Assuntos
Corticosteroides/uso terapêutico , Antineoplásicos/efeitos adversos , Resistência a Medicamentos , Fator Estimulador de Colônias de Granulócitos/efeitos adversos , Imunoglobulinas Intravenosas/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Pele/efeitos dos fármacos , Síndrome de Sweet/tratamento farmacológico , Adulto , Biópsia , Humanos , Masculino , Mieloma Múltiplo/diagnóstico , Indução de Remissão , Índice de Gravidade de Doença , Pele/patologia , Síndrome de Sweet/induzido quimicamente , Síndrome de Sweet/diagnóstico , Resultado do TratamentoRESUMO
Therapy-related acute myelogenous leukemia (t-AML) is a generally fatal disease with a very poor response to conventional chemotherapy. Allogeneic stem cell transplantation (allo-SCT) has been reported in patients with chemotherapy- responsive t-AML. However its use is limited owing to complications from previous treatments. Nonmyeloablative conditioning provides rapid hematologic engraftment and it is a feasible option for patients who are at increased risk for conventional SCT. There are few data on their use in patients with t-AML. We describe the case of a boy who developed visceral fungal infection with liver abscesses after induction chemotherapy for t-AML. He received allo-SCT with a nonmyeloablative regimen, plus amphotericin B during the transplant procedure. The patient is alive and free of both leukemia and fungal infection 2 years after allo-SCT. Nonmyeloablative allo-SCT may provide durable remission in patients with t-AML, preexisting invasive fungal infections, and a high risk of adverse effects from standard chemotherapy and prolonged cytopenia, without resurgence of the fungal infection.
Assuntos
Candidíase/microbiologia , Transplante de Células-Tronco Hematopoéticas , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/terapia , Anfotericina B/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Candidíase/tratamento farmacológico , Criança , Humanos , Leucemia Mieloide Aguda/diagnóstico , Masculino , Transplante Homólogo , Resultado do TratamentoAssuntos
Doença de Hodgkin/diagnóstico , Leishmaniose Visceral/diagnóstico , Linfonodos/patologia , Adolescente , Animais , Doença de Hodgkin/complicações , Humanos , Leishmania donovani/isolamento & purificação , Leishmaniose Visceral/complicações , Leishmaniose Visceral/parasitologia , Linfonodos/parasitologia , MasculinoRESUMO
The combination of methotrexate and cyclosporine A (MTX-CSA) is the standard regimen for the prevention of graft vs. host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (allo-SCT) from HLA-identical siblings. Mycophenolate mofetil and CSA (MMF-CSA) combination has been successfully used for GVHD prophylaxis after non-reduced intensity conditioning (non-RIC) allo-SCT with peripheral blood or non-G-CSF stimulated bone marrow as stem cell source. We report the results of the first prospective trial of the MMF-CSA combination for acute GVHD prophylaxis in 47 patients after non-RIC G-CSF stimulated allo-BMT (G-BMT) from HLA-identical siblings in patients with severe aplastic anemia (SAA) or hematological malignancies. Median age was 28 yr (range, 6-48 yr). Median follow-up was 22 months. The median time to neutrophil and platelets recovery were nine d (range, 8-17) and 16 d (range, 10-28), respectively. Acute GVHD of grade II-IV and chronic GVHD occurred in 51% and 27%, respectively. Overall survival rates at two yr for patients with SAA and hematological malignancies were 87% and 65%, respectively. The event-free survival at two yr for patients with hematological malignancies was 76%. We concluded that MMF-CSA appears equivalent to MTX-CSA for GVHD prophylaxis in patients receiving non-RIC G-BMT from HLA-identical siblings, with a tendency for more rapid neutrophil engraftment.