Márcio Tavares - Academia.edu (original) (raw)

Papers by Márcio Tavares

Intensive Care Medicine Experimental, Oct 1, 2015

Leukemia & Lymphoma, 2017

Acute leukemia (AL) is the most common hematological malignancy requiring intensive care unit (IC... more Acute leukemia (AL) is the most common hematological malignancy requiring intensive care unit (ICU) management. Data on long-term survival are limited. This is a post hoc analysis of the prospective multicenter data from France and Belgium: A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique [A Research Group on Acute Respiratory Failure in Onco-Hematological Patients (French)] Study, to identify determinants of 1-year survival in critically ill AL patients. A total of 278 patients were admitted in the 17 participating ICUs. Median age was 58 years and 70% had newly diagnosed leukemia. ICU mortality rate was 28.6 and 39.6% of the patients alive at 1 year. Admission for intensive monitoring was independently associated with better 1-year survival by multivariate analysis. Conversely, relapsed/refractory disease, secondary leukemia, mechanical ventilation and renal replacement therapy were independently associated with 1-year mortality. This study confirms the impact of organ dysfunction on long-term survival in ICU patients with AL. Follow-up studies to assess respiratory and renal recovery are warranted.

International Journal of Hematology and Therapy, 2015

Solitary Plasmacytoma (SP) is a rare plasma cell dyscrasia characterized by localized plasma cell... more Solitary Plasmacytoma (SP) is a rare plasma cell dyscrasia characterized by localized plasma cell infiltration. Radiotherapy is recommended as the treatment of choice. Epidemiological data is important to evaluate the effectiveness of treatment and the progression to Multiple Myeloma (MM). We described the clinical features and follow-up of 32 patients with SP treated with radiotherapy as primary treatment at our Department of Radiotherapy and we reviewed the literature on prognostic factors of progression to MM. Ninety percent of patients (71% complete response and 19% partial response) responded to treatment. Fourteen patients progressed to MM with a median time of progression of 16, 9 months. With a median follow-up of 40 months, the 5 and 10-year estimated Overall Survey (OS) was 62, 6% and 47, 7% respectively. Predictive factors of progression are still controversial. New factors are emerging in the fields of pathology, imagiology and immunology and thus we wait longer follow-up to confirm their predictive value. SP is highly radiosensitive and radiotherapy combines excellent control rates with minimal toxicity. However, it is a heterogeneous disease and approximately half of the patients will progress to MM. Identifying the patients more likely to progress would allow us to treat them in a different way.

Journal of Hematology & Thromboembolic Diseases, 2015

Background: Primary mediastinal B-cell lymphoma (PMBCL) is a distinct clinicopathologic entity fr... more Background: Primary mediastinal B-cell lymphoma (PMBCL) is a distinct clinicopathologic entity from diffuse large B-cell lymphoma. The optimal first-line therapy for PMBCL is subject of ongoing debate with no accepted standard of care. Patients and Methods: We searched retrospectively for adult patients with newly diagnosed PMBCL treated at our department between 2002 and 2014. Clinical, management and follow-up data were collected. Staging and response assessment of patients included PET and/or CT scan. Results: Twenty-nine patients with PMBCL (17 female and 12 male) were included. The median age at diagnosis was 36 years (18-79 years). Eighteen (62.1%) and 20 (69%) patients had limited-stage and bulky disease, respectively. All patients were treated with rituximab-based combination chemotherapy; 21 patients underwent consolidation radiotherapy. Seven patients (24.1%) were transplanted (six in first remission and the remaining in second remission). At the end of frontline therapy, 28 patients had responded (27 complete response and 1 partial response) and one patient showed progressive disease. Febrile neutropenia was the most frequent acute adverse event and three patients developed late toxicity. The median follow-up was 51,5 months. The 5-year overall progression-free survival was 83.8%. Four patients died, half of which died within the first year after diagnosis. Conclusion: Our study shows favorable prognosis of patients with PMBCL treated with rituximab-based chemotherapy and consolidation radiotherapy or autologous stem-cell transplant. While consolidation therapy continues to be commonly used, its role has become increasingly controversial.

Revista Española de Medicina Nuclear e Imagen Molecular (English Edition), 2020

To investigate the prognostic value of interim PET (PETi) in adult HL patients, comparing visual ... more To investigate the prognostic value of interim PET (PETi) in adult HL patients, comparing visual with semiquantitative analysis. Material and methods: Retrospective analysis of Hodgkin's lymphoma (HL) patients diagnosed between 2012 and 2016 in the Onco-hematology Department of Instituto Português de Oncologia-Porto (median follow-up: 46.5 months [2.6-66.4]). Fifty-eight patients with available PET at diagnosis (PET0) and PETi data were included. PETi scans were analyzed according to Deauville 5-point scale (5-PS), and cutoff values for changes in maximum standardized uptake value [SUVmax], peak SUV [SUVpeak], metabolic tumour volume [MTV] and total lesion glycolysis index [TLG] between PETi and PET0 were computed using ROC analysis. Visual and semiquantitative data were compared with each other in the prediction of patient outcomes. Results: Semiquantitative analysis obtained a higher sensitivity for persistent/relapsed disease compared to the 5-PS (70% vs. 10%, respectively), but lower specificity. It also demonstrated better predictive performance for response to first-line therapy (negative predictive value >92%). The positive predictive value was similar for all five measurements. At 60 months of follow-up, there was a significant difference between the progression free survival (PFS) curves of patients with positive and negative PETi according to SUVmax (56.9% vs. 88.0%, p < 0.05), SUVpeak (55.9% vs. 88.1%, p < 0.05), MTV (35.3% vs. 88.7%, p < 0.05), and TLG (42.4% vs. 88.1%, p < 0.05). Statistical significance was not reached when considering 5-PS results. Discussion: PETi interpretation according to a semiquantitative approach appears to discriminate HL patients better than the visual 5-PS analysis. This could allow better detection of persistent or early relapsed disease, while a negative PETi result could support de-escalating therapy intensity.

$Research paper thumbnail of Successful treatment of refractory chylous ascites due to follicular lymphoma with very low-dose radiotherapy$

Reports of Practical Oncology & Radiotherapy, 2019

Chylous ascites is an extremely rare complication of lymphoma. Here, we discuss the case of a pat... more Chylous ascites is an extremely rare complication of lymphoma. Here, we discuss the case of a patient presenting with refractory chylous ascites due to a massive retroperitoneal follicular lymphoma, staged as IVB. The patient was unresponsive to chemoimmunotherapy, which prompted us to consider alternative treatment strategies. Low-dose radiotherapy was initiated and resulted in a marked decrease of the lymphadenopathy and complete regression of the peritoneal fluid. Low-dose radiotherapy represents a well-tolerated, highly effective treatment and should remain an important modality in cases of follicular lymphoma-associated chylous ascites.

Journal of intensive care medicine, Jan 10, 2016

This was an observational retrospective study aimed to examine the frequency and associated facto... more This was an observational retrospective study aimed to examine the frequency and associated factors of withdrawing or withholding life support (WWLS) in the intensive care unit (ICU) of a comprehensive cancer center. Medical records of adult patients with cancer admitted to the ICU between January 2010 and December 2014 were reviewed. Patients who died during that period were classified into 2 groups: full life support and withdrawing and withholding life support. The relative impact of demographic and clinical factors was assessed using logistic regression. A total of 247 patients died in our unit (mortality rate of 16.3%). Their median age was 62 (interquartile range [IQR] 51-73) years, there were 142 (57.5%) male patients, and they had predominantly solid malignancies (62.3%). The median Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation scores were 67 (IQR 54-80) and 29 (IQR 23-55), respectively. Ninety-six (38.9%) patients died after WWLS wi...

Journal of Child Neurology, 2015

Since its original description 2 decades ago, posterior reversible encephalopathy syndrome has be... more Since its original description 2 decades ago, posterior reversible encephalopathy syndrome has been reported in children with several predisposing conditions. Epidemiologic data of posterior reversible encephalopathy syndrome in children with hematologic malignancies is still scarce. Herein, we describe the clinical and radiologic features along with the outcome and follow-up of posterior reversible encephalopathy syndrome complicating the treatment of children with hematologic malignancies. Ten patients with a median age of 6.3 years were diagnosed with posterior reversible encephalopathy syndrome. Six of them were undergoing chemotherapy and the remaining 4 were at 37, 52, 78, and 857 days after allogenic hematopoietic stem cell transplant. The median follow-up was 27.6 months. Even though follow-up imaging showed complete resolution of abnormalities in those 10 children, 2 developed secondary epilepsy. Despite accurate diagnosis of posterior reversible encephalopathy syndrome and...

$Research paper thumbnail of Compassionate use of glasdegib in combination with low-dose cytarabine for relapsed, refractory acute myeloid leukemia or high-risk myelodysplastic syndrome$

Annals of Hematology, 2020

Management of patients with relapsed, refractory (R/R) acute myeloid leukemia (AML) or high-risk ... more Management of patients with relapsed, refractory (R/R) acute myeloid leukemia (AML) or high-risk myelodysplastic syndrome (HR-MDS) remains a challenge. For most patients, treatment options are limited, responses are inadequate, and patients should be considered for experimental therapies. Aberrant Hedgehog (Hh) pathway activation has been implicated in the maintenance of leukemic stem cells, emerging as a promising therapeutic target [1, 2]. In November 2018, the Hh pathway inhibitor glasdegib, in combination with low-dose cytarabine (LDAC), received Food and Drug Administration approval for the treatment of newly diagnosed AML in adults who are ineligible for intensive induction chemotherapy [2, 3]. Here, we report six adult patients with R/R AML or HR-MDS treated with glasdegib, obtained through a compassionate use program following authorization by the Portuguese regulatory agency (INFARMED), plus LDAC between May and December 2019 (Table 1). Glasdegib was given orally at a dose of 100 mg daily for 28 days, and LDAC was given subcutaneously at 20 mg/m2/day for 10 days per cycle, until progression or unacceptable toxicity. Median age was 66 years * Márcio Tavares