RESUMO
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
Autologous or allogeneic SCT with conventional conditioning (chemotherapy with or without irradiation) has emerged as an effective and potentially curative therapy in patients with hematologic malignancies and in other selected solid tumors; however, several patients experience significant early and delayed side effects, including long-term endocrine imbalance and infertility. In spite of several reproductive recovery and pregnancy reports published in the oncology literature, review of medical literature reveals a paucity of comparable information in the SCT field. We report here four cases of ovarian recovery in patients who received hormonal replacement therapy after diagnosis of primary ovarian failure due to high-dose chemotherapy and SCT.
Assuntos
Terapia de Reposição de Estrogênios , Transplante de Células-Tronco Hematopoéticas , Insuficiência Ovariana Primária/tratamento farmacológico , Condicionamento Pré-Transplante/efeitos adversos , Adulto , Feminino , Humanos , Recém-Nascido , Menstruação/efeitos dos fármacos , Ovário/fisiologia , Gravidez , Insuficiência Ovariana Primária/induzido quimicamente , Resultado do TratamentoRESUMO
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 TratamentoRESUMO
We report two cases of refractory chronic graft-versus-host disease after donor lymphocyte infusions in which the skin lesions improved dramatically with the use of intravenous pulses of lidocaine. This form of therapy has been used successfully for the cutaneous involvement of scleroderma and may have vasodilator and anti-inflammatory effects.
Assuntos
Doença Enxerto-Hospedeiro/patologia , Lidocaína/administração & dosagem , Transfusão de Linfócitos/efeitos adversos , Dermatopatias/tratamento farmacológico , Adulto , Transplante de Medula Óssea , Criança , Doença Crônica , Feminino , Doença Enxerto-Hospedeiro/tratamento farmacológico , Doença Enxerto-Hospedeiro/etiologia , Humanos , Injeções Intravenosas , Leucemia/complicações , Leucemia/terapia , Masculino , Recidiva , Esclerodermia Localizada/tratamento farmacológico , Esclerodermia Localizada/etiologia , Esclerodermia Localizada/patologia , Dermatopatias/etiologia , Dermatopatias/patologia , Transplante HomólogoRESUMO
Natural killer (NK) and lymphokine activated killer (LAK) functions were measured in 40 patients with chronic Chagas disease divided into asymptomatic/indeterminate (18) and symptomatic forms (22) and in 24 healthy controls. A chromium release assay was used employing K562 or P815 cell lines as targets. There was no difference in either NK or LAK activity between the three groups. A small number of patients in each group showed results above or below the normal range for controls. However, there was no correlation between NK and LAK values in the same individual. In conclusion, NK immunosuppression associated with human chronic Chagas disease.