Common mental disorders in hematopoietic stem cell transplant patients: a scoping review / Trastornos mentales comunes en pacientes con trasplante de células madre hematopoyéticas: revisión del alcance / Transtornos mentais comuns em pacientes transplantados com células-tronco hematopoéticas: revisão de escopo

ABSTRACT Objective: to map common recurrent mental disorders in patients undergoing hematopoietic stem cell transplantation. Methods: this is a scoping review carried out in January 2022 in electronic databases and repositories of dissertations and thesis. Studies that answered the research question, met the objective of the study and were available in full electronically, in any language, were included. Results: the sample consisted of 28 studies, 14 of which were published in the United States of America. The common mental disorders found were depressive, anxiety, post-traumatic stress and mood disorders. Twenty symptoms were mentioned, among the most prevalent are fatigue and sleep disorders/insomnia. Conclusions: the difficulty and importance of carrying out the differential diagnosis of these disorders were highlighted, since their symptoms can be confused with other health problems and have a strong potential to interfere with patients' evolution.

RESUMEN Objetivo: mapear los trastornos mentales recurrentes comunes en pacientes sometidos a trasplante de células madre hematopoyéticas. Métodos: se trata de una revisión de alcance realizada en enero de 2022 en bases de datos electrónicas y repositorios de disertaciones y tesis. Se incluyeron publicaciones que respondieron a la pregunta de investigación, cumplieron con el objetivo del estudio y estaban disponibles en su totalidad en formato electrónico, en cualquier idioma. Resultados: la muestra estuvo compuesta por 28 estudios, 14 de los cuales fueron publicados en los Estados Unidos de América. Los trastornos mentales comunes encontrados fueron depresión, ansiedad, estrés postraumático y trastornos del estado de ánimo. Se mencionaron 20 síntomas, entre los más prevalentes se encuentran fatiga y trastornos del sueño/insomnio. Conclusiones: se destacó la dificultad e importancia de realizar el diagnóstico diferencial de estos trastornos, ya que sus síntomas pueden confundirse con otros problemas de salud y tienen un fuerte potencial de interferir en la evolución del paciente.

RESUMO Objetivo: mapear os transtornos mentais comuns recorrentes em pacientes submetidos ao transplante de células-tronco hematopoéticas. Métodos: trata-se de revisão de escopo realizada em janeiro de 2022 em bases de dados eletrônicas e repositórios de dissertações e tese. Foram incluídas publicações que respondessem à questão de pesquisa, atendessem ao objetivo do estudo e que estivessem disponíveis na íntegra em meio eletrônico, em qualquer idioma. Resultados: a amostra foi composta por 28 estudos, dos quais 14 foram publicados nos Estados Unidos da América. Os transtornos mentais comuns encontrados foram os transtornos depressivos, de ansiedade, estresse pós-traumático e de humor. Foram citados 20 sintomas, entre os mais prevalentes estão a fadiga e distúrbios do sono/insônia. Conclusões: evidenciaram-se a dificuldade e a importância de realizar o diagnóstico diferencial desses transtornos, uma vez que seus sintomas podem ser confundidos com outros problemas de saúde e têm forte potencial para interferir na evolução do paciente.

Calidad de vida y toxicidad financiera de los receptores de trasplantes de células madre hematopoyéticas en COVID-19 / Quality of life and financial toxicity of hematopoietic stem cell transplant recipients in COVID-19 / Qualidade de vida e toxicidade financeira dos transplantados de células-tronco hematopoéticas na COVID-19

Objetivo: evaluar y correlacionar la calidad de vida y la toxicidad financiera de pacientes adultos sometidos a trasplante de células madre hematopoyéticas durante el período de la pandemia de COVID-19. Método: estudio observacional, analítico, realizado con 35 pacientes en un hospital de referencia para trasplante en Latinoamérica. Para la recolección de datos, se utilizaron los cuestionarios Functional Assessment Cancer Therapy Bone Marrow Transplantation y el COmprehensive Score for financial Toxicity. Para el análisis de los datos se utilizaron las pruebas de correlación de Spearman y Mann-Whitney. Resultados: la calidad de vida general durante la COVID-19 mostró un puntaje bajo (67,09/108) con mayor deterioro en el bienestar funcional (14,47/28), bienestar social (16,76/28) y preocupaciones adicionales (23,41/40). Los promedios del grupo alogénico fueron inferiores a los del grupo autólogo en todos los dominios, presentando diferencia significativa en relación a preocupaciones adicionales (p=0,01) y en el índice de evaluación del tratamiento (p=0,04). Se consideró que la toxicidad financiera tenía un impacto leve (22.11/44). Se observó una relación, aunque no significativa, entre la calidad de vida y la toxicidad financiera (p=0,051). Conclusión: la calidad de vida de la muestra fue baja; existe una correlación entre la calidad de vida y la toxicidad financiera, aunque no significativa. Cuanto mayor es la toxicidad financiera, menor es la calidad de vida.

Objective: to evaluate and correlate the quality of life and financial toxicity of adult patients undergoing hematopoietic stem cell transplantation during the COVID-19 pandemic. Method: observational, analytical study, carried out with 35 patients in a reference hospital for transplantation in Latin America. For data collection, the Functional Assessment Cancer Therapy Bone Marrow Transplantation and COmprehensive Score for Financial Toxicity questionnaires were used. Spearman and Mann-Whitney correlation tests were used for data analysis. Results: general quality of life during COVID-19 had a low score (67.09/108) with greater impairment in functional well-being (14.47/28), social well-being (16.76/28) and additional concerns (23.41/40). The means of the allogeneic group were lower than those of the autologous group in all domains, showing a significant difference in relation to additional concerns (p=0.01) and in the treatment evaluation index (p=0.04). Financial toxicity was considered to have a slight impact (22.11/44). There was a relationship, albeit not significant, between quality of life and financial toxicity (p=0.051). Conclusion: the quality of life of the sample was low; there is a correlation between quality of life and financial toxicity, although not significant. The higher the financial toxicity, the lower the quality of life.

Objetivo: avaliar e correlacionar a qualidade de vida e a toxicidade financeira dos pacientes adultos submetidos ao transplante de células-tronco hematopoéticas no período da pandemia de COVID-19. Método: estudo observacional, analítico, realizado com 35 pacientes em um hospital de referência para o transplante na América Latina. Para coleta de dados, utilizaram-se os questionários Functional Assessment Cancer Therapy Bone Marrow Transplantation e COmprehensive Score for financial Toxicity. Na análise dos dados empregaram-se os testes de correlação de Spearman e Mann-Whitney. Resultados: a qualidade de vida geral, durante a COVID-19, apresentou baixo escore (67,09/108), com maior comprometimento nas funções bem-estar funcional (14,47/28), social (16,76/28) e preocupações adicionais (23,41/40). As médias do grupo alogênico foram inferiores às do autólogo em todos os domínios, apresentando diferença significativa em relação às preocupações adicionais (p=0,01) e ao índice de avaliação do tratamento (p=0,04). A toxicidade financeira foi considerada de impacto leve (22,11/44). Observou-se relação, ainda que não significativa, entre a qualidade de vida e a toxicidade financeira (p=0,051). Conclusão: a qualidade de vida da amostra foi baixa, logo há uma correlação entre qualidade de vida e a toxicidade financeira, embora não significativa. Quanto maior a toxicidade financeira, menor a qualidade de vida.

Impacto de la calidad de vida relacionada a la salud en pacientes pediátricos con trasplante de progenitores hematopoyéticos en una institución colombiana / Impact of health-related quality of life on pediatric patients who underwent hematopoietic stem cell transplantation in a Colombian institution

Introducción. El trasplante de células madre hematopoyéticas es la opción curativa para algunas enfermedades y está aumentando el tiempo de supervivencia de los pacientes. La calidad de vida relacionada con la salud en estos pacientes no se evalúa de manera sistemática. Objetivos. Describir la calidad de vida relacionada con la salud y las complicaciones en niños con trasplante de células madre hematopoyéticas. Materiales y métodos. Es un estudio transversal en pacientes pediátricos sobrevivientes al trasplante. Se midió la calidad de vida relacionada con la salud, utilizando el cuestionario KIDSCREEN-27 en pacientes entre 8 y 14 años y la SF-12™ (Short Form-12) en pacientes mayores de 14 años. El análisis estadístico se realizó en el software Stata 12. Utilizamos el modelo de Rasch, trasladando estimación de parámetros a valores t para obtener el resultado de los cuestionarios. Resultados. En total, 42 pacientes respondieron alguno de los cuestionarios. Los eventos adversos más frecuentes fueron "enfermedad crónica de injerto Vs. contra huésped" y "complicaciones endocrinas". De acuerdo con la normalidad de datos del KIDSCREEN-27, los puntajes de las dimensiones "ambiente escolar" y "soporte social y pares" fueron inferiores al percentil 50. En el cuestionario SF-12™, el grupo que utilizaba inmunosupresores tuvo un menor puntaje en el componente físico. Conclusiones. En general, los resultados del KIDSCREEN-27 sugieren un cierto déficit de calidad de vida en pacientes entre 8 y 14 años. Los cuestionarios mostraron confiabilidad en la muestra.

Introduction: Hematopoietic stem cell transplantation is the curative option for some diseases and is increasing patient survival. The health-related quality of life in these patients is not systematically evaluated. Objectives: The present study sought to describe the health-related quality of life and complications in children who underwent hematopoietic stem cell transplantation. Materials and methods: A cross-sectional study was conducted on pediatric transplanted survivors. Health-related quality of life was measured using the KIDSCREEN-27 scale and Short Form-12 (SF-12) in patients between 8 and 14 years of age and those over 14 years, respectively. Statistical analysis was performed using STATA 12 software. We used the Rasch model person parameter estimates translated into T-values to score the questionnaire. Results: A total of 42 children answered the questionnaires. The most frequent adverse events were chronic graft Vs. host disease and endocrine complications. According to European norm data in the KIDSCREEN-12 scale, scores for the school dimension and social and peer support were below the 50th. percentile. The group administered immunosuppressants had lower scores on the physical component of the SF-12™ scale. Conclusions: In general, the KIDSCREEN-27 does appear to suggest some quality-of-life deficit in younger children. The scales showed reliability in this population.

Educación del paciente adulto en trasplante de células progenitoras hematopoyéticas / Education of the adult patientin hematopoietic progenitor cell transplantation

El Trasplante de Médula ósea es actualmente, una alternativa en patologías oncológicas, que busca curación y sobrevida del paciente, los cuidados de enfermería en todas las etapas del tratamiento están encaminados a proporcionar atención oportuna y eficaz, con la finalidad de prevenir, tratar y superar complicaciones propias del proceso. La educación de los pacientes y cuidadores favorece a que el paciente aprenda a autocuidarse, a disminuir su ansiedad, a realizar cambios en su comportamiento y estilo de vida y a prevenir la no adherencia al tratamiento. El objetivo fue diseñar un programa educativo sobre los cuidados que el paciente y su familia debe conocer al ingreso y estadía en el servicio de trasplante de Médula Osea. Diseño Metodológico: la búsqueda se efectuó en bases de datos: Pubmed y Google Académico y Scielo. Se analizaron 13 artículos para el desarrollo del trabajo. Resultados: Educar a los pacientes y sus familias sobre el proceso del trasplante de Medula Osea es un gran desafío que necesita de actualización permanente del personal de enfermería. Brindar conocimientos sobre medidas preventivas y pautas que ayuden a sobrellevar este proceso, permitirá tener al paciente como un miembro activo en sus cuidados, disminuyendo su ansiedad y si es necesario realizando modificaciones en su estilo de vida[AU]

Bone Marrow Transplantation is currently an alternative in oncological pathologies, which seeks healing and patient survival, here nursing care at all stages of treatment is aimed at providing timely and effective care, in order to prevent, treat and overcome complications of the process. The education of patients and caregivers favors the patient learning to care for himself, to reduce his anxiety, to make changes in his behavior and lifestyle and to prevent non-adherence to treatment. The objective was to design an educational program on the care that the patient and his family should know during their admission and stay in the Bone Marrow Transplant Service. Methodological design: the search was carried out in the database: Pubmed and Google Scholar and Scielo. 13 articles were analyzed for the development of the work. Results: Educating patients and their families about the bone marrow transplant process is a great challenge that requires permanent updating of the nursing staff. Providing knowledge about preventive measures and guidelines to help cope with this process will allow us to have the patient as an active member in their care, reducing their anxiety and, if necessary, making changes to their lifestyle[AU]

O Transplante de Medula Óssea é atualmente uma alternativa nas patologias oncológicas, que busca a cura e a sobrevivência do paciente, aqui a assistência de enfermagem em todas as etapas do tratamento visa proporcionar uma assistência oportuna e eficaz, | 24a fim de prevenir, tratar e superar complicações do processo. A educação de pacientes e cuidadores favorece que o paciente aprenda a cuidar de si mesmo, a diminuir sua ansiedade, a realizar mudanças em seu comportamento e estilo de vida e a prevenir a não adesão ao tratamento. O objetivo foi elaborar um programa educativo sobre os cuidados que o paciente e sua família devem conhecer durante sua admissão e permanência no serviço de transplante de medula óssea. Desenho metodológico: a busca foi realizada nas bases de dados: Pubmed e Google Acadêmico e Scielo. 13 artigos foram analisados para o desenvolvimento do trabalho. Resultados: Educar os pacientes e seus familiares sobre o processo de transplante de medula óssea é um grande desafio que exige atualização permanente da equipe de enfermagem. Fornecer conhecimento sobre medidas preventivas e orientações para auxiliar no enfrentamento desse processo nos permitirá ter o paciente como um membro ativo em seu cuidado, reduzindo sua ansiedade e, se necessário, realizando mudanças em seu estilo de vida[AU]

Incidence and risk factors of adverse events in pediatric hemato-oncological patients: A cohort study.

BACKGROUND: Pediatric hemato-oncological (HO) patients are highly susceptible to the occurrence of adverse events (AE), nevertheless few research has been done in this field. Our aim was to describe the incidence, type, severity and preventability of AE in these patients, including bone marrow transplant (BMT) patients, and to identify patient's risk factors for having an AE. METHODS: Retrospective cohort study. Children under 18yo hospitalized at the HO or BMT ward in 2016 were eligible for the study. Type of AE, severity and preventability were described as absolute and relative frequencies. Cumulative incidence of patients with at least one AE (CI_AE) and the rate of occurrence of all AE were calculated. Risk factors (sex, recovery probability, comorbidities and being a BMT patient) were analyzed using logistic regression. RESULTS: 114 patients were included, 58% were male, average age was 8.7yo and 25 were BMT patients. 44 had at least one AE, with CI_AE of 38.6% (95%CI 29.7-47.5). Overall rate of occurrence of AE was 2.5 cases per 100 patients-day (95%CI 2.15-2.98). For BMT and non-BMT patients they were 2.8 (95%CI 2.2-3.6) and 2.5 (95%CI 1.98-3.1) respectively. Healthcare related infection was the most frequent AE. Most AE were moderate and with high preventability. Being a BMT patient was the only independent factor associated with the occurrence of at least one AE (OR=11.5, p<0.001). CONCLUSIONS: Our findings suggest that AE tend to be moderate and preventable in HO pediatric patients. BMT patients seem to be at greater risk of having an AE. Strategies focused on patient safety need to account for their specific characteristics.

Neurotoxicidades apresentadas por pacientes submetidos ao transplante de células-tronco hematopoéticas: uma revisão de escopo / Neurotoxicidades en pacientes sometidos al trasplante de células madre hematopoyéticas: una revisión de alcance / Neurotoxicity presented by patients undergoing hematopoietic stem cell transplantation: a scoping review

Resumo Objetivo Mapear os tipos de neurotoxicidades apresentadas por pacientes submetidos ao Transplante de Células-Tronco Hematopoéticas. Métodos Trata-se de uma Scoping Review, orientada a partir do método proposto pelo Joanna Briggs Institute, e seguiu as recomendações do Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. A busca pelos estudos foi realizada entre os meses de julho e agosto de 2020 e ocorreu nas bases de dados e em portais de teses e dissertações nacionais e internacionais. Resultados A amostra final foi composta por 71 artigos científicos, todos na língua Inglesa. Houve destaque para o ano de 2018 com 14 (19%) publicações. Observou-se prevalência de estudos realizados nos Estados Unidos da América com 29 (40,8%). No tocante a população, todos (100%) os artigos são sobre pacientes submetidos ao transplante de células-tronco hematopoéticas que apresentaram neurotoxicidades. Acerca dos quimioterápicos utilizados no regime de condicionamento pré-transplante de células-tronco hematopoéticas sete (9,8%) utilizaram a combinação de Fludarabina e Ciclofosfamida, seguida da Ciclosporina e Tacrolimus em seis (8,4%), ciclosporina em quatro (5,6%), Fludarabina em três (4,2%). Quanto às neurotoxicidades apresentadas em pacientes submetidos ao transplante, evidenciou-se a síndrome de encefalopatia reversível posterior em 19 (26,7%) estudos. Cabe ressaltar que outros estudos identificaram essa síndrome, porém relataram sintomas diferentes. Conclusão As neurotoxicidades apresentadas por pacientes submetidos ao transplante de células-tronco hematopoéticas, são encefalopatia reversível posterior, leucoencefalopatia reversível posterior, encefalopatia de Wernicke, encefalopatia hipertensiva, encefalopatia metabólica, encefalopatia límbica, complicações hemorrágicas e convulsões.

Resumen Objetivo Mapear los tipos de neurotoxicidades en pacientes sometidos al trasplante de células madre hematopoyéticas. Métodos Se trata de una Scoping Review, orientada a partir del método propuesto por el Joanna Briggs Institute, que siguió las recomendaciones del Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. La búsqueda de los estudios se realizó entre los meses de julio y agosto de 2020 y ocurrió en las bases de datos y en portales de tesis de doctorado y maestría nacionales e internacionales. Resultados La muestra final estuvo compuesta por 71 artículos científicos, todos en lengua inglesa. Se destacó el año 2018 con 14 publicaciones (19 %). Se observó una prevalencia de estudios realizados en Estados Unidos de América con 29 (40,8 %). En lo que se refiere a la población, todos los artículos (100 %) tratan sobre pacientes sometidos al trasplante de células madre hematopoyéticas que presentaron neurotoxicidades. Sobre los quimioterápicos utilizados en el régimen de acondicionamiento previo al trasplante de células madre hematopoyéticas, siete (9,8 %) utilizaron la combinación de Fludarabina y Ciclofosfamida, seguida de la Ciclosporina y Tacrolimus en seis (8,4 %), ciclosporina en cuatro (5,6 %), Fludarabina en tres (4,2 %). Con relación a las neurotoxicidades en pacientes sometidos al trasplante, se evidenció el síndrome de encefalopatía reversible posterior en 19 estudios (26,7 %). Cabe destacar que otros estudios identificaron ese síndrome, pero refirieron síntomas distintos. Conclusión Las neurotoxicidades presentadas por pacientes sometidos al trasplante de células madre hematopoyéticas son encefalopatía reversible posterior, leuco encefalopatía reversible posterior, encefalopatía de Wernicke, encefalopatía hipertensiva, encefalopatía metabólica, encefalopatía límbica, complicaciones hemorrágicas y convulsiones.

Abstract Objective To map the types of neurotoxicity presented by patients undergoing Hematopoietic Stem Cell Transplantation. Methods This is a scoping review, guided by the method proposed by the Joanna Briggs Institute, and followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews recommendations. The search for studies was carried out between the months of July and August 2020 and took place in databases and in national and international theses and dissertations portals. Results The final sample consisted of 71 scientific articles, all in English. There was a highlight for the year 2018 with 14 (19%) publications. There was a prevalence of studies carried out in the United States of America with 29 (40.8%). Regarding the population, all (100%) articles are about patients undergoing hematopoietic stem cell transplantation who presented neurotoxicity. Regarding the chemotherapeutic agents used in the pre-transplantation regimen of hematopoietic stem cells, seven (9.8%) used the combination of Fludarabine and Cyclophosphamide, followed by Cyclosporine and Tacrolimus in six (8.4%), Cyclosporine in four (5.6%), Fludarabine in three (4.2%). As for the neurotoxicity presented in patients undergoing transplantation, the posterior reversible encephalopathy syndrome was evidenced in 19 (26.7%) studies. It should be noted that other studies have identified this syndrome, but have reported different symptoms. Conclusion The neurotoxicity presented by patients undergoing hematopoietic stem cell transplantation are posterior reversible encephalopathy, posterior reversible leukoencephalopathy, Wernicke's encephalopathy, hypertensive encephalopathy, metabolic encephalopathy, limbic encephalopathy, hemorrhagic complications and seizures.

As dimensões intangíveis da prática assistencial: biopolítica, ética e afeto em sua relação com a clínica / Intangible dimensions of care: biopolitics, ethics and affection in relation to clinical practice / Las dimensiones intangibles de la práctica asistencial: biopolítica, ética y afecto en su relación con la clínica

Este artigo é parte inicial de uma pesquisa realizada em um centro de transplante de medula óssea, do Sistema Único de Saúde (SUS), cujos usuários são pessoas em situação de extrema vulnerabilidade. Sua proposta é analisar dimensões que atravessam a prática em saúde e não se reduzem a resultados imediatamente mensuráveis, podendo ser chamadas de dimensões intangíveis do cuidar. O objetivo é refletir sobre o encontro profissional-paciente, em sua relação com o adoecimento e a morte, sob o conceito psicanalítico de inconsciente. Para isso, foi realizado o relato de situações vividas no campo denominadas vinhetas clínicas; e, com base nas articulações teóricas elaboradas, consideram-se os vetores da biopolítica, ética e afeto como axiais à assistência. Conclui com a necessidade de propor perspectivas do cuidar que reconheçam a subjetividade concernida à prática assistencial. (AU)

This article is based on the initial stages of a study undertaken in a public bone marrow transplant center for extremely vulnerable people. We analyze dimensions that cut across health care practice not reduced to immediately measureable results, otherwise called intangible dimensions of care. We reflect on the intersection between health professionals and patients in relation to illness and death drawing on the psychoanalytic concept of the unconscious. To this end, we document situations experienced in the field called clinical vignettes. Drawing on the theoretical framework, we consider the vectors biopolitics, ethics and affection to be core aspects of care. We conclude that there is a need for approaches to care that recognize the subjectivity of health care practice. (AU)

Este artículo es parte inicial de una investigación realizada en un centro de trasplante de médula ósea del Sistema Único de Salud, cuyos usuarios son personas en situaciones de extremada vulnerabilidad. Su propuesta es analizar dimensiones que atraviesan la práctica en salud y no se reducen a resultados inmediatamente mensurables, pudiendo llamarse de dimensiones intangibles del cuidar. El objetivo es reflexionar sobre el encuentro profesional-paciente en su relación con la enfermedad y la muerte, bajo el concepto psicoanalítico de inconsciente. Para ello, se realizó el relato de situaciones vividas en el campo, denominadas viñetas clínicas; y a partir de las articulaciones teóricas elaboradas se consideran los vectores de la biopolítica, ética y afecto como axiales a la asistencia. Se concluye con la necesidad de proponer perspectivas del cuidar que reconozcan la subjetividad relativa a la práctica asistencial. (AU)

Análise dos fatores associados ao retransplante de células-tronco hematopoiéticas: estudo caso-controle / Analysis of factors associated with hematopoietic stem-cell retransplantation: a case-control study / Análisis de factores asociados al Retrasplante de Células Madre Hematopoyéticas: un estudio de caso-control

Resumo Objetivo: analisar os fatores associados ao insucesso do Transplante de Células-Tronco Hematopoiéticas (TCTH) em pacientes submetidos ao retransplante de Células-Tronco Hematopoiéticas (RCTH). Método: estudo quantitativo do tipo caso-controle para avaliar pacientes submetidos ao RCTH. Para tanto, utilizou-se amostra pareada de dois controles para cada caso (2:1). O grupo caso foi constituído pelos prontuários de saúde com todos os pacientes que foram submetidos ao RCTH (28) e o grupo controle (56) incluiu pacientes que receberam apenas um transplante. Três variáveis nortearam o pareamento: sexo, diagnóstico e tipo de transplante. Resultados: vinte e quatro (85,71%) pacientes do grupo caso receberam retransplante devido a recidiva da doença e quatro (14.29%) devido a falha do enxerto. Uma diferença estatística foi encontrada na análise entre os pacientes que não usaram o ácido ursodesoxicólico, analgésicos opioides ou imunossupressores. A necessidade de um RCTH entre aqueles que usaram estes medicamentos de forma inapropriada foi 16,12, 12,79 e 4,5 vezes maior, respectivamente, do que entre os que as usaram corretamente. Conclusão: houve uma diferença relacionada ao motivo que levou ao retransplante e os indivíduos analisados. A conclusão é que a razão preditiva para retransplante nesta amostra foi a recidiva da doença.

Abstract Objective: to analyze the factors associated with the failure of Hematopoietic Stem Cell Transplantation (HSCT) in patients undergoing Hematopoietic Stem Cell Retransplantation (HSCR). Method: this study implemented a quantitative approach and was a case-control type which addressed patients undergoing HSCR. To do so, a paired sample of two controls was used for each case (2:1). The case group consisted of the medical records of all patients who underwent HSCR (28) and the control group (56) of those who underwent only one transplant. Three variables guided the pairing: gender, diagnosis and type of transplant. Results: a total of 24 (85.71%) patients in the case group were re-transplanted due to disease relapse and four (14.29%) due to graft failure. There was a statistical difference in the analysis between patients who did not use ursodeoxycholic acid, opioid analgesics and immunosuppressants. The need for HSCR among those who used these medications inappropriately was 16.12, 12.79 and 4.5 times more likely, respectively, than those who used them correctly. Conclusion: there was a difference regarding the reasons which led to the retransplantation and the analyzed subjects, and this study concluded that the predictive reason for retransplantation in the studied sample was disease relapse.

Resumen Objetivo: analizar los factores asociados con el fracaso del Trasplante de Células Madre Hematopoyéticas (TCMH) en pacientes sometidos al Retrasplante de Células Madre Hematopoyéticas (RCMH). Método: estudio cuantitativo de tipo caso-control que abordó pacientes sometidos al RCMH. Para esto, se utilizó una muestra pareada de dos controles para cada caso (2:1). El grupo caso estuvo formado por los registros médicos de todos los pacientes que fueron sometidos al RCMH (28) y el grupo control (56) por los que fueron sometidos a un solo trasplante. Tres variables guiaron el emparejamiento: género, diagnóstico y tipo de trasplante. Resultados: un total de 24 (85.71%) pacientes en el grupo caso fueron retransplantados debido a la recaída de la enfermedad y 4 (14.29%) por el fracaso del injerto. Hubo una diferencia estadística en el análisis entre los pacientes que no usaron ácido ursodesoxicólico, analgésicos opioides e inmunosupresores. La necesidad de RCMH entre los que usaron estos medicamentos de manera inapropiada se encontraba 16,12 - 12,79 y 4,5 veces más probable, respectivamente, que aquellos que los usaron correctamente. Conclusión: hubo diferencia en cuanto a las razones que llevaron al retrasplante de los sujetos analizados. Este estudio concluyó que la razón predictiva del retrasplante, en la muestra estudiada, fue la recidiva de la enfermedad.

Effects of guided imagery relaxation in hematopoietic stem-cell transplantation patients: a quasi-experimental study / Efecto de la relajación con imagen guiada en trasplantados de células madre hematopoyéticas: estudio cuasi experimental / Efeito do relaxamento com imagem guiada em transplantados de células-tronco hematopoéticas: estudo quase experimental

ABSTRACT Objective: To analyze the effects of the technique of virtual reality guided imagery in the vital signs of hematopoietic stem-cell transplantation patients. Method: Quasi-experimental study with 35 participants who received an intervention using virtual reality guided imagery with progressive muscle relaxation, applied three times a week for four weeks in a referral hospital for transplants in the south of Brazil. Data collected included: temperature, arterial pressure, respiratory rate, heart rate, pain, and oxygen saturation, before and after each intervention. The comparisons were analyzed using Wilcoxon's test. Results: There was a clinical significance between the mean measurements before and after for respiratory rate (p=0.00) in all stages, and for the variables Heart rate, Temperature, and Oxygen saturation from the 1st to the 12th measurements (p=0.05). Conclusion: The intervention was low cost, easy to apply, and showed positive effects, presenting itself as an option for patient-focused care.

RESUMEN Objetivo: Analizar efectos de técnica de imagen guiada por realidad virtual en los signos vitales de trasplantados de células madre hematopoyéticas. Método: Estudio cuasi experimental con 35 participantes que recibieron intervención de imagen guiada por realidad virtual con relajación muscular progresivo, aplicada tres veces por semana durante cuatro semanas, en hospital de referencia en trasplante del Sur de Brasil. Los datos recolectados fueron: temperatura, presión arterial, respiración, frecuencia cardíaca, dolor y saturación de oxígeno, antes y después de cada intervención. Las comparaciones analizadas por test de Wilcoxon. Resultados: Hubo significación clínica entre las medianas de los contrastes de antes y después para Frecuencia respiratoria (p=0,00) en todas etapas; y en las variables Frecuencia cardíaca, Temperatura y Saturación de oxígeno, entre la 1ª hasta 12ª evaluación (p=0,05). Conclusión: Los efectos de la intervención mostrados favorables, bajo costo y fácil realización, siendo una opción de acción de cuidado centrado en el paciente.

RESUMO Objetivo: Analisar os efeitos da técnica de imagem guiada por realidade virtual nos sinais vitais de transplantados de células-tronco hematopoéticas. Método: Estudo quase experimental com 35 participantes que receberam intervenção de imagem guiada por realidade virtual com relaxamento muscular progressivo, aplicada três vezes por semana durante quatro semanas, em um hospital de referência em transplante no Sul do Brasil. Os dados coletados foram: temperatura, pressão arterial, respiração, frequência cardíaca, dor e saturação de oxigênio, antes e depois de cada intervenção. As comparações foram analisadas pelo teste de Wilcoxon. Resultados: Houve significância clínica entre as médias das aferições de antes e depois para Frequência respiratória (p=0,00) em todas as etapas; e nas variáveis Frequência cardíaca, Temperatura e Saturação de oxigênio, entre a 1ª até 12ª avaliação (p=0,05). Conclusão: Os efeitos da intervenção se mostraram favoráveis, de baixo custo e fácil realização, sendo uma opção de ação de cuidado centrado no paciente.

Fotoféresis extracorpórea en enfermedad injerto contra huésped en una población pediátrica / Extracorporeal Photopheresis in Pediatric Graft-vs-Host Disease

Antecedentes La fotoféresis extracorpórea (FEC) es una terapia inmunomoduladora indicada para la enfermedad injerto contra huésped (EICH) en adultos y niños, no obstante, existen pocos estudios en esta última población. Objetivo Describir las características demográficas, la respuesta clínica, los efectos adversos y la evolución de los pacientes pediátricos con EICH aguda (EICH-a) y EICH crónica (EICH-c) tratados con FEC. Materiales y métodos Se incluyeron todos los pacientes con EICH-a y EICH-c sometidos a tratamiento con FEC entre enero de 2012 y diciembre de 2018 en el Servicio de Dermatología del Hospital Italiano de Buenos Aires. Se utilizó el sistema UVAR-XTS™ en 2 pacientes y el CELLEX™ en el resto, con 2 sesiones por semana y reevaluación al mes en EICH-a, 2 sesiones cada 2 semanas con reevaluación a los 3 meses en EICH-c, y en ambos finalización según respuesta. Resultados Evaluamos 9 pacientes pediátricos con EICH refractaria, dependiente y/o resistente a corticoides sistémicos tratados con FEC. Siete pacientes fueron respondedores y 2 no respondedores. La piel presentó respuesta completa (RC) en 1/9 y respuesta parcial en 7/9 pacientes, el hígado, el sistema gastrointestinal y las mucosas presentaron RC en 3/5, 1/2 y 4/5 pacientes, respectivamente. Dos pacientes fallecieron durante el periodo estudiado. Conclusión La FEC es una buena opción terapéutica para los pacientes pediátricos con EICH aguda y crónica (AU)

Background Extracorporeal photopheresis (ECP) is an immunomodulatory therapy used to treat graft-vs-host disease (GVHD) in adults and children. Few studies have examined its use in children. Objective To describe demographic characteristics, clinical response, adverse effects, and outcomes in a series of pediatric patients with acute or chronic GVHD treated with ECP. Material and methods We included all pediatric patients with acute or chronic GVHD treated with ECP by the Dermatology Department of Hospital Italiano de Buenos Aires between January 2012 and December 2018. We used the UVAR-XTS™ system (2 patients) and the CELLEX system (7 patients). Patients with acute GVHD received 2 sessions a week and were reassessed at 1 month, while those with chronic GVHD received 2 sessions every 2 weeks and were reassessed at 3 months. Treatment duration in both scenarios varied according to response. Results We evaluated 9 pediatric patients with corticosteroid-refractory, -dependent, and/or -resistant GVHD treated with ECP. Seven responded to treatment and 2 did not. Response was complete in 1 of the 9 patients with skin involvement and partial in 7. Complete response rates for the other sites of involvement were 60% (3/5) for the liver, 50% (1/2) for the gastrointestinal system, and 80% (4/5) for mucous membranes. Two patients died during the study period. Conclusion ECP is a good treatment option for pediatric patients with acute or chronic GVHD (AU)

Utilidad de la biopsia digestiva para el diagnóstico de la enfermedad injerto contra huésped / Usefulness of digestive biopsy in the diagnosis of graft-versus-host disease

Introducción: La enfermedad injerto contra huésped (EICH) esuna complicación frecuente de los trasplantes de células precursorashematopoyéticas alogénicos (alo-TCPH), con gran morbimortalidad.La clínica intestinal es inespecífica, planteando el diagnóstico diferencial con infecciones y etiología medicamentosa. Aunque las biopsiasintestinales son el gold standard, no existe consenso sobre la mejortécnica para obtenerlas.nObjetivo: Evaluar los resultados de las técnicas empleadas paraobtener biopsias en pacientes con sospecha de EICH intestinal. Material y métodos: Estudio retrospectivo que incluye pacientessometidos a alo-TCPH entre 2010 y 2019, con sospecha de EICH intes-tinal estudiados mediante biopsias digestivas: esofagogastroduodenales(endoscopia digestiva alta - EDA) o rectales (colonoscopia o biopsiadirecta). Recogimos variables cuantitativas, expresadas como medianay rango intercuartílico; y cualitativas, expresadas en frecuencia absolutay porcentaje. Resultados: Estudiamos 23 pacientes (60,9% varones). La medianade edad en el momento de la biopsia fue 9 años (7-14 años). EmpleamosEDA en el 47,8% (n= 11), colonoscopia en 26,1% (n= 6) y biopsiadirecta en el 34,8% (n= 8); siendo positivas para EICH en 2 (18,2%), 2(33,3%) y 4 (50%), respectivamente.Conclusiones. Las muestras obtenidas mediante biopsia directase plantean como una alternativa eficiente en el diagnóstico del EICH.(AU)

Introduction: Graft-versus-host disease (GVHD) is a frequentcomplication of allogeneic hematopoietic stem cell transplantation(allo-HSCT), with high morbidity and mortality rates. Intestinalclinical signs are unspecific, which means differential diagnosis withinfections and drug-related etiology should be carried out. Even though intestinal biopsy is widely considered as the gold standardtechnique, there is no consensus as to which sampling method is best. Objective: To assess the results of the biopsy techniques usedin patients with suspected intestinal GVHD.Materials and methods. A retrospective study of patients withsuspected intestinal GVHD undergoing allo-HSCT from 2010 to2019 was carried out. They were assessed through digestive biopsy– esophagogastroduodenal biopsy (upper GI endoscopy – UGIE)or rectal biopsy (colonoscopy or direct biopsy). Quantitative vari-ables, expressed as median and interquartile range, and qualitativevariables, expressed as absolute frequency and percentage, werecollected. Results:23 patients were studied, 60.9% of whom were male.Median age at biopsy was 9 years (7-14 years). UGIE was used in47.8% of patients (n=11), colonoscopy was used in 26.1% of pa-tients (n=6), and direct biopsy was used in 34.8% of patients (n=8),with GVHD positive results in 2 (18.2%), 2 (33.3%), and 4 (50%)patients, respectively. Conclusions: Samples taken through direct biopsy stand as aneffective alternative in GVHD diagnosis.(AU)

Extracorporeal Photopheresis in Pediatric Graft-vs-Host Disease.

BACKGROUND: Extracorporeal photopheresis (ECP) is an immunomodulatory therapy used to treat graft-vs-host disease (GVHD) in adults and children. Few studies have examined its use in children. OBJECTIVE: To describe demographic characteristics, clinical response, adverse effects, and outcomes in a series of pediatric patients with acute or chronic GVHD treated with ECP. MATERIAL AND METHODS: We included all pediatric patients with acute or chronic GVHD treated with ECP by the dermatology department of Hospital Italiano de Buenos Aires between January 2012 and December 2018. We used the UVAR-XTS™ system (2 patients) and the CELLEX system (7 patients). Patients with acute GVHD received 2 sessions a week and were reassessed at 1 month, while those with chronic GVHD received 2 sessions every 2 weeks and were reassessed at 3 months. Treatment duration in both scenarios varied according to response. RESULTS: We evaluated 9 pediatric patients with corticosteroid-refractory, -dependent, and/or -resistant GVHD treated with ECP. Seven responded to treatment and 2 did not. Response was complete in 1 of the 9 patients with skin involvement and partial in 7. Complete response rates for the other sites of involvement were 60% (3/5) for the liver, 50% (1/2) for the gastrointestinal system, and 80% (4/5) for mucous membranes. Two patients died during the study period. CONCLUSION: ECP is a good treatment option for pediatric patients with acute or chronic GVHD.

Respiratory viral infections in pediatric patients with hematopoietic stem cell transplantation.

Background: Viral respiratory infections in pediatric patients with hematopoietic stem cell transplantation (HSCT) significantly impact morbidity and mortality. It is necessary to determine the viral agents and their frequency of presentation to understand their impact on transplantation patients' evolution. Methods: From January 2017 to December 2019, we conducted a cross-sectional, descriptive, and observational study of patients who underwent HSCT with a viral respiratory infection. Viral identification was performed using multiplex polymerase chain reaction for nine respiratory viruses. Descriptive statistics were performed with a report of central tendency measures and percentages. Results: Of the 54 pediatric patients who underwent HSCT, 59.2% presented an airway infection; in turn, at least one viral agent was identified in 59.3% of these patients. The most frequent viral agents were influenza (25.9%), human rhinovirus (18.5%), and respiratory syncytial virus (18.5%). Viral co-infections occurred in 36.8% of the cases. The reported complications were supplemental oxygen requirement (73.6%), support with mechanical ventilation (21%), admission to the pediatric intensive care unit (15.7%), and mortality associated with a viral respiratory infection (10.5%). Conclusions: Viral respiratory infections are frequent in pediatric patients with HSCT; influenza A/B virus was the most frequent agent. As morbidity and mortality increase due to these infections in patients with HSCT, strategies are necessary for its prevention and timely treatment after transplantation.

Introducción: Las infecciones respiratorias virales en los pacientes pediátricos con trasplante de células progenitoras hematopoyéticas (TCPH) impactan significativamente la morbilidad y la mortalidad. Para comprender su impacto en la evolución de los pacientes receptores de trasplantes es necesario conocer la frecuencia de presentación y los agentes virales. Métodos: De enero de 2017 a diciembre de 2019 se llevó a cabo un estudio transversal, descriptivo y observacional de los pacientes sometidos a TCPH que tuvieron una infección viral de vías respiratorias. La identificación de los virus se realizó por medio de la prueba de reacción en cadena de la polimerasa multiplex para nueve virus respiratorios. Se realizó estadística descriptiva con reporte de medidas de tendencia central y porcentajes. Resultados: De los 54 pacientes incluidos, el 59.2% presentaron una infección de vías respiratorias y se identificó al menos un agente viral en el 59.3% de estos casos. Los virus más frecuentes fueron influenza (25.9%), rinovirus humano (18.5%) y virus sincitial respiratorio (18.5%). En el 36.8% de los casos se detectaron coinfecciones virales. Se presentaron las siguientes complicaciones: requerimiento de oxígeno suplementario (73.6%), soporte con ventilación mecánica (21%), ingreso a la unidad de cuidados intensivos pediátricos (15.7%) y muerte asociada a infección por virus respiratorios (10.5%). Conclusiones: Las infecciones respiratorias virales en los pacientes pediátricos con TCPH son frecuentes; el virus influenza A/B es el agente más habitual. Debido a que estas infecciones se asocian con mayor morbimortalidad en los pacientes con TCPH, son estrategias necesarias para su preven­ción y tratamiento oportuno posterior al trasplante.

Respiratory viral infections in pediatric patients with hematopoietic stem cell transplantation / Infecciones respiratorias virales en pacientes pediátricos con trasplante de células progenitoras hematopoyéticas

Abstract Background: Viral respiratory infections in pediatric patients with hematopoietic stem cell transplantation (HSCT) significantly impact morbidity and mortality. It is necessary to determine the viral agents and their frequency of presentation to understand their impact on transplantation patients’ evolution. Methods: From January 2017 to December 2019, we conducted a cross-sectional, descriptive, and observational study of patients who underwent HSCT with a viral respiratory infection. Viral identification was performed using multiplex polymerase chain reaction for nine respiratory viruses. Descriptive statistics were performed with a report of central tendency measures and percentages. Results: Of the 54 pediatric patients who underwent HSCT, 59.2% presented an airway infection; in turn, at least one viral agent was identified in 59.3% of these patients. The most frequent viral agents were influenza (25.9%), human rhinovirus (18.5%), and respiratory syncytial virus (18.5%). Viral co-infections occurred in 36.8% of the cases. The reported complications were supplemental oxygen requirement (73.6%), support with mechanical ventilation (21%), admission to the pediatric intensive care unit (15.7%), and mortality associated with a viral respiratory infection (10.5%). Conclusions: Viral respiratory infections are frequent in pediatric patients with HSCT; influenza A/B virus was the most frequent agent. As morbidity and mortality increase due to these infections in patients with HSCT, strategies are necessary for its prevention and timely treatment after transplantation.

Resumen Introducción: Las infecciones respiratorias virales en los pacientes pediátricos con trasplante de células progenitoras hematopoyéticas (TCPH) impactan significativamente la morbilidad y la mortalidad. Para comprender su impacto en la evolución de los pacientes receptores de trasplantes es necesario conocer la frecuencia de presentación y los agentes virales. Métodos: De enero de 2017 a diciembre de 2019 se llevó a cabo un estudio transversal, descriptivo y observacional de los pacientes sometidos a TCPH que tuvieron una infección viral de vías respiratorias. La identificación de los virus se realizó por medio de la prueba de reacción en cadena de la polimerasa multiplex para nueve virus respiratorios. Se realizó estadística descriptiva con reporte de medidas de tendencia central y porcentajes. Resultados: De los 54 pacientes incluidos, el 59.2% presentaron una infección de vías respiratorias y se identificó al menos un agente viral en el 59.3% de estos casos. Los virus más frecuentes fueron influenza (25.9%), rinovirus humano (18.5%) y virus sincitial respiratorio (18.5%). En el 36.8% de los casos se detectaron coinfecciones virales. Se presentaron las siguientes complicaciones: requerimiento de oxígeno suplementario (73.6%), soporte con ventilación mecánica (21%), ingreso a la unidad de cuidados intensivos pediátricos (15.7%) y muerte asociada a infección por virus respiratorios (10.5%). Conclusiones: Las infecciones respiratorias virales en los pacientes pediátricos con TCPH son frecuentes; el virus influenza A/B es el agente más habitual. Debido a que estas infecciones se asocian con mayor morbimortalidad en los pacientes con TCPH, son estrategias necesarias para su prevención y tratamiento oportuno posterior al trasplante.

Hematopoietic stem cell transplantation in a patient with osteopetrosis and mutation in CLCN7: long-term follow-up / Trasplante de células progenitoras hematopoyéticas en un paciente con osteopetrosis y mutación en CLCN7: seguimiento a largo plazo

Abstract Background: Osteopetrosis is a rare hereditary bone dysplasia characterized by insufficient osteoclast activity that results in increased bone mineral density. Hematopoietic stem cell transplantation (HSCT) can reverse skeletal abnormalities and restore hematopoiesis. Case report: We present the case of a 3-year and 2-month-old male patient with the diagnosis of osteopetrosis. The patient underwent allogeneic HSCT (Allo-HSCT) using 100% compatible bone marrow from a related donor and received a myeloablative conditioning regimen and a CD34 cell dose (4.7 × 107/kg). In the early post-transplant, frequent complications such as pneumonitis, hypercalcemia, and hyperphosphatemia ocurred. With a suitable granulocytic graft and chimerism of 100%, it was considered a successful transplant. However, the patient showed a delayed platelet graft treated with a platelet-stimulating factor for 6 months. The patient is currently disease-free, outpatient follow-up, with no data on graft-versus-host disease, and no progressive neurological damage. Conclusions: Osteopetrosis is a childhood disease that requires clinical suspicion and early diagnosis. HSCT is necessary at an early age to prevent disease progression and sensorineural, hematological, and endocrinological functions damage that can lead to death.

Resumen Introducción: La osteopetrosis es una displasia ósea hereditaria poco común, caracterizada por una actividad osteoclástica deficiente que aumenta la densidad mineral ósea. Se considera que el trasplante de células progenitoras hematopoyéticas (TCPH) puede revertir las anormalidades esqueléticas y restaurar la hematopoyesis. Caso clínico: Se presenta el caso de un paciente de sexo masculino, de 3 años y 2 meses de edad, con diagnóstico tardío de osteopetrosis. Se realizó un TCPH alogénico de donador relacionado 100% compatible con médula ósea. Se utilizaron un régimen de acondicionamiento mieloablativo y una dosis celular de CD34 de 4.7 × 107/kg de peso. En el postrasplante temprano, el paciente desarrolló complicaciones como neumonitis, hipercalcemia e hiperfosfatemia. Con un injerto granulocítico adecuado y quimerismo del 100% se consideró un trasplante exitoso. Sin embargo, el paciente presentó retraso en el injerto plaquetario, por lo que se administró factor estimulante de plaquetas por 6 meses. Actualmente el paciente se encuentra libre de enfermedad, en seguimiento ambulatorio, sin datos de enfermedad del injerto contra el hospedero y con pruebas de neurodesarrollo sin deterioro neurológico progresivo. Conclusiones: La osteopetrosis es una enfermedad infantil que requiere una sospecha clínica y un diagnóstico temprano, ya que es necesario un TCPH a corta edad como tratamiento para evitar la progresión de la enfermedad y el deterioro de las funciones neurosensoriales, hematológicas y endocrinológicas que puede derivar en la defunción del paciente.

Extracorporeal Photopheresis in Pediatric Graft-vs-Host Disease. / Fotoféresis extracorpórea en enfermedad injerto contra huésped en una población pediátrica.

BACKGROUND: Extracorporeal photopheresis (ECP) is an immunomodulatory therapy used to treat graft-vs-host disease (GVHD) in adults and children. Few studies have examined its use in children. OBJECTIVE: To describe demographic characteristics, clinical response, adverse effects, and outcomes in a series of pediatric patients with acute or chronic GVHD treated with ECP. MATERIAL AND METHODS: We included all pediatric patients with acute or chronic GVHD treated with ECP by the Dermatology Department of Hospital Italiano de Buenos Aires between January 2012 and December 2018. We used the UVAR-XTS™ system (2 patients) and the CELLEX system (7 patients). Patients with acute GVHD received 2 sessions a week and were reassessed at 1 month, while those with chronic GVHD received 2 sessions every 2 weeks and were reassessed at 3 months. Treatment duration in both scenarios varied according to response. RESULTS: We evaluated 9 pediatric patients with corticosteroid-refractory, -dependent, and/or -resistant GVHD treated with ECP. Seven responded to treatment and 2 did not. Response was complete in 1 of the 9 patients with skin involvement and partial in 7. Complete response rates for the other sites of involvement were 60% (3/5) for the liver, 50% (1/2) for the gastrointestinal system, and 80% (4/5) for mucous membranes. Two patients died during the study period. CONCLUSION: ECP is a good treatment option for pediatric patients with acute or chronic GVHD.

Atypical toxoplasmic retinochoroiditis in patients with malignant hematological diseases. / Retinocoroiditis toxoplásmica de presentación atípica en pacientes con enfermedades hematológicas malignas.

In immunocompromised patients, toxoplasmosis may have atypical presentation with bilateral, extensive or multifocal involvement. We report a case series of atypical toxoplasmic retinocoroiditis in patients with malignant hematological diseases who are usually immunosuppressed. Four patients were diagnosed of atypical toxoplasmic retinochoroiditis, all of them had immunosuppression (100%) and half of them (50%) had received a bone marrow transplant. The polymerase chain reaction for toxoplasma was positive in 75% of cases, and in one case (25%) the diagnosis was made with clinical and serological criteria. One patient presented ocular toxoplasmosis despite being on prophylactic treatment with atovaquone. Patients with atypical ocular toxoplasmosis and hematological diseases are generally immunocompromised, but they do not always have history of a bone marrow transplant. The presentation may be due to a primary infection or a reactivation of the disease. The aqueous humor and/or vitreous polymerase chain reaction allow confirming the diagnosis to perform a proper treatment.

Diagnóstico de leucemia mieloide aguda durante el embarazo. Reporte de caso / Acute myeloid leukemia diagnosed during pregnancy. Case report

Resumen ANTECEDENTES: La leucemia mieloide aguda es el cuarto cáncer diagnosticado con más frecuencia durante el embarazo. En la actualidad, su tratamiento en las distintas etapas del embarazo sigue suponiendo un desafío diagnóstico y terapéutico para los obstetras, oncólogos y hematólogos. OBJETIVO: Reportar el caso clínico de una paciente embarazada a quien se diagnosticó leucemia mieloide aguda en el primer trimestre, el seguimiento efectuado y el tratamiento propuesto. Además, se revisa la bibliografía existente en relación con este cáncer. CASO CLÍNICO: Paciente de 33 años, embarazada, con 12 + 5 semanas de amenorrea. Se envió al servicio de Hematología debido al hallazgo de pancitopenia en los estudios de laboratorio del primer trimestre. Enseguida de completar el estudio y tomar una biopsia de médula ósea, se estableció el diagnóstico de leucemia mieloblástica aguda NMP1 y FLT-3 negativos, con 20% de blastos. El embarazo finalizó sin contratiempos a las 15 semanas, mediante interrupción voluntaria, luego de recibir información del diagnóstico, pronóstico y riesgo de teratogenia del tratamiento. En la actualidad, la paciente permanece en lista de espera para trasplante de médula ósea histocompatible. CONCLUSIONES: La correcta atención al control de los análisis de laboratorio, propios del embarazo, puede permitir un diagnóstico temprano que permita iniciar un tratamiento inmediato, decisivo para el pronóstico. Todo esto, además de la atención y asesoramiento multidisciplinario, resulta esencial para asegurar el bienestar de la madre y del feto.

Abstract BACKGROUND: Acute myeloid leukemia is the fourth most frequently cancer in association with pregnancy. Nowadays, clinical management of AML occurring during pregnancy is a diagnostic and therapeutic challenging. OBJECTIVE: To report the unpublished case of pregnant diagnosed with acute myeloid leukemia in the first trimester of pregnancy, as well as the follow-up carried out and the proposed treatment. We also review the existing literature in relation to this entity. CLINICAL CASE: 33-year-old patient, at 12+5 weeks of pregnancy. She was admitted to the hematology service due to the discovery of pancytopenia in the laboratory tests performed in the first trimester. After completing the study and performing a bone marrow biopsy, the patient was diagnosed with NMP1 and FLT-3 Negative acute myeloblastic leukemia, with 20% blasts. The pregnancy ended without incident at 15 weeks, by means of a voluntary interruption of the pregnancy, after receiving information on the diagnosis, prognosis and risk of teratogenicity from the treatment. Currently, the patient is on the waiting list for histocompatibility bone marrow transplant. CONCLUSIONS: The importance of analytical control during pregnancy can allow an early diagnosis, to establish an immediate treatment, key for the prognosis. All this, in addition to the multidisciplinary approach and advice, is essential to ensure maternal and fetal well-being.

Cuidados de enfermagem com pacientes submetidos a transplante de células-tronco hematopoiética / Cuidados de enfermería de pacientes sometidos a trasplante de células madre hematopoyética / Nursing care for patients undergoing hematopoietic stem cell transplantation

Resumo Objetivo: Mapear estudos de enfermagem que contemplem os cuidados de enfermagem com pacientes submetidos ao transplante de células-tronco hematopoiética. Métodos: Revisão de escopo, cuja busca foi realizada nas bases MEDLINE, CINAHL e LILACS, no período de junho a agosto de 2019, em português, inglês e espanhol. Foram selecionadas 18 publicações que contemplavam a temática. Resultados: Os cuidados de enfermagem estiveram relacionados às fases do transplante, a saber: condicionamento, infusão, pega e pós-transplante. Conclusão: O conhecimento específico do cuidado de enfermagem com o paciente submetido ao transplante de células-tronco hematopoiética permite ao enfermeiro o reconhecimento de complicações dessa clientela, favorecendo intervenções precoces e visando ao restabelecimento do indivíduo, contribuindo, assim, para uma assistência de enfermagem baseada em evidências.

Resumen Objetivo: Mapear estudios de enfermería que contemplen los cuidados de enfermería de pacientes sometidos al trasplante de células madre hematopoyética. Métodos: Revisión de alcance, cuya búsqueda fue realizada en las bases MEDLINE, CINAHL y LILACS, en el período de junio a agosto de 2019, en portugués, inglés y español. Fueron seleccionadas 18 publicaciones que contemplaban la temática. Resultados: Los cuidados de enfermería estuvieron relacionados con las fases del trasplante, a saber: acondicionamiento, infusión, injerto y postrasplante. Conclusión: El conocimiento específico sobre los cuidados de enfermería de pacientes sometidos al trasplante de células madre hematopoyética permite al enfermero reconocer las complicaciones de esta clientela, favorece intervenciones precoces en busca de la recuperación del individuo y, de esta forma, contribuye para una atención de enfermería basada en evidencias.

Abstract Objective: To map nursing studies that address nursing care for patients submitted to hematopoietic stem cell transplantation. Methods: Scoping review, whose search was carried out in the MEDLINE, CINAHL and LILACS bases, from June to August 2019, in Portuguese, English and Spanish. We selected 18 publications on the theme. Results: The nursing care was related to the phases of the transplantation, namely: conditioning, infusion, harvest, and post-transplantation. Conclusion: The specific knowledge of nursing care for patients submitted to hematopoietic stem cell transplantation allows the nurse to recognize complications of this clientele, favoring early interventions and aiming to restore the patient, thus contributing to evidence-based nursing care.

Implicações da covid-19 num serviço de transplante de células-tronco hematopoéticas referência na américa latina / Implicaciones del covid-19 en un servicio de trasplante de células madre hematopoyéticas de referencia en américa latina / Implications of covid-19 in a hematopoietic stem cell transplantation service reference in latin america

Objetivo descrever as implicações ocasionadas pela pandemia COVID-19 num serviço de referência para Transplante de Células-Tronco Hematopoéticas na América Latina. Método estudo observacional, transversal, realizado entre março e outubro de 2020. Foram analisadas descritivamente as mudanças instituídas no serviço de transplante e comparadas com os protocolos de cuidado desenvolvidos por instituições internacionais e nacionais, e o reflexo dessas ações nos atendimentos ambulatoriais, nas internações, nos transplantes e na equipe multiprofissional. Resultados das 137 internações, 25 (18%) pacientes apresentaram sintomas respiratórios ou febre, dos quais 2 estavam positivos para SARS-CoV-2. Dos 72 profissionais, 8 (11%) foram contaminados, sendo 5 assintomáticos. Foram adotados novos fluxos de atendimento com o intuito de minimizar os riscos e a exposição, como o reagendamento de consultas e o adiamento de transplantes. Conclusão as intervenções realizadas mostraram-se eficientes e estão de acordo com as recomendações de órgãos nacionais e internacionais, no entanto, a constante vigilância é uma necessidade.

Objetivo describir las implicaciones causadas por la pandemia de COVID-19 en un servicio de referencia para el Trasplante de Células Madre Hematopoyéticas en América Latina. Método estudio observacional transversal realizado entre marzo y octubre de 2020. Los cambios instituidos en el servicio de trasplante fueron analizados descriptivamente y comparados con los protocolos de atención desarrollados por instituciones internacionales y nacionales, y el reflejo de estas acciones en atención ambulatoria, hospitalizaciones, trasplantes y personal multiprofesional. Resultados de las 137 internaciones, 25 (18%) pacientes tenían síntomas respiratorios o fiebre, cuyo 2 eran positivos para SARS-CoV-2. De los 72 profesionales, 8 (11%) estaban infectados, con 5 asintomáticos. Se adoptaron nuevos flujos de atención para minimizar los riesgos y la exposición, como la reprogramación de citas y el aplazamiento de trasplantes. Conclusión las intervenciones realizadas fueron eficientes y están de acuerdo con las recomendaciones de los organismos nacionales e internacionales, sin embargo, la vigilancia constante es una necesidad.

Objective to describe the implications caused by the COVID-19 pandemic in a reference service for Hematopoietic Stem Cell Transplantation in Latin America. Method observational, cross-sectional study conducted between March and October 2020. The changes instituted in the transplant service were descriptively analyzed and compared with the care protocols developed by international and national institutions, and the reflection of these actions in outpatient care, hospitalizations, transplants and multiprofessional staff. Results of the 137 hospitalizations, 25 (18%) patients had respiratory symptoms or fever, of which 2 were positive for SARS-CoV-2. Of the 72 professionals, 8 (11%) were infected, with 5 asymptomatic. New care flows were adopted in order to minimize risks and exposure, such as rescheduling appointments and postponing transplants. Conclusion the interventions performed were efficient and are in accordance with the recommendations of national and international bodies, however, constant surveillance is a necessity.