Donor characteristics and hematopoietic stem cell transplantation outcome: experience of a single center in Southern Brazil

ABSTRACT Background: Hematopoietic stem cell transplantation is a curative treatment for many patients with hematological disorders. Donor-recipient genetic disparity, especially involving the human leukocyte antigen system is a critical factor for transplant outcome. Objective: To evaluate retrospectively donor characteristics and correlations with the occurrence of acute and chronic graft-versus-host disease, disease-free survival and overall survival in a Brazilian population submitted to allogeneic hematopoietic stem cell transplantation between 1994 and 2012 in a single center. Results: Three hundred and forty-seven consecutive transplantations were included. Related transplants (81.2%) were significantly more common than unrelated transplants (18.7%); donor and recipient median ages were 34 (range: 1-61) and 33 (range: 3-65) years respectively with donor HLAs being matched for 333 (95.9%) patients. Donor gender, cytomegalovirus status and ABO incompatibility did not influence the five-year overall survival. In univariate analyses, overall survival was negatively influenced by the presence of acute graft-versus-host disease (33% vs. 47%, respectively; p-value = 0.04), unrelated transplant (41.5% vs. 50.9%, respectively; p-value = 0.045) and donors aged over 40 years (41% vs. 52%, respectively; p-value = 0.03). Older donors were associated with a higher rate of acute (52% vs. 65.8%; p-value = 0.03) and chronic graft-versus-host disease (60% vs. 43%, respectively; p-value = 0.015). In multivariate analyses, acute graft-versus-host disease [relative risk (RR): 1.8; 95% confidence interval (CI): 1.1-29; p-value = 0.008] and older donors (RR: 1.6; 95% CI 1.11-2.24; p-value = 0.013) were associated with higher transplant-related mortality. Conclusions: In transplant patients, to have a donor older than 40 years of age seems to significantly increase the incidence of acute and chronic graft-versus-host disease and transplant-related mortality with no impact on disease-free survival and overall survival. In spite of the rather small cohort of patients, these findings are similar to what is described in the literature suggesting that a younger donor should be chosen whenever possible.

Fibrobroncoscopia no diagnóstico e decisão terapêutica de infecções respiratórias em pacientes neutropênicos febris hematológicos / Fiberoptic bronchoscopy in the diagnosis and therapeutic decision for respiratory infections in hematological febrile neutropenic patients

INTRODUÇÃO: A neutropenia febril é uma complicação frequente dos pacientes submetidos ao tratamento quimioterápico ou Transplante de Célula Tronco Hematopoiética (TCTH). A fibrobroncoscopia (FBC) flexível tem sido utilizada para auxiliar no diagnóstico de doenças pulmonares. No entanto, não há consenso em relação ao benefício do exame para estabelecer diagnóstico e alterar o tratamento das doenças pulmonares nesse contexto. Estudos prévios, retrospectivos e bastante heterogêneos, com pacientes imunocomprometidos não-HIV mostraram que o rendimento da fibrobroncoscopia para estabelecer diagnóstico etiológico varia de 13 a 81% e gera alteração de terapêutica em 5 e 51%. O objetivo deste estudo foi avaliar o rendimento da Fibrobroncoscopia, o risco ao procedimento em pacientes hematológicos e neutropênicos. MÉTODOS: Estudo transversal retrospectivo que avaliou pacientes com neoplasia hematológica e neutropenia febril e que tenham sido submetidos à fibrobroncoscopia diagnóstica entre janeiro de 2011 e dezembro de 2012 internados no Hospital de Clínicas de Porto Alegre. RESULTADOS: Foram incluídos 45 pacientes: 18 (36%) tiveram resultado positivo no Lavado Broncoalveolar (LAB), sendo que houve mudança na conduta terapêutica em 95% dos pacientes que apresentaram positividade no LAB. Com relação ao risco do procedimento tivemos uma taxa de 2,2% de complicação, com um paciente que apresentou dessaturação imediatamente após o procedimento. CONCLUSÃO: Apesar do número limitado de pacientes, nossos achados indicam que a realização da fibrobroncoscopia com LAB em pacientes neutropênicos é segura e com um rendimento semelhante aos descritos na literatura

INTRODUCTION: Febrile neutropenia is a common complication in patients undergoing chemotherapy or hematopoietic Stem Cell Transplantation (HSCT). Flexible fiberoptic bronchoscopy has been used to aid in the diagnosis of pulmonary diseases. However, there is no consensus regarding the benefit of the exam in establishing diagnosis and in changing the treatment of lung disease in this context. Previous retrospective studies, quite heterogeneous and with non-HIV immunocompromised patients, showed that the yield of fiberoptic bronchoscopy in establishing etiology ranges from 13% to 81%, and in changing therapy, from 5% to 51%. To evaluate the efficiency of Fiberoptic bronchoscopy and the procedure-related risk for neutropenic patients with hematologic malignancy. METHODS: This retrospective cross-sectional study analyzed the medical records of patients with hematologic malignancy with febrile neutropenia who had undergone diagnostic fiberoptic bronchoscopy between January 2011 and December 2012 at the Hospital de Clínicas de Porto Alegre. RESULTS: A total of 45 patients were included: 18 (36%) tested positive for bronchoalveolar lavage, with change in therapeutic management occurring for 95% of them. The procedure-related risk was 2.2%, with one patient showing desaturation immediately after the procedure. CONCLUSION: Despite the limited number of patients, our findings indicate that fiberoptic bronchoscopy in neutropenic patients is safe, and the results are similar to those previously reported

Características clínicas dos portadores de hemoglobinopatia S / Clinical characteristical of the hemoglobinopathy S patients

Os pacientes portadores de hemoglobinopatia S sofrem de uma anemia hemolítica crônica com repercussões sistêmicas. Estudo transversal retrospectivo com 64 pacientes portadores de hemoglobinopatia S, cujo objetivo foi descrever as suas manifestações clínicas. Com relação à gravidade clínica, 75,7 por cento dos portadores de anemia falciforme (SS) apresentaram doença grave, enquanto que 67,7 por cento dos portadores de traço falciforme (AS) apresentaram doença benigna, de acordo com os critérios de gravidade da doença. As alterações clínicas sistêmicas dos indivíduos portadores de hemoglobinopatia S estão presentes em algum momento de suas evoluções, sendo que o tipo e gravidade destas estão diretamente ligadas às variantes genéticas da doença