Papers by Carmen Vergueiro
JBMTCT, Jul 17, 2021
<jats:p>Brazil has a vast Hematopoietic Stem Cell Transplantation (HSCT) program with 126 t... more <jats:p>Brazil has a vast Hematopoietic Stem Cell Transplantation (HSCT) program with 126 teams and 86 Centers recognized by the Ministry of Health. Outcomes of these transplants are unknown. The objective of this work is to create a public database to help the public and health care professionals to find information on allogenic HSCT performed in Brazil. Methods: The team chose indicators, outcomes, and developed tools to accept secure data input using e-DBtC, Access, RedCap and excel spreadsheet. All data was inserted into the Virtual Analytics platform after careful validation and then presented as tables and graphics in separate portals for healthcare professionals and general public. Results: 29 HSCT centers participating in the project sent data on all consecutive allogeneic transplants performed between August 2019-2020. We gathered data from 943 transplants, with results arranged in graphs and tables, with the possibility of using various filters, so users can customize their search. In conclusion, more than 60% of all allogenic transplants performed in the country are now included in the Map of BMT, in an easy and accessible way to be searched. We hope to continue this initiative and extend it to other services, emphasizing great accomplishment of the Brazilian transplant community.</jats:p>
The number of hematopoietic stem cell transplantation (HSCT) in Brazil is growing rapidly. To bet... more The number of hematopoietic stem cell transplantation (HSCT) in Brazil is growing rapidly. To better understand the outcomes of HSCT in Brazil, strategies have been developed with the Center for International Blood and Marrow Transplant Research (CIBMTR), using its standardized registry structure and data sharing application. The methods adopted to establish the registry were through efforts to increase the Brazilian centers that report to CIBMTR included training courses for HSCT data managers, the officialization of a multicenter HSCT study using the CIBMTR structure and the partnership between Brazilian Society of Bone Marrow Transplantation (SBTMO) and the CIBMTR. Here we describe the history for establishing the HSCT Brazilian database using the CIBMTR back to center data and present the aggregated results since 2016. We found a significant increase in the numbers of active centers reporting to CIBMTR from 11 in 2016 to 21 in 2020 corresponding to higher numbers of transplants ...
Transplantation and Cellular Therapy
Transplantation and Cellular Therapy
Transplantation and Cellular Therapy
JBMTCT
To increase the report of Brazilian hematopoietic stem cell transplantation (HSCT) data to the Ce... more To increase the report of Brazilian hematopoietic stem cell transplantation (HSCT) data to the Center for International Blood and Marrow Transplant Research (CIBMTR), the Data Managers Working Group (GTGD) of the Brazilian Society of Bone Marrow Transplants (SBTMO), and the Sao Paulo State Bone Marrow Association (AMEO) developed several strategies since 2016: training data managers (GDs) in national and international HSCT meetings, the development of a free online teaching course (EAD) in Portuguese on Transplant Essential Data (TED), online and presential training course for new data managers offered by AMEO, the approval by the National Committee of Ethics in Research (CONEP) of a national multicenter protocol to formalize sharing data of Brazilian transplants with the CIBMTR, and the first multicenter evaluation our HSCT results using the CIBMTR Data Back to Center. The contract between SBTMO and CIBMTR was signed in 2019 and GTGD of the SBTMO was officially created. These act...
Biology of Blood and Marrow Transplantation
Introduction Many developing countries do not have a consolidated registry to report hematopoieti... more Introduction Many developing countries do not have a consolidated registry to report hematopoietic stem cell transplant outcomes (HSCT), what poses a great challenge to understand the HSCT results. The CIBMTR is an excellent strategy for these countries to report, validate, and to have their own nationwide data. Objective To report strategies and tools developed in Brazil to increase the number of active centers reporting data to the CIBMTR. Methods The Brazilian Society of Bone Marrow Transplant (SBTMO) and Sao Paulo State Bone Marrow Association (AMEO), in partnership with the CIBMTR and support from the Brazilian government (PRONON-SUS), have outlined strategies and developed tools to improve data reporting: data managers visited the CIBMTR for specific training, online-based learning tools were developed in Portuguese; the SBTMO has constituted a formal data manager working group and has worked on a formal agreement with the CIBMTR to have organized nationwide data back to the country. The data managers group organized an online real time communication tool (WhatsApp) with the senior data managers and with an outstanding Portuguese-speaking staff of the CIBMTR (Figure 1). Results and Discussion Since the beginning of the project in 2016, the number of centers registered at the CIBMTR has increased from 24 to 33 and among them, the number of centers with current reports increased from 9 to 16 (Figure 2). With the expected delay in starting this process complete CIBMTR affiliation, inclusion of new centers in the study for reporting data in the nationwide Platform, submission to the local ethics committee, and training of data managers, we expect this number to further increase in the next months. There was a 50% increase in the number of participants at the SBTMO meeting organized for Brazilian data managers, 23 participants in 2017, and 52 in 2019. The participation of data managers at the Tandem Meetings increased from 3 in 2016 to 10 in 2019. The SBTMO data managers working group has their mission, vision and values published in the society's webpage. A multicenter study was approved in 2017 to send national data to the CIBMTR and in 2019 it gained Central Brazilian IRB (CONEP) approval, currently with 19 participating centers. AMEO has started training of new data managers with governmental support (Pronon), currently with 144 students from 36 centers. Conclusion The actions developed in our country have reached a large number of centers and professionals being prepared to report high quality data to the CIBMTR. The SBTMO recognition may help to establish data managers as an official activity in the country. We hope the Brazilian example may encourage other centers and countries, ultimately aiming at improving the quality of care for patients who need HSCT.
Blood
4711 Allogeneic unrelated hematopoietic stem cell transplants (HSCT) are complex procedures that ... more 4711 Allogeneic unrelated hematopoietic stem cell transplants (HSCT) are complex procedures that need adequate hospital infrastructure, a competent team, high-cost procedures and medications. Most transplants that are performed in Brazil are paid by the government. The national health system reimburses the hospital U$ 35,801.00 as a flat rate. The government has recently increased this amount by 60% but there are not national studies to use to evaluate the appropriateness of this amount. The objective of this study was to retrospectively evaluate the cost of ten consecutive unrelated donor HSCT performed in our institution. Methods: The project was approved by our IRB (CEP-UNIFESP #1875/11) and granted waiver to request consent. The costs were evaluated from the first appointment until one year after transplant or death divided as 1) pre-HSCT, 2) conditioning therapy, 3) from the day of transplant until first discharge, 4) until D+100, 5) until D+180, and 6) until D+360. The costs i...
Biology of Blood and Marrow Transplantation
Data management is essential to understand hematopoietic stem cell transplantation (HSCT) activit... more Data management is essential to understand hematopoietic stem cell transplantation (HSCT) activity and outcomes in a country, and to design strategies to improve results. Most developing countries, however, have neither a national registry, nor data managers knowledgeable to understand the complicated medical information involved in HSCT. The best strategy to treat patients is not the same in different regions, where social conditions and education may have profound implications on transplant results. Physicians may take part in specific projects, but only trained professional data managers make registries possible and reliable. Designing registries and forms is also extremely challenging. More than 2,500 HSCT are performed in Brazil annually, most of them payed by the government. Understanding the urgent need of knowing HSCT outcomes, the Brazilian government has approved a public grant (Pronon) to train Data Managers to start a Brazilian HSCT Registry (RBTMO). Objectives: To develop a training program to capacitate new data managers in all HSCT Centers performing unrelated donor transplants. Methods: A grant developed by Ameo, a Brazilian Non-Governmental Organization, was approved by the Brazilian government. It includes to: 1) select 3 health-care professionals fluent in English, 2) train them to understand HSCT-related issues, 3) translate the CIBMTR forms to Portuguese, 4) translate and adapt the CIBMTR manual, 5) prepare teaching material; 6) contract the public centers performing unrelated donor HSCT to hire a health care professional who will be paid by the grant to be trained, and to register the patients, 7) provide a laptop with internet access; 8) online web-based training in Portuguese for 2 months withclasses and discussions 3 hours/day, 3 days/week, pre and post-evaluations and documentation of participation; 9) visit each public contracted center for at least 3 days within 3 months for personal contact, teaching and understanding local characteristics and difficulties; 10) weekly meetings to maintain and improve data managers' skills, solve questions, and to build up cooperation among data managers from the different centers, 11) 2 more cycles will follow including auditing patient registration, 12) develop a portal in Portuguese to retrieve transplant outcomes with no patient or center identifiers. Results and conclusion: Three nurses are being trained and preparing the teaching materials. The contracts will be done in 2018, and the Data Manager training will start in early 2019. By the end of 2020, we expect to have a large team of data managers trained in Brazil and a strong cooperation with the CIBMTR to use the enhanced data back to center model to have the Brazilian HSCT Registry.
Rev Bras Hematol Hemoter, Dec 1, 1999
Revista Brasileira De Hematologia E Hemoterapia, 2007
Biology of Blood and Marrow Transplantation, 2015
The number of allogeneic hematopoietic stem cell (HSC) transplants performed globally each year c... more The number of allogeneic hematopoietic stem cell (HSC) transplants performed globally each year continues to increase. Advances in HLA typing, better supportive care, and administration of reduced-intensity conditioning regimens allow treatment of older patients with older sibling donors. Pretransplant donor assessment and testing are very important processes affecting the quality and safety of donation. For unrelated HSC donors detailed recommendations for health assessment have been published, allowing donation only if they are unrestrictedly healthy. Eligibility criteria for related donors are less strict and vary significantly between centers. In situations where a family donor does not meet the suitability criteria for unrelated donors, involved physicians often struggle with the decision whether the matched relative is suitable for donation or not. On behalf of the Worldwide Network for Blood and Marrow Transplantation Standing Committee on Financial disclosure: See Acknowledgments on page 2059.
Revista do Instituto de Medicina Tropical de São Paulo, 2005
The frequency of intestinal infection by Cryptosporidium sp. was determined in 60 patients, atten... more The frequency of intestinal infection by Cryptosporidium sp. was determined in 60 patients, attended at the Haematological and Haemotherapeutical Service of "Santa Casa de Misericórdia" of São Paulo, suffering lymphoproliferative diseases (Group 1). As control group (Group 2) 59 persons without haematological diseases, but with the same life time and living at the same place of that of haematological patients, had been examined. The stool parasitological tests performed disclosed Cryptosporidium sp. oocysts in six (10%) individuals belonging to Group 1, whereas, in Group 2, nobody showed infection by this coccidian. Among the patients infected by Cryptosporidium sp. only one showed diarrhoeal faeces.
Revista Brasileira de …, 2007
Hemochromatosis is one of the most frequent genetic diseases in humans and one of the most import... more Hemochromatosis is one of the most frequent genetic diseases in humans and one of the most important causes of iron overload. The aims of this study were to determine the frequency of C282Y, H63D and S65C mutations of the HFE gene in Brazilian patients with ...
Arq. méd. hosp. Fac. …, 1990
Resumo: A ultra-sonografia cervical tem sido realizada rotineiramente em pacientes protadores de ... more Resumo: A ultra-sonografia cervical tem sido realizada rotineiramente em pacientes protadores de linfomas malignos, objetivando a deteccäo, localizaçäo e delimitaçäo de linfonodos cervicais, demonstrando-se importante método propedêutico, principalmente ...
Sao Paulo Medical …, 2008
CONTEXT: DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) is a type of drug rea... more CONTEXT: DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) is a type of drug reaction commonly mistaken for a viral infection. It must be recognized promptly due to its high morbidity and 10% mortality rate. Few cases of DRESS syndrome induced by ...
Revista Brasileira de …, 2008
Objetivos: Estimar a prevalência da infecção pelo Helicobacter pylori (HP) e determinar os fatore... more Objetivos: Estimar a prevalência da infecção pelo Helicobacter pylori (HP) e determinar os fatores associados, em adultos saudáveis, doadores voluntários de medula óssea em São Paulo, Brasil. Métodos: 248 indivíduos saudáveis, residentes na zona urbana de São Paulo, responderam a um questionário relatando condições sociais e domiciliares na infância e na vida adulta, assim como antecedentes gastrintestinais e principais fatores associados à infecção. Amostras de sangue foram coletadas e o soro foi analisado utilizando um teste de ELISA previamente validado. Resultados: A prevalência da infecção pelo HP em 248 doadores foi de 48,8%, IC 95% = [45,6; 52,0]. Na análise univariada, a infecção pelo HP esteve significativamente associada à ausência de água encanada (p=0,040), a escolaridade da mãe (p=0,005) e do indivíduo (p<0,001). Na análise múltipla, os fatores independentes foram a escolaridade da mãe e do indivíduo. Conclusões: A prevalência de infecção de 48,8% mostra que na região urbana de São Paulo, onde há água tratada e esgoto encanado, temos uma prevalência semelhante à encontrada em países industrializados. O fator de maior significância para a aquisição do HP foi a escolaridade, seja individual ou materna, o que sugere que os hábitos higiênicos e comportamentais possam ser determinantes da infecção.
Human Immunology, 2007
The aim of the present study was to identify and evaluate, by means of the analysis of class I an... more The aim of the present study was to identify and evaluate, by means of the analysis of class I and II MHC genes in two different geographic areas of Brazil (State of Sao Paulo and Piaui), possible differences in the genetic structure of these populations, by the comparison with populations from the three ethnic groups that originated the Brazilian urban populations: European, African and Amerindian. Data were collected 250 donors from Sao Paulo and 97 donors from Piaui, typified by the PCR/SSP method.Genetic distances between the populations studied and those used for comparison revealed a close relationship between Brazilian and European populations, especially those from Portugal. Distances from African populations were also small, whereas very high when compared to native populations. The distances between Sao Paulo and European populations were slightly smaller than between the latter and that of Piaui. On the other hand, the distances between Piaui and Amerindian populations were slightly smaller than between the latter and Sao Paulo population. This reflects a greater European contribution and a smaller native contribution in the composition of Sao Paulo, compared to that of Piaui, which corroborates the historical immigration data for these regions.
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Papers by Carmen Vergueiro