Guidelines For The Diagnosis, Classification, Prophylaxis And Treatment Of Chronic Graft-versus-host Disease [diretrizes Para O Diagnóstico, Classificação, Profilaxia E Tratamento Da Doença Enxerto Contra Hospedeiro Crônica]

The lack of widely-used standardized diagnostic criteria may impair both the true evaluation of chronic graft-versus-host disease and the correlation of its severity with transplant-related mortality. At the I Consensus of the Brazilian Society of Bone Marrow Transplantation - SBTMO that took place in June 2009, the Group of GVHD Studies Brazil-Seattle (GEDECH), presented the guidelines for diagnosis, classification, prophylaxis and treatment of chronic GVHD as proposed by the National Institutes of Health and based on the reality in Brazilian Centers. These proposals, including standardization of features used in diagnosis and tools to score involved organs and to assess the overall severity, should be used in clinical studies of chronic graft-versus-host disease. These criteria are useful to better analyze the incidence of this disease, in addition to evaluate the extension of the involvement of organs or the site affected and its influence on late transplantation mortality. Prophylaxis and treatment proposed for this important complication of hematopoietic stem cell transplantations were discussed and graded according to the levels of evidence established by the National Institutes of Health.32SUPPL. 12239Shulman, H.M., Sullivan, K.M., Weiden, P.L., Chronic graft-versus-host syndrome in man. 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Diagnosis and staging working group report (2005) Biol Blood Marrow Transplant, 11 (12), pp. 945-956Martin, P.J., Weisdorf, D., Przepiorka, D., Hirschfeld, S., Farrell, A., Rizzo, J.D., Design of Clinical Trials Working Group National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: VI. Design of Clinical Trials Working Group report (2006) Biol Blood Marrow Transplant, 12 (5), pp. 491-505Pavletic, S.Z., Martin, P., Lee, S.J., Mitchell, S., Jacobsohn, D., Cowen, E.W., Response criteria working group. Measuring therapeutic response in chronic graft-versus-host disease: National institutes of health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: IV. response criteria working group report (2006) Biol Blood Marrow Transplant, 12 (3), pp. 252-566Couriel, D., Carpenter, P.A., Cutler, C., Bolanos-Meade, J., Treister, N.S., Gea-Banacloche, J., Ancillary therapy and supportive care of chronic graft-versus-host disease: National institutes of health consensus development project on criteria for clinical trials in chronic Graft-versus-host disease: V. Ancillary Therapy and Supportive Care Working Group Report (2006) Biol Blood Marrow Transplant, 12 (4), pp. 375-396Shulman, H.M., Kleiner, D., Lee, S.J., Morton, T., Pavletic, S.Z., Farmer, E., Histopathologic diagnosis of chronic graft-versus-host disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host D. Disease: II. 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therapy for refractory chronic graft-versus-host disease with mycophenolate mofetil and tacrolimus (1999) Bone Marrow Transplant, 24, pp. 517-520Busca, A., Locatelli, F., Marmont, F., Audisio, E., Falda, M., Response to mycophenolate mofetil therapy in refractory chronic graft-versus-host disease (2003) Haematologica, 88, pp. 837-839Flowers, M.E., Apperley, J.F., Besien, K., A multicenter prospective phase II randomized study of extracorporeal photopheresis for treatment of chronic graft-versus-host disease (2008) Blood, 112 (7), pp. 2667-2674Couriel, D.R., Hosing, C., Saliba, R., Extracorporeal photo-chemotherapy for the treatment of steroid-resistant chronic GVHD (2006) Blood, 107, pp. 3074-3080Apisarnthanarax, N., Donato, M., Korbling, M., Extracorporeal photopheresis therapy in the management of steroid-refractory or steroid-dependent cutaneous chronic graft-versus-host disease after allogeneic stem cell transplantation: Feasibility and results (2003) Bone Marrow Transplant, 31 (6), pp. 459-465Foss, F.M., Divenuti, G.M., Chin, K., Prospective study of extracorporeal photopheresis in steroid-refractory or steroid-resistant extensive chronic graft-versus-host disease: Analysis of response and survival incorporating prognostic factors (2005) Bone Marrow Transplant, 35 (12), pp. 1187-1193Carnevale-Schianca, F., Martin, P., Sullivan, K., Flowers, M., Gooley, T., Anasetti, C., Changing from cyclosporine to tacrolimus as salvage therapy for chronic graft-versus-host disease (2000) Biol Blood Marrow Transplant, 6 (6), pp. 613-620Tzakis, A.G., Abu-Elmagd, K., Fung, J.J., Bloom, E.J., Nour, B., Greif, F., FK 506 rescue in chronic graft-versus-host-disease after bone marrow transplantation (1991) Transplant Proc, 23 (6), pp. 3225-3227Couriel, D.R., Saliba, R., Escalon, M.P., Hsu, Y., Ghosh, S., Ippoliti, C., Sirolimus in combination with tacrolimus and corticosteroids for the treatment of resistant chronic graft-versus-host disease (2005) Br J Haematol, 130 (3), pp. 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Retrospective Study Of Stem Cell Transplantation For Acute Myeloid Leukemia (aml): The Brazilian Experience [estudo Retrospectivo Do Tratamento De Leucemia Mielóide Aguda Com O Transplante De Medula óssea - A Experiência Brasileira]

Data from the International Bone Marrow Transplant Registry (IBMTR) contribute for the improvement of Bone Marrow Transplant (BMT) worldwide. We studied the Brazilian experience in BMT for AML to compare this with international data. We performed a retrospective study by sending questionnaires to 16 BMT centers regarding clinical and treatment variables. Statistical analyses concerning autologous BMT (autoBMT) and allogeneic BMT (alloBMT) were performed using the Kaplan-Meier method and the log-rank test. All p-values were two-tailed. We collected data from 731 patients (205 autoBMT and 526 alloBMT). Median overall survival (OS) for autoBMT patients was longer than alloBMT patients (1035 vs. 466 days, p=0.0012). AlloBMT stem cell source (SCS): 73% bone marrow stem cell (BMSC), 23% peripheral blood stem cells (PBSC) and 4% umbilical cord blood. Among the autoBMT patients, the SCS was 63% PBSC, 22% BMSC and 15% both. The SCS did not impact on OS. There was no difference in OS between different FAB classifications in the alloBMT group, but in the autoBMT the M3 patients had longer survival. As expected, the main cause of mortality among autoBMT patients was related to disease relapse (60%), while in the alloBMT, to infection (38%). In both groups we found longer OS in first complete remission (1CR) compared to second (2CR) and other (p<0.0001), and longer OS in de novo AML than in secondary. In the alloBMT group we found more patients with advanced disease (60%), while in the autoBMT group, we found more M3 patients (24%), which could explain the difference in OS. Most of our results are in accordance with IBMTR data. 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