Implementação de protocolo alternativo de condicionamento para transplante autólogo de células-tronco hematopoiéticas em linfoma de hodgkin e linfomas não-hodgkin
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Data
2021-05-31
Autores
Campoó, Isabela Marina Ressineti Mendes
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Universidade Estadual Paulista (Unesp)
Resumo
Quimioterapia em altas doses seguida de transplante autólogo de células tronco hematopoéticas é o tratamento de escolha para linfomas recaídos e refratários em pacientes elegíveis. Vários esquemas de altas doses de quimioterapia têm sido propostos como regimes de condicionamento. Os mais comumente utilizados são esquemas contendo Carmustina em combinação com outras drogas, entre elas o Melfalano. Com a súbita indisponibilidade da Carmustina e o abastecimento irregular de Melfalano no mercado brasileiro, houve necessidade de substituição dos esquemas tradicionais. Dentre as alternativas disponíveis o regime LACE (Lomustina, Citarabina, Ciclofosfamida e Etoposide) é atrativo pois utiliza a Lomustina em substituição à Carmustina e não utiliza Melfalano, suprindo as duas principais deficiências de drogas encontradas no mercado brasileiro na atualidade. Objetivo: Implantar no Serviço de Transplante de Medula Óssea do Hospital das Clínicas da Faculdade de Medicina de Botucatu um protocolo padrão de condicionamento em linfomas baseado no esquema LACE. Avaliar os perfis de toxicidades e compará-las historicamente com outros esquemas clássicos de condicionamento. Materiais e Métodos: entre Abril de 2019 e Dezembro de 2020 foram incluídos consecutivamente 14 pacientes adultos portadores de Linfomas não-Hodgkin ou Linfoma de Hodgkin com indicação de transplante autólogo de células progenitoras hematopoiéticas submetidos a condicionamento com regime LACE. Resultados: O tempo mediano para enxertia de neutrófilos foi 11 dias e para plaquetas de 13 dias. Todos os pacientes tiveram quadros infecciosos controlados com suporte antimicrobiano adequado. As toxicidades foram, em sua maioria, de graus leves e comparáveis à outros esquemas clássicos, com redução expressiva das taxas de mucosite oral. Conclusão: O esquema LACE é um regime de condicionamento factível e bem tolerado pelos pacientes, com toxicidade aceitável e comparável a esquemas clássicos de condicionamento.
High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation is the treatment of choice for relapsed and refractory lymphomas. Several high-dose chemotherapy regimens have been proposed as conditioning regimens. The most used are those containing Carmustine in combination with other drugs, including Melphalan. With the shortage of Carmustine in the Brazilian market, associated with an irregular supply of Melphalan, there is a need to look for alternative conditioning regimens. The LACE regimen (Lomustine, Cytarabine, Cyclophosphamide, and Etoposide) is attractive because it includes Lomustine instead of Carmustine and does not include Melphalan. Therefore, it is a feasible regimen to be used in Brazil. Objective: to implement LACE as the standard conditioning protocol for lymphomas in the Bone Marrow Transplantation Service at Hospital das Clínicas of Botucatu Medical School; to assess toxicity profile and tolerability compared to other classical conditioning schemes. Materials and Methods: between April 2019 and December 2020, 14 consecutive adult patients with non-Hodgkin or Hodgkin lymphoma with an indication for autologous hematopoietic stem-cell transplantation were included and submitted to LACE-based conditioning. Results: The median time for neutrophil engraftment was 11 days, and for platelets, 13 days. All patients had infectious conditions controlled with the appropriate antimicrobial support. Toxicities were mostly mild (grades 1 and 2) and comparable to those described for classical conditioning regimens, with the advantage of significantly reduced rates of oral mucositis. Conclusion: LACE is a feasible and well-tolerated conditioning regimen with an acceptable toxicity profile.
High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation is the treatment of choice for relapsed and refractory lymphomas. Several high-dose chemotherapy regimens have been proposed as conditioning regimens. The most used are those containing Carmustine in combination with other drugs, including Melphalan. With the shortage of Carmustine in the Brazilian market, associated with an irregular supply of Melphalan, there is a need to look for alternative conditioning regimens. The LACE regimen (Lomustine, Cytarabine, Cyclophosphamide, and Etoposide) is attractive because it includes Lomustine instead of Carmustine and does not include Melphalan. Therefore, it is a feasible regimen to be used in Brazil. Objective: to implement LACE as the standard conditioning protocol for lymphomas in the Bone Marrow Transplantation Service at Hospital das Clínicas of Botucatu Medical School; to assess toxicity profile and tolerability compared to other classical conditioning schemes. Materials and Methods: between April 2019 and December 2020, 14 consecutive adult patients with non-Hodgkin or Hodgkin lymphoma with an indication for autologous hematopoietic stem-cell transplantation were included and submitted to LACE-based conditioning. Results: The median time for neutrophil engraftment was 11 days, and for platelets, 13 days. All patients had infectious conditions controlled with the appropriate antimicrobial support. Toxicities were mostly mild (grades 1 and 2) and comparable to those described for classical conditioning regimens, with the advantage of significantly reduced rates of oral mucositis. Conclusion: LACE is a feasible and well-tolerated conditioning regimen with an acceptable toxicity profile.
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Palavras-chave
Condicionamento para o transplante, Doença de hodgkin, Linfomas não hodgkin, Transplante autólogo, Transplante de células-tronco hematopoéticas