Diferença na reconstituição imune específica para o citomegalovírus pós transplante de células tronco-hematopoiéticas autólogo e alogênico
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2019-02-21
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Universidade Estadual Paulista (Unesp)
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O citomegalovírus (CMV) é uma das principais causas de morbidade e mortalidade em receptores de transplante de células tronco hematopoiéticas. As complicações que podem surgir após o transplante são numerosas e diversas, estando o CMV e a doença do enxerto contra o hospedeiro (DECH) entre as mais importantes. A infecção pelo CMV pode afetar qualquer órgão e células do sistema imunitário e os receptores soropositivos para o CMV estão sob risco de reativação. Receptores de transplante alogênico de células tronco-hematopoiéticas têm um risco significantemente maior de infecção por CMV em comparação com receptores de transplante autólogo em função do uso de imunossupressores na profilaxia da DECH. O trabalho teve como objetivo a implantação e a avaliação da reconstituição imune CMV-específica através de uma técnica de dosagem de interferon-gama (Quantiferon-CMV). Observou-se que a reconstituição imune CMV-específica foi diferente em cada tipo de TCTH. Os pacientes autólogos mantiveram a imunidade até o d+120, diferentemente dos alogênicos. Já nos alogênicos, observou-se que os pacientes que realizaram TCTH do tipo aparentado, obtiveram uma recuperação imune CMV-específica melhor que o não-aparentado e o haploidêntico até o D+60. Nenhum paciente do tipo haploidêntico recuperou a imunidade no D+30. No D+90 observou-se que cerca de 60% dos receptores de transplantes alogênicos recuperaram a imunidade CMV-específica, variando entre 55,5% a 67,5.
Cytomegalovirus (CMV) is one of the leading causes of morbidity and mortality in hematopoietic stem cell transplant recipients. The complications that may arise after transplantation are numerous and diverse, with CMV and graft versus host disease (GVHD) being among the most important. CMV infection can affect any organ and cells of the immune system, and CMV seropositive recepients are at risk of reactivation. Allogeneic hematopoietic stem cell transplant (HSCT) recipients have a significantly increased risk of CMV infection compared to autologous HSCT recipients due to the use of immunosuppressive drugs in the prophylaxis of GVHD. The aim of the study was to implement and evaluate CMV-specific immune reconstitution through an interferon-gamma releasing assay (Quantiferon-CMV). It was observed that CMV-specific immune reconstitution was different in each type of HSCT. Autologous patients maintained immunity until D+120, unlike the allogeneic HSCT recipients. Among the allogeneic HSCT, we observed that recipients of matched related donor HSCT showed a faster CMV-specific immune recovery in comparison with the patients receiving unrelated and haploidentical donor HSCT until D+60. No haploidentical HSCT rcipients recovery CMV-immunity on D+30. At D+90, approximately 60% of the allogeneic transplant recipients had recovered CMVspecific immunity, ranging from 55.5% to 67.5.
Cytomegalovirus (CMV) is one of the leading causes of morbidity and mortality in hematopoietic stem cell transplant recipients. The complications that may arise after transplantation are numerous and diverse, with CMV and graft versus host disease (GVHD) being among the most important. CMV infection can affect any organ and cells of the immune system, and CMV seropositive recepients are at risk of reactivation. Allogeneic hematopoietic stem cell transplant (HSCT) recipients have a significantly increased risk of CMV infection compared to autologous HSCT recipients due to the use of immunosuppressive drugs in the prophylaxis of GVHD. The aim of the study was to implement and evaluate CMV-specific immune reconstitution through an interferon-gamma releasing assay (Quantiferon-CMV). It was observed that CMV-specific immune reconstitution was different in each type of HSCT. Autologous patients maintained immunity until D+120, unlike the allogeneic HSCT recipients. Among the allogeneic HSCT, we observed that recipients of matched related donor HSCT showed a faster CMV-specific immune recovery in comparison with the patients receiving unrelated and haploidentical donor HSCT until D+60. No haploidentical HSCT rcipients recovery CMV-immunity on D+30. At D+90, approximately 60% of the allogeneic transplant recipients had recovered CMVspecific immunity, ranging from 55.5% to 67.5.
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Transplante de células tronco hematopoiéticas, Citomegalovírus, Quantiferon, Hematopoietic stem cell transplantation, Cytomegalovirus, Quantiferon