Assuntos
Diabetes Mellitus Tipo 1/metabolismo , Transplante de Células-Tronco Hematopoéticas/métodos , Testículo/metabolismo , Adolescente , Adulto , Área Sob a Curva , Criança , Ciclofosfamida/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Masculino , Estudos Retrospectivos , Fatores de Tempo , Transplante AutólogoRESUMO
Studies have shown that autologous hematopoietic SCT (HSCT) can be used as an intensive immunosuppressive therapy to treat refractory patients and to prevent the progression of multiple sclerosis (MS). This is a prospective multicentric Brazilian MS trial comparing two conditioning regimens: BEAM/horse ATG and CY/rabbit ATG. Most (80.4%) of the 41 subjects in the study had the secondary progressive MS subtype and the mean age was 42 years. The baseline EDSS score in 58.5% of the subjects was 6.5 and 78% had a score of 6.0 or higher, respectively. The complication rate during the intra-transplantation period was 56% for all patients: 71.4% of the patients in the BEAM/hATG group and 40% in the CY/rATG group (P=0.04). Three subjects (7.5%) died of cardiac toxicity, sepsis and alveolar hemorrhage, all of them in the BEAM/ATG group. EFS was 58.54% for all patients: 47% in the BEAM/hATG group and 70% in the CY/rATG group (P=0.288). In conclusion, the CY/rATG regimen seems to be associated with similar outcome results, but presented less toxicity when compared with the BEAM/hATG regimen. Long-term follow-up would be required to fully assess the differences in therapeutic effectiveness between the two regimens.
Assuntos
Transplante de Células-Tronco Hematopoéticas/métodos , Esclerose Múltipla/terapia , Condicionamento Pré-Transplante/métodos , Adulto , Animais , Soro Antilinfocitário/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carmustina/administração & dosagem , Citarabina/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Rejeição de Enxerto/prevenção & controle , Mobilização de Células-Tronco Hematopoéticas , Cavalos , Humanos , Masculino , Melfalan/administração & dosagem , Pessoa de Meia-Idade , Qualidade de Vida , CoelhosRESUMO
We report here the first six cases of leprosy associated with HLA-identical allogeneic SCT in different phases and with different findings and outcomes. Skin and peripheral nerves may be sites of leprosy associated with SCT, stressing the importance of differential diagnosis between leprosy and GVHD or drug reactions. Clinical manifestations of leprosy before or after transplantation did not influence the outcome of SCT in our cases.
Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hanseníase/etiologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Hanseníase/diagnóstico , Hanseníase/patologia , Masculino , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/etiologia , Dermatopatias/diagnóstico , Dermatopatias/etiologia , Transplante Homólogo , Resultado do TratamentoAssuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Leucemia Mieloide Aguda/etiologia , Transplante de Células-Tronco/efeitos adversos , Medula Óssea/metabolismo , Antígenos HLA/química , Humanos , Imunofenotipagem , Cariotipagem , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , Leucemia Mieloide Aguda/genética , Masculino , Pessoa de Meia-Idade , Repetições Minissatélites , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Transplante de Células-Tronco/métodos , Doadores de TecidosRESUMO
We have investigated the relationship between fetal hemoglobin (HbF) levels and metabolic control in subjects with insulin-dependent (N = 79) and non-insulin-dependent diabetes mellitus (N = 242). HbF and hemoglobin A1c (HbA1c) levels were increased in subjects with type 1 and type 2 diabetes as compared to levels in nondiabetic individuals (P<0.0001), and were significantly higher in type 1 than in type 2 diabetes subjects. Lower levels of HbA1c and HbF were observed in type 2 diabetes subjects treated by diet, intermediate levels in those treated with oral hypoglycemic agents, and higher levels in those treated with insulin. HbF and HbA1c levels were correlated in type 1 diabetes (R2 = 0.57, P<0.0001) and type 2 diabetes (R2 = 0.58, P<0.0001) subjects. Following intense treatment, twelve diabetic patients showed significant improvement both in HbA1c and HbF values. We conclude that increased HbF levels reflect poor metabolic control in subjects with diabetes mellitus.