Infusão de leucócitos do doador para o tratamento da recidiva de doenças hematológicas malignas após transplante de medula óssea alogênico

dc.contributor.authorSeber, Adriana [UNIFESP]
dc.date.accessioned2015-12-06T23:00:58Z
dc.date.available2015-12-06T23:00:58Z
dc.date.issued2000
dc.description.abstractPacientes que receberam transplante de medula ossea (TMO) alogenico nao rejeitam celulas do doador. Assim, e possivel utilizar leucocitos maduros do sangue periferico do doador para destruir o cancer recidivado, produzindo o efeito imunologico de um segundo transplante sem a toxicidade do regime preparatorio. Casuistica e metodo: Pacientes com recidiva ou doenca linfoproliferativa (DLP) apos TMO alogenico foram tratados com infusao de doses crescentes de linfocitos T do doador, iniciando com 107/kg em doencas estaveis, 108/kg nas agressivas e 106/kg em DLP. Escalonamos a dose a cada 4-16 semanas ate o maximo de 5Xl08, caso nao ocorresse aplasia, remissao ou doenca do enxerto contra o hospedeiro (DECH). Resultados: Entre 1995 e 1997, 21 pacientes de 7-57 anos (mediana 40), g homens, receberam infusoes de leucocitos para o tratamento de recidiva de leucemia mieloide cronica (LMC), mieloide aguda (LMA), linfoide aguda (LLA), sindrome mielodisplasica (SMD), mieloma multiplo (MM), linfoma nao Hodgkin (LNH) e doenca de Hodgkin (DH). Um paciente foi tratado para DLP e DH. Em 21/22 tratamentos foram utilizados quimioterapia (l9), radioterapia (7), interferon (3), interleucina-2 (2), imunoterapia (2) ou suspensao da ciclosporina (4). Apos a infusao, 4 pacientes apresentaram DECH aguda II/III e 7 DECH cronica limitada. Nao houve mielossupressao grave atribuivel a infusao de leucocitos. A progressao da doenca apos o tratamento envolveu com frequencia sitios extra-medulares. Com a combinacao de estrategias terapeuticas, seis pacientes atingiram remissao completa: 2/2 LMC, 1/3 MM, 1/7 LMA, 1/3 LLA, l / l DLP. O paciente com DLP faleceu por recidiva da DH. Ha 5 pacientes (24 por cento) vivos em remissao com excelente estado geral entre dois e quatro anos apos a recidiva da doencapt
dc.description.abstractAfter allogeneic bone marrow transplants (BMT), the patients are tolerant of the donor cells. Therefore, donor’s mature peripheral blood lymphocytes can be transfused to destroy relapsed cancer cells, producing the immunologic effect of a second BMT without the toxicity of a second preparative regimen. Methods: Patients who relapsed or developed lymphoproliferative disease (LPD) after allogeneic BMT were treated with donor leukocyte infusions (DLI) at the Johns Hopkins Oncology Center, USA. Stable disease was treated with escalating doses of T-cells, beginning at 107/kg, given every 16 weeks until complete remission (CR) was achieved, graft-versus-host disease (GVHD) or aplasia developed, or the fourth and last dose of 5x108 was given. Similar escalating approach was used to treat aggressive diseases, starting at 108 T-cells/Kg and giving the second dose four weeks after the first one. Results: Between 1995 and 1997, 21 patients 7-57-yo (median 40), 9 man and 12 women, were treated with DLI for relapsed acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), myelodysplastic syndrome, multiple myeloma (MM), non-Hodgkin’s lymphoma and Hodgkin’s disease (HD). One patient was treated for both HD and LPD, increasing to 22 the number of treatments. After the DLI, 3 patients developed acute GVHD II/III, and 7 chronic GVHD. No patient developed severe myelosuppression, which could be attributed to the DLI. Extramedullary disease progression occurred fairly often. Six complete remissions were achieved using a combination of DLI, chemotherapy, radiation and immunotherapy in 2/2 CML, 1/3 MM, 1/7 AML, 1/3 ALL, 1/1 LPD. The patient with LPD died of progressive HD. Five patients (24%) are alive in remission with excellent performance status 1072-1373 days after the first DLI.
dc.description.sourceBV UNIFESP: Teses e dissertações
dc.format.extent235 p.
dc.identifier.citationSão Paulo: [s.n.], 2000. 235 p. tab.
dc.identifier.fileepm-016539.pdf
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/16789
dc.language.isopor
dc.publisherUniversidade Federal de São Paulo (UNIFESP)
dc.rightsAcesso restrito
dc.subjectTransplante de Medula Ósseapt
dc.subjectRecidivapt
dc.subjectDoenças Hematológicaspt
dc.subjectNeoplasiaspt
dc.titleInfusão de leucócitos do doador para o tratamento da recidiva de doenças hematológicas malignas após transplante de medula óssea alogênicopt
dc.typeDissertação de mestrado
unifesp.campusUniversidade Federal de São Paulo, Escola Paulista de Medicinapt
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