Transplante de células-tronco hematopoiéticas: iniquidades na distribuição em território brasileiro, 2001 a 2020 / Hematopoietic stem-cell transplants in Brazil: inequities in the distribution in Brazilian territory, 2001 to 2020

Resumo O objetivo deste artigo é descrever a distribuição de Centros Transplantadores (CTs) e transplantes de células-tronco hematopoiéticas (TCTH) no território brasileiro. Estudo descritivo, que reúne informações sobre a distribuição CTs e o número de procedimentos realizados entre 2001 e 2020, a partir das fontes dos dados: Sociedade Brasileira de Terapia celular e Transplantes de Medula Óssea (SBTMO); Associação Brasileira de Transplante de Órgãos (ABTO); Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS); e Ministério da Saúde (MS). Foram identificados 86 CTs, com predominância na região Sudeste do país (64%). A região Norte não possui CTs. No período contabilizaram-se mais de 30 mil procedimentos, concentrados nas regiões Sudeste e Sul. O TCTH do tipo alogênico foi prevalente. Constataram-se divergências entre os números de transplantes realizados a depender da fonte consultada. Apesar do crescimento do número de procedimentos no período do estudo, tanto a distribuição de CTs quanto o número de TCTHs se concentrou em regiões mais desenvolvidas. Essa heterogeneidade pode ter propiciado iniquidades no acesso ao tratamento pela população.

Abstract The scope of this article is to describe the distribution of Transplant Centers (TCs) and hematopoietic stem-cell transplants (HSCTs) in the Brazilian territory. It is a descriptive study, which brings together information on the distribution of TCs and the number of procedures performed between 2001 and 2020, based on the following data sources: the Brazilian Cell Therapy and Bone Marrow Transplant Society of (SBTMO); the Brazilian Organ Transplant Association (ABTO); the Hospital Information System of the Unified Health System (SIH/SUS); and the Ministry of Health (MS). A total of 86 TCs were identified, predominantly in the Southeastern region of the country (64%). There are no TCs in the Northern region. Throughout the period, there were more than 30,000 procedures, concentrated in the Southeastern and Southern regions. The allogeneic type of HSCT was prevalent. Differences were found between the numbers of transplants performed depending on the source consulted. Despite the increase in the number of procedures during the period studied, both the distribution of TCs and the number of HSCTs were concentrated in more developed regions. This heterogeneity may have led to inequities in the access of the population to treatment.

Extracorporeal shock wave therapy combined with autologous bone marrow stem cells transplantation for treating early-stage osteonecrosis of the femoral head / 中华物理医学与康复杂志

Objective To observe the therapeutic effects of extracorporeal shock wave therapy (ESWT) combined with autologous bone marrow stem cells (BMSC) transplantation in treating early-stage osteonecrosis of the femoral head (ONFH).Methods Forty patients diagnosed as stage Ⅰ or Ⅱ according to the classification of osteonecrosis of the femoral head put forward by the Association Research Circulation Osseous were randomly divided into a treatment group and a control group with 20 cases in each group.Both groups were treated with BMSC transplantation,while the treatment group was further treated with ESWT the next day.Harris scores were assigned before the treatment and 3,6,12 and 24 months after the treatment to evaluate hip function,the degree of pain and the effects of the treatment.Frog-bit X-rays of the anteroposterior pelvis were taken to assess the stages.Results There were significant differences in the Harris scores and pain degree of the two groups before and at the different time points after the treatment.After 6,12 and 24 months,significant differences were observed in the two values between the two groups.After 12 months the number of hips rated excellent,good and medium level were 8,18 and 1 in the treatment group and 5,13 and 8 in the control group,showing significant differences.Conclusion Extracorporeal shock wave therapy along with autologous bone marrow stem cell transplantation can be used to treat patients with early stage osteonecrosis of the femoral head,relieving their pain and improving their joint function.

Trasplante de medula ósea en Brasil: dimensión bioética / Bone marrow transplants in Brazil: the bioethical dimension / Transplantes de medula óssea no Brasil: dimensão bioética

El presente estudio busca analizar la práctica de los trasplantes de médula ósea en Brasil a la luz de la Bioética. Partiendo del presupuesto constitucional brasileño de que la salud es un derecho de todas las personas, analiza el acceso a estos servicios médicos especializados por parte de los ciudadanos socialmente vulnerables. Presenta el panorama legal de este campo del conocimiento científico en el país, mostrando la legislación general relativa a los trasplantes de órganos y tejidos, además de la reglamentación específica relacionada con los trasplantes de médula ósea, incluyendo la logística pública de apoyo al desarrollo del proceso de atención médica. Considerando aspectos relacionados con el uso de células tronco hematopoyéticas y tomando la bioética como referencia, discute la vulnerabilidad de los pacientes de bajas condiciones socio-económicas, la responsabilidad pública del Estado para con esas personas y la necesidad de darles la debida protección, teniendo en cuenta los patrones sociales de desigualdad observados en los países periféricos como Brasil...

This study intends to analyze the practice of bone marrow transplants in Brazil from the perspective of Bioethics. Starting from the constitutional Brazilian tenet that health is a right belonging to every person, it analyzes the question of access to specialized medical services by socially vulnerable citizens. It presents the legal outlook of this field of scientific knowledge in the country, presenting its general legislation dealing with organ and tissue transplants, besides the specific regulations related to bone marrow transplants, including the logistics of public support for the development of the medical care process. Considering aspects related to the use of Hematopoietic stem cells (HSC) and taking Bioethics as reference, it discusses the vulnerability of socioeconomically deprived patients, the government’s public responsibility toward these people, and the need to provide them with the proper protection, keeping in mind the social patterns of inequality observed in peripheral countries such as Brazil...

O presente estudo visa analisar a prática dos transplantes de medula óssea no Brasil à luz da Bioética. Partindo do pressuposto constitucional brasileiro de que a saúde é um direito de todas as pessoas, analisa o acesso a estes serviços médicos especializados por parte dos cidadãos socialmente vulneráveis. Apresenta o panorama legal deste campo do conhecimento científico no país, mostrando a legislação geral relativa aos transplantes de órgãos e tecidos, além da regulamentação específica relacionada com os transplantes de medula óssea, incluindo a logística pública de apoio ao desenvolvimento do processo de atendimento médico. Considerando aspectos relacionados com o uso de células-tronco hematopoiéticas e tomando a bioética como referência, discute a vulnerabilidade dos pacientes de baixas condições socio-econômicas, a responsabilidade pública do Estado para com essas pessoas e a necessidade de lhes dar a devida proteção, levando em conta os padrões sociais de desigualdade observados nos países periféricos como o Brasil...

Cyclosporine monitoring in patients with renal, cardiac and bone marrow transplants: A comparison between clone enzyme donor immunoassay and fluorescence polarization immunoassay methods.

In the present study a new method for selectively determining parent cyclosporine in whole blood, a clone enzyme donor immunoassay (CEDIA; Boehringer Mannheim), was compared with a fluorescence polarization immunoassay (FPIA; TDxAbbott). A total of 429 samples were collected, comprising 371 renal, 34 cardiac, 14 bone marrow and 10 corneal transplant recipients. Regression equations in 429 samples is CEDIA cyclosporine (ng/mL) = 0.999 x FPIA (ng/mL) + 1.684, (r=0.997). The linearity analysis was done from 0 – 1,000 ng/mL, which gave a good analytical range of between 15-600 ng/mL. The new CEDIA method also has within-rin CV = 1.77 – 3.69 percent which is better than the FPIA method (2.20 – 6.10 percent). The advantages of the new CEDIA method are the lower cost of the reagents and the fact that there is no need to purchase a new automated clinical chemistry analyser since it can be applied to routine chemistry instruments immediately after the reagents become available to the laboratory.