RESUMO
BACKGROUND: Hematopoietic stem cell transplantation is used in the treatment of children with malignant and non-malignant diseases. However, apheresis of peripheral blood stem cells (PBSC) represents a challenge in children below 10 kg. METHODS: A retrospective trial was conducted in the Cellular Therapy Department of Portuguese Oncology Institute of Porto. INCLUSION CRITERIA: children with body weight inferior to 10 kg who underwent autologous PBSC apheresis until 2021. Demographic and clinical data were collected and our institutional protocol was described. COBE Spectra apheresis system (TerumoBCT, Lakewood, Colorado) until 2012 and then Spectra Optia (TerumoBCT) were used. RESULTS: Sixteen leukocytaphereses were performed in 13 patients-nine females (69%). Mean age and weight were 13.31 months (±5.26) and 8.31 kg (±1.17), respectively. The initial CD34+ cells/µL in peripheral blood was 70.8 (±61.9). A central venous catheter (CVC) was exclusively used in all but one patient, in whom a peripheral vein was also required. In 10 procedures, both heparin and anticoagulant citrate dextrose solution-formula A (ACD-A) were used; in the remaining ones, only ACD-A was employed. The median duration of each procedure was 168 minutes (±45) and 2.96 blood volumes (±0.31) were processed. Median CD34+ cells yield per leukocytapheresis was 6.52 × 106 /kg (±9.87 × 106 ). CD34+ cell extraction rates were not significantly different between the two apheresis systems. Platelet and magnesium levels were significantly lower after collection (P < .001 and P = .009, respectively). CONCLUSIONS: Although recommendations are lacking, we have successfully and safely performed leukocytaphereses in children with body weight below 10 kg. The authors believe that a permanent and dynamic comprehensive evaluation of each child is paramount for attaining good results.
Assuntos
Remoção de Componentes Sanguíneos , Neoplasias , Células-Tronco de Sangue Periférico , Feminino , Humanos , Criança , Estudos Retrospectivos , Antígenos CD34 , Remoção de Componentes Sanguíneos/métodos , Leucaférese , Neoplasias/terapia , Magreza , Mobilização de Células-Tronco HematopoéticasRESUMO
INTRODUCTION: Pregnant women with thromboembolic diseases, previous thrombotic episodes or thrombophilia family history were supervised in a multidisciplinary Obstetrics/ Hematology consultation in Centro Hospitalar São João EPE, Porto, Portugal. For the evaluation and medication of these women, a risk stratification scale was used. PURPOSES: The aim of this study was to validate a Risk Stratification Scale and thromboprophylaxis protocol by means of comparing it with a similar scale, developed and published by Sarig. MATERIAL AND METHODS: We have compared: The distribution, by risk groups, obtained through the application of the two scales on pregnant women followed at Centro Hospitalar São João, Porto, Portugal, consultation; the sensibility and specificity for each one of the scales (DeLong scale, applied to Receiver Operating Characteristic) curves; the outcomes in pregnancies followed in Hospital São João, Porto, PortugalResults: According to our Hema-Obs risk stratification scale, 29% were allocated to low-risk, 47% to high-risk and 24% to very-high-risk groups. According to Galit Sarig risk stratification scale, 24% were considered low-risk, 53% moderate, 16% high-risk and 7% as very high-risk group. In our study we observed 9% of spontaneous abortions, in comparison with 18% in the Galit Sarig cohort. From the application of Receiver Operating Characteristic curve to both risk stratification scales, the results of the calculated areas were 58,8% to our Hema-Obs risk stratification scale and 38,7% to Galit Sarig risk stratification scale, with a Delong test significancie of p = 0.0006. CONCLUSIONS: We concluded that Hema-Obs risk stratification scale is an effective support for clinical monitoring of therapeutic strategies.
Introdução: Na consulta de Hematologia-Obstetrícia do Centro Hospitalar São João EPE, as grávidas com trombofilias, episódios trombóticos anteriores e/ou história familiar de trombofilia são avaliadas e medicadas, recorrendo a uma escala de estratificação de risco (EER Hema-Obs).Objectivos: Pretende-se, com este trabalho, avaliar a eficácia desta escala de estratificação de risco, comparando-a com uma escala semelhante, desenvolvida e publicada por Sarig (escala de estratificação de risco Sarig).Material e Métodos: Procedeu-se às seguintes comparações: distribuição, por grupos de risco, obtida pela aplicação das duas escalas, em simultâneo, a 250 grávidas seguidas, na consulta do Centro Hospitalar São João EPE; sensibilidade e especificidade para cada uma das escalas (teste DeLong aplicado às curvas Receiver Operating Characteristic); desfechos nas gestações seguidas no Centro Hospitalar São João EPE e pelo grupo de Sarig no Rambam Health Care Campus (Israel).Resultados: A estratificação de risco nas 250 grávidas foi: a) com a escala de estratificação de risco Hema-Obs - Risco Materno (29%), Alto Risco Materno-Fetal (47%), Muito Alto Risco Materno-Fetal (24%); b) com a escala de estratificação de risco Sarig - Baixo (24%), Intermédio (53%), Alto (16%), Muito Alto (7%). Aplicando as curvas Receiver Operating Characteristic a ambas as escalas, resultam áreas calculadas de 58,8% para a escala de estratificação de risco Hema-Obs e de 38,7% para a escala de estratificação de risco de Sarig, correspondendo a uma diferença estatisticamente significativa (p = 0,0006 pelo teste de DeLong). Nas gestações acompanhadas no Centro Hospitalar São João EPE verificaram-se 91% de gestações bem-sucedidas e 9% de abortamentos; nas gestações acompanhadas por Sarig verificaram-se 82% de gestações bem-sucedidas e 18% de abortamentos.Conclusões: Conclui-se que a escala de estratificação de risco Hema-Obs constitui um suporte eficaz para estratégias terapêuticas de acompanhamento clínico.