Autologous stem cell transplantation for the treatment of pediatric solid tumors in Brazil

Hosp Clin, Pediat Oncol Unit, Porto Alegre, RS, BrazilUniversidade Federal de São Paulo, GRAACC, Pediat Oncol Inst, São Paulo, BrazilHosp AC Camargo Fund Antonio Prudente, Dept Pediat, São Paulo, BrazilSanta Casa de São Paulo, Pediat Hematol & Bone Marrow Transplantat Unit, São Paulo, BrazilUniversidade Federal de São Paulo, GRAACC, Pediat Oncol Inst, São Paulo, BrazilWeb of Scienc

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

Pacientes 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 doencaAfter 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.BV UNIFESP: Teses e dissertaçõe

Association of low pre-transplant TREC levels and increased risk for severe acute GVHD and infection after hematopoietic stem cell transplantation

Universidade Federal de São Paulo, Div Immunogenet, São Paulo, BrazilUniversidade Federal de São Paulo, Div Hematol, Bone Marrow Unit, São Paulo, BrazilUniversidade Federal de São Paulo, Pediat Oncol Inst, Pediat Bone Marrow Unit, São Paulo, BrazilSanta Marcelina Hosp, Bone Marrow Unit, São Paulo, BrazilUniversidade Federal de São Paulo, Div Immunogenet, São Paulo, BrazilUniversidade Federal de São Paulo, Div Hematol, Bone Marrow Unit, São Paulo, BrazilUniversidade Federal de São Paulo, Pediat Oncol Inst, Pediat Bone Marrow Unit, São Paulo, BrazilWeb of Scienc

Earlier Diagnosis of Invasive Fusariosis with Aspergillus Serum Galactomannan Testing

Cross-reactivity of Fusarium species with serum galactomannan antigen (GMI) test has been observed. We sought to evaluate if GMI could help to early diagnose invasive fusariosis and to monitor treatment response. We reviewed the records of all patients with invasive fusariosis between 2008 and 2012 in three Brazilian hospitals. We selected patients who had at least 1 GMI test within 2 days before or after the date of the first clinical manifestation of fusariosis, and analyzed the temporal relationship between the first positive GMI test and the date of the diagnosis of invasive fusariosis, and the kinetics of GMI in relation to patients' response to treatment. We also selected 18 controls to determine the sensitivity and specificity of the test. Among 18 patients, 15 (83%) had at least one positive GMI (median 4, range 1-15). the sensitivity and specificity of was 83% and 67%, respectively. GMI was positive before the diagnosis of invasive fusariosis in 11 of the 15 cases (73%), at a median of 10 days (range 3-39), and after the diagnosis in 4 cases. GMI became negative in 8 of the 15 patients; 3 of these 8 patients (37.5%) were alive 90 days after the diagnosis of fusariosis compared with 2 of 7 (29%) who did not normalize GMI (p = 1.0). GMI is frequently positive in invasive fusariosis, and becomes positive before diagnosis in most patients. These findings may have important implications for the choice of antifungal therapy in settings with high prevalence of invasive fusariosis

Quantitative analysis of circulating CD34+cells as a guide for peripheral blood stem cell(PBSC) collections by leukapheresis

UNIFESP, GRAACC, Pediat Oncol Inst, Sao Paulo, BrazilSirio Libanes HOsp, Sao Paulo, BrazilSanta Paula Hosp, Sao Paulo, BrazilUNIFESP, GRAACC, Pediat Oncol Inst, Sao Paulo, BrazilWeb of Scienc

Unrelated Donor Bone Marrow Transplantation for Myelodysplastic Syndrome in Children

We describe long-term disease-free survival (DFS) after unrelated donor bone marrow transplantation (BMT) for myelodysplastic syndrome (MDS) in <= 8 patients aged years. Forty-six patients had refractory cytopenia (RC), 55 refractory anemia with excess blasts (RAEB), and 17 refractory anemia with excess blasts in transformation (RAEB-t). Transplant-related mortality was higher after mismatched BMT (relative risk [RR] 3.29, P=.002). Disease recurrence was more likely with advanced stages of MDS at the time of BMT: RAEB (RR 6.50, P=.01) or RAEB-t (RR 11.00, P=.004). Treatment failure (recurrent disease or death from any cause; inverse of DFS) occurred in 68 patients. Treatment failure was higher after mismatched BMT (RR 2.79, P=.001) and in those with RAEB-t (RR 2.38, P=.02). Secondary MDS or chemotherapy prior to BMT was not associated with recurrence or treatment failure. Similarly, cytogenetic abnormalities were not associated with transplant outcomes. Eight-year DFS for patients with RC after matched and mismatched unrelated donor BMT was 65% and 40%, respectively. Corresponding DFS for patients with RAEB and RAEB-t was 48% and 28%, respectively. When a matched adult unrelated donor is available, BMT should be offered as first-line therapy, and children with RC can be expected to have the best outcome. Biol Blood Marrow Transplant 17: 723-728 (2011) (C) 2011 American Society for Blood and Marrow Transplantatio