CONTEXT AND OBJECTIVE: Hematopoietic stem cell transplantation (HSCT) has been widely used for tr... more CONTEXT AND OBJECTIVE: Hematopoietic stem cell transplantation (HSCT) has been widely used for treating oncological and hematological diseases. Although HSCT has helped to improve patient survival, the risk of developing infection during hospitalization is an important cause of morbidity and mortality. This study aimed to analyze the infection profile during hospitalization and the associated risk factors among patients undergoing autologous HSCT at the University Hospital, Universidade Federal de Juiz de Fora. DESIGN AND SETTING: This was a cross-sectional study on patients undergoing autologous HSCT at a public university hospital. METHODS: Patients with febrile neutropenia between 2004 and 2009 were retrospectively evaluated regarding their infection profile and associated risk factors. RESULTS: Infection occurred in 57.2% of 112 patients with febrile neutropenia. The main source of infection was the central venous catheter (25.9%). Infection was chiefly due to Gram-positive bact...
O Transplante de células-tronco hematopoéticas (TCTH) tem sido amplamente utilizado para o tratam... more O Transplante de células-tronco hematopoéticas (TCTH) tem sido amplamente utilizado para o tratamento de diferentes doenças malignas ou não. Apesar de seus benefícios, é considerada uma terapêutica de risco, devido às complicações inerentes ao tratamento que podem contribuir para aumentar a morbi-mortalidade. A infecção é uma das complicações mais graves, que gera aumento de custos de tratamento e de permanência hospitalar, podendo, inclusive, levar à morte. Esta complicação está associada à quimioterapia utilizada durante o período de internação, que leva o paciente à imunossupressão grave. Na tentativa de minimizar o risco de infecção, são utilizadas medidas profiláticas que incluem o isolamento do paciente e a restrição de visitantes. Contudo, cada centro faz uso de medidas diferenciadas, sem uma padronização de ações. O presente estudo pretendeu realizar uma revisão da literatura com a intenção de analisar as medidas de prevenção de infecção utilizadas nos diferentes serviços. F...
This is an observational and cross-sectional study, carried out in May 2020, targeting adult indi... more This is an observational and cross-sectional study, carried out in May 2020, targeting adult individuals of both sexes who are members of multiprofessional teams working in Brazilian HSCT units in the current period of the pandemic by completing and analyzing a questionnaire. pre-formulated. HSCT units that cannot access the questionnaire were excluded from the study. The analysis of the operation profile of HSCT units in Brazil, through the application of a pre-structured questionnaire, is not an accurate tool, since it assumes some premises that may prove to be wrong, especially in this current scenario in Brazil. However, the data reveal the vulnerability of patients with onco-hematological diseases to infection by COVID-19, especially during HSCT procedures, in relation to the general population. Despite its limitations, it can be valuable to plan policies.
As células-tronco de dentes decíduos exfoliados, isoladas como uma subpopulação das células-tronc... more As células-tronco de dentes decíduos exfoliados, isoladas como uma subpopulação das células-tronco da polpa dentária, demonstram possuir a capacidade de se diferenciarem in vitro em neurônios, adipócitos, odontoblastos e osteoblastos. Devido a sua facilidade de obtenção, que não envolve um procedimento invasivo, esta linhagem celular é considerada uma grande promessa para a medicina regenerativa. Os objetivos deste trabalho foram estabelecer e caracterizar duas linhagens de células-tronco de dentes decíduos humanos. As linhagens foram isoladas a partir de amostras de crianças saudáveis de 6 anos de idade. Os resultados mostraram, por citometria de fluxo, que as células foram positivas para marcadores de células-tronco mesenquimais (CD105 (SH2), SH3 e SH4) e negativa para a marcação hematopoiética (CD45) e que as linhagens estabelecidaseram constituídas de uma população homogênea de células-tronco. As células obtidas foram avaliadas quanto a sua proliferação e capacidade de diferenci...
JUSTIFICATIVA E OBJETIVOS: Os linfomas representam a quarta doença maligna mais frequente na gest... more JUSTIFICATIVA E OBJETIVOS: Os linfomas representam a quarta doença maligna mais frequente na gestação, sendo o linfoma de Hodgkin (LH) o tipo mais comum. O tratamento em gestantes é individualizado com radioterapia ou quimioterapia. A decisão de realizar o tratamento quimioterápico durante a gravidez deve ser avaliada à luz dos efeitos sobre a vida materna, caso o tratamento seja adiado. Evidências sugerem que a quimioterapia durante o primeiro trimestre de gravidez aumenta o risco de abortos espontâneos, morte fetal e malformações, sendo menor quando o tratamento é com monoquimioterapia. Ausência de estudos aleatórios e escassez da literatura fazem com que não existam evidências sólidas sobre qual a melhor conduta a ser tomada. O objetivo deste relato foi apresentar a evolução de uma paciente com diagnóstico de linfoma de Hodgkin. RELATO DO CASO: Paciente de 18 anos, 22 semanas de gestação, apresenta linfonodomegalia em fossa supraclavicular direita. A biópsia revela LH esclerose n...
Os fungos do genero Fusarium sp sao comumente encontrados no solo e em restos orgânicos. Sao reco... more Os fungos do genero Fusarium sp sao comumente encontrados no solo e em restos orgânicos. Sao reconhecidos como causa de infeccao localizada envolvendo unhas, pele traumatizada ou a cornea. A infeccao disseminada por Fusarium sp e encontrada quase que exclusivamente em imunodeprimidos, em particular em neutropenicos ou em pacientes recebendo quimioterapia ou transplante de medula ossea. Atualmente, Fusarium sp sao considerados patogenos emergentes e, em alguns centros, ja representam a terceira causa mais comum de micose invasiva, apos Candida e Aspergillus . Relatamos o caso de uma paciente de 62 anos, portadora de mieloma multiplo, que desenvolveu fusariose disseminada em seu segundo transplante autologo de medula ossea. No vigesimo dia pos-transplante evoluiu com necessidade de suporte intensivo e veio a obito. Fusariose, em sua forma disseminada, e uma infeccao rara, de dificil suspeita diagnostica e mesmo com o tratamento, na maioria das vezes a evolucao e fatal.
Herpes simplex virus (HSV) is prevalent worldwide and known as a notorious opportunistic pathogen... more Herpes simplex virus (HSV) is prevalent worldwide and known as a notorious opportunistic pathogen ofimmunocompromised patients. During the course of HSV treatment, acyclovir (ACV)-resistant HSV strains may emerge, causing many clinical complications. Because few studies in this area showing the presence and/or frequency ofACV-resistant HSV are available, the authors evaluated the sensitivity of HSV isolated from 3 hematopoietic stem cell transplant recipients and 24 normal patients observed in a University Hospital in Rio de Janeiro, Brazil. Twenty-seven HSV isolated in VERO cells and typed by the direct immunofluorescence assay were tested for their susceptibility to various concentrations ofACV by the dye-uptake method. The susceptibility of the HSV strains was expressed as ED50 (the concentration of drug reducing viral cytophatic effect by 50%). The sensitivity to ACV by the dye-uptake assay revealed that 25 samples (92.6%) were sensitive to ACV concentrations < 1.5 microg/mL....
Mycosis Fungoides is typically an indolent disease in early stages. However, approximately 30% of... more Mycosis Fungoides is typically an indolent disease in early stages. However, approximately 30% of patients have advanced staged disease at presentation and 20% will develop it at some time. These patients have a poorer prognosis with a median survival of 2-4 years. The only curative option for mycosis fungoides may be hematopoietic allogeneic stem cell transplantation. We report the case of a patient with mycosis fungoides in an advanced stage (IIB), refractory to treatment options. She underwent allogeneic hematopoietic stem-cell transplantation (allo-HSCT). The patient remains in complete remission nineteen months after allo-HSCT. Allogeneic transplantation can alter the natural history of mycosis fungoides and should be considered in patients who have refractory disease or short-lived responses with standard therapies.
O Transplante de celulas-tronco hematopoeticas (TCTH) tem sido amplamente utilizado para o tratam... more O Transplante de celulas-tronco hematopoeticas (TCTH) tem sido amplamente utilizado para o tratamento de diferentes doencas malignas ou nao. Apesar de seus beneficios, e considerada uma terapeutica de risco, devido as complicacoes inerentes ao tratamento que podem contribuir para aumentar a morbi-mortalidade. A infeccao e uma das complicacoes mais graves, que gera aumento de custos de tratamento e de permanencia hospitalar, podendo, inclusive, levar a morte. Esta complicacao esta associada a quimioterapia utilizada durante o periodo de internacao, que leva o paciente a imunossupressao grave. Na tentativa de minimizar o risco de infeccao, sao utilizadas medidas profilaticas que incluem o isolamento do paciente e a restricao de visitantes. Contudo, cada centro faz uso de medidas diferenciadas, sem uma padronizacao de acoes. O presente estudo pretendeu realizar uma revisao da literatura com a intencao de analisar as medidas de prevencao de infeccao utilizadas nos diferentes servicos. F...
Background Diarrhea is frequently seen in autologous stem cell transplantation. Although toxicity... more Background Diarrhea is frequently seen in autologous stem cell transplantation. Although toxicity related to conditioning is the most common cause, infectious pathogens can play a distinctive role particularly in certain regions and environments. Methods The role of enteropathogens was investigated in 47 patients submitted to autologous stem cell transplantation at a Brazilian center between May 2011 and May 2013. All patients who presented with diarrhea consented to stool sample analysis to identify the etiological agents including coccidia, Strongyloides sp., Clostridium difficile and other pathogenic bacteria. Results Thirty-nine patients (83%) had diarrhea, among whom seven (17.5%) presented with coccidia, three (7.5%) with Candida sp., one (2.5%) with C. difficile, and one (2.5%) with Giardia lamblia. There was a tendency toward a higher incidence of diarrhea in older patients (p-value = 0.09) and those who received conditioning with lomustine, etoposide, cytarabine, and melpha...
OBJECTIVE To identify how the Brazilian hematology centers treated and diagnosed cases of acute m... more OBJECTIVE To identify how the Brazilian hematology centers treated and diagnosed cases of acute myeloid leukemia in 2009. METHODS An epidemiological observational multicenter study of 11 listed Brazilian centers that treat acute myeloid leukemia and perform bone marrow transplantation. Data were collected from clinical charts of patients with acute myeloid leukemia treated at the said centers between 2005 and 2009. The availability for immunophenotyping and cytogenetic tests was assessed. RESULTS During 2009, a total of 345 new cases of acute myeloid leukemia were diagnosed. Differences were noted in the tests performed between patients who initiated treatment at the center and those referred for treatment. Of the participating centers, 72% conducted some type of molecular study in acute myeloid leukemia upon diagnosis. CONCLUSION Treatment for acute myeloid leukemia in Brazil shows significantly inferior results when compared to other centers worldwide.
In the past few decades, genetic data has become increasingly important for acute leukemia diagno... more In the past few decades, genetic data has become increasingly important for acute leukemia diagnosis and patients stratification. Indeed, the present World Health Organization (WHO) leukemia classification system is largely based upon genetically defined subgroups. Gene expression profile (GEP) may correctly predict most genetic leukemia subtypes, but so far no GEP report has evaluate patients from Latin America. In the present study, we used gene expression microarray data to build an acute leukemia classifier. Bone marrow samples were collected from 231 individuals at diagnosis, 110 presented de novo acute myeloid leukemia (AML), 97 had de novo acute lymphoid leukemia (ALL) and the remaining 24 were controls who had other conditions including chronic leukemias or non-hematological diseases. GEP was evaluated based on mRNA expression signatures obtained with the Sure Print G3 Human GE (60k) system (Agilent Technologies). k-nearest neighbors prediction algorithm was applied and the ...
Diarrhea is frequently seen in autologous stem cell transplantation. Although toxicity related to... more Diarrhea is frequently seen in autologous stem cell transplantation. Although toxicity related to conditioning is the most common cause, infectious pathogens can play a distinctive role particularly in certain regions and environments. The role of enteropathogens was investigated in 47 patients submitted to autologous stem cell transplantation at a Brazilian center between May 2011 and May 2013. All patients who presented with diarrhea consented to stool sample analysis to identify the etiological agents including coccidia, , and other pathogenic bacteria. Thirty-nine patients (83%) had diarrhea, among whom seven (17.5%) presented with coccidia, three (7.5%) with sp., one (2.5%) with , and one (2.5%) with . There was a tendency toward a higher incidence of diarrhea in older patients (-value = 0.09) and those who received conditioning with lomustine, etoposide, cytarabine, and melphalan (-value = 0.083). Furthermore, the number of days of neutropenia was higher in patients with diarr...
CONTEXT AND OBJECTIVE: Hematopoietic stem cell transplantation (HSCT) has been widely used for tr... more CONTEXT AND OBJECTIVE: Hematopoietic stem cell transplantation (HSCT) has been widely used for treating oncological and hematological diseases. Although HSCT has helped to improve patient survival, the risk of developing infection during hospitalization is an important cause of morbidity and mortality. This study aimed to analyze the infection profile during hospitalization and the associated risk factors among patients undergoing autologous HSCT at the University Hospital, Universidade Federal de Juiz de Fora. DESIGN AND SETTING: This was a cross-sectional study on patients undergoing autologous HSCT at a public university hospital. METHODS: Patients with febrile neutropenia between 2004 and 2009 were retrospectively evaluated regarding their infection profile and associated risk factors. RESULTS: Infection occurred in 57.2% of 112 patients with febrile neutropenia. The main source of infection was the central venous catheter (25.9%). Infection was chiefly due to Gram-positive bact...
O Transplante de células-tronco hematopoéticas (TCTH) tem sido amplamente utilizado para o tratam... more O Transplante de células-tronco hematopoéticas (TCTH) tem sido amplamente utilizado para o tratamento de diferentes doenças malignas ou não. Apesar de seus benefícios, é considerada uma terapêutica de risco, devido às complicações inerentes ao tratamento que podem contribuir para aumentar a morbi-mortalidade. A infecção é uma das complicações mais graves, que gera aumento de custos de tratamento e de permanência hospitalar, podendo, inclusive, levar à morte. Esta complicação está associada à quimioterapia utilizada durante o período de internação, que leva o paciente à imunossupressão grave. Na tentativa de minimizar o risco de infecção, são utilizadas medidas profiláticas que incluem o isolamento do paciente e a restrição de visitantes. Contudo, cada centro faz uso de medidas diferenciadas, sem uma padronização de ações. O presente estudo pretendeu realizar uma revisão da literatura com a intenção de analisar as medidas de prevenção de infecção utilizadas nos diferentes serviços. F...
This is an observational and cross-sectional study, carried out in May 2020, targeting adult indi... more This is an observational and cross-sectional study, carried out in May 2020, targeting adult individuals of both sexes who are members of multiprofessional teams working in Brazilian HSCT units in the current period of the pandemic by completing and analyzing a questionnaire. pre-formulated. HSCT units that cannot access the questionnaire were excluded from the study. The analysis of the operation profile of HSCT units in Brazil, through the application of a pre-structured questionnaire, is not an accurate tool, since it assumes some premises that may prove to be wrong, especially in this current scenario in Brazil. However, the data reveal the vulnerability of patients with onco-hematological diseases to infection by COVID-19, especially during HSCT procedures, in relation to the general population. Despite its limitations, it can be valuable to plan policies.
As células-tronco de dentes decíduos exfoliados, isoladas como uma subpopulação das células-tronc... more As células-tronco de dentes decíduos exfoliados, isoladas como uma subpopulação das células-tronco da polpa dentária, demonstram possuir a capacidade de se diferenciarem in vitro em neurônios, adipócitos, odontoblastos e osteoblastos. Devido a sua facilidade de obtenção, que não envolve um procedimento invasivo, esta linhagem celular é considerada uma grande promessa para a medicina regenerativa. Os objetivos deste trabalho foram estabelecer e caracterizar duas linhagens de células-tronco de dentes decíduos humanos. As linhagens foram isoladas a partir de amostras de crianças saudáveis de 6 anos de idade. Os resultados mostraram, por citometria de fluxo, que as células foram positivas para marcadores de células-tronco mesenquimais (CD105 (SH2), SH3 e SH4) e negativa para a marcação hematopoiética (CD45) e que as linhagens estabelecidaseram constituídas de uma população homogênea de células-tronco. As células obtidas foram avaliadas quanto a sua proliferação e capacidade de diferenci...
JUSTIFICATIVA E OBJETIVOS: Os linfomas representam a quarta doença maligna mais frequente na gest... more JUSTIFICATIVA E OBJETIVOS: Os linfomas representam a quarta doença maligna mais frequente na gestação, sendo o linfoma de Hodgkin (LH) o tipo mais comum. O tratamento em gestantes é individualizado com radioterapia ou quimioterapia. A decisão de realizar o tratamento quimioterápico durante a gravidez deve ser avaliada à luz dos efeitos sobre a vida materna, caso o tratamento seja adiado. Evidências sugerem que a quimioterapia durante o primeiro trimestre de gravidez aumenta o risco de abortos espontâneos, morte fetal e malformações, sendo menor quando o tratamento é com monoquimioterapia. Ausência de estudos aleatórios e escassez da literatura fazem com que não existam evidências sólidas sobre qual a melhor conduta a ser tomada. O objetivo deste relato foi apresentar a evolução de uma paciente com diagnóstico de linfoma de Hodgkin. RELATO DO CASO: Paciente de 18 anos, 22 semanas de gestação, apresenta linfonodomegalia em fossa supraclavicular direita. A biópsia revela LH esclerose n...
Os fungos do genero Fusarium sp sao comumente encontrados no solo e em restos orgânicos. Sao reco... more Os fungos do genero Fusarium sp sao comumente encontrados no solo e em restos orgânicos. Sao reconhecidos como causa de infeccao localizada envolvendo unhas, pele traumatizada ou a cornea. A infeccao disseminada por Fusarium sp e encontrada quase que exclusivamente em imunodeprimidos, em particular em neutropenicos ou em pacientes recebendo quimioterapia ou transplante de medula ossea. Atualmente, Fusarium sp sao considerados patogenos emergentes e, em alguns centros, ja representam a terceira causa mais comum de micose invasiva, apos Candida e Aspergillus . Relatamos o caso de uma paciente de 62 anos, portadora de mieloma multiplo, que desenvolveu fusariose disseminada em seu segundo transplante autologo de medula ossea. No vigesimo dia pos-transplante evoluiu com necessidade de suporte intensivo e veio a obito. Fusariose, em sua forma disseminada, e uma infeccao rara, de dificil suspeita diagnostica e mesmo com o tratamento, na maioria das vezes a evolucao e fatal.
Herpes simplex virus (HSV) is prevalent worldwide and known as a notorious opportunistic pathogen... more Herpes simplex virus (HSV) is prevalent worldwide and known as a notorious opportunistic pathogen ofimmunocompromised patients. During the course of HSV treatment, acyclovir (ACV)-resistant HSV strains may emerge, causing many clinical complications. Because few studies in this area showing the presence and/or frequency ofACV-resistant HSV are available, the authors evaluated the sensitivity of HSV isolated from 3 hematopoietic stem cell transplant recipients and 24 normal patients observed in a University Hospital in Rio de Janeiro, Brazil. Twenty-seven HSV isolated in VERO cells and typed by the direct immunofluorescence assay were tested for their susceptibility to various concentrations ofACV by the dye-uptake method. The susceptibility of the HSV strains was expressed as ED50 (the concentration of drug reducing viral cytophatic effect by 50%). The sensitivity to ACV by the dye-uptake assay revealed that 25 samples (92.6%) were sensitive to ACV concentrations < 1.5 microg/mL....
Mycosis Fungoides is typically an indolent disease in early stages. However, approximately 30% of... more Mycosis Fungoides is typically an indolent disease in early stages. However, approximately 30% of patients have advanced staged disease at presentation and 20% will develop it at some time. These patients have a poorer prognosis with a median survival of 2-4 years. The only curative option for mycosis fungoides may be hematopoietic allogeneic stem cell transplantation. We report the case of a patient with mycosis fungoides in an advanced stage (IIB), refractory to treatment options. She underwent allogeneic hematopoietic stem-cell transplantation (allo-HSCT). The patient remains in complete remission nineteen months after allo-HSCT. Allogeneic transplantation can alter the natural history of mycosis fungoides and should be considered in patients who have refractory disease or short-lived responses with standard therapies.
O Transplante de celulas-tronco hematopoeticas (TCTH) tem sido amplamente utilizado para o tratam... more O Transplante de celulas-tronco hematopoeticas (TCTH) tem sido amplamente utilizado para o tratamento de diferentes doencas malignas ou nao. Apesar de seus beneficios, e considerada uma terapeutica de risco, devido as complicacoes inerentes ao tratamento que podem contribuir para aumentar a morbi-mortalidade. A infeccao e uma das complicacoes mais graves, que gera aumento de custos de tratamento e de permanencia hospitalar, podendo, inclusive, levar a morte. Esta complicacao esta associada a quimioterapia utilizada durante o periodo de internacao, que leva o paciente a imunossupressao grave. Na tentativa de minimizar o risco de infeccao, sao utilizadas medidas profilaticas que incluem o isolamento do paciente e a restricao de visitantes. Contudo, cada centro faz uso de medidas diferenciadas, sem uma padronizacao de acoes. O presente estudo pretendeu realizar uma revisao da literatura com a intencao de analisar as medidas de prevencao de infeccao utilizadas nos diferentes servicos. F...
Background Diarrhea is frequently seen in autologous stem cell transplantation. Although toxicity... more Background Diarrhea is frequently seen in autologous stem cell transplantation. Although toxicity related to conditioning is the most common cause, infectious pathogens can play a distinctive role particularly in certain regions and environments. Methods The role of enteropathogens was investigated in 47 patients submitted to autologous stem cell transplantation at a Brazilian center between May 2011 and May 2013. All patients who presented with diarrhea consented to stool sample analysis to identify the etiological agents including coccidia, Strongyloides sp., Clostridium difficile and other pathogenic bacteria. Results Thirty-nine patients (83%) had diarrhea, among whom seven (17.5%) presented with coccidia, three (7.5%) with Candida sp., one (2.5%) with C. difficile, and one (2.5%) with Giardia lamblia. There was a tendency toward a higher incidence of diarrhea in older patients (p-value = 0.09) and those who received conditioning with lomustine, etoposide, cytarabine, and melpha...
OBJECTIVE To identify how the Brazilian hematology centers treated and diagnosed cases of acute m... more OBJECTIVE To identify how the Brazilian hematology centers treated and diagnosed cases of acute myeloid leukemia in 2009. METHODS An epidemiological observational multicenter study of 11 listed Brazilian centers that treat acute myeloid leukemia and perform bone marrow transplantation. Data were collected from clinical charts of patients with acute myeloid leukemia treated at the said centers between 2005 and 2009. The availability for immunophenotyping and cytogenetic tests was assessed. RESULTS During 2009, a total of 345 new cases of acute myeloid leukemia were diagnosed. Differences were noted in the tests performed between patients who initiated treatment at the center and those referred for treatment. Of the participating centers, 72% conducted some type of molecular study in acute myeloid leukemia upon diagnosis. CONCLUSION Treatment for acute myeloid leukemia in Brazil shows significantly inferior results when compared to other centers worldwide.
In the past few decades, genetic data has become increasingly important for acute leukemia diagno... more In the past few decades, genetic data has become increasingly important for acute leukemia diagnosis and patients stratification. Indeed, the present World Health Organization (WHO) leukemia classification system is largely based upon genetically defined subgroups. Gene expression profile (GEP) may correctly predict most genetic leukemia subtypes, but so far no GEP report has evaluate patients from Latin America. In the present study, we used gene expression microarray data to build an acute leukemia classifier. Bone marrow samples were collected from 231 individuals at diagnosis, 110 presented de novo acute myeloid leukemia (AML), 97 had de novo acute lymphoid leukemia (ALL) and the remaining 24 were controls who had other conditions including chronic leukemias or non-hematological diseases. GEP was evaluated based on mRNA expression signatures obtained with the Sure Print G3 Human GE (60k) system (Agilent Technologies). k-nearest neighbors prediction algorithm was applied and the ...
Diarrhea is frequently seen in autologous stem cell transplantation. Although toxicity related to... more Diarrhea is frequently seen in autologous stem cell transplantation. Although toxicity related to conditioning is the most common cause, infectious pathogens can play a distinctive role particularly in certain regions and environments. The role of enteropathogens was investigated in 47 patients submitted to autologous stem cell transplantation at a Brazilian center between May 2011 and May 2013. All patients who presented with diarrhea consented to stool sample analysis to identify the etiological agents including coccidia, , and other pathogenic bacteria. Thirty-nine patients (83%) had diarrhea, among whom seven (17.5%) presented with coccidia, three (7.5%) with sp., one (2.5%) with , and one (2.5%) with . There was a tendency toward a higher incidence of diarrhea in older patients (-value = 0.09) and those who received conditioning with lomustine, etoposide, cytarabine, and melphalan (-value = 0.083). Furthermore, the number of days of neutropenia was higher in patients with diarr...
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