scholarly journals Clinical and epidemiological profile of children and adolescents submitted to the hematopoietic cell transplantation

2019 ◽  
Vol 35 (5) ◽  
Author(s):  
Wanessa da Silva Peres Bezerra ◽  
Marcos Antonio Ferreira Júnior ◽  
Isabelle Campos de Azevedo ◽  
Mayk Penze Cardoso ◽  
Andreia Insabralde de Queiroz Cardoso ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Cell Transplantation ◽  
Peripheral Blood ◽  
Chronic Gvhd ◽  
Rio Grande ◽  
The State ◽  
Definitive Treatment ◽  
Main Diagnosis ◽  
Hematopoietic Stem ◽  
Epidemiological Profile

The Hematopoietic stem cell transplantation (HSCT) is used in children as a definitive treatment for various oncological, immune deficiencies, hemoglobinopathy, and malignancies diseases that involve the hematological system, congenital metabolism disorders, among others. To characterize the clinical and epidemiological profile of children and adolescents submitted to HSCT at a referral service in the state of Rio Grande do Norte. This is a quantitative, retrospective, observational, descriptive and analytical quantitative approach approaching the medical records of children and adolescents submitted to HSCT in a referral hospital service for this type of transplantation in the state of Rio Grande do Sul North (RN). The final sample consisted of 35 records patients aged between 2 and 18 years old who underwent HSCT from February 2008 to December 2015 and who presented the data necessary for the study. The records analyzed showed a little majority of male patients (51.42%) and 60.00% of these men were students and 71.42% lived in the state of the Rio Grande do Norte. According to the clinical characteristics, 34.3% of the patients had Acute Lymphoblastic Leukemia and 25.71% had Acute Myeloid Leukemia as the main diagnosis. Gastrointestinal toxicities were the most frequent (97.1%) and all patients received antineoplastic/chemotherapeutic and antiemetic treatment. The allogeneic HSCT was the most frequently performed (57.14%) and the most used source of Hematopoietic progenitor cells (HPC) was the peripheral blood (54.29%) and 5.71% of these patients developed the Graft versus Host Disease (GVHD), of which one was affected by acute GVHD and another by chronic GVHD. Septsis was the most frequent cause of death (60%). The profile of the clinical variables presented by the children and adolescents of this study shows that the most prevalent diagnosis was ALL, the most frequent toxicities were gastrointestinal, cardiac, respiratory and hematological, the most common HSCT was allogeneic peripheral blood and the greatest cause of mortality was sepsis. These data are similar to studies conducted in North America, Europe and Asia.

scholarly journals Classical Monocyte Deficiency Calculated By the Mono-Index Can Predict Mortality in Allogeneic Hematopoietic Stem Cell Transplantation Patients

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5666-5666 ◽  
Author(s):  
Vinicius Campos de Molla ◽  
Matheus Vescovi Gonçalves ◽  
Elisa Y Kimura ◽  
Vergilio Colturato ◽  
Maura V Ikoma ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Adaptive Immunity ◽  
Cell Transplantation ◽  
Peripheral Blood ◽  
Chronic Gvhd ◽  
Horizontal Line ◽  
Hematopoietic Stem ◽  
Common Diagnosis ◽  
Classical Monocytes

Background: Most studies in immune reconstitution after allogeneic hematologic stem cell transplantation (alloHSCT) focus on adaptive immunity, particularly in lymphocyte recovery. Classical monocytes (cMo) are part of the innate immunity, playing an important role in the defense against fungal and bacterial infections. The innate and adaptive immunity are closely related, and non-classical monocytes (ncMo) participate in this connection, regulating T cell response. However, the role of these cells in the graft versus tumor effect and graft versus host disease (GVHD) is still unclear. Objectives: The aim of the study was to investigate cMo and ncMo reconstitution after alloHSCT and a possible impact of these cells subsets on acute and chronic GVHD, relapse, non-relapse related mortality (NRM) and overall survival (OS). Patients and Methods: This is a retrospective analysis of 77 patients who underwent alloHSCT in 4 different transplant centers in Brazil. Peripheral blood samples were collected from patients at neutrophil engraftment (NE) and 3, 7, 14, 21, and 42 days after NE. The cMo (DR+, CD11c+, CD14+, CD16-) and ncMo (DR+, CD11c+, CD14-, CD16+) were classified and analyzed by 8-color multiparametric flow cytometry (FACSCanto II). In order to analyze the possible impact of duration and severity of monocytopenia after transplant, we calculated then the 'mono-index' and the 'ncMo-index', based on the area over the curve (AOC) of absolute cMO counts (AMC) and absolute ncMo counts, respectively, considering a horizontal line of AMC 0.5x10e9/L as cut-off value for both subpopulations. Results: The medium follow up was 82 months. Out of 77 patients, 46 (60%) were male, and the median age was 17 years (range: 1-74). The stem cell source was bone marrow in 36 (47%), cord blood in 23 (30%), and peripheral blood in 18 (23%); and donors were matched unrelated in 61 (79%), and matched related in 16 (21%) cases. Most patients received myeloablative conditioning (n=47, 61%); and acute leukemia was the most common diagnosis (72%). A total of 40 (52%) patients received total body irradiation (TBI), and 27 (35%) patients received antithymocyte globulin (ATG). We calculated the possible impact of cMo at all timepoints and found no differences in the main outcomes between patients with lower or higher counts. We then analyzed the AOC of all cMo counts (the mono-index). A higher index represents a more severe deficiency of cMo. We then used the receiver operating characteristic (ROC) curve to define the cut-off value of 14234.4 cells/days x mm3 to discriminate patients as cMo deficient (n=31, 40%) or non-deficient (n=46, 60%). Non relapse mortality (NRM) at 6 years was higher in cMo deficient patients calculated by the mono-index (40% vs. 16% for non-deficient, p=0.02, Figure 1). Deficient patients also had worse OS at 6 years (58% vs. 37% for non-deficient, p=0.03, Figure 2). In multivariate analyses, cMo deficiency calculated by the mono-index remained significantly associated with NRM (hazard ratio 3.07, 95% confidence interval) and OS (HR 2.05, 95%CI 1.20-7.85). We observed no impact of mono-index on acute or chronic GVHD or relapse. We observed no impact of the ncMo counts at all timepoints or the ncMo-index in any of the analyzed outcomes. Conclusion: cMo deficiency calculated by the mono-index can predict mortality in alloHSCT. Mono-Index is an inexpensive, accessible and easy to perform tool that might help clinicians in predicting unfavorable outcomes. Further studies are needed to confirm these findings and to test how different transplant strategies or therapeutic changes might interfere with monocytes recovery in alloHSCT. Disclosures No relevant conflicts of interest to declare.

scholarly journals Psychological suffering of patients transplanted with hematopoietic stem cells

2019 ◽  
Vol 35 (5) ◽  
Author(s):  
Isabelle Campos de Azevedo ◽  
Marcos Antonio Ferreira Júnior ◽  
Vanessa Giavarotti Taboza Flores ◽  
Elenilda de Andrade Pereira Gonçalves ◽  
Oleci Pereira Frota ◽  
...  
Keyword(s):  
Stem Cells ◽  
Psychological Distress ◽  
Hematopoietic Stem Cells ◽  
Autologous Transplantation ◽  
Rio Grande ◽  
The State ◽  
Main Diagnosis ◽  
Hematopoietic Stem ◽  
Referral Service ◽  
Psychological Suffering

Hematopoietic stem cell transplantation (HSCT) affects serious risks for the patient, including death. For this reason, it is considered a treatment that can cure or can present morbidities and lead to death. In this context, patients experience the first psychological conflicts before this transplant. To describe the psychological suffering developed by patients transplanted with hematopoietic stem cells from a referral service in the state of Rio Grande do Norte. This is a cross-sectional study with a quantitative, descriptive, hospital-based approach developed with patients submitted to HSCT at a referral service in the state of Rio Grande do Norte. Data were collected between March and September of 2016, through the evaluation of the medical records of 43 patients who underwent HSCT and developed some type of psychological distress. Among 43 patients with psychological disorders, 51.16% were female, 62.79% developed anxiety 32.56% developed insomnia and 20.93% developed depression. Of these, 27.91% had a main diagnosis indicating the transplantation of Multiple Myeloma (MM), and 58.14 received autologous transplantation. It was observed that the patient had psychological suffering from the diagnosis until the end. The health professional praxis also must go beyond the resolution of physical human responses and, especially in these cases, it should aim at the early identification of signs and symptoms of psychological distress, being possible to achieve the real health needs and treat them with effectiveness.

Endothelial and Circulating Progenitor Cells in Hematological Diseases and Allogeneic Hematopoietic Stem Cell Transplantation

2018 ◽  
Vol 25 (35) ◽  
pp. 4535-4544 ◽  
Author(s):  
Annalisa Ruggeri ◽  
Annalisa Paviglianiti ◽  
Fernanda Volt ◽  
Chantal Kenzey ◽  
Hanadi Rafii ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Peripheral Blood ◽  
Circulating Endothelial Cells ◽  
Hematopoietic Stem ◽  
Hematological Diseases

Background: Circulating endothelial cells (CECs), originated form endothelial progenitors (EPCs) are mature cells not associated with vessel walls and detached from the endothelium. Normally, they are present in insignificant amounts in the peripheral blood of healthy individuals. On the other hand, elevated CECs and EPCs levels have been reported in the peripheral blood of patients with different types of cancers and other diseases. Objective: This review aims to provide an overview on the characterization of CECs and EPCs, to describe isolation methods and to identify the potential role of these cells in hematological diseases and hematopoietic stem cell transplantation. Methods: We performed a detailed search of peer-reviewed literature using keywords related to CECs, EPCs, allogeneic hematopoietic stem cell transplantation, and hematological diseases (hemoglobinopathies, hodgkin and non-hodgkin lymphoma, acute leukemia, myeloproliferative syndromes, chronic lymphocytic leukemia). Results: CECs and EPCs are potential biomarkers for several clinical conditions involving endothelial turnover and remodeling, such as in hematological diseases. These cells may be involved in disease progression and in the neoplastic process. Moreover, CECs and EPCs are probably involved in endothelial damage which is a marker of several complications following allogeneic hematopoietic stem cell transplantation. Conclusion: This review provides information about the role of CECs and EPCs in hematological malignancies and shows their implication in predicting disease activity as well as improving HSCT outcomes.

scholarly journals Epidemiological profile of 39 cases of microcephaly caused by congenital infections diagnosed in the state of Rio Grande do Sul between 2015-2017

2019 ◽  
Author(s):  
Silvani Herber ◽  
Anna Pires Terra ◽  
André Anjos da Silva ◽  
Maria Teresa Sanseverino ◽  
Lucas Rosa Fraga ◽  
...  
Keyword(s):  
Rio Grande ◽  
The State ◽  
Rio Grande Do Sul ◽  
Congenital Infections ◽  
Epidemiological Profile

Total Skin Electron Beam and Non-Myeloablative Allogeneic Hematopoietic Stem-Cell Transplantation in Advanced Mycosis Fungoides and Sézary Syndrome

2010 ◽  
Vol 28 (14) ◽  
pp. 2365-2372 ◽  
Author(s):  
Madeleine Duvic ◽  
Michele Donato ◽  
Bouthaina Dabaja ◽  
Heather Richmond ◽  
Lotika Singh ◽  
...  
Keyword(s):  
Electron Beam ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Cell Lymphoma ◽  
Chronic Gvhd ◽  
Complete Response ◽  
Cutaneous T Cell Lymphoma ◽  
Hematopoietic Stem

Purpose Transformed mycosis fungoides (MF) and Sézary syndrome (SS) are currently incurable. We studied the safety and efficacy of total skin electron beam with allogeneic hematopoietic stem-cell transplantation (HSCT) in patients with cutaneous T-cell lymphoma (CTCL). Patients and Methods Nineteen patients with advanced CTCL (median age, 50 years; four prior therapies) underwent total skin electron beam radiation followed by allogeneic HSCT between July 2001 and July 2008. Sixteen patients were conditioned with fludarabine (125 mg/m2) and melphalan (140 mg/m2) plus thymoglobulin (for mismatched donors). Graft-versus-host disease (GVHD) prophylaxis was with tacrolimus/mini methotrexate. Results Eighteen patients experienced engraftment, and one died as a result of sepsis on day 16. Median time to recovery of absolute neutrophil count (ANC) was 12 days. Fifteen achieved full donor chimerism, 12 had acute GVHD, and 12 were treated for chronic GVHD. The overall intent-to-treat response was 68%, and the complete response rate was 58%. Four of six patients died in complete remission as a result of bacterial sepsis (n = 2), chronic GVHD and fungal infection (n = 1), or lung cancer (n = 1); only two died as a result of progressive disease. Eight experienced relapse in skin; five regained complete response with reduced immunosuppression or donor lymphocyte infusions. Eleven of 13 are currently in complete remissions, with median follow-up of 19 months (range, 1.3 to 8.3 years). Median overall survival has not been reached. Conclusion Total skin electron beam followed by allogeneic stem-cell transplantation merits additional evaluation for a selected group of patients with refractory, advanced, cutaneous T-cell lymphoma with evidence for graft-versus-tumor effect.

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