RESUMO
INTRODUCTION: Haematopoietic cell transplantation with nonmyeloablative conditioning (NMC-HCT) is used in the treatment of haematological malignancies. MATERIAL AND METHODS: Use of NMC-HCT in Denmark from 2000-07 was examined. RESULTS: Unrelated donor searches resulted in a suitable donor in 75% of cases of which 36% were transplanted. Among 244 patients referred for NMC-HCT, 72% were transplanted. There was a significant difference in the number of NMC-HCTs between national regions. Increasing waiting time resulted in 22% of the referred patients being taken off the waiting list without NMC-HCT. CONCLUSION: Some patients may have had a chance of cure if they had been transplanted without delay.
Assuntos
Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas , Condicionamento Pré-Transplante , Neoplasias Hematológicas/mortalidade , Histocompatibilidade , Humanos , Taxa de Sobrevida , Condicionamento Pré-Transplante/métodos , Transplante Homólogo , Listas de EsperaRESUMO
Thirty patients with haematological malignancies received peripheral blood stem cells from human leucocyte antigen (HLA)-identical sibling donors after non-myeloablative conditioning with fludarabine and total body irradiation. Twenty-seven patients received the transplant as an outpatient procedure. All patients engrafted. The probability of acute graft-versus-host disease (GVHD) grades II-IV and extensive chronic GVHD was 57% and 80%, respectively. Patients alive on day +365 experienced a median of 44 d (range 4-151) of hospitalization during the first year. In the entire cohort, GVHD accounted for 22%, infections for 18%, thrombotic thrombocytopenic purpura (TTP) for 16% and engraftment syndrome for 14% of the time in hospital. The 1-year risk of TTP was 26%. Acute GVHD was a risk factor for the development of TTP (P = 0.008). With a median follow-up of 602 d, the 2-year estimates for overall survival, progression-free survival, non-relapse mortality and relapse related mortality were 68%, 43%, 22% and 13%, respectively. This transplantation regimen is feasible and induces long-term remissions in heavily pretreated patients. The procedure can be performed in the outpatient setting, but complications could result in a substantial number of admissions during the first year.
Assuntos
Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/métodos , Condicionamento Pré-Transplante/métodos , Adulto , Assistência Ambulatorial , Feminino , Sobrevivência de Enxerto , Doença Enxerto-Hospedeiro/etiologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Púrpura Trombocitopênica Trombótica/etiologia , Quimeras de Transplante , Resultado do TratamentoRESUMO
Genetic epidemiology--i.e. studies of the interaction between genes and environment--has lead to the identification of monogenic disorders and more recently of genes involved in polygenic diseases by means of family (linkage) and populations (association) studies. The recent complete sequencing of the human genome combined with new methods such as gene expression analyses with microchip technology and proteome analyses including bioinformatics increases the possibility to find genes involved in various diseases and help to identify new targets for therapy and/or prevention.
