UČESTALOST I TERAPIJA RELAPSA NAKON ALOGENE TRANSPLANTACIJE MATIČNIH ĆELIJA HEMATOPOEZE
Sažetak
Uvod/Cilj: Relaps osnovne bolesti nakon alogene transplantacije matičnih ćelija hematopoeze (alo-TMĆH) je jedna od najtežih i najćešćih posttransplantacijskih komplikacija i predstavlja vodeći uzrok neuspeha terapije i smrti pacijenata. Cilj rada jeste procena učestalosti i tipa relapsa, u odnosu na vreme javljanja; analiza uticaja kondicionih režima na pojavu relapsa; pregled terapijskih mogućnosti nakon pojave relapsa; kao i procena prognoze pacijenata koji ispolje relaps.
Metode: U retrospektivnu kohortnu studiju uključeno je 58 pacijenata kojima je izvršena alo-TMĆH. Pre transplantacije, sprovedena je terapija kondicionim režimom redukovanog intenziteta (RIC) ili mijeloablativnim režimom (MAC). Dijagnoza relapsa je postavljana analizom mijelograma, analizom citogenetike, analizom minimalne rezidualne bolesti, analizom ćelijskog himerizma, kao i analizom imunohematološkog himerizma antigena krvno grupnih sistema. Formirana je baza podataka po ispitivanim obeležjima bolesnika. Preživljavanje bolesnika analizirano je Kaplan-Majerovom metodom i upoređivano uz pomoć log-rank testa.
Rezultati: Češće je upotrebljavan MAC (43 pacijenta) u odnosu na RIC (15 pacijenata), kao kondicioni režim. Nakon transplantacije, relaps je imalo 18 (34%) od 53 pacijenta. Izbor kondicionog režima nije imao uticaja na javljanje relapsa, ali su pacijenti na RIC režimu duže živeli (38,5 ± 7 meseci) u odnosu na pacijente na MAC režimu (27,8 ± 3,5 meseci). Međutim, razlika u preživljavanju nije imala statistički značaj (p = 0,318). Prosečno vreme preživljavanja pacijenata koji su imali relaps iznosilo je 26 ± 5 meseci, dok je kod pacijenata koji nisu imali relaps iznosilo 41 ± 4 meseca.
Zaključak: Pacijenti koji su primili slabije kondicione režime (RIC) imali su duže vreme preživljavanja, bez povećanja stope relapsa. U budućnosti treba razmotriti uključivanje pacijenata starijih od 60 godina, kao kandidata za transplantaciju, kao i moguću primenu profilaktičke terapije, radi preveniranja relapsa kod visokorizičnih pacijenata.
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