RESUMO
Identification of pretransplantation risk factors is important in evaluating patient outcomes after hematopoietic stem cell transplantation. Current scoring schemes, such as the European Group for Blood and Marrow Transplantation risk score or the Hematopoietic Cell Transplantation-Specific Comorbidity Index, may under-rate disease and disease status at the time of transplantation. The recently published Disease Risk Index (DRI) specifically investigates these aspects by defining 4 risk groups (low, intermediate, high, very high) with significant differences in overall survival (OS). We retrospectively investigated whether the DRI could be applied at the transplantation center of Geneva's University Hospitals (Geneva, Switzerland), where 64% of patients are underwent transplantation with T cell-depleted grafts (TDEP). We analyzed 409 patients with various hematological malignancies who underwent transplantation between January 1998 and October 2012. Using the DRI, the 4-year OS for the low, intermediate, high, and very high groups was 82%, 53%, 27%, and 31%, respectively (P < .0001). For TDEP patients, the 4-year OS for low, intermediate, and high overall risk groups was 86%, 53%, and 33%, respectively (P < .0001). As patients in the very high overall risk group are usually not eligible for TDEP, our group comprised too few patients (n = 3) for meaningful analysis. For non-TDEP patients, the 4-year OS for low, intermediate, high, and very high overall risk groups was 63%, 54%, 22%, and 18%, respectively (P < .0001). Our results confirm the prognostic value of the DRI in a cohort with a majority of TDEP patients.
Assuntos
Transplante de Células-Tronco Hematopoéticas/métodos , Condicionamento Pré-Transplante/métodos , Transplante Homólogo/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Depleção Linfocítica , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento , Estudos de Validação como Assunto , Adulto JovemAssuntos
Facilitação Imunológica de Enxerto , Transplante de Células-Tronco Hematopoéticas , Leucemia Mieloide Aguda , Depleção Linfocítica , Mutação , Tirosina Quinase 3 Semelhante a fms/genética , Adulto , Idoso , Aloenxertos , Intervalo Livre de Doença , Feminino , Humanos , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/mortalidade , Leucemia Mieloide Aguda/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Paraproteinaemia is frequent in the population above 50 years of age. It is commonly associated in patients with multiple myeloma with diverse renal involvements, such as cast nephropathy, light chain deposition disease, amyloidosis and Fanconi syndrome. A rapid diagnosis is necessary to implement a specific and aggressive treatment in order to prevent development of end-stage renal disease. Plasma exchanges or daily dialysis with high-cut off filter associated with chemotherapy may decrease the plasmatic concentration and production of monoclonal light chains. Bortezomib, thalidomide and lenalidomide are promising therapeutic agents, whose effects in patients with myeloma-associated renal diseases should be more thoroughly studied. Autologous hematopoietic cell transplantation remains the standard of care treatment for eligible patients.