RESUMO
Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplants (allo-HSCT) associated with significant morbidity and mortality. The earliest and most common manifestation is cutaneous graft-versus-host disease. This review focuses on the pathophysiology, clinical features, prevention and treatment of cutaneous graft-versus-host disease. We discuss various insights into the disease's mechanisms and the different treatments for acute and chronic skin graft-versus-host disease.
Assuntos
Doença Enxerto-Hospedeiro/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Dermatopatias/etiologia , Doença Crônica , Exantema/etiologia , Exantema/terapia , Glucocorticoides/uso terapêutico , Doença Enxerto-Hospedeiro/terapia , Humanos , Fotoferese/métodos , Dermatopatias/terapiaRESUMO
Abstract Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplants (allo-HSCT) associated with significant morbidity and mortality. The earliest and most common manifestation is cutaneous graft-versus-host disease. This review focuses on the pathophysiology, clinical features, prevention and treatment of cutaneous graft-versus-host disease. We discuss various insights into the disease's mechanisms and the different treatments for acute and chronic skin graft-versus-host disease.
Assuntos
Humanos , Dermatopatias/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Doença Enxerto-Hospedeiro/etiologia , Dermatopatias/terapia , Doença Crônica , Fotoferese/métodos , Exantema/etiologia , Exantema/terapia , Glucocorticoides/uso terapêutico , Doença Enxerto-Hospedeiro/terapiaRESUMO
BACKGROUND AIMS. Lymphedema is a common complication with breast cancer treatment that does not have a definite cure. Our objective was to determine the efficacy of autologous stem cells (ASC) in the treatment of lymphedema secondary to mastectomy and axillary lymphadenectomy in comparison with traditional decongestive treatment with compression sleeves. METHODS. A prospective study including 20 women with lymphedema secondary to breast cancer surgery with axillary lymphadenectomy was conducted. Women were assigned at random to one of two groups. One group of 10 women was injected with ASC in the affected arm, whereas the other 10 women comprised the control group and received traditional compression sleeve therapy (CST). The follow-up for both groups was 12 weeks. Pain, sensitivity and mobility were assessed before and after therapy. RESULTS. There was improvement in the volume of lymphedema in both groups, with no significant difference. In the ASC group there was an overall volume reduction during the follow-up, whereas in the CST group lymphedema recurred after the compression sleeve was removed. CONCLUSIONS. Our findings suggest that ASC injection for patients with lymphedema can be an effective treatment. It reduces arm volume and associated co-morbidities of pain and decreased sensitivity. Traditional CST was also effective for lymphedema reduction, but it was dependent on continuous use of the treatment.
Assuntos
Neoplasias da Mama/terapia , Carcinoma/terapia , Linfedema/etiologia , Complicações Pós-Operatórias , Transplante de Células-Tronco , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/fisiopatologia , Neoplasias da Mama/cirurgia , Carcinoma/patologia , Carcinoma/fisiopatologia , Carcinoma/cirurgia , Bandagens Compressivas , Feminino , Seguimentos , Humanos , Linfedema/prevenção & controle , Mastectomia , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Transplante AutólogoRESUMO
The authors report their experience with allogeneic hematopoietic stem cell transplantation in infants at a university hospital in México. Five infants had one of each of the following diagnoses: acute lymphoblastic leukemia, osteopetrosis for which the patient underwent 2 procedures, acute disseminated multiorgan Langerhans cell histiocytosis, and two cases of hemophagocytic lymphohistiocytosis. The source of stem cells for grafting in 2 children was peripheral blood, and in 3 children was unrelated cord blood. A reduced-intensity conditioning regimen including fludarabine, cyclophosphamide, and melphalan was administrated. Three patients are disease-free transplant survivors without graft-versus-host disease after 46, 34, and 16 months.
