Assuntos
Sobrevivência de Enxerto , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Proteínas Tirosina Quinases/antagonistas & inibidores , Condicionamento Pré-Transplante , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Transplante de Células-Tronco Hematopoéticas , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Myeloproliferative neoplasms are a category of diseases that have been traditionally amenable to allogeneic hematopoietic progenitor cell transplantation. Current developments in drug therapy have delayed transplantation for more advanced phases of the disease, especially for patients with CML, whereas transplantation remains a mainstream treatment modality for patients with advanced myelofibrosis and chronic myelomonocytic leukemia. Reduced-intensity conditioning has decreased the treatment-related mortality, and advances in the use of alternative donors for transplantation could extend the use of this procedure to an increasing number of patients with improved safety and efficacy. Here we review the current knowledge about allogeneic transplantation for myeloproliferative neoplasms and discuss the most important aspects to be considered when contemplating transplantation for patients with these diseases. Janus kinase 2 inhibitors offer the promise to improve spleen size and performance of patients with myelofibrosis and extend transplantation for patients with more advanced disease.
Assuntos
Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas , Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia , Mielofibrose Primária/terapia , Inibidores de Proteínas Quinases/uso terapêutico , Condicionamento Pré-Transplante/métodos , Aloenxertos , Neoplasias Hematológicas/enzimologia , Humanos , Janus Quinase 2/antagonistas & inibidores , Leucemia Mielogênica Crônica BCR-ABL Positiva/enzimologia , Proteínas de Neoplasias/antagonistas & inibidores , Proteínas de Neoplasias/metabolismo , Mielofibrose Primária/enzimologiaRESUMO
The Gastrointestinal Stromal Tumor (GIST) is the most common sarcoma of the gastrointestinal tract. Major prognostic indices in the evaluation and management of GIST include the size, location and tumor mitotic rate. The discovery of the mutation in the tyrosine kinase receptor c-KIT (CD117) revolutionized the treatment of GIST in the early twenty-first century. Since the first case report of the success of the tyrosine kinase inhibitor (TKI) imatinib, in the treatment of a female patient with metastatic GIST, the paradigm of treatment of this tumor has evolved tremendously. The initial use in metastatic GISTs has progressed to use of the TKI in both the adjuvant and neoadjuvant settings. It is now standard of care for patients with complete resection of primary localized GIST, with high risk of recurrence, to have at least one year of adjuvant imatinib. Recent SSGVXIII study shows that patients benefit from extended duration of therapy.
