RESUMO
The COVID-19 pandemic has affected 187 countries, representing a global public health problem. The increasing number of critically ill patients and deaths have fueled a desperate search for treatments that can halt the course of the disease. Currently, there are several experimental therapies with demonstrated in vitro activity against COVID-19 used in clinical practice, including hydroxychloroquine, remdesivir, interleukin-6 pathway inhibitors, and convalescent plasma; however, to date no agent has proven efficacy against COVID-19. In the case of convalescent plasma, this therapy consists in obtaining neutralizing antibodies from previously infected individuals by plasmapheresis and administering them to patients with severe disease. Recently, the use of convalescent plasma has shown promising results in preliminary studies, with case series reporting a decrease in temperature, and viral load, as well as improvement in clinical parameters among patients receiving this treatment. However, there are still unmet needs regarding the safety profile, tolerability, dosage, and timing this therapy should be given. Based on this, the objective of our study was to develop and propose a practical approach for the compassionate use of convalescent plasma for the treatment of patients with severe COVID-19, given the constrains and limitations of developing countries. We encourage health professionals in developing countries to use the current evidence and approaches to experimental treatments for patients with COVID-19, adapting them to their conditions, and always based on a thorough risk-benefit evaluation for each patient, and whenever possible to design and promote the much needed research in this field.
Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Assistência ao Convalescente , COVID-19 , Ensaios de Uso Compassivo , Infecções por Coronavirus/etiologia , Estado Terminal , Países em Desenvolvimento , Humanos , Imunização Passiva , Pandemias , Seleção de Pacientes , Plasmaferese , Pneumonia Viral/etiologia , SARS-CoV-2 , Soroterapia para COVID-19RESUMO
El trasplante de células hematopoyéticas (TCH) es la infusión de células progenitoras a fin de restablecer la función medular e inmune en pacientes con enfermedades hematológicas malignas y no malignas adquiridas y genéticas. El impacto del TCH se refleja en las alternativas de tratamiento, mayor difusión de la técnica y mejores opciones al paciente.El procedimiento consiste en la obtención de progenitores hematopoyéticos periféricos, mediante las células CD34+ (2- 2.5 x 106/Kg peso); es un excelente predictor de prendimiento del injerto. El trasplante de donante no relacionado, permite tratamiento a pacientes que carecen de donantes familiares histo-idénticos. Otra variante de TCH es el mini-trasplante, utilizando dosis bajas de quimioterapia e inmunosupresores, produciendo menos complicaciones, pero jerarquizando el efecto injerto sobre tumor, que permite la remisión de enfermedades neoplásicas hematológicas y no hematológicas, siendo una alternativa en países en vías de desarrollo, por la posibilidad de disminuir costos y complicaciones.
Transplant of Hematopoietic Stem Cells (HSCT) is the infusion of hematopoietic progenitor cells in patients with hematologic malignant, non malignant, acquired and genetic disorders of the bone marrow to reestablish inmune and marrow function. The impact of the HSCT reflects on the choices of treatment, the wide diffusion of the technique and better options to the patient.This procedure consist to obtain the peripheral hematopoietic progenitors; through the CD34+ cells (22.5 x 106/Kg) is an excellent predictor of the successful of the engraftment. Transplant from not-related donors allow treatment to patients who lack of haploidentical family donors. Other variable of HSCT is mini-transplant, using low-doses of chemotherapy and inmunosupressors, it produces less complications, and enhances the effect graft vs tumor. This allows the remission of the malignant hematologic and non-hematologic diseases. It is becoming a good choice for treatment in developing countries, because decrease costs and complications.