Transplante alogênico de células-tronco hematopoiéticas com doador familiar HLA-idêntico para leucemias agudas: análise dos dados do Serviço de Transplante de Medula Óssea do Hospital das Clínicas da UFMG

Abstract

Introduction: Acute leukemias are a heterogeneous diseases group with high morbimortality. Allogeneic bone marrow transplantation is a very efficacious therapeutic option for its treatment. The paucity of papers in the Brazilian literature about allogeneic bone marrow transplantation for acute leukemias justifies the studies concerned to know the characteristics and the outcome of these patients. Objetives: Appraising the results of hematopoietic stem-cell transplantation with a matched sibling in transplanted patients with acute leukemia in Hospital das Clínicas da Universidade Federal de Minas Gerais and compare them with the available literature data. Material and Methods: A retrospective cohort study was performed with all transplanted patients with acute leukemia myeloid, lymphocytic and biphenotypic who received an non-manipulated allograft of bone marrow or peripheral blood from amatched sibling in the Bone Marrow Transplantation Unit in Hospital das Clínicas da UFMG from July 1995 to December 2005. Data were retrospectively collected from the patients registers by a specific form.Results: The median age of the 125 included patients was 28.7 years. Eighty-one patients presented acute myeloid leukemia; 38 with acute lymphocytic leukemia; and six patients with biphenotypic leukemia. Thirty-two patients were in first complete remission, while 23 were in second remission and 70 were transplanted in an advanced disease stage (refractory, relapsed, or beyond second remission). Thecumulative incidence of neutrophil recovery (D+60), platelet recovery (D+100) and acute graft-versus-host disease (D+100) were respectively 90.4%, 74.2% and 47.2%. Twenty-nine patients presented chronic graft-versus-host disease. The overall survival and event free-survival estimates at 10 years were 22.9% and 22.1%, respectively. Regarding patient clinical situation at transplantation, overall survival was 56.3% for patients in first remission, 38% for those in second remission and3.7% for patients with advanced disease. Conclusions: This study shows a worse outcome than reported in literature. It could be due to a higher proportion of transplanted patients with advanced disease. Nevertheless, evolution was similar to other studies taking into consideration patientstransplanted in first or second remission.