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Vojnosanitetski pregled
2011, vol. 68, br. 12, str. 1026-1032
jezik rada: engleski
vrsta rada: originalan članak
doi:10.2298/VSP1112026S


Uticaj izvora matičnih ćelija hematopoeze na ishod alogene transplantacije u lečenju hematoloških maligniteta
aVojnomedicinska akademija
bClinical Center of Serbia, Clinic of Hematology, Belgrade

e-adresa: stamatovicm@sbb.rs

Sažetak

Uvod/Cilj. Periferna krv (PK) se sve češće koristi kao izvor matičnih ćelija (MĆ) hematopoeze za alogenu transplantaciju. Uprkos višegodišnjem iskustvu, uticaj izvora MĆ na ishod transplantacije u lečenju hematoloških maligniteta nije jasno definisan. Cilj rada bio je da se uporede rezultati alogenih transplantacija MĆ iz PK (TPMĆ) i transplantacija koštane srži (TKS) prema dinamici prihvatanja kalema, učestalosti i jačini ranih (mukozitis, akutna bolest 'kalem protiv domaćina', (graft-versus-host disease - aGvHD) i odloženih (hronični GvHD - hGvHD) komplikacija procedure, mortalitetu uzrokovanom transplantacijom (TRM), potrebi za transfuzijama, relapsima i ukupnom preživljavanju (OS). Metode. Analizirano je 158 bolesnika, 64 ženskog, 94 muškog pola, prosečne starosti 29 godina (9-57), sa oboljenjima: akutna mijeloidna leukemija (AML) - 39, akutna limfoblastna leukemija (ALL) - 47, hronična mijeloidna leukemija (CML) - 32, mijelodisplastični sindrom (MDS) - 10, Hodgkinova bolest (MH) - 2, multipli mijelom (MM) - 3, granulocitni sarkom (GrSa) - 3, teška aplatična anemija (sAA) - 22, kod kojih je u periodu 1989-2009. urađena alogena transplantacija MĆ. Bolesnici su prema izvoru transplantiranih MĆ bili podeljeni u dve grupe: prva grupa sa TKS - 74 i druga sa TPMĆ - 84 bolesnika. Kod svih bolesnika davalac je bio HLA podudarni srodnik. Matične ćelije iz koštane srži prikupljene su multiplim aspiracijama bedrene kosti, a iz periferne krvi jednom 'aferezom velikog volumena' posle primene rekombinantnog faktora koji stimuliše ljudske kolonije (rHuG-CSF, 5-12 μg/kgtm, 5 dana). Svi bolesnici primili su neselektovanu suspenziju MĆ. Kondicioni režimi bili su prilagođeni bolestima, a prevencija GvHD bila je kombinacija ciklosporina A i metotreksata. Rezultati. Prihvatanje kalema, prema broju polimorfonukleara i trombocita bilo je značajno brže (p < 0,001) u grupi bolesnika sa TPMĆ, nego u grupi sa TKS. Potrebe za transfuzijama bile su značajno veće u grupi bolesnika sa TKS (p < 0,01). Ovi bolesnici imali su češće orofaringealni mukozitis stepena 3/4 (33,3% vs 10,0%, p < 0,05). Nije bilo značajne razlike u učestalosti aGvHD i hGvHD među grupama. Bolesnici sa TPMĆ imali su značajno češći hGvHD ekstenzivne forme (29,1% vs 11,29%, p < 0,05). Izvor MĆ nije bitnije uticao na TRM (21,62% vs 23,8%, I= 0 ,64) i relapse (21,6% vs 29,7%, p = 0,32). Bolesnici sa TKS imali su značajno bolje OS (logrank 2,33; p < 0,05). Zaključak. Periferna krv kao izvor obezbedila je veći prinos ćelija i brže prihvatanje kalema, sa ređim ranim komplikacijama transplantacije, što je uticalo na ekonomski aspekt lečenja. Alogene TPMĆ bile su praćene češćom pojavom ekstenzivne forme hGvHD, dok uticaj izvora MĆ na TRM i relaps bolesti nije utvrđen. Ukupno preživljavanje bilo je bolje kod bolesnika lečenih primenom TKS, ali za definitivno zaključivanje potrebno je randomizirano ispitivanje većeg broja ispitanika.

Ključne reči

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