Papers by José Francisco C. Marques
Hematology, Transfusion and Cell Therapy
Hematology, Transfusion and Cell Therapy, 2021
Jornal Brasileiro de Economia da Saúde, 2020
Objective: In the private healthcare sector in Brazil, the dearth of information regarding transf... more Objective: In the private healthcare sector in Brazil, the dearth of information regarding transfusion cost may compromise the management of conditions requiring long-term transfusion. Therefore, the present study aimed to estimate the cost of chronic red blood cell (RBC) transfusion in this context. Methods: A payer perspective was chosen for the analysis. A survey performed by an expert advisory board gathered information on the amounts reimbursed by health plans to blood centers per outpatient transfusion of a single RBC bag in multitransfused patients. Survey results were contrasted to RBC transfusion cost calculated using Brazilian Hierarchical Classification of Medical Procedures (CBHPM) parameters from 2018 and 2010, the latter suggested by the advisory board as more accurately reflecting market prices. Results: Six blood centers in the South and Southeast of Brazil were surveyed. The median amount reimbursed per RBC unit was R$ 1,066.44 (interquartile range: R$ 665.00-1,252....
Hematology, Transfusion and Cell Therapy, 2020
Biology of Blood and Marrow Transplantation, 2019
Bone marrow transplantation, 1995
Allogeneic blood stem cell (BSC) transplantation has been performed experimentally in some patien... more Allogeneic blood stem cell (BSC) transplantation has been performed experimentally in some patients with success. Wider application of this therapeutic modality has been hampered ultimately by many factors, mainly the concern that infusion of large numbers of donor T cells could result in an increased incidence and severity of graft-versus-host disease (GVHD). We report the short-term results of 17 allogeneic BSC transplants in patients with hematologic malignancies. When compared to standard BMT results, BSC transplants showed the advantages of faster engraftment, shorter hospital stay and fewer antibiotic needs. The incidence and severity of GVHD, as well as the general BMT-associated morbidity, was comparable between the two groups. BSC collection by apheresis was well tolerated and associated with less morbidity for donors, probably reducing the cost of the treatment. The collection of BSC was a single apheresis procedure and yielded adequate numbers of stem cells to ensure engr...
Journal of Clinical Apheresis, 2014
At the combined American Society for Apheresis (ASFA) Annual Meeting/World Apheresis Association ... more At the combined American Society for Apheresis (ASFA) Annual Meeting/World Apheresis Association (WAA) Congress in San Francisco, California, in April of 2014, the opening session highlighted the status of apheresis outside of the United States. The organizers invited physicians active in apheresis in countries not usually represented at such international gatherings to give them a forum to share their experiences, challenges, and expectations in their respective countries with regard to both donor and therapeutic apheresis. Apheresis technology is expensive as well as technically and medically demanding, and low and median income countries have different experiences to share with the rest of the world. Apheresis procedures also require resources taken for granted in the developed world, such as reliable electrical power, that can be unpredictable in parts of the developing world. On the other hand, it was obvious that there are significant disparities in access to apheresis within ...
Transfusion and Apheresis Science, 2004
To evaluate, in vitro, the effects of collecting and cryopreserving fresh dry platelet concentrat... more To evaluate, in vitro, the effects of collecting and cryopreserving fresh dry platelet concentrates (PCs). Standard and dry PCs were collected in the same apheresis procedure. PCs were evaluated by mean platelet volume (MPV), pH, glucose and LDH levels. Activation was examined by flow cytometry using anti-CD41, anti-CD42 and anti-CD62p monoclonal antibodies and annexin binding assay. Platelet function was assessed by aggregation using ADP, collagen and arachidonic acid as agonists. Dry PCs were compared to standard PCs and to cryopreserved dry PCs. We also compared the use of ThromboSol to 5% DMSO as cryoprotectives. Dry PCs presented a significantly reduced pH and glucose (p<0.001), increased LDH levels and CD62p expression (p<0.001) and diminished aggregation response to ADP (p<0.001). Platelet cryopreservation was associated with platelet lysis, activation and loss of function. Dry PCs cryopreserved with TS were associated with statistically higher LDH levels (p<0.001) and a higher percentage of annexin binding (p=0.005), in addition to a lower number of CD42 positive platelets (p=0.01). Dry PCs should be rapidly frozen after collection to avoid a fall in pH and platelet activation. 5% DMSO performed better than TS to cryopreserve dry PCs.
Journal of Clinical Apheresis, 2014
Introduction: Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy caused by... more Introduction: Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy caused by decreased activity of ADAMTS13, resulting in reduced clearance of ultralarge von Willebrand factor (VWF) multimers. Treatment of TTP is therapeutic plasma exchange (TPE) with replacement with fresh frozen plasma (FFP). Cryoprecipitate‐poor plasma (CPP) is a plasma product with lower concentrations of large VWF multimers, and similar amounts of ADAMTS13. CPP is regarded as at least as efficacious as FFP in TTP but evidence of additional benefits has not been demonstrated. Furthermore, there are limited data on the frequency of adverse events associated with CPP. Material and methods: In our center, the choice between CPP and FFP is performed before the 1st TPE session at the physicians' discretion. Here, we retrospectively evaluated the efficacy and safety of CPP based on the number of sessions, volume of plasma exposure, frequency of exacerbations/relapses, and adverse events. Resul...
Transfusion and Apheresis Science, 2006
Peripheral blood progenitor cells (PBPC) collection after high dose chemotherapy can be influence... more Peripheral blood progenitor cells (PBPC) collection after high dose chemotherapy can be influenced by several factors. We searched for parameters that may predict the best day to start harvesting of PBPC in order to collect most CD34+ cells with the least number of aphereses. We studied patients who underwent mobilization chemotherapy for autologous transplantation. The influence of age, sex, diagnosis, number of previous chemotherapy cycles, peripheral blood (PB) counts at day of mobilization (D0), day of neutrophils <1.0 x 10(9) l(-1) and day of nadir and interval between both (delta) on harvesting was investigated. Multivariate linear correlation models were built to predict the best harvesting with principles of parsimony. In patients where sequential CD34+ cell count was performed, the theoretical day of peak was calculated by interpolation in polynomial regression. One hundred and thirty four patients entered the analysis: 36 Hodgkin's lymphoma (HL), 65 B-large cell lymphoma (NHL) and 33 multiple myeloma (MM). Day of harvesting correlated with nr CHT, hemoglobin on D0, day of granulocytes <1.0 x 10(9) l(-1), delta and dosis of mobilization therapy. The day of CD34+ peak could be calculated by the formula = (-0.41) x Hemoglobin D0 + (day peripheral CD34+ cells = 10 x 10(6) microl(-1)) x 0.99 + 7.8. This model could explain 81% of the variance of the peak day and was stable by bootstrap resampling. Day of peripheral CD34+ cells = 10 x 10(6) microl(-1) preceded the calculated peak by 3-9 days. Although the day of best collection can be predicted using only sequential PB counts after mobilization chemotherapy, a model of prediction using peripheral CD34+ cell count is important especially for optimizing collection in poor mobilizing patients.
Transfusion, 2008
BACKGROUND: Optimization of peripheral blood stem cell (PBSC) collection for autologous bone marr... more BACKGROUND: Optimization of peripheral blood stem cell (PBSC) collection for autologous bone marrow transplantation is necessary for a good standard of care and cost‐effectiveness. An algorithm was validated for prediction of the day of maximum peripheral CD34+ cell concentration after mobilization chemotherapy (DayCD34peak).STUDY DESIGN AND METHODS: This study compared mobilization and collection variables of a cohort of patients where apheresis was started at the DayCD34peak predicted by the algorithm with a patient group where PBSCs were collected when PB CD34+ cell concentration reached 10 per µL per day (DayCD34threshold). DayCD34peak was calculated according to the equation DayCD34peak = −0.41 × HbD0 + 0.99 × DayCD34threshold + 7.8 (with HbD0 representing the hemoglobin value on Day 0).RESULTS: The mean number of apheresis procedures per patient based on the DayCD34threshold was 1.74, but decreased to 1.35 when applying the new method (DayCD34peak). For lymphomas, the mean num...
Arquivos de Neuro-Psiquiatria, 2002
Rasmussen's encephalitis is characterized by refractory epilepsy, neurological deterioration ... more Rasmussen's encephalitis is characterized by refractory epilepsy, neurological deterioration and progressive atrophy of one cerebral hemisphere. The objective of this study is to describe the importance of neuropsychological evaluation in the treatment decision and follow-up of patients with Rasmussen´s encephalitis. Neuropsychological assessment was performed in two steps. Firstly, the clinical history was obtained and the Vineland adaptative behavior scale (VABS) was applied. After this first step, the patients with social maturity level equal or higher than the inferior limit underwent a battery of neuropsychological assessment. We evaluated three patients before any specific treatment was started, and six months after the intervention (surgery or plasmapheresis). Patient 1 underwent left hemispherectomy and had global improvement on second neuropsychological assessment. This suggests that the decision of performing surgery was adequate. Patients 2 and 3 underwent plasmaphere...
Transfusion, Jan 3, 2015
Pregnancy represents a challenge for women with sickle cell disease (SCD), with higher rates of b... more Pregnancy represents a challenge for women with sickle cell disease (SCD), with higher rates of both maternal and fetal complications. The aim of this study was to evaluate the impact of prophylactic transfusion support administered specifically to pregnant women with sickle hemoglobin C disease. Patients were divided into two groups according to the type of transfusion support received: 10 women received prophylactic erythrocytapheresis or manual exchange transfusion at 28 weeks of gestation, and 14 received transfusions only on demand, due to acute complications, or received no transfusions at all. Our results indicated higher frequencies of SCD-related complications in the group that did not receive prophylactic transfusion support (35.7% vs. only 10% in the erythrocytapheresis group). Furthermore, these complications were more severe in this group and included all cases of acute chest syndrome. A significant difference was observed concerning gestational age at birth (38.7 weeks...
Arquivos de Neuro-Psiquiatria, 2004
We analyzed the experience of Unicamp Clinical Hospital with plasma exchange (PE) therapy in myas... more We analyzed the experience of Unicamp Clinical Hospital with plasma exchange (PE) therapy in myasthenia gravis (MG). About 17.8 % of a totality of MG patients had PE performed: 26 cases, 19 women and seven men. The mean age-onset of MG was 28 years, extremes 11 and 69. Minimum deficit observed in the group was graded IIb (O & G) or IIIa (MGFA scale). One patient had prethymectomy PE. In seven the procedures were performed due to myasthenic crisis and in 18 patients due to severe myasthenic symptoms or exacerbation of previous motor deficit. Two patients were also submitted to chronic PE considering refractoriness to other treatments. Twenty-six patients had 44 cycles of PE and 171 sessions. The mean number of sessions was 3.9 (SD ± 1.4) each cycle; median 5, extremes 2 and 6. The mean time by session was 106,5 minutes (SD ± 35.2); median 100.5 (extremes of 55 and 215). The mean volume of plasma exchanged in each session was 2396 ml (SD ± 561); median 2225 (extremes 1512 and 4500). S...
, pela supervisão e constantes conselhos em momentos decisivos. Ao Hemocentro da UNICAMP, vincula... more , pela supervisão e constantes conselhos em momentos decisivos. Ao Hemocentro da UNICAMP, vinculado à pessoa do Prof. Dr. Cármino Antonio de Souza, pela oportunidade de me aprimorar. À Faculdade de Odontologia São Leopoldo Mandic, por viabilizar meu desenvolvimento na carreira acadêmica e permitir a condução das análises histomorfométricas desta pesquisa, por meio da colaboração da Profa. Dra. Cristiane Furuse. Aos pacientes voluntários deste estudo, pela confiança, coragem e ajuda no desenvolvimento da ciência. Ao Roberto Zulli, pela ajuda nas avaliações estatísticas do estudo.
Transfusion Science, Oct 1, 2000
Objective. We analysed peripheral blood progenitor cell (PBPC) mobilisation and collection in ord... more Objective. We analysed peripheral blood progenitor cell (PBPC) mobilisation and collection in order to assess the main factors related to CD34 cell yields in patients aected by haematological malignancies. Patients and Methods. The features of CD34 cell mobilisation of patients with haematological malignancies that underwent autologous bone marrow transplantation were examined. Mobilisation chemotherapy consisted mainly of cyclophosphamide (CY) 4 or 7 g/m 2 followed by growth factors. Leukapheresis was started when the WBC counts reached 1.0´10 9 /l with the aim to collect at least 5´10 6 CD34 cells/kg body weight. The aphereses were performed on continuous-¯ow blood cell separators. The analysed variables were: age, diagnosis, CT mobilisation regimen, type of growth factor, number of previous CT lines, prior radiotherapy, days for WBC recovery and number of aphereses procedures to achieve the target of CD34 cells. Results. There were 41 consecutive patients (26 M/15 F): 21 non-HodgkinÕs lymphoma (NHL), 15 HodgkinÕs disease (HD), two chronic myeloid leukaemia (CML) and three multiple myeloma (MM). Eleven patients could not collect the proposed threshold of CD34 cells. CY 4 mobilised patients recovered WBC counts in less days (P 0.03). By ANOVA, the days to WBC recovery had a linear function of the predictors``number of aphereses'' and``type of mobilisation CT'' (coecients: 0.86 and 0.95, respectively). For the number of aphereses and WBC recovery after CT mobilisation, we obtained a correlation coecient of 0.36 (P 0.02). Conclusion. This study shows that it is feasible to mobilise and collect PBPC in patients previously treated with CT with or without RT. There was a linear correlation between the days for WBC recovery and the number of aphereses needed to collect the target number of CD34 cells. The study suggests that early WBC recovery, using mainly CY 4 mobilisation chemotherapy, is an important predictor of a low number of aphereses to achieve a good CD34 yield.
Bone Marrow Transplantation, 1998
We present the results of a prospective, randomised study comparing PBPC and BM focusing on engra... more We present the results of a prospective, randomised study comparing PBPC and BM focusing on engraftment, acute and chronic GVHD and survival. Forty patients with haematological malignancies received HLA-identical sibling BM (group A) or PBPC (group B). Evaluable patients were 19 (A) and 18 (B). Median age was 35 (17-56) in A and 29.5 (9-51) in B. Conditioning was mainly Bu-Cy2; GVHD prophylaxis was CSA-MTX. PBPC were harvested after 5 days of G-CSF 10 g/kg/day. Median days for an ANC Ͼ0.5 ؋ 10 9 /l was 18 (13-30) in A and 16 (11-25) in B (P = 0.10). Platelets Ͼ20 ؋ 10 9 /l occurred at ؉17 (10-40) in A and ؉12 (9-36) in B (P = 0.01). The probability of у2 grade a-GVHD was 19% (A) and 27% (B) (P = 0.53). The probability of all grade c-GVHD was 70% with BM. In spite of the small number of patients in group B (PBPC), our data suggest the great majority of them will have c-GVHD (P = 0.08); extensive disease was present in 50 and 100%, respectively (P = 0.05). The estimates of overall survival for A and B at 1000 days are 51 and 47%, respectively (P = 0.67); DFS at 1000 days are 52 and 58%, respectively (P = 0.50). PBPC resulted in faster platelet engraftment. The incidence of acute and chronic GVHD was similar in both groups, but the severity of c-GVHD was higher with PBPC. No differences in survival and DFS have been observed to date.
Revista Brasileira de Hematologia e Hemoterapia, 2016
treatment depending on the patient's setting and clinical status. This article presents the guide... more treatment depending on the patient's setting and clinical status. This article presents the guidelines on Beta-thalassemia major-regular blood transfusion therapy. Description of the method used to gather evidence These guidelines use the technique of systematic review and information recovery based on the evidence-based medicine
International Journal of Gynecology & Obstetrics, 2006
Objective: To evaluate the effects of prophylactic transfusion by means of erythrocytapheresis at... more Objective: To evaluate the effects of prophylactic transfusion by means of erythrocytapheresis at the beginning of the third trimester of pregnancy in women with sickle cell disease (SCD). Methods: A cohort of 14 pregnant women with SCD who received prophylactic erythrocytapheresis transfusions at the beginning of the third trimester was retrospectively compared with a cohort of 17 pregnant women who received simple prophylactic transfusions for no indication other than SCD severity. Results: Prophylactic erythrocytapheresis transfusions were associated with a lower risk of intrauterine growth restriction (OR, 0.11; 95% confidence interval, 0.01-1.00) and oligohydramnios (OR, 0.65; 95% confidence interval, 0.45-0.92) in pregnant women with SCD. Conclusion: These results suggest that erythrocytapheresis transfusions are beneficial in women with SCD who are in the third trimester of pregnancy. Given the decrease in transfusion risks, this therapy deserves further evaluation in future trials.
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Papers by José Francisco C. Marques