Alterações oftalmológicas em pacientes pediátricos com leucemia linfoblástica aguda
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFS |
Texto Completo: | http://ri.ufs.br/jspui/handle/riufs/10530 |
Resumo: | Introduction: Acute Lymphoblastic Leukemia (ALL) is a cancer commonly found among young people and responsible for 26% of childhood cancer cases. Today, up to 90% of such patients have an average survival rate of five-year free of the illness. Ocular manifestations (OM) arising from ALLs might be secondary to tumor-induced vascular anomalies or related to direct infiltration of the neoplastic cells into the eye and orbit, or to medications used in treatment such as chemotherapy and glucocorticoids (GC). Since this is an oncological disease with a high potential for cure, in young individuals with a high life expectancy, the identification of possible long-term ocular complications resulting from the treatment and correlation with predictive factors of relapse of the disease may support the design of an ophthalmological protocol for these patients cases. yet existent in scientific literature. Objective: To characterize OM in pediatric patients under treatment for ALL and to evaluate if they are associated with predictive risk factors for relapse, with protocols (1999 or 2009), gender and cerebrospinal fluid (CSF) infiltration Methods: A prospective cohort study was conducted in children and adolescents with ALL from January 2013 to December 2017, followed by a systematic review associating pediatric patients under treatment for ALL and ocular hypertension (OH), because OH is the most prevalent OM. The patients underwent ophthalmologic evaluations before starting treatment (D0), on the eighth day (D8), at the 28th day (D28), and at six months (D6 months). Ocular hypertension (OH) was considered in results above 21 mmHg. Measures of visual acuity (VA) <20/40 were considered visual loss (VL). Results: The results of the cohort involved 55 patients and 18 (32.7%) presented OM, been OH (20.0%), retinal hemorrhage (7.3%) and VL (7.3%) the most frequent finds. A strong association was found between patients with OM and those with a high risk of relapse (p=0.035, Cramer V=0.31) and who used the 1999 protocol (p=0.022, Cramer V=0.32). The risk of OM in patients from the 1999 protocol was 1,799 (CI=1,154-2,804), while in those at high risk of relapse it was 1,647 (CI=1,111-2,442). The results of the systematic review were limited to a total of four publications, two of individual case reports, one report of five patients and another prospective descriptive with twelve patients, with results varying from total ocular pressure control and VA preservation, to irreversible blindness. Conclusion: Patients with ALL have a high incidence of OM due to the treatment and the disease itself, and it may even be asymptomatic and evolve with VL. Patients submitted to the 1999 protocol and at high risk of relapse are more likely to present OM and these variables are strongly associated. OH is the most prevalent OM. Few studies have been found correlating children with ALL and OH. Due to the possibility of disparate results from silent OH without visual changes to irreversible blindness. Therefore, a protocol is proposed that contemplates systematic ophthalmological examination with the measurement of IOP immediately after diagnosis of ALL (D0) and subsequently at D8, D28 and D6months. |
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Mendonça, Cristiano de QueirozCipolotti, Rosana2019-02-20T23:13:18Z2019-02-20T23:13:18Z2018-12-14MENDONÇA, Cristiano de Queiroz. Alterações oftalmológicas em pacientes pediátricos com leucemia linfoblástica aguda. 2018. 92 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Sergipe, Aracaju, 2018.http://ri.ufs.br/jspui/handle/riufs/10530Introduction: Acute Lymphoblastic Leukemia (ALL) is a cancer commonly found among young people and responsible for 26% of childhood cancer cases. Today, up to 90% of such patients have an average survival rate of five-year free of the illness. Ocular manifestations (OM) arising from ALLs might be secondary to tumor-induced vascular anomalies or related to direct infiltration of the neoplastic cells into the eye and orbit, or to medications used in treatment such as chemotherapy and glucocorticoids (GC). Since this is an oncological disease with a high potential for cure, in young individuals with a high life expectancy, the identification of possible long-term ocular complications resulting from the treatment and correlation with predictive factors of relapse of the disease may support the design of an ophthalmological protocol for these patients cases. yet existent in scientific literature. Objective: To characterize OM in pediatric patients under treatment for ALL and to evaluate if they are associated with predictive risk factors for relapse, with protocols (1999 or 2009), gender and cerebrospinal fluid (CSF) infiltration Methods: A prospective cohort study was conducted in children and adolescents with ALL from January 2013 to December 2017, followed by a systematic review associating pediatric patients under treatment for ALL and ocular hypertension (OH), because OH is the most prevalent OM. The patients underwent ophthalmologic evaluations before starting treatment (D0), on the eighth day (D8), at the 28th day (D28), and at six months (D6 months). Ocular hypertension (OH) was considered in results above 21 mmHg. Measures of visual acuity (VA) <20/40 were considered visual loss (VL). Results: The results of the cohort involved 55 patients and 18 (32.7%) presented OM, been OH (20.0%), retinal hemorrhage (7.3%) and VL (7.3%) the most frequent finds. A strong association was found between patients with OM and those with a high risk of relapse (p=0.035, Cramer V=0.31) and who used the 1999 protocol (p=0.022, Cramer V=0.32). The risk of OM in patients from the 1999 protocol was 1,799 (CI=1,154-2,804), while in those at high risk of relapse it was 1,647 (CI=1,111-2,442). The results of the systematic review were limited to a total of four publications, two of individual case reports, one report of five patients and another prospective descriptive with twelve patients, with results varying from total ocular pressure control and VA preservation, to irreversible blindness. Conclusion: Patients with ALL have a high incidence of OM due to the treatment and the disease itself, and it may even be asymptomatic and evolve with VL. Patients submitted to the 1999 protocol and at high risk of relapse are more likely to present OM and these variables are strongly associated. OH is the most prevalent OM. Few studies have been found correlating children with ALL and OH. Due to the possibility of disparate results from silent OH without visual changes to irreversible blindness. Therefore, a protocol is proposed that contemplates systematic ophthalmological examination with the measurement of IOP immediately after diagnosis of ALL (D0) and subsequently at D8, D28 and D6months.Introdução: Leucemia Linfoblástica Aguda (LLA) é o câncer mais comumente encontrado entre os jovens, responsável por 26% dos casos de câncer infantil, com taxa de sobrevida de doença de 90% em cinco anos. As manifestações oculares (MO) decorrentes das LLAs podem estar relacionadas à infiltração direta do olho e da órbita pelas células neoplásicas, serem secundárias às anormalidades vasculares tumor-induzidas ou a medicações usadas no tratamento como quimioterápicos e glicocorticoides (GC). Por ser doença oncológica com alto potencial de cura, em indivíduos jovens com elevada expectativa de vida, a identificação de eventuais complicações oculares de longo prazo decorrentes do tratamento e a correlação com fatores preditivos de recaída da doença poderá subsidiar o delineamento de um protocolo oftalmológico para esses casos. Objetivo: Caracterizar as MO em pacientes pediátricos com LLA e avaliar se estão associados a fatores de risco preditivos para recaída, com os protocolos (1999 ou 2009), gênero e infiltração liquórica. Métodos: Realizado estudo de coorte prospectivo em crianças e adolescentes com LLA, de janeiro de 2013 a dezembro de 2017, seguido de estudo de revisão sistemática, associando pacientes pediátricos em tratamento para LLA e hipertensão ocular (HO), devido a HO ser a MO mais prevalente. No estudo da coorte os pacientes foram submetidos a avaliações oftalmológicas antes do início do tratamento (D0), no oitavo dia (D8), no 28º dia (D28) e aos seis meses (D6 meses). A HO foi definida quando o resultado da aferição da pressão ocular foi >21 mmHg. Medidas de acuidade visual (AV) <20/40 foram consideradas como baixa visão (BAV). Resultados: Os resultados da coorte envolveram 55 pacientes e destes, 33% apresentaram MO. As principais foram HO (20%) , hemorragia retiniana (7,3%) e BAV (7,3%). Forte associação foi encontrada entre pacientes com MO e alto risco de recaída (p = 0,035, Cramer V = 0,31) e os que usaram o protocolo de 1999 (p = 0,022, Cramer V = 0,32). O risco de MO em pacientes do protocolo de 1999 foi de 1,8 (IC = 1,154-2,804) e o risco de MO em pacientes de alto risco foi de 1,6 (IC= 1,111-2,442). Os resultados da revisão sistemática limitaram-se a quatro publicações sendo dois de relatos de casos individuais, um relato de cinco pacientes e outro descritivo prospectivo com doze pacientes, com resultados variando de total controle da pressão ocular e conservação da AV, até cegueira irreversível. Conclusão: Pacientes pediátricos com LLA têm alta incidência de MO devido ao tratamento e à própria doença, podendo ser assintomáticos ou evoluírem com complicações que podem chegar a BAV. Aqueles submetidos ao protocolo de 1999 e com alto risco de recaída são os mais propensos a apresentar MO e essas variáveis estão fortemente associadas. A HO é a MO mais prevalente. Poucos estudos foram encontrados correlacionando crianças com LLA e HO, com resultados variando de HO silenciosa, sem alterações visuais, até cegueira irreversível. Portanto, é proposto um protocolo que contemple exame oftalmológico sistemático com a medida da PIO imediatamente após o diagnóstico de LLA (D0) e, posteriormente, em D8, D28 e D6meses.AracajuporLeucemia linfoblástica agudaGlaucomaEsteroidesQuimioterapiaAcute lymphoblastic leukemiaSteroidsChemotherapyCIENCIAS DA SAUDEAlterações oftalmológicas em pacientes pediátricos com leucemia linfoblástica agudainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisPós-Graduação em Ciências da SaúdeUniversidade Federal de Sergipereponame:Repositório Institucional da UFSinstname:Universidade Federal de Sergipe (UFS)instacron:UFSinfo:eu-repo/semantics/openAccessTEXTCRISTIANO_QUEIROZ_MENDONCA.pdf.txtCRISTIANO_QUEIROZ_MENDONCA.pdf.txtExtracted texttext/plain192062https://ri.ufs.br/jspui/bitstream/riufs/10530/3/CRISTIANO_QUEIROZ_MENDONCA.pdf.txta81c87124fa17b1958355606bed68c3fMD53THUMBNAILCRISTIANO_QUEIROZ_MENDONCA.pdf.jpgCRISTIANO_QUEIROZ_MENDONCA.pdf.jpgGenerated Thumbnailimage/jpeg1261https://ri.ufs.br/jspui/bitstream/riufs/10530/4/CRISTIANO_QUEIROZ_MENDONCA.pdf.jpg4eb628e121df40a6339b984d4e0db2c3MD54LICENSElicense.txtlicense.txttext/plain; charset=utf-81475https://ri.ufs.br/jspui/bitstream/riufs/10530/1/license.txt098cbbf65c2c15e1fb2e49c5d306a44cMD51ORIGINALCRISTIANO_QUEIROZ_MENDONCA.pdfCRISTIANO_QUEIROZ_MENDONCA.pdfapplication/pdf1329260https://ri.ufs.br/jspui/bitstream/riufs/10530/2/CRISTIANO_QUEIROZ_MENDONCA.pdff73ee5fd9cb2bbdeaf81845f79c60b88MD52riufs/105302019-02-20 20:13:18.959oai:ufs.br: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Repositório InstitucionalPUBhttps://ri.ufs.br/oai/requestrepositorio@academico.ufs.bropendoar:2019-02-20T23:13:18Repositório Institucional da UFS - Universidade Federal de Sergipe (UFS)false |
dc.title.pt_BR.fl_str_mv |
Alterações oftalmológicas em pacientes pediátricos com leucemia linfoblástica aguda |
title |
Alterações oftalmológicas em pacientes pediátricos com leucemia linfoblástica aguda |
spellingShingle |
Alterações oftalmológicas em pacientes pediátricos com leucemia linfoblástica aguda Mendonça, Cristiano de Queiroz Leucemia linfoblástica aguda Glaucoma Esteroides Quimioterapia Acute lymphoblastic leukemia Steroids Chemotherapy CIENCIAS DA SAUDE |
title_short |
Alterações oftalmológicas em pacientes pediátricos com leucemia linfoblástica aguda |
title_full |
Alterações oftalmológicas em pacientes pediátricos com leucemia linfoblástica aguda |
title_fullStr |
Alterações oftalmológicas em pacientes pediátricos com leucemia linfoblástica aguda |
title_full_unstemmed |
Alterações oftalmológicas em pacientes pediátricos com leucemia linfoblástica aguda |
title_sort |
Alterações oftalmológicas em pacientes pediátricos com leucemia linfoblástica aguda |
author |
Mendonça, Cristiano de Queiroz |
author_facet |
Mendonça, Cristiano de Queiroz |
author_role |
author |
dc.contributor.author.fl_str_mv |
Mendonça, Cristiano de Queiroz |
dc.contributor.advisor1.fl_str_mv |
Cipolotti, Rosana |
contributor_str_mv |
Cipolotti, Rosana |
dc.subject.por.fl_str_mv |
Leucemia linfoblástica aguda Glaucoma Esteroides Quimioterapia |
topic |
Leucemia linfoblástica aguda Glaucoma Esteroides Quimioterapia Acute lymphoblastic leukemia Steroids Chemotherapy CIENCIAS DA SAUDE |
dc.subject.eng.fl_str_mv |
Acute lymphoblastic leukemia Steroids Chemotherapy |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE |
description |
Introduction: Acute Lymphoblastic Leukemia (ALL) is a cancer commonly found among young people and responsible for 26% of childhood cancer cases. Today, up to 90% of such patients have an average survival rate of five-year free of the illness. Ocular manifestations (OM) arising from ALLs might be secondary to tumor-induced vascular anomalies or related to direct infiltration of the neoplastic cells into the eye and orbit, or to medications used in treatment such as chemotherapy and glucocorticoids (GC). Since this is an oncological disease with a high potential for cure, in young individuals with a high life expectancy, the identification of possible long-term ocular complications resulting from the treatment and correlation with predictive factors of relapse of the disease may support the design of an ophthalmological protocol for these patients cases. yet existent in scientific literature. Objective: To characterize OM in pediatric patients under treatment for ALL and to evaluate if they are associated with predictive risk factors for relapse, with protocols (1999 or 2009), gender and cerebrospinal fluid (CSF) infiltration Methods: A prospective cohort study was conducted in children and adolescents with ALL from January 2013 to December 2017, followed by a systematic review associating pediatric patients under treatment for ALL and ocular hypertension (OH), because OH is the most prevalent OM. The patients underwent ophthalmologic evaluations before starting treatment (D0), on the eighth day (D8), at the 28th day (D28), and at six months (D6 months). Ocular hypertension (OH) was considered in results above 21 mmHg. Measures of visual acuity (VA) <20/40 were considered visual loss (VL). Results: The results of the cohort involved 55 patients and 18 (32.7%) presented OM, been OH (20.0%), retinal hemorrhage (7.3%) and VL (7.3%) the most frequent finds. A strong association was found between patients with OM and those with a high risk of relapse (p=0.035, Cramer V=0.31) and who used the 1999 protocol (p=0.022, Cramer V=0.32). The risk of OM in patients from the 1999 protocol was 1,799 (CI=1,154-2,804), while in those at high risk of relapse it was 1,647 (CI=1,111-2,442). The results of the systematic review were limited to a total of four publications, two of individual case reports, one report of five patients and another prospective descriptive with twelve patients, with results varying from total ocular pressure control and VA preservation, to irreversible blindness. Conclusion: Patients with ALL have a high incidence of OM due to the treatment and the disease itself, and it may even be asymptomatic and evolve with VL. Patients submitted to the 1999 protocol and at high risk of relapse are more likely to present OM and these variables are strongly associated. OH is the most prevalent OM. Few studies have been found correlating children with ALL and OH. Due to the possibility of disparate results from silent OH without visual changes to irreversible blindness. Therefore, a protocol is proposed that contemplates systematic ophthalmological examination with the measurement of IOP immediately after diagnosis of ALL (D0) and subsequently at D8, D28 and D6months. |
publishDate |
2018 |
dc.date.issued.fl_str_mv |
2018-12-14 |
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2019-02-20T23:13:18Z |
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2019-02-20T23:13:18Z |
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MENDONÇA, Cristiano de Queiroz. Alterações oftalmológicas em pacientes pediátricos com leucemia linfoblástica aguda. 2018. 92 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Sergipe, Aracaju, 2018. |
dc.identifier.uri.fl_str_mv |
http://ri.ufs.br/jspui/handle/riufs/10530 |
identifier_str_mv |
MENDONÇA, Cristiano de Queiroz. Alterações oftalmológicas em pacientes pediátricos com leucemia linfoblástica aguda. 2018. 92 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Sergipe, Aracaju, 2018. |
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