Revista colombiana de hematología y oncología
The Colombian Journal of Hematology and Oncology, edited by the Colombian Association of Hematology and Oncology (ACHO), is a peer-reviewed periodical scientific publication, which aims to expand and disseminate knowledge related to hematology, oncology and other areas related. With a biannual periodicity (January-June and July-December) it delivers scientific articles approved by the editorial committee and evaluated by peers to the scientific and academic community.
Bogotá: Asociación Colombiana de Hematología y Oncología, 2012-
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
Flow cytometry in the diagnosis and monitoring of patients with paroxysmal nocturnal hemoglobinuria
Introduction: HPN is a clonal disease of hematopoietic stem cells, characterized by intravascular hemolysis, thrombotic episodes, risk of bone marrow failure, and damage to organs such as the kidney and lung. Mutations in the PIGA gene cause a deficiency of glycosylphosphatidylinositol (GPI)-anchored proteins, increasing cellular susceptibility to complement-mediated lysis. Given its variable clinical presentation, early diagnosis and continuous monitoring with flow cytometry (CF) are crucial for effective management. Objective: To describe the application of CF in the diagnosis and follow-up of patients with HPN, highlighting its usefulness, benefits, and limitations. Methods: A literature review was conducted in databases such as PubMed, Embase, Scopus, Web of Science, and Google Scholar of studies published between January 2000 and July 2024. Studies in humans that describe the use of CF in the diagnosis and monitoring of HPN were included. Results: 40 studies were selected. CF has high sensitivity and specificity (>95%) for detecting GPI-deficient cells using markers such as CD55 and CD59. CF was effective for quantifying clonal burden, monitoring response to anti-C5 treatment, and detecting complications such as thrombosis and myelodysplastic syndromes. Advanced CF techniques allowed for the identification of clones at low levels (<0.1%), facilitating timely clinical interventions. Conclusions: Flow cytometry supports the diagnosis and monitoring of HPN, improving disease management and optimizing treatment.
Copyright (c) 2025 Revista colombiana de hematología y oncología https://creativecommons.org/licenses/by-nc-nd/4.0
Rosai Dorfman disease with nodal and multiple bone involvement: case report
Introduction: Rosai-Dorfman disease is a rare form of sinus histiocytosis, characterized by massive infiltration of histiocytes in lymph nodes and extranodal sites. Clinically, it usually presents with massive lymphadenopathy, fever, elevated erythrocyte sedimentation rate (ESR), and hypergammaglobulinemia. Treatment may be conservative or include corticosteroids, antimetabolites, or surgery in specific cases. Objective: To present a case of Rosai-Dorfman disease with multiple lymph node and bone involvement in a pediatric patient, highlighting that the primary care physician often plays a key role in evaluating the initial clinical syndrome and referring the patient for specialized diagnosis and management. Clinical Case: A 7-year-old female patient presented with bilateral cervical and inguinal adenopathy, intermittent fever, night sweats, and leg pain. Radiographs reported multiple polyostotic lytic lesions in the pelvis and appendicular skeleton. Differential diagnoses included Langerhans cell histiocytosis, disseminated histoplasmosis, and Hodgkin lymphoma. Biopsy of a lesion in the left ulna confirmed the diagnosis of Rosai-Dorfman disease. Conclusions: The nonspecific presentation of this disease and its similarities to other conditions underscore the importance of an interdisciplinary approach and a broad differential diagnosis. Recognizing its features aids in achieving an accurate diagnosis and appropriate treatment.
Infantile high-grade glioma with CLIP2-MET fusion mutation: a case report and therapeutic challenges
Introduction: Infantile high-grade gliomas are rare malignancies of the central nervous system (CNS) in children. Despite advancements, significant challenges remain in their treatment. A better understanding of their molecular biology may provide new therapeutic options. Clinical case: We report the case of a 30-month-old female diagnosed with an infantile high-grade glioma. Following urgent surgical resection, molecular analysis via a fusion panel identified a CLIP2-MET fusion mutation. This finding suggested potential treatment with crizotinib, a targeted therapy. However, several barriers delayed treatment initiation, including the lack of approval for crizotinib use in CNS tumors in Colombia and concerns about interactions with anticonvulsant therapy. Despite a brief period of clinical stability after initiating treatment, the patient unfortunately succumbed to the disease. Conclusion: Infantile high-grade gliomas pose significant therapeutic challenges, but identifying specific gene fusions, such as CLIP2-MET, may open new avenues for targeted therapy. This case underscores the need for regulatory adaptations to facilitate access to promising treatments when evidence supports their potential efficacy. To our knowledge, this is the first case in Colombia where an infantile glioma was treated with crizotinib, highlighting both the promise and the challenges of precision medicine in pediatric oncology.
Characterization of the response to treatment with ANTI-D immunoglobulin in patients with primary immune thrombocytopenia in a high complexity Colombian health center
Introduction: Primary immune thrombocytopenia (PIT) is an autoimmune disorder characterized by platelet destruction and reduced platelet production. Anti-D immunoglobulin (Anti-D Ig) is a less expensive therapeutic option, but its efficacy in the local population is not well studied. Objective: To describe the clinical and paraclinical response to treatment with intravenous Anti-D Ig (50 µg/kg) in Rh+ patients with TIP. Methods: Retrospective cohort study in 25 patients treated between 2020-2022 in a hematology center in Colombia. Sociodemographic, clinical and paraclinical variables were analyzed. Response was defined as a platelet count (PR) >30,000/µL or an increase ≥2 times the baseline value. Results: 80% responded to treatment, with a median post-treatment PR of 94,000/µL at 1 year. Most (70%) required 2-4 doses. Skin and mucosal hemorrhagic manifestations decreased significantly. Hemoglobin drop was mild in 33.3%. Mild adverse effects such as asthenia (20.8%) and osteomioarthralgias (4.2%) were reported. Conclusion: Treatment with Ig Anti-D showed high efficacy and tolerance in patients who did not respond to steroids, with a favorable safety profile and results superior to those reported internationally. Its use may be a viable option in this population.
Chronic myeloid leukemia in an adolescent: report of an unusual case
Introduction: Chronic myeloid leukemia (CML) is a hematological disease that is infrequent in the pediatric population, representing only 2-3% of leukemias in children. This neoplasm is characterized by the t(9;22) translocation whose detection confirms the diagnosis. In pediatric patients tend to be more aggressive compared to adults. Clinical case: A 13-year-old female patient presents with increased abdominal circumference, generalized pallor, and unquantified weight loss over two months. On physical examination, hepatomegaly, splenomegaly, and pallor are observed. Laboratory tests reveal leukocytosis of 728,470 cells/mm3, hemoglobin of 7.6 g/dL, neutrophils at 90%, and platelets at 474,000 cells/mm3. Studies confirm chronic myeloid leukemia in the chronic phase. Discussion: CML, caused by the t(9;22) translocation, is characterized by the fusion of the BCR-ABL gene, which transforms hematopoietic stem cells into leukemic cells. This translocation activates tyrosine kinase, driving the disease. In pediatric patients, clinical manifestations are often more severe, with higher rates of anemia, significant leukocytosis, and splenomegaly. Diagnosis is confirmed by detecting BCR-ABL1 through PCR, FISH, or cytogenetic analysis. The treatment of choice is tyrosine kinase inhibitors, with Imatinib being the most used.
18F-FET PET/CT study to differentiate tumor viability from radiation necrosis in high-grade glioma patients: experience from a reference center in Medellín, Colombia
Introduction: Gliomas account for the majority of primary malignant CNS tumors in adults, and glioblastoma is the most frequent subtype. Standard management combines surgical resection and the Stupp protocol. A persistent challenge is to distinguish post-treatment changes from true recurrence, even with advanced MRI. In this context, 18F-FET PET/CT provides metabolic information that helps discriminate tumor viability from radionecrosis and optimize decision-making. Methods: Description of the 18F-FET PET/CT acquisition protocol and presentation of five clinical cases of high-grade gliomas with MRI findings suggestive of recurrence. All patients underwent 18F-FET PET/CT to differentiate radionecrosis from viable tumor, with histopathological confirmation or close follow-up, and the impact on therapeutic management and clinical outcome was documented. Results: Five cases of patients with high-grade gliomas who underwent 18F-FET PET/CT are presented, and the impact of these findings on clinical management is described. Discussion: 18F-FET PET/CT shows a peak uptake at approximately 60 minutes and a high lesion-to-background ratio, making it useful for biopsy guidance, surgical and radiotherapy planning, assessment of recurrence, and follow-up. When combined with MRI, it achieves diagnostic accuracies close to 98–100%. Its limitations include false positives (inflammation, infarction, hemorrhage) and false negatives in some low-grade tumors, so multimodal correlation is required. Conclusion: 18F-FET PET/CT is consolidating itself as a non-invasive, safe, and effective technique for evaluating tumor viability in high-grade gliomas and for improving decision-making in complex diagnostic scenarios.
Acute myeloid leukemia in a patient with Graves' disease, causality or coexistence?: case report
Introduction: Thyroid hormones play a regulatory role in hematopoiesis, which has led to hypotheses regarding a potential association between thyroid disease and hematologic malignancies. To date, this relationship has not been firmly established due to the lack of robust supporting evidence. This case report documents the rare coexistence of Graves’ disease and acute myeloid leukemia (AML), underscoring the importance of a comprehensive diagnostic approach in patients with persistent hematologic abnormalities. Clinical case: A 33-year-old woman with a history of Graves’ disease, previously treated with methimazole for three years, discontinued therapy for one year and resumed treatment one month prior to presenting to the emergency department. She was admitted with fever and odynophagia unresponsive to outpatient antibiotic therapy. On examination, she exhibited altered vital signs and enlarged tonsils with purulent exudate. Laboratory findings revealed bicytopenia with agranulocytosis and microcytic hypochromic anemia. Methimazole-induced agranulocytosis was suspected, leading to discontinuation of the thionamide and initiation of antimicrobial therapy and beta-blockers. Despite drug withdrawal, neutrophil counts failed to improve significantly, prompting hematology consultation. A bone marrow biopsy revealed 23.6% myeloid blasts, confirming the diagnosis of AML. This finding raises the possibility that the agranulocytosis may have been an initial manifestation of AML rather than solely a drug-induced adverse event. Conclusion: This case highlights the need for prospective studies to explore the relationship between autoimmune thyroid disease and leukemia in order to enhance understanding and clinical management of these complex interactions.
Hairy cell leukemia in a tertiary hospital in Bogotá: a case series
Introduction: Hairy cell leukemia (HCL) is a malignant neoplasm of B lymphocytes. Histologically, it is characterized by lymphocytes with multiple hair-like projections. Its immunophenotype is positive for CD123, CD103, CD25, CD11c, annexin A and its genotype presents a somatic mutation in the BRAFV600E gene. It is considered a rare disease, accounting for only 2% of all leukemias. However, there are few epidemiological data in Colombia. Clinical cases: we present four cases of patients diagnosed with PCL who were managed with the standard protocol cladribine-rituximab in an institution in the city of Bogotá. This work seeks to provide information to local epidemiology and raise awareness of the disease. Conclusion: the complete remission of the disease in the present case series is consistent with the evidence available in the literature. Studies with greater statistical power are needed to more accurately assess the therapeutic response to this protocol and the detection of minimal residual disease.
Budget impact of dasatinib compared to nilotinib as first- and second-line therapies for chronic myeloid leukemia in Colombia
Introduction: Chronic Myeloid Leukemia (CML) is a hematologic neoplasm treated with tyrosine kinase inhibitors (TKIs), which have improved survival but pose financial challenges for healthcare systems. Objective: Conduct a Budget Impact Analysis (BIA) from the Colombian healthcare system perspective, comparing Dasatinib and Nilotinib, two leading second-generation TKIs used in first- and second-line CML treatment. Methods: A budget impact analysis was conducted from the Colombian healthcare system perspective using a Markov model and decision tree over a 10-year horizon. Dasatinib and Nilotinib were compared as first- and second-line treatments for chronic-phase Philadelphia-positive CML. Costs of treatment, administration, and monitoring were included. Model robustness was assessed through sensitivity analysis using data from local sources, literature, and expert input. Results: A cohort of 507 chronic-phase CML patients was analyzed. Increasing Dasatinib use by 20% resulted in substantial savings: COP 9.7 billion in first-line and COP 11.8 billion in second-line treatment, compared to Nilotinib. Conclusions: Dasatinib is a budget-favorable alternative to Nilotinib due to its lower annual cost and comparable efficacy. Savings could be maximized using its lowest market price. Appropriate patient selection enhances treatment-free remission (TFR) outcomes, generating additional benefits for the Colombian healthcare system.
analysis of the budgetary impact of therapeutic advances
Management of acquired hemophilia a with CyDRi therapeutic strategy: case report
Introduction: Acquired hemophilia is an autoimmune disease caused by autoantibodies against factor VIII. Its incidence is 1.5 cases per million per year, primarily affecting adults aged 64-78. Until recently, the standard treatment was prednisone, but its high rate of adverse effects and low remission rate led to the search for alternatives. The CyDRi regimen has shown better remission rates, shorter time to achieve remission, and fewer adverse effects. We present the first case in the country treated with this regimen. Case report: A 78-year-old woman with a history of hypereosinophilia syndrome presented with a sudden-onset subcutaneous hematoma in the right upper limb, evolving over three days. Laboratory tests revealed prolonged aPTT, decreased factor VIII levels, and high factor VIII inhibitor activity, confirming acquired hemophilia. CyDRi therapy was initiated, leading to normalization of factor VIII levels and Bethesda units within four days. No bleeding episodes occurred in the first six months, and no major adverse effects were observed. Conclussion: This case highlights the efficacy and safety of the CyDRi regimen as a promising alternative for acquired hemophilia, with the potential to improve clinical outcomes and reduce complications associated with conventional treatments.
Hypereosinophilia as the initial sign of B-cell acute lymphoblastic leukemia: case report
Introduction: Hypereosinophilia is rarely associated with B-cell lymphoblastic leukemia (B-ALL) and when presented, it relates to diagnostic delays and an ominous prognosis. Clinical case: A 24-year-old male presents with a month-long history of anemia, associated with B symptoms, and eosinophilia. Initially managed for intermittent rib pain and during the course of treatment, autoimmune and infectious causes were ruled out. The bone marrow analysis shows signs of B-ALL. Normal cytogenetics. Receives an induction hyperCVAD therapy to remission, with adequate control of the disease. Conclusions: This case highlights the atypical and unusual symptoms associated with eosinophilic infiltration as an initial sign of B-ALL. The prognosis in these cases is poor, associated with the biology of the disease, and on many occasions, diagnostic delays.
FET PET a new functional aid in brain tumors
Research Abstracts: 6th National Congress of Research in Hematology and Oncology
This supplementary issue contains abstracts from 89 Hematology and 83 Oncology papers presented within the framework of the Sixth National Congress of Research in Hematology and Oncology, held in the city of Santa Marta in November 2024. The privilege of hosting this biennial congress offers multiple benefits, such as fostering a science-oriented culture, providing information that can be utilized to enhance clinical practice, and establishing professional and scientific networks for collaborative work. We hope that this reading complements that of the award-winning abstracts from the same event, which were published in a previous supplementary issue.
Characterization of variants in exon 28 of the VWF gene and their genotype-phenotype correlation in a sample of patients with von Willebrand disease type 2.
Introduction Von Willebrand's disease is the most common hereditary coagulopathy in the population, the approach of molecular analysis as diagnostic support has been little EvW type 2. The aim of this study is to characterize variants in exon 28 of the VWF gene and to perform genotype-phenotype correlation in a sample of patients with type 2 VWD. Methos: 20 samples from patients previously diagnosed with VWD were analyzed. Von Willebrand disease type 2 with ages between 8 and 56 years. Analysis of Exon 28 of the VWF gene was performed, by amplification, verification by electrophoresis in agarose gels and sequencing with the Big Dye Terminator V3.1 Kit. Results: The pathogenic variant was identified in 15 (88.2%) unrelated patients. The p.Gly1609Arg variant was identified in 52.9% of the patients analyzed (n=9) alone or in combination, followed in frequency by p.Ile1425Phe (n=3), and p.Ala1437Thr (n=3) alone or in combination, 1 patient with p.Arg1597Trp and another with p.Arg1334Trp. Additionally, two pathogenic variants were identified in 31.6% (n=6) of patients (2 patients with p.Gly1609Arg/p.Ala1437Thr; 1 patient p.Gly1609Arg/p.Ser1506Leu; 1 patient p.Gly1609Arg/p.Arg1597Trp; 1 patient p.Gly1609Arg/p.Val1279Phe; and 1 patient p.Ile1628Thr/p.Ser1325Phe). No variant was identified in 2 patients (11.8%). It was possible to reclassify the EvW type 2 subtype in 40% (n=8) of patients. Conclusions: This is the first study performed in the country, which allowed the identification of the genetic cause of EvW for the first time in Colombia by sequencing specific exons in a follow-up cohort.
Advances in the molecular classification of brain tumors
In 1918, Percival Bailey completed his medical training, after which he eagerly pursued the elusive knowledge of brain physiology. Hoping to continue his training, Percival Bailey sent letters to two prominent members of the medical community, one a psychiatrist and the other a neurosurgeon. Harvey Cushing responded first, so Bailey met him at Brigham Hospital in Boston, where he had amassed an extensive repository of brain tumor specimens. As the specimens were evaluated, the two doctors discovered that some aggressive lesions grew rapidly, while others followed a benign course. During macroscopic evaluation, Bailey grouped 400 specimens according to survival time, correlating their appearance with clinical outcomes after the neurosurgical procedure. After two thousand surgeries, Cushing and Bailey demonstrated that the cellular structure of a tumor could guide initial treatment and prognosis.
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Special Supplement – Research Abstracts: 36th Congress of the Latin American Society of Pediatric Oncology (SLAOP) and 23rd Congress of the Colombian Association of Pediatric Hematology and Oncology (ACHOP) – Cali, June 2025
PiRNAs and PIWI-like proteins as new biomarkers in cancer
piRNAs and PIWI-like proteins in cancer and their future as biomarkers and therapy targets in breast cancer
Globally, breast cancer (BC) is the most common type of cancer, with 2.296.840 new cases in 2020 with almost 700.000 related deaths. Due to the high burden this represents, it is imperative to expand horizons to be able to find novel biomarkers and therapeutic targets that can be used to improve prognosis, treatment, and survival of breast cancer patients. In recent years, numerous studies have been conducted looking for the association between piRNAs (PIWI – interacting RNAs) and the development, pathogenesis, metastasis, and progression of different types of cancer, including BC. PiRNAs are small molecules (24-31 nucleotides) that interact with the PIWI-protein complex (PIWI-like proteins - HIWI/HILI in humans) performing regulatory functions by inducing transcriptional, post-transcriptional, translational, and post-translational epigenetic changes, which has been observed to contribute to cancer development through modifications in cell proliferation, transposon silencing, genome rearrangement, epigenetic regulation, protein regulation, and stem cell maintenance. In breast cancer, a strong association has been found between the expression of some piRNAs, PIWI-like proteins and tumor development. If a specific piRNA could be associated with a distinct type of cancer, it could then be used as an early biomarker which would allow for a better prognosis. Findings surrounding these molecular mechanisms could also spark interest in studies focusing on the modification of the expression of piRNAs in cancer cells. In this article, we intend to review in a straightforward manner the current information about piRNAs/PIWI-like proteins focusing on their expression in BC.
CAR-T therapy poses multiple barriers, such as high cost and limited availability of commercially patented products. In different hospital and academic centers, the production of CAR-T “in house” has been developed as an alternative to overcome these obstacles. The objective of this narrative review is to describe the information reported regarding the manufacturing, effectiveness and safety of “in house” or “academic” CAR-T products; Through a non-systematic search of the literature in the NCBI-PUBMED databases, series and case reports were included, as well as Phase I and II studies available in English and Spanish. In this review, reports from Spain, India, Canada, China, Israel, and Brazil have been identified, showing the feasibility of CAR-T production in academic centers with a low frequency of production failures, with favorable clinical results, predictable toxicity profile, and potential significant resource savings. In particular, the development of academic CAR-Ts such as ARI-0001 and its approval for hospital use in Spain opens a great opportunity to improve access to CAR-T therapy in Europe, and potentially in lower-resource countries such as Latin America.
Myocarditis secondary to holo-transretinoic acid in a pediatric patient with acute promyelocytic leukemia
Introduction: Acute promyelocytic leukemia is a type of acute myeloid leukemia, the standard treatment for which is the use of ATRA in combination with chemotherapy. Adverse effects have been reported with the use of ATRA, however, cardiovascular consequences have not yet been reported in Colombia, making this the first case of myocarditis due to ATRA in Colombia, during the treatment of a patient with acute promyelocytic leukemia. Clinical case: Female school patient admitted with bicytopenia and changes in flow cytometry compatible with APL. With genetic confirmation by FISH for translocation 15;17. Treatment was started with ATRA at 30 mg/m2/day and idarubicin. After twenty days of treatment, thrombocytopenia with altered coagulation times persisted, so the ATRA dose was adjusted to 40 mg/m2/day, after which the patient presented chest pain, hemodynamic instability, hydroelectrolytic alteration, elevated troponin and atrial peptide. An echocardiogram was performed, showing altered myocardial contraction, valvular failure and alveolar infiltrate on chest x-ray. Given the clinical, laboratory and imaging findings, ATRA myocarditis was considered. Conclusion: ATRA therapy can be considered safe and with few adverse effects, however, higher doses in the pediatric population can be associated with symptoms of chest pain, elevated cardiac biomarkers, as well as echocardiographic changes that should alert professionals of a possible myocardial alteration. However, the differential diagnosis of ATRA differentiation syndrome should be ruled out as another possible cause given its higher prevalence reported in the literature.
The Role of Interculturality in Overcoming Health Inequity and Cancer Care: A Narrative Review
Introduction: Traditional medicine plays a vital role in the cultural identity and health of Indigenous communities, offering a holistic approach that connects body, mind, spirit, and environment. However, its integration with Western medicine faces challenges due to monocultural approaches and limited recognition of Indigenous perspectives. Objectives: To analyze how traditional and Western medical practices intersect in cancer management, focusing on their integration and healthcare professionals’ perceptions. Methods: A narrative review was conducted using systematic searches in Redalyc, Google Scholar, and PubMed, with terms related to cultural competence, health inequities, Indigenous peoples, and cancer. Forty-one relevant studies were selected and analyzed. Results: Indigenous communities face systemic geographic, cultural, and structural barriers to accessing healthcare. Integrating traditional practices into oncology care has shown benefits, including improved quality of life and patient satisfaction. However, healthcare professionals lack cultural competence, highlighting the need for training and policy reforms to address skepticism and resource limitations. Conclusions: An intercultural health model is essential to reduce inequities and foster collaboration between medical systems. Recommendations include training healthcare professionals, implementing inclusive policies, and ensuring active participation of Indigenous communities to enhance health outcomes.
Burkitt leukemia, presentation and survival; report of two cases and review of the literature
Introduction: Burkitt leukemia is a rare entity, also called Burkitt acute lymphoblastic leukemia (B-ALL), and is considered a variant of Burkitt lymphoma/leukemia (B-ALL). It has characteristics similar to acute lymphoblastic leukemia, the most common cancer in children, which is why it should be taken into account in clinical practice. The objective of this article is to present two clinical cases, a rare entity that represents approximately 2% of acute lymphoblastic leukemias in pediatrics. Clinical cases: Two cases of Burkitt leukemia with typical characteristics are presented., with abdominal predominance, consistent with what has been described in the literature as sites of greatest occurrence according to subtype. In this article, the cases were confirmed histologically and immunophenotypically. Discussion: This entity is an aggressive lymphoma, described last century by Denis Burkitt in Africa. It represents the majority of non-Hodgkin lymphomas in children, being less common but more lethal when diagnosed in adults. The etiology is unknown, but risk factors, such as some viral infections, have been described. The prognosis depends on the response to first-line management. Refractory or relapsed Burkitt lymphoma is difficult to successfully treat. Conclusion: Burkitt lymphoma is a heterogeneous disease; despite its rapid progression, it is one of the types of non-Hodgkin lymphoma with the best prognosis. More than 90% of children with localized tumors and more than 85% with disseminated disease are cured.
Adenovirus infection in pediatric hematopoietic stem cell transplant recipients.
Introduction: adenovirus infection occurs in approximately 14–16% of patients within the first 3–4 months following allogeneic hematopoietic stem cell transplantation (HSCT), with higher incidence in the pediatric population compared to adults. This is associated with an increased risk of adenovirus disease and overall mortality at 6 months. Prevention of adenovirus disease relies on early detection of viral replication in blood or stool and timely intervention. Cidofovir, a cytosine monophosphate nucleotide analog, is currently the only antiviral agent recommended for adenovirus infection. Method: a systematic review was conducted on adenovirus infection in hematopoietic cell transplant recipients. Full-text articles were assessed, and key information was extracted, including study design, population, diagnosis, treatment, and clinical outcomes. Due to heterogeneity among studies, findings were summarized narratively. Results: in pediatric transplant recipients, fecal screening is recommended both before and after the procedure. Treatment strategies include immunosuppression reduction, cidofovir or brincidofovir administration. Immunotherapy with virus-specific T cells shows promise, although its use is limited by accessibility and production time. Early monitoring improves prognosis. Conclusion: adenovirus infection in HSCT requires timely diagnosis and screening, along with antiviral treatment and adoptive immunotherapy. In Colombia, these therapies are currently unavailable; therefore, it is essential to raise awareness of their importance to improve care for these immunosuppressed patients.
Clinical relationship between helicobacter pylori and immune thrombocytopenic purpura: a topic review
A thematic review was conducted on the pathophysiological aspects, clinical characteristics, and diagnostic criteria underlying the relationship between Helicobacter pylori (HP) and Immune Thrombocytopenic Purpura (ITP). Mechanisms such as molecular mimicry and the modulation of phagocytic activity have been proposed to explain this association. The diagnosis of ITP requires a comprehensive evaluation, including a detailed medical history and specific laboratory tests. Despite recent advances, challenges remain in understanding these mechanisms and in developing effective, personalized treatments for patients.
Small cell lung cancer: case report with complete clinical response to chemoimmunotherapy
Introduction: Small cell lung carcinoma (SCLC) accounts for 15% of lung cancer cases. It is classified as extensive stage (ES-SCLC) when there is metastasis or if the volume of disease cannot be covered in a single radiotherapy field. Two-thirds of cases present with extensive disease and therefore with a poor prognosis. Despite achieving high objective response rates (ORR) to treatment, complete response (CR) rates do not exceed 3% and the vast majority of patients relapse early. Currently, immunotherapy, especially PD-1 axis blockade in combination with platinum-based chemotherapy is the standard of care. Clinical case: 57-year-old patient with stage ES-SCLC who achieved CR after four cycles of chemoimmunotherapy with durvalumab and carboplatin + etoposide, which is maintained after twenty-two months of treatment. Conclusion: A relationship has been found between ORR and survival, but it is unknown whether CR can be a surrogate for overall survival in SCLC in the era of immunotherapy. In this case, the absence of poor prognostic factors such as extra-thoracic metastatic disease probably favored CR. Biomarkers such as PD-L1 and TMB currently do not allow for treatment selection. In transcriptomic studies, the inflamed subtype (SCLC-I) appears to have a greater benefit from immunotherapy, however it requires prospective validation studies.
piRNAs and PIWI-like proteins in cancer and their future as biomarkers and therapy targets in pancreatic cancer: a systematic review
Introduction: This systematic review explores the roles of PIWI-interacting RNAs (piRNAs) and PIWI-like proteins in pancreatic cancer, assessing their potential as diagnostic and therapeutic biomarkers. Recent studies suggest that piRNAs and PIWI proteins play roles in gene regulation associated with cancer progression, positioning them as promising targets in oncology. Methods: The review adhered to PRISMA guidelines, focusing on the potential of piRNAs and PIWI-like proteins as biomarkers for diagnosis, prognosis, or therapeutic prediction in pancreatic cancer. Studies in PubMed, EMBASE, and ScienceDirect were included, focusing on expression data, diagnosis, prognosis, or treatment of pancreatic tumors. Only studies published in English or Spanish from the last five years were considered. Risk of bias was assessed using SYRCLE’s tool, a modified CONSORT checklist, and AMSTAR2. Results: Five key studies were selected. Findings indicate that piR-162725 enhances diagnostic accuracy for early-stage pancreatic cancer in combination with CA19-9, while piR-017061 inhibits pancreatic cancer cell growth through EFNA5 mRNA degradation. PIWIL1 promotes metastasis via a piRNA-independent pathway, and piR-hsa-30937 in small extracellular vesicles creates an immunosuppressive environment in pancreatic neuroendocrine tumors. Conclusions: piRNAs and PIWI-like proteins demonstrate potential as biomarkers and therapeutic targets in pancreatic cancer. Future studies are required to validate these findings in larger cohorts and explore piRNA-based therapies. An in-depth understanding of piRNAs' mechanistic roles could improve early detection and therapeutic outcomes in pancreatic cancer.
piRNAs and PIWI-like proteins in cancer and their future as biomarkers and therapeutic targets in lung cancer: a systematic review
Introduction: This systematic review evaluates the current evidence on the role of PIWI-interacting RNAs (piRNAs) in lung cancer, emphasizing their diagnostic and therapeutic potential. Lung adenocarcinoma, a major global health concern, necessitates exploration of alternatives to traditional methods. piRNAs, small non-coding RNAs, are abnormally expressed in cancerous tissues and biological fluids, indicating their potential as biomarkers and therapeutic targets. Methods: A comprehensive search was performed in PubMed and ScienceDirect databases according to PRISMA guidelines. The search focused on studies examining piRNA expression, their diagnostic value in LUAD tissues and extracellular vesicles, and their therapeutic implications. Studies published from 2020 onward were included and evaluated for bias and quality. Results: Out of nineteen initially identified papers, five studies met the inclusion criteria. These studies identified specific piRNAs with elevated expression in LUAD, such as piR-hsa-26925 and piR-hsa-5444, which showed strong diagnostic performance (AUC = 0.833). Additionally, piRNAs from extracellular vesicles, including piR-hsa-164586, demonstrated potential for early detection of Non-Small Cell Lung Cancer (AUC = 0.624). Conclusions: piRNAs show promise as non-invasive biomarkers for early diagnosis and potential therapeutic targets in lung cancer. Further research is needed to validate these findings and understand the underlying mechanisms to improve clinical applications.
Wilms' Tumor: Survival Analysis in Children Under 15 Treated at a Pediatric Oncology Unit of a Cancer Treatment Institution
At the National Institute of Cancerology (INC) in Colombia, the treatment of Wilms' tumor (WT) follows strategies from the National Wilms Tumor Study Group (NWTSG I to V). Objective: to describe the clinical characteristics, overall survival (OS) and event-free survival (EFS) of children under 15 years of age with WT, treated with a protocol based on NWTSG guidelines between 2008 and 2018. Methods: a retrospective observational study of a cohort of children under 15 years of age with a diagnosis of WT, treated according to NWTSG guidelines at the INC between January 1, 2008, and December 31, 2018. A descriptive analysis of demographic and clinical variables was performed. EFS and OS were calculated using the Kaplan-Meier method. Results: we identified 48 patients with a diagnosis of WT; the mean age was 3.95 years (±2.27), with a male-to-female ratio of 1.18. The majority (58%) presented with advanced-stage disease (III and IV). Unfavorable histology was observed in 16.7%, with a relapse rate of 31% and a mortality rate of 21%. The EFS and OS rates were 62% and 77.3%, respectively, at 10.4 years; the most common cause of mortality was relapse. Conclusion: at INC, most children with WT present with advanced-stage disease. Although survival rates achieved with multidisciplinary treatment are lower in middle-income countries compared to high-income countries, they are reasonably acceptable. Enhanced diagnostic testing is necessary to develop more precisely risk-adapted treatments.
Hematologic and Cardiac Adverse Reactions to the First Chemotherapy Regimen in Women with Non-Metastatic Breast Cancer
Breast cancer is the most prevalent malignant neoplasm and the leading cause of cancer-related death among women worldwide. The effectiveness of treatment depends on completing the full course; however, adverse reactions to chemotherapy can limit treatment, deteriorate quality of life, and decrease survival rates. Assessing the incidence and severity of these reactions is crucial for prognosis. Objective: To determine the incidence of grade 1 to 5 hematological and cardiac adverse reactions in women aged 18 to 80 years with non-metastatic breast cancer undergoing their first chemotherapy regimen. Methods: A quantitative, descriptive, single-cohort retrospective study was conducted on patients newly diagnosed with breast cancer in 2021 and 2022, who were managed with their first chemotherapy regimen at an institution in Bogotá D.C. Results: A total of 295 patient medical records were reviewed, revealing an overall incidence of hematological adverse reactions of 94,24% (95% CI: 90,97% - 96,37%), with an incidence of 31,20% (95% CI: 26,20% - 36,70%) for grade 3 and 4 severity. The incidence of cardiotoxicity was 8,80% (95% CI: 5,50% - 12,10%). Discussion: Adverse reactions to chemotherapy are frequent and necessitate close monitoring to prevent complications. Identifying high-risk patients before initiating chemotherapy can significantly improve clinical outcomes and reduce healthcare costs.
antineoplastic combined chemotherapy protocols
drug-related side effects and adverse reactions
Low molecular weight heparin-induced skin necrosis in the critically ill cardiovascular patient: A case report
Introduction: Low molecular weight heparin-induced skin necrosis is a rare but potentially serious adverse reaction observed mainly in patients under treatment with this anticoagulant. Although thrombocytopenia is a more common complication, dermal necrosis occurs in less than 0.2% of cases. Clinical case: This report describes the case of a 78-year-old male patient with a cardiovascular history, who presented extensive necrotic lesions after administration of subcutaneous heparin for thromboembolic prophylaxis. Five days after treatment, the patient developed fever, erythema and painful ecchymosis, which prompted his transfer to the intensive care unit. After identification of necrotic hemorrhagic lesions, together with mild thrombocytopenia, heparin-induced skin necrosis was suspected, and the patient underwent several washing and debridement procedures by the plastic surgery service. The evolution was favorable, achieving healing by second intention and progressive recovery of the affected areas. Conclusion: Early identification of drug-induced lesions, immediate discontinuation of heparin and a multidisciplinary approach to avoid major complications and improve clinical outcomes could generate a better prognosis in these cases.