Trasplante alogénico haploidéntico de progenitores hematopoyéticos en pediatría en Uruguay

  • Gustavo Dufort Centro Hospitalario Pereira Rossell, Centro Hemato-Oncológico Pediátrico. Coordinador
  • Luis A. Castillo Centro Hospitalario Pereira Rossell. Centro Hemato-Oncológico Pediátrico. Director
  • Silvia Pisano Centro Hospitalario Pereira Rossell, Departamento de Hemoterapia y Medicina Transfusional.
  • Mariela Castiglioni Centro Hospitalario Pereira Rossell, Centro Hemato-Oncológico Pediátrico.
  • Carolina Pagés Centro Hospitalario Pereira Rossell, Centro Hemato-Oncológico Pediátrico.
  • Elizabeth Simón Centro Hospitalario Pereira Rossell, Centro Hemato-Oncológico Pediátrico.
  • Silvana Zuccolo Centro Hospitalario Pereira Rossell, Centro Hemato-Oncológico Pediátrico.
  • Andrea Incoronato Centro Hospitalario Pereira Rossell, Centro Hemato-Oncológico Pediátrico.
  • Rodrigo Barcelona Centro Hospitalario Pereira Rossell, Centro Hemato-Oncológico Pediátrico.
  • Magdalena Schelotto Centro Hospitalario Pereira Rossell, Centro Hemato-Oncológico Pediátrico.
  • Fabiana Morosini Centro Hospitalario Pereira Rossell, Centro Hemato-Oncológico Pediátrico.
  • María Ferrando Centro Hospitalario Pereira Rossell, Centro Hemato-Oncológico Pediátrico.
  • Clara Peña Centro Hospitalario Pereira Rossell, Centro Hemato-Oncológico Pediátrico. Nurse Jefe
  • Anaulina Silveira Centro Hospitalario Pereira Rossell, Centro Hemato-Oncológico Pediátrico. Analista de datos
  • Adriana Tiscornia Centro Hospitalario Pereira Rossell, Departamento de Hemoterapia y Medicina Transfusional.
  • Rossana Mezzano Centro Hospitalario Pereira Rossell, Departamento de Hemoterapia y Medicina Transfusional.
  • Felipe Lemos Centro Hospitalario Pereira Rossell, Departamento de Hemoterapia y Medicina Transfusional.
  • Luján Guerrero Centro Hospitalario Pereira Rossell, Departamento de Radioterapia.
  • Valentina Ferreira Centro Hospitalario Pereira Rossell, Departamento de Radioterapia.
  • Hugo Giordano Asociación Española, Laboratorio de Citometría de Flujo. Jefe
  • Beatriz Boggia Centro Hospitalario Pereira Rossell, Departamento de Hemoterapia y Medicina Transfusional. Jefe
  • Aldo Quarnetti Centro Hospitalario Pereira Rossell, Departamento de Radioterapia. Jefe
  • Agustín Dabezies Centro Hospitalario Pereira Rossell, Centro Hemato-Oncológico Pediátrico. Coordinador
Palabras clave: TRASPLANTE HOMÓLOGO, HAPLOIDÍA, CÉLULAS MADRE HEMATOPOYÉTICAS

Resumen

Introducción: el trasplante alogénico de progenitores hematopoyéticos (TPH) es actualmente la única opción de tratamiento curativo disponible para un número de neoplasias hematológicas de alto riesgo, así como para algunas enfermedades no malignas hereditarias o adquiridas. El TPH haploidéntico (HI) es una opción válida para pacientes que no tienen un hermano HLA-idéntico. 
Objetivo: describir los resultados obtenidos con TPH HI en pediatría. 
Material y método: en el año 2005 se inició en el Centro Hemato-Oncológico Pediátrico del Centro Hospitalario Pereira Rossell un programa de TPH HI para aquellos pacientes sin donante relacionado HLA-idéntico. 
Resultados: se trasplantaron 32 pacientes, 24 con neoplasias hematológicas y 8 con enfermedades no malignas. Se utilizaron dos estrategias de prevención de la enfermedad injerto contra huésped (EICH), depleción de linfocitos T (DLT) in vitro (28 pacientes) y DLT alorreactivos in vivo con altas dosis de ciclofosfamida postrasplante (4 pacientes). Veintisiete pacientes (84%) tuvieron un implante con quimerismo total del donante. La incidencia de EICH agudo y crónico fue de 26,9% y 11,8%, respectivamente. La muerte no relacionada a recaída al año del trasplante fue de 21,9%. Con una mediana de seguimiento de 32 meses, la sobrevida global a dos años fue de 52,4%. 
Conclusiones: el TPH HI ha demostrado ser una opción factible en nuestro medio para aquellos pacientes sin donante HLA-idéntico. Los resultados son comparables a los obtenidos con otros donantes alternativos y con costos más accesibles. Uruguay está hoy día mejor posicionado para ofrecer un TPH a los pacientes que así lo requieran.

Citas

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Publicado
2014-03-31
Cómo citar
1.
Dufort G, Castillo LA, Pisano S, Castiglioni M, Pagés C, Simón E, Zuccolo S, Incoronato A, Barcelona R, Schelotto M, Morosini F, Ferrando M, Peña C, Silveira A, Tiscornia A, Mezzano R, Lemos F, Guerrero L, Ferreira V, Giordano H, Boggia B, Quarnetti A, Dabezies A. Trasplante alogénico haploidéntico de progenitores hematopoyéticos en pediatría en Uruguay. Rev. Méd. Urug. [Internet]. 31 de marzo de 2014 [citado 27 de enero de 2020];30(1):17-9. Disponible en: http://revista.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/256
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