Maintain Efficacy and Spare Toxicity: Traditional and New Radiation-Based Conditioning Regimens in Hematopoietic Stem Cell Transplantation.

Novelty in total body irradiation (TBI) as part of pre-transplant conditioning regimens lacked until recently, despite the developments in the field of allogeneic stem cell transplants. Long-term toxicities have been one of the major concerns associated with TBI in this setting, although the impact of TBI is not so easy to discriminate from that of chemotherapy, especially in the adult population. More recently, lower-intensity TBI and different approaches to irradiation (namely, total marrow irradiation, TMI, and total marrow and lymphoid irradiation, TMLI) were implemented to keep the benefits of irradiation and limit potential harm. TMI/TMLI is an alternative to TBI that delivers more selective irradiation, with healthy tissues being better spared and the control of the radiation dose delivery. In this review, we discussed the potential radiation-associated long-term toxicities and their management, summarized the evidence regarding the current indications of traditional TBI, and focused on the technological advances in radiotherapy that have resulted in the development of TMLI. Finally, considering the most recent published trials, we postulate how the role of radiotherapy in the setting of allografting might change in the future.

Clinical relevance of minimal rsidual disease monitoring in mature B-cell disorders: Role of qualitative PCR-based strategies

Os tratamentos atuais induzem remissäo clínica completa em uma alta percentagem de pacientes portadores de Síndromes linfoproliferativas de células B maduras (SLBM). No entanto, muitos destes pacientes recaem devido a persistência de células tumorais residuais que säo indetectáveis pelos métodos de diagnóstico convencionais. Os métodos baseados na reaçäo emcadeia da polimerase (PCR) qualitativos cada vez mais têm sido utilizados para a detecçäo da doença residual mínima (DRM) e propiciam informaçöes úteis em relaçäo ao prognóstico dos pacientes. Neste relato as condutas atuais em relaçäo a DRM e o emprego dos métodos de PCR qualitativos e quantitativos säo apresentadas e discutida a importância da monitorizaçäo da DRM para os transplantes autólogos e alogênicos de medula óssea. A experiência acumulada nas últimas décadas demonstra que as análises de PCR têm um impacto no prognóstico da maioria das SLBM, especialmente nos pacientes submetidos a programas com altas doses de quimioterapia. As principais vantagens da monitorizaçäo molecular säo: rapidez na avaliaçäo da atividade anti-tumoral dos novos tratamentos e identificaçäo precoce dos pacientes que apresentem alto risco de recaída de moléstia.