ABSTRACT The treatment and evolution of B-cell non-Hodgkin lymphoma (B-NHL) has undergone important changes in the last years with the emergence of targeted therapies, such as monoclonal antibodies, small molecules, antibody-drug conjugates, and bispecific antibodies. Nevertheless, a significant portion of patients remains refractory or relapsed (R/R) to the new therapeutic modalities, representing thus an unmet medical need. The use of CAR-T cells for the treatment of B-NHL patients has shown to be a promising therapy with impressive results in patients with R/R disease. The expectations are as high as the imminent approval of CAR-T cell therapy in Brazil, which it is expected to impact the prognosis of R/R B-NHL. The aim of this manuscript is to offer a consensus of specialists in the field of onco-hematology and cellular therapy, working in Brazil and United States, in order to discuss and offer recommendations in the present setting of the use of CAR-T cells for patients with B-NHL.

O diagnóstico diferencial das anemias microcíticas é complexo e sua investigação laboratorial, de custo elevado. O uso de índices hematimétricos para racionalizar a abordagem diagnóstica tem sido proposto para contornar essa problemática. OBJETIVO: Avaliar a utilidade diagnóstica dos índices hematimétricos nas anemias microcíticas, de modo prospectivo, em hospital geral de alta complexidade. MÉTODOS: Foram analisados 2278 hemogramas realizados nos nossos serviços. Baseados em eletroforese de hemoglobina e ferritina, estratificamos 52 pacientes adultos com anemia microcítica em três grupos: Anemia ferropriva (AF; n=26 pacientes), Beta-Talassemia Menor (BTM; n=17) e Anemia não-ferropriva e não-beta-Talassemia (ANFNT; n=9). Avaliamos o uso dos seguintes índices hematimétricos na discriminação dos três grupos, por análise de variância e curvas ROC: RBC, VCM, HCM, RDW, índices de England e de Green. RESULTADOS: Nenhum dos índices permitiu a separação integral dos três grupos. Determinamos valores de corte para cada um dos índices e calculamos sensibilidade (S), especificidade(E), valores preditivos positivo e negativo e eficácia, em função de sua melhor discriminação. A discriminação de BTM foi melhor realizada pelo RBC acima de 5 milhões/mL, com S=82,3% e E=82,8%; enquanto a anemia ferropriva, pelo RDW acima de 16%, mas com S de apenas 69,2% e E=80,7%. CONCLUSÕES: A anemia ferropriva apresenta difícil diagnóstico presuntivo pelos índices, devendo ser realizada confirmação laboratorial. Valores elevados de RBC em anêmicos devem fazer suspeitar de traço talassêmico, sendo recomendável confirmação diagnóstica.

OBJECTIVE: To evaluate prospectively RBC indices as a diagnostic tool at a high complexity general hospital. METHODS: We analyzed 2278 blood cell counts from the core laboratory of our service and we found 343(15%) microcytic anemias. Concomitant serum samples were found from 52 patients above 14 years-old, and ferritin measurement and hemoglobin electrophoresis were performed. We classified our patients in three groups: Iron-deficiency anemia (AF; 26 patients), beta-thalassemia minor (BTM; n=17) and non-iron-deficiency-non-beta-thalassemia (ANFNT; n=9). We evaluated the following RBC indices for group discrimination, with variance and ROC curve analysis: RBC, MCV, MCH, RDW, England's index and Green's index. RESULTS: None of the indices allowed complete discrimination of all groups. We have established limits for each of the indices, and sensitivity (S), specificity(E), positive and negative predictive values and test efficiency were determined. BTM was better distinguished from the other groups by RBC (above 5 millions/mL) and England's index (<6), both with S=82.3% and E of 82.8%. A RDW above 16% was the best index of AF, with S=69.2% and E= 80.7%. CONCLUSIONS: Presumptive diagnosis of AF is troublesome when using RBC indices; diagnosis should be based on complete laboratory evaluation. Elevated RBC levels, specially above 5 millions/muL, in anemic patients with microcytosis are important indicatives of BTM, and confirmatory tests are suggested.

The frequency of coinfection with Strongyloides stercoralis and human T-cell leukemia/lymphoma virus type 1 (HTML-1) was determined in 91 blood donors examined at the blood bank of a large hospital in São Paulo city, Brazil. As control group 61 individuals, not infected by HTLV-1, were submitted to the same techniques for the diagnosis of S. stercoralis infection. In HTLV-1 infected patients the frequency of S. stercoralis infection was 12.1%; on the other hand, the control group showed a frequency significantly lower of S. stercoralis infection (1.6%), suggesting that HTLV-1 patients shoud be considered as a high risk group for strongyloidiasis in São Paulo city.