profilaxis con CCPa se compararon los sangrados antes y después de recibir profilaxis (11-12 meses) en ocho pacientes hemofílicos con inhibidores de alta respuesta. Material y métodos: se realizó un estudio multicéntrico, se incluyeron niños y adultos con diagnóstico de hemofilia A, con título de inhibidores altos, de cuatro centros de atención en dos ciudades. Se excluyeron pacientes con hemofilia adquirida. Resultados: seis pacientes tenía...

Clinical Lymphoma Myeloma and Leukemia, 2021

Objective and Outcomes Measures: Our aim was to characterize the population of patients diagnosed... more Objective and Outcomes Measures: Our aim was to characterize the population of patients diagnosed with AML who were attended in 7 health institutions in Colombia, from 2009 to 2020, included based on RENEHOC (online platform) and PETHEMA (Spanish Program for Hematology Treatments). Kaplan-Meier analysis was used to assess overall survival at 1 year (1-OS) and 5 years (5-OS) of follow-up and relapse-free survival (1-RFS, 5-RFS). Results: A total of 289 patients were included; almost half (50.2%) were female, and the median age at diagnosis was 62 years old (14–95). Most patients were ECOG 1 (39.3%) and ECOG 2 (38.8%). The patients (12.5%) presented with secondary AML, and 0.3% had hereditary predisposition syndromes to AML (Down syndrome). Complete remission was achieved in 45.0% of patients, 17.8% absolute resistance, and 13.6% patients died in induction, the majority after day 15 (66.7%). Most of the patients received intensive chemotherapy 7+3 induction regimen (55.8%). Hematopoietic stem cell transplantation (HSCT) was a treatment option for 21.2% of patients, and 77.4% met criteria for HSCT. Allogeneic HSCT (alloTPH) was performed in 19% and autologous HSCT (autoTPH) in 2.2%. The survival at 1-OS and 5-OS was 56.1% (95%CI 48.0–63.4) and 26.7% (95%CI 18.1–36.1), respectively. The RFS was 56.6% (95%CI 48.4–64.0) at 1-year and 22.2% (95%CI 14.0–31.6) at 5-years. For patients younger than 65 years ( Conclusion: Our results also show AML in an older population and that age is associated with shorter survival. We identified a low proportion of AlloHSCT, despite the survival benefit compared to non-transplant patients.

Clinical Lymphoma Myeloma and Leukemia, 2021

Blood, 2020

Introduction: Allogeneic hematopoietic stem cell transplantation (HCT) is a potentially curative ... more Introduction: Allogeneic hematopoietic stem cell transplantation (HCT) is a potentially curative treatment for several malignant and non-malignant hematological diseases. However, sometimes it is challenging to find human leukocyte antigen (HLA)-matched related or unrelated donors, especially in minority populations such as Hispanics. Transplantation of T cell replete HLA haploidentical graft (HaploHCT) followed by a high dose post-transplantation cyclophosphamide (PTCy) to eradicate alloreactive T cells is an option for populations with low donor availability. HaploHCT has emerged as an effective and safe strategy in this population (Luznik L et al. BBMT 2008), but data in Hispanics is scarce. Objective: The aim of our study was to describe the clinical characteristics and assess overall survival at 100 days, 1- and 3-years of patients who underwent haploHCT in two Colombian reference centers. Methods: An observational retrospective study was conducted at two tertiary referral cent...

Clinical Lymphoma Myeloma and Leukemia, 2020

Context Long-term TKI treatment is related to notable adverse events, quality-of-life impact, and... more Context Long-term TKI treatment is related to notable adverse events, quality-of-life impact, and significant costs to health systems. TFR has been shown to be safe in multiple clinical trials, so it has become a new goal for CML management, although information about TFR in Colombia is scarce. Objective Our aim is to show the outcomes of TFR in Colombia. Design The Colombian Association of Hematology and Oncology (ACHO)'s hematological disease registry (RENEHOC) is a multicenter study that has collected information in 14 centers with Institutional Ethics Committee approval. This report represents a sub-analysis of the patients in the registry in whom discontinuation was performed. Setting RENEHOC is a nationwide, multicenter registry on hematologic malignancies that captures information from academic and general community centers. Since 2019, it has been collecting information on CML. Patients or other participants A total of 357 CML adult patients treated in the last 20 years have been registered until now on RENEHOC. Twenty patients were considered candidates for TFR; in 14 of them, TKI have been discontinued. Interventions Treatment was according to investigator preferences. Ten patients received Imatinib as first-line and ten received second-generation TKI. Four required a second line (Nilotinib); three due to intolerance. Nine patients discontinued in a standardized TFR program, three with the intention to seek a pregnancy, one for toxicity (pleural effusion), and one for personal reasons. Main outcome measures The main outcome measured is survival without TKI re-initiation. Results The mean age was 56 yrs. (25–92), 11 were women, and 19 were in the chronic phase. On average, they received 9.3 years of TKI (3.2–14) and were in RMM for 6.9 years before TFR. At a median follow-up of 15.2 months (range 1–44.5), 12 patients remain TKI-free; the patients that re-initiated TKI regained 4.5 MMR. Five patients developed withdrawal syndrome. Conclusions The TFR is a real goal for a selected group of patients with CML. This report represents real-world data in Colombia, showing its feasibility and safety under well-controlled settings. Funding ACHO has received grants for RENEHOC project from Takeda, Abbvie, Amgen, Dr. Reddy's.

Clinical Lymphoma Myeloma and Leukemia, 2020

Clinical Lymphoma Myeloma and Leukemia, 2020

Context: Multiple myeloma (MM) as a malignant hematologic entity is a disease that causes signifi... more Context: Multiple myeloma (MM) as a malignant hematologic entity is a disease that causes significant morbidity and mortality worldwide. Understanding its characteristics in our population may help to improve diagnosis and treatment of patients. Objective: The aim of our study was to analyze clinical features and outcome factors of MM patients in two centers in Colombia and standardize them with the Colombian population. Design: We conducted a cross-sectional, retrospective, observational study. Socio-demographic, clinical, therapeutic, and outcomes features from MM patients that attended two institutions in Bogota DC and Bucaramanga, Santander between 2013 and 2019 were collected. Setting: University Medical Centers. Patients: Adult patients aged 18 and older diagnosed with MM during hospitalization or in consultation with hematology services were selected. A total of 335 patients were selected, from which 319 patients met all the inclusion criteria and were included for analysis in the study. Results: The median age was 62 years IRQ [54–70], with 49.4% (n=165) males. High paraproteins in the serum were as follows: IgG 136 (49.1%), IgA 51 (18.4%), IgM 3 (1.1%), and immune paresis 42 (15.2%) but no high IgD were detected. High kappa light chain levels were found in 48.6%, while high lambda light chain levels were seen in 28.1%. One or more cytogenetic alterations were observed in 12 patients (5.6%), the most common being del13 (25%), followed by del17p13 (16,7%). Bortezomib-based therapy was used in 93.2%, the CyBorD protocol (Cyclophosphamide-Bortezomib-Dexamethasone) in 34.1%, and the VTD protocol (bortezomib thalidomide dexamethasone) in 15.5%. Bone marrow transplant was performed in 105 patients, of whom 6 required a second transplant. Patients treated with more than one line of treatment presented higher overall survival than patients with only one line of treatment. Overall survival was 83.26%, and 38 patients relapsed (16.74%). Conclusions: Survival outcomes have significantly improved, especially best response to treatment. A concise overview of clinical and prognostic factors should be taken into account at diagnosis.

Clinical Lymphoma Myeloma and Leukemia, 2018

Colombia Medica, 2014

Background: The information of gene expression obtained from databases, have made possible the ex... more Background: The information of gene expression obtained from databases, have made possible the extraction and analysis of data related with several molecular processes involving not only in brain homeostasis but its disruption in some neuropathologies; principally in Down syndrome and the Alzheimer disease. Objective: To correlate the levels of transcription of 19 genes located in the Down Syndrome Critical Region (DSCR) with their expression in several substructures of normal human brain. Methods: There were obtained expression profiles of 19 DSCR genes in 42 brain substructures, from gene expression values available at the database of the human brain of the Brain Atlas of the Allen Institute for Brain Sciences", (http://human.brain-map.org/). The co-expression patterns of DSCR genes in brain were calculated by using multivariate statistical methods. Results: Highest levels of gene expression were registered at caudate nucleus, nucleus accumbens and putamen among central areas...

Blood, 2019

Background: Survivors of hematopoietic stem cell transplantation (HSCT) are 2 to 4 times more lik... more Background: Survivors of hematopoietic stem cell transplantation (HSCT) are 2 to 4 times more likely to develop cardiovascular diseases, accounting for 2-11% of mortality among long-term survivors. Early diagnosis and treatment of modifiable risk factors, such as arterial hypertension, are imperative in this group of patients. The aim of this study is to evaluate the prevalence and associated factors for arterial hypertension following HSCT in a Colombian population. Methods: A retrospective study was conducted in 220 consecutive adult HSCT recipients who underwent transplantation between 2009 and 2017 at a third level referral center in Colombia. Blood pressure data, from two different measures, were collected at 7 time points: day of mobilization for autologous HSCT (auto-HSCT) and day 0 before infusion for allogeneic HSCT (allo-HSCT), day 7, and months 1, 3, 6 and 12 post-HSCT. Arterial hypertension was defined as a systolic blood pressure 140mmHg and/or a diastolic blood pressur...

Acta Médica Colombiana, 2017

Introducción y Objetivos. Las NMPC son relativamente raras, con incidencias que varían entre 0,47... more Introducción y Objetivos. Las NMPC son relativamente raras, con incidencias que varían entre 0,47-1,03/100.000 habitantes, es importante para el país conocer las características clínicas de estos pacientes. Se presenta el primer reporte del trabajo del registro colombiano de NMPC. Materiales y métodos. Estudio observacional multicéntrico retrospectivo y prospectivo en ocho centros del país, de abril de 2013 a diciembre de 2014. Las variables cualitativas se presentan con frecuencias absolutas y relativas; y las cuantitativas se resumen en medidas de tendencia central y dispersión. Resultados. 11 centros fueron aprobados, 8 ingresaron pacientes. En los primeros 179 casos reportados el 50 % eran hombres, la edad promedio al diagnóstico 58,7 años (rango: 19-92). 93 son Trombocitemia Esencial (TE), 55 Policitemia Vera (PV), 31 Mielofibrosis (MF). 41% tenían esplenomegalia al diagnóstico. 20% tuvieron complicaciones trombóticas y 12,85% sangrado. Solo en 57,5% se realizó JAK, de ellos en...

Journal of Comparative Social Work, 2019

EnglishThis paper explores the differences and similarities in three social work processes as vie... more EnglishThis paper explores the differences and similarities in three social work processes as viewed by social workers in Norway and Cuba. Contrasting social work processes in these exemplars of de-familialized and familialized welfare contexts offer insight into where social work practices can be governed by international and universal policy, and where context specific national policies may be more appropriate. A qualitative study and thematic analysis based on four focus group interviews (two in each country), with a total of 19 social workers from the respective contexts, were conducted. An international validated vignette of a typical social work case was employed as a tool to help facilitate a group interaction and discussion. The first is an engagement process: how social workers make their decisions on how, or if, to engage with clients. Both Cuban and Norwegian social workers will respond to a client in need, prioritizing children in particular. A second process related to ...

Journal of Comparative Social Work, 2019

There is a lack of research into social worker perspectives in a Latin American context and a com... more There is a lack of research into social worker perspectives in a Latin American context and a comparison of these with European social work practices that currently predominate in the literature. In response to this shortfall, a Nordic-Latin American research seminar on welfare issues was held at the University of Havana´s Department of Sociology in January 2018. This special issue, 'Welfare in Latin America and the Nordic countries', was conceived during this seminar, as was the NORPART project 'Cuban and Nordic welfare' (2019-2023), funded by the Norwegian Partnership Programme for Global Academic Cooperation. The guest editors (the authors of this editorial) participated in the events. Overview of the special issue Although our starting point was a Norwegian-Cuban connection, the special issue addresses Latin America and the Nordic countries more broadly, since there are several issues related to welfare that transfer across these wider international regions. The special issue involves contributions from academics in Chile, Cuba, Norway and Sweden, with in-depth studies on Brazil (Heitmann), Chile (Ellingsen et al., Jensen et al.; Oltedal and Nygren), Cuba (Oltedal et al.), Mexico (Ursin) and Norway (Ellingsen et al.; Oltedal and Nygren, Oltedal et al.

AIDS Research and Human Retroviruses, 2010

The mechanistic basis of the target-site preference of lentivirus DNA integration is not well und... more The mechanistic basis of the target-site preference of lentivirus DNA integration is not well understood. In the present in silico study, we describe the integrational profile of simultaneous HIV-1 and HIV-2 infection. A total of 352 genomic DNA sequences from human peripheral blood mononuclear cells (PBMCs) obtained from GenBank and possessing the 5 0 LTR of HIV were used to characterize the structure and composition of local chromatin associated with high frequency integration sites. These sequences were aligned with the draft human genome (hg18) using BLAST (NCBI) and BLAT (UCSC) in order to derive information about chromosome localization, functional aspects of coding protein genes, CpG island number, and repetitive elements flanking integration sites. No significant differences in the integrational profile between HIV-1 and HIV-2 were found. However, we observed a tendency in both lentiviruses to integrate in the vicinity of protein coding genes. Multiple regression analysis showed a strong correlation between the number of genes and the number of CpG islands in regions with high integration frequency, mainly in chromosome 17 (R ¼ 0.95, p < 0.05). Our results provide strong evidence that HIV-1 and HIV-2 have common genomic environments in the local chromatin regions with high gene density and CpG islands. The understanding of local genomic environments with a high frequency of integration would be the starting point to develop novel antiviral strategies for lentiviral infection.

Clinical Lymphoma Myeloma and Leukemia, 2018

Automática y Robótica en Latinoamérica. Aportes desde la Academia, 2021

Context: Tyrosine kinase inhibitors (TKIs) dramatically changed outcomes in CML; achieving and ma... more Context: Tyrosine kinase inhibitors (TKIs) dramatically changed outcomes in CML; achieving and maintaining treatment milestones is highly dependent on adherence. Colombia subscribes a principle of universal health coverage; however, there is significant difference in access to high-cost drugs between different insurance types (Subsidized [SS] vs Contributory [SC]). Objective: To describe the current patient management and outcomes of CML in Colombia and possible factors associated with outcomes. Design: ACHO’s hematological disease registry (RENEHOC) is a multicenter study that has collected information on CML patients since 2019. Setting: RENEHOC is a real-world registry that captures information from 16 academic and general community centers in 5 cities in Colombia. Patients or Other Participants: Adult CML patients. Interventions: Due to its observational nature, all treatment decisions depend on treating investigator preferences. Main Outcomes Measures: RENEHOC is an online data...

Blood, 2021

Introduction Acute lymphoblastic leukemia (ALL) is a clonal hematopoietic disorder that originate... more Introduction Acute lymphoblastic leukemia (ALL) is a clonal hematopoietic disorder that originates from B or T lymphoid progenitors and has well validated prognostic and predictive factors that influence outcomes. One of the strongest prognostic factors is the detection of minimal residual disease (MRD) which measures residual cell population after treatment when a morphologic complete response has been achieved. MRD positivity is associated with a higher risk of relapse and poor response to chemo or radiotherapy Objectives The aim of the study was to assess the prognostic impact of post-induction MRD status in a cohort of ALL Colombian patients in terms of relapse-free survival (RFS) and overall survival (OS). Methods This is a retrospective observational study conducted at a Colombian university hospital and included a cohort of ALL patients diagnosed between 2013 and 2020 treatment according to protocol PETHEMA (Spanish Program for Hematology Treatments). MRD was measured with 8-...

Acta Médica Colombiana, 2015

Introducción: la complicación más grave de los pacientes con hemofilia es el desarrollo de anticu... more Introducción: la complicación más grave de los pacientes con hemofilia es el desarrollo de anticuerpos inhibidores; hasta un 30% de los pacientes con hemofilia A severa los desarrollan. Para erradicarlos, la inducción de tolerancia inmune es el tratamiento de elección; cuando persisten, los tratamientos profilácticos con agentes de puente como el concentrado de complejo de protrombina activado CCPa (FEIBA®) o rFVIIa (Novoseven®) ofrecen una alternativa terapéutica para reducir los sangrados y la artropatía hemofílica. Para evaluar la eficacia de profilaxis con CCPa se compararon los sangrados antes y después de recibir profilaxis (11-12 meses) en ocho pacientes hemofílicos con inhibidores de alta respuesta. Material y métodos: se realizó un estudio multicéntrico, se incluyeron niños y adultos con diagnóstico de hemofilia A, con título de inhibidores altos, de cuatro centros de atención en dos ciudades. Se excluyeron pacientes con hemofilia adquirida. Resultados: seis pacientes tenía...

Clinical Lymphoma Myeloma and Leukemia, 2021

Objective and Outcomes Measures: Our aim was to characterize the population of patients diagnosed... more Objective and Outcomes Measures: Our aim was to characterize the population of patients diagnosed with AML who were attended in 7 health institutions in Colombia, from 2009 to 2020, included based on RENEHOC (online platform) and PETHEMA (Spanish Program for Hematology Treatments). Kaplan-Meier analysis was used to assess overall survival at 1 year (1-OS) and 5 years (5-OS) of follow-up and relapse-free survival (1-RFS, 5-RFS). Results: A total of 289 patients were included; almost half (50.2%) were female, and the median age at diagnosis was 62 years old (14–95). Most patients were ECOG 1 (39.3%) and ECOG 2 (38.8%). The patients (12.5%) presented with secondary AML, and 0.3% had hereditary predisposition syndromes to AML (Down syndrome). Complete remission was achieved in 45.0% of patients, 17.8% absolute resistance, and 13.6% patients died in induction, the majority after day 15 (66.7%). Most of the patients received intensive chemotherapy 7+3 induction regimen (55.8%). Hematopoietic stem cell transplantation (HSCT) was a treatment option for 21.2% of patients, and 77.4% met criteria for HSCT. Allogeneic HSCT (alloTPH) was performed in 19% and autologous HSCT (autoTPH) in 2.2%. The survival at 1-OS and 5-OS was 56.1% (95%CI 48.0–63.4) and 26.7% (95%CI 18.1–36.1), respectively. The RFS was 56.6% (95%CI 48.4–64.0) at 1-year and 22.2% (95%CI 14.0–31.6) at 5-years. For patients younger than 65 years ( Conclusion: Our results also show AML in an older population and that age is associated with shorter survival. We identified a low proportion of AlloHSCT, despite the survival benefit compared to non-transplant patients.

Clinical Lymphoma Myeloma and Leukemia, 2021

Blood, 2020

Introduction: Allogeneic hematopoietic stem cell transplantation (HCT) is a potentially curative ... more Introduction: Allogeneic hematopoietic stem cell transplantation (HCT) is a potentially curative treatment for several malignant and non-malignant hematological diseases. However, sometimes it is challenging to find human leukocyte antigen (HLA)-matched related or unrelated donors, especially in minority populations such as Hispanics. Transplantation of T cell replete HLA haploidentical graft (HaploHCT) followed by a high dose post-transplantation cyclophosphamide (PTCy) to eradicate alloreactive T cells is an option for populations with low donor availability. HaploHCT has emerged as an effective and safe strategy in this population (Luznik L et al. BBMT 2008), but data in Hispanics is scarce. Objective: The aim of our study was to describe the clinical characteristics and assess overall survival at 100 days, 1- and 3-years of patients who underwent haploHCT in two Colombian reference centers. Methods: An observational retrospective study was conducted at two tertiary referral cent...

Clinical Lymphoma Myeloma and Leukemia, 2020

Context Long-term TKI treatment is related to notable adverse events, quality-of-life impact, and... more Context Long-term TKI treatment is related to notable adverse events, quality-of-life impact, and significant costs to health systems. TFR has been shown to be safe in multiple clinical trials, so it has become a new goal for CML management, although information about TFR in Colombia is scarce. Objective Our aim is to show the outcomes of TFR in Colombia. Design The Colombian Association of Hematology and Oncology (ACHO)'s hematological disease registry (RENEHOC) is a multicenter study that has collected information in 14 centers with Institutional Ethics Committee approval. This report represents a sub-analysis of the patients in the registry in whom discontinuation was performed. Setting RENEHOC is a nationwide, multicenter registry on hematologic malignancies that captures information from academic and general community centers. Since 2019, it has been collecting information on CML. Patients or other participants A total of 357 CML adult patients treated in the last 20 years have been registered until now on RENEHOC. Twenty patients were considered candidates for TFR; in 14 of them, TKI have been discontinued. Interventions Treatment was according to investigator preferences. Ten patients received Imatinib as first-line and ten received second-generation TKI. Four required a second line (Nilotinib); three due to intolerance. Nine patients discontinued in a standardized TFR program, three with the intention to seek a pregnancy, one for toxicity (pleural effusion), and one for personal reasons. Main outcome measures The main outcome measured is survival without TKI re-initiation. Results The mean age was 56 yrs. (25–92), 11 were women, and 19 were in the chronic phase. On average, they received 9.3 years of TKI (3.2–14) and were in RMM for 6.9 years before TFR. At a median follow-up of 15.2 months (range 1–44.5), 12 patients remain TKI-free; the patients that re-initiated TKI regained 4.5 MMR. Five patients developed withdrawal syndrome. Conclusions The TFR is a real goal for a selected group of patients with CML. This report represents real-world data in Colombia, showing its feasibility and safety under well-controlled settings. Funding ACHO has received grants for RENEHOC project from Takeda, Abbvie, Amgen, Dr. Reddy's.

Clinical Lymphoma Myeloma and Leukemia, 2020

Clinical Lymphoma Myeloma and Leukemia, 2020

Context: Multiple myeloma (MM) as a malignant hematologic entity is a disease that causes signifi... more Context: Multiple myeloma (MM) as a malignant hematologic entity is a disease that causes significant morbidity and mortality worldwide. Understanding its characteristics in our population may help to improve diagnosis and treatment of patients. Objective: The aim of our study was to analyze clinical features and outcome factors of MM patients in two centers in Colombia and standardize them with the Colombian population. Design: We conducted a cross-sectional, retrospective, observational study. Socio-demographic, clinical, therapeutic, and outcomes features from MM patients that attended two institutions in Bogota DC and Bucaramanga, Santander between 2013 and 2019 were collected. Setting: University Medical Centers. Patients: Adult patients aged 18 and older diagnosed with MM during hospitalization or in consultation with hematology services were selected. A total of 335 patients were selected, from which 319 patients met all the inclusion criteria and were included for analysis in the study. Results: The median age was 62 years IRQ [54–70], with 49.4% (n=165) males. High paraproteins in the serum were as follows: IgG 136 (49.1%), IgA 51 (18.4%), IgM 3 (1.1%), and immune paresis 42 (15.2%) but no high IgD were detected. High kappa light chain levels were found in 48.6%, while high lambda light chain levels were seen in 28.1%. One or more cytogenetic alterations were observed in 12 patients (5.6%), the most common being del13 (25%), followed by del17p13 (16,7%). Bortezomib-based therapy was used in 93.2%, the CyBorD protocol (Cyclophosphamide-Bortezomib-Dexamethasone) in 34.1%, and the VTD protocol (bortezomib thalidomide dexamethasone) in 15.5%. Bone marrow transplant was performed in 105 patients, of whom 6 required a second transplant. Patients treated with more than one line of treatment presented higher overall survival than patients with only one line of treatment. Overall survival was 83.26%, and 38 patients relapsed (16.74%). Conclusions: Survival outcomes have significantly improved, especially best response to treatment. A concise overview of clinical and prognostic factors should be taken into account at diagnosis.

Clinical Lymphoma Myeloma and Leukemia, 2018

Colombia Medica, 2014

Background: The information of gene expression obtained from databases, have made possible the ex... more Background: The information of gene expression obtained from databases, have made possible the extraction and analysis of data related with several molecular processes involving not only in brain homeostasis but its disruption in some neuropathologies; principally in Down syndrome and the Alzheimer disease. Objective: To correlate the levels of transcription of 19 genes located in the Down Syndrome Critical Region (DSCR) with their expression in several substructures of normal human brain. Methods: There were obtained expression profiles of 19 DSCR genes in 42 brain substructures, from gene expression values available at the database of the human brain of the Brain Atlas of the Allen Institute for Brain Sciences", (http://human.brain-map.org/). The co-expression patterns of DSCR genes in brain were calculated by using multivariate statistical methods. Results: Highest levels of gene expression were registered at caudate nucleus, nucleus accumbens and putamen among central areas...

Blood, 2019

Background: Survivors of hematopoietic stem cell transplantation (HSCT) are 2 to 4 times more lik... more Background: Survivors of hematopoietic stem cell transplantation (HSCT) are 2 to 4 times more likely to develop cardiovascular diseases, accounting for 2-11% of mortality among long-term survivors. Early diagnosis and treatment of modifiable risk factors, such as arterial hypertension, are imperative in this group of patients. The aim of this study is to evaluate the prevalence and associated factors for arterial hypertension following HSCT in a Colombian population. Methods: A retrospective study was conducted in 220 consecutive adult HSCT recipients who underwent transplantation between 2009 and 2017 at a third level referral center in Colombia. Blood pressure data, from two different measures, were collected at 7 time points: day of mobilization for autologous HSCT (auto-HSCT) and day 0 before infusion for allogeneic HSCT (allo-HSCT), day 7, and months 1, 3, 6 and 12 post-HSCT. Arterial hypertension was defined as a systolic blood pressure 140mmHg and/or a diastolic blood pressur...

Acta Médica Colombiana, 2017

Introducción y Objetivos. Las NMPC son relativamente raras, con incidencias que varían entre 0,47... more Introducción y Objetivos. Las NMPC son relativamente raras, con incidencias que varían entre 0,47-1,03/100.000 habitantes, es importante para el país conocer las características clínicas de estos pacientes. Se presenta el primer reporte del trabajo del registro colombiano de NMPC. Materiales y métodos. Estudio observacional multicéntrico retrospectivo y prospectivo en ocho centros del país, de abril de 2013 a diciembre de 2014. Las variables cualitativas se presentan con frecuencias absolutas y relativas; y las cuantitativas se resumen en medidas de tendencia central y dispersión. Resultados. 11 centros fueron aprobados, 8 ingresaron pacientes. En los primeros 179 casos reportados el 50 % eran hombres, la edad promedio al diagnóstico 58,7 años (rango: 19-92). 93 son Trombocitemia Esencial (TE), 55 Policitemia Vera (PV), 31 Mielofibrosis (MF). 41% tenían esplenomegalia al diagnóstico. 20% tuvieron complicaciones trombóticas y 12,85% sangrado. Solo en 57,5% se realizó JAK, de ellos en...

Journal of Comparative Social Work, 2019

EnglishThis paper explores the differences and similarities in three social work processes as vie... more EnglishThis paper explores the differences and similarities in three social work processes as viewed by social workers in Norway and Cuba. Contrasting social work processes in these exemplars of de-familialized and familialized welfare contexts offer insight into where social work practices can be governed by international and universal policy, and where context specific national policies may be more appropriate. A qualitative study and thematic analysis based on four focus group interviews (two in each country), with a total of 19 social workers from the respective contexts, were conducted. An international validated vignette of a typical social work case was employed as a tool to help facilitate a group interaction and discussion. The first is an engagement process: how social workers make their decisions on how, or if, to engage with clients. Both Cuban and Norwegian social workers will respond to a client in need, prioritizing children in particular. A second process related to ...

Journal of Comparative Social Work, 2019

There is a lack of research into social worker perspectives in a Latin American context and a com... more There is a lack of research into social worker perspectives in a Latin American context and a comparison of these with European social work practices that currently predominate in the literature. In response to this shortfall, a Nordic-Latin American research seminar on welfare issues was held at the University of Havana´s Department of Sociology in January 2018. This special issue, 'Welfare in Latin America and the Nordic countries', was conceived during this seminar, as was the NORPART project 'Cuban and Nordic welfare' (2019-2023), funded by the Norwegian Partnership Programme for Global Academic Cooperation. The guest editors (the authors of this editorial) participated in the events. Overview of the special issue Although our starting point was a Norwegian-Cuban connection, the special issue addresses Latin America and the Nordic countries more broadly, since there are several issues related to welfare that transfer across these wider international regions. The special issue involves contributions from academics in Chile, Cuba, Norway and Sweden, with in-depth studies on Brazil (Heitmann), Chile (Ellingsen et al., Jensen et al.; Oltedal and Nygren), Cuba (Oltedal et al.), Mexico (Ursin) and Norway (Ellingsen et al.; Oltedal and Nygren, Oltedal et al.

AIDS Research and Human Retroviruses, 2010

The mechanistic basis of the target-site preference of lentivirus DNA integration is not well und... more The mechanistic basis of the target-site preference of lentivirus DNA integration is not well understood. In the present in silico study, we describe the integrational profile of simultaneous HIV-1 and HIV-2 infection. A total of 352 genomic DNA sequences from human peripheral blood mononuclear cells (PBMCs) obtained from GenBank and possessing the 5 0 LTR of HIV were used to characterize the structure and composition of local chromatin associated with high frequency integration sites. These sequences were aligned with the draft human genome (hg18) using BLAST (NCBI) and BLAT (UCSC) in order to derive information about chromosome localization, functional aspects of coding protein genes, CpG island number, and repetitive elements flanking integration sites. No significant differences in the integrational profile between HIV-1 and HIV-2 were found. However, we observed a tendency in both lentiviruses to integrate in the vicinity of protein coding genes. Multiple regression analysis showed a strong correlation between the number of genes and the number of CpG islands in regions with high integration frequency, mainly in chromosome 17 (R ¼ 0.95, p < 0.05). Our results provide strong evidence that HIV-1 and HIV-2 have common genomic environments in the local chromatin regions with high gene density and CpG islands. The understanding of local genomic environments with a high frequency of integration would be the starting point to develop novel antiviral strategies for lentiviral infection.

Clinical Lymphoma Myeloma and Leukemia, 2018