Transplante de Progenitores Hematopoiéticos

Consumo Transfusional

 

Fátima Amado*, Marika Bini-Antunes*, Luísa Santos*, Maria Rosales*, Fernando Campilho†, Pedro Pimentel†, Alzira Carvalhais†

*Departamento de Imuno-Hemoterapia;

†Serviço de Transplantação de Médula Óssea, Instituto Português de Oncologia Francisco Gentil, Porto

 

O objectivo deste estudo foi avaliar, nos doentes submetidos a transplante de progenitores hematopoiéticos (TPH) alogénico, o efeito do regime de condicionamento, da fonte de progenitores, das compatibilidades ABO e HLA e do parentesco do par dador/receptor no consumo transfusional no período pós-transplante.

Avaliamos retrospectivamente os doentes submetidos ao primeiro alotransplante no período compreendido entre Janeiro 2003 e Setembro 2005. Consultaram-se as bases de dados do Departamento de Imuno-Hemoterapia. A análise estatística foi realizada com recurso ao programa SPSS®. No período considerado realizaram-se 97 alotransplantes, dos quais 94 foram primeiros transplantes e elegíveis para o estudo (43,6% sexo feminino e 56,4% sexo masculino, mediana de idades de 38,5 anos, limites 6 meses-66 anos).

Foram submetidos a um regime de condicionamento mieloablativo 50 doentes (53,2%) e a condicionamento de intensidade reduzida (CIR) 44 doentes (46,8%).

Relativamente à fonte de progenitores utilizados, em 88,3 % dos doentes (n=83) foram células progenitoras hematopoiéticas perifericas (CPHP), em 7,5% (n=7) medula óssea (MO) e em 4,2% (n=4) sangue de cordão umbilical (SCU). No que respeita ao sistema HLA e ao parentesco, 95,7 % (n=90) dos transplantes foram HLA compatíveis e 87,2% (n=82) foram de dador relacionado. Relativamente ao sistema ABO do par dador/receptor, 27,6% (n=26) dos casos apresentavam incompatibilidade maior, 10,6% (n=10) menor e 57,4% (n=54) eram compatíveis.

Não observamos diferenças estatisticamente significativas nas medianas de episódios transfusionais de concentrados de eritrócitos (CE) e de concentrados de plaquetas (CP) no que se refere a incompatibilidade ABO (p>0,05).

Nos doentes transplantados com CPHP observamos uma tendência para um menor consumo transfusional de CP relativamente aos transplantados com SCU e MO. No entanto, o teste estatístico aplicado não mostrou um resultado significativo para os CE (p=0,054), provavelmente por causa do pequeno número de doentes transplantados com SCU e MO na população estudada.

Os CIR foram associados a um menor consumo de CP (p< 0,0001).

Não observamos diferenças significativas no número de episódios transfusionais de CE e CP no que se refere a incompatibilidade HLA e ao parentesco no par dador/receptor (p>0,05).

Palavras-chave: transplante alogénico; progenitores hematopoiéticos; compatibilidade; transfusões; concentrados de plaquetas; concentrados de eritrócitos.

 

 

Transfusion Requirements After Allogeneic Hematopoietic Stem Cell Transplantation

 

We retrospectively studied all the first allogeneic hematopoietic stem cell transplantation (HSCT) performed in our Centre between January 2003 and September 2005. We evaluated the influence of haematopoietic stem cell source, ABO and HLA compatibility and relationship in donor/recipient pair as well as conditioning regimen (myeloablative versus reduced intensity) on transfusion requirements. We analysed patients’ transfusion requirements during a 100 days period after transplantation. The medians of red blood cells (RBC) and platelets (PL) transfusion episodes (TE) were considered as an estimative of the transfusion requirements. We performed a statistical analysis recurring to the SPSS® software.

Ninety four patients (43.6% women, 56.4% men), median age 38.5 years (range 6 months-66 years), were submitted to a first HSCT. In 88.3% (n=83) of patients the haematopoietic stem cell source was peripheral blood, in 7.4% (n=7) bone marrow (BM) and in 4.3% (n=4) umbilical cord blood (UCB). In 95.7% of cases there was HLA compatibility and in 87.2% a relationship between the donor and the recipient. We observed a major ABO incompatibility in 27.6% (n=26) of cases and minor in 10.6% (n=10). In 57.4% (n=54) of transplants there was ABO compatibility. Conditioning regimen was myeloablative and of reduced intensity in 53.2% (n=50) and in 46.8% (n=44) of patients, respectively. We observed that ABO compatibility had not a major impact on transfusion requirements (p>0.05).

Patients transplanted with peripheral blood progenitor cells (PBPC) showed a tendency to a lesser PL transfusion need when compared to patients transplanted with UCB and BM but the test applied was not significant for RBC, probably because of the low number UCB and BM transplants considered in this study.

Reduced intensity conditioning was associated with a reduced PL transfusion need (p< 0.0001).

In unrelated transplants and HLA mismatches the transfusion episodes after transplantation were not higher when compared to related and HLA compatible transplants (p>0.05).

Key-words: hematopoietic stem cell transplantation; transfusion.

 

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Correspondência:

Dr.ª Marika Bini-Antunes

Departamento de Imuno-Hemoterapia

IPO Francisco Gentil, EPE

Rua António Bernardino Almeida

4200-072 Porto

e-mail: marika.bini@email.it