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THE BRAZILIAN SOCIETY FOR BLOOD AND MARROW TRANSPLANTATION (SBTMO) PRESENTS THE BRAZILIAN GUIDELINES ON HEMATOPOIETIC STEM CELL TRANSPLANTATION

THE BRAZILIAN SOCIETY FOR BLOOD AND MARROW TRANSPLANTATION (SBTMO) PRESENTS THE BRAZILIAN GUIDELINES ON HEMATOPOIETIC STEM CELL TRANSPLANTATION

This is an observational and cross-sectional study, carried out in May 2020, targeting adult individuals of both sexes who are members of multiprofessional teams working in Brazilian HSCT units in the current period of the pandemic by completing and analyzing a questionnaire. pre-formulated. HSCT units that cannot access the questionnaire were excluded from the study. The analysis of the operation profile of HSCT units in Brazil, through the application of a pre-structured questionnaire, is not an accurate tool, since it assumes some premises that may prove to be wrong, especially in this current scenario in Brazil. However, the data reveal the vulnerability of patients with onco-hematological diseases to infection by COVID-19, especially during HSCT procedures, in relation to the general population. Despite its limitations, it can be valuable to plan policies.

Introduction: Microvascular endothelial damage is a well-recognized complication of bone marrow transplantation (BMT) and the mechanisms of this disorder are still poorly under­stood. The objective of this scenario is to evaluate the relationship between inflammatory markers and other factors that influence platelet consumption and platelet transfusion yield, as well as the presence of embolic and / or vascular thrombotic events in patients submitted to high-dose chemotherapy conditioning for Bone marrow transplant. Material and Methods: Prospective analysis of patients, including 25 patients who under­went autologous and allogenic BMT. The patients were evaluated in relation to previous radiotherapy, CD34 + cell count, period of neutropenia, body mass index (BMI), ferritin, re­active C protein (RCP), relating these factors to the number of platelet transfusions, plate­let refractoriness and vascular events such as sinusoidal obstruction syndrome (SOS) and bone marrow grafting syndrome. Results: Only BMI> 25 Kg / m2 of the studied variables presented a statistically significant value (p = 0.003) in relation to the lower need for transfusion of platelet concentrate. For platelet refractoriness and / or vascular events none of the variables was statistically sig­nificant. The conditions found in the 3 cases of platelet refractoriness and in the 2 cases of vascular events have characteristics like those described in the literature. Conclusion: Although the cause is unclear, we agree with data reported in the literature that patients with high BMI have a lower need for transfusion of platelets. Small sampling limits our comparisons and significant statistical inference; however, we cannot rule out the relevance of a descriptive analysis of the results, especially if we consider that each patient should be evaluated in an individualized way in clinical practice.

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The first HSCT program in Latin America started in 1979 at the Federal University Hospital (Curitiba, Paraná). Over the years, the number of centers performing transplants in the country increased, generating the need to know the results of this modality of treatment. Understanding the HSCT scenario in Brazil is still challenging since not all Brazilian centers report data to the Center for International Blood and Marrow Research (CIBMTR). Although it has been improving over the last years, infrastructure and trained data managers are still lacking. The partnership between the Brazilian Cellular Therapy and Bone Marrow Transplant Society (SBTMO) and the CIBMTR, allowed the return of Brazilian data registered in the CIBMTR, through the Data Back to Center (DBtC), in a standardized and organized way. With this database it was possible to know the demographic data and the outcomes of transplants performed in Brazil. Between 2012 and 2021, complete information of 7,982 transplants were reported to the CIBMTR from 31 Brazilian transplant centers. The consolidation of the Hematopoietic Stem Cell Transplantation Brazilian Registry (HSCTBR) using CIBMTR infrastructure, allowed the Brazilian Summary slides development and update. Despite the difference in the number of cases and of follow-up time, the results in this study were similar to those presented in the US Summary Slides.

Patients with multiple myeloma (MM) in clinical con­ditions to be referred to autologous hematopoietic stem cell transplantation (AHSCT) generally start therapy with an induction chemotherapy followed by high-dose alkylating and AHSCT. The ideal regimen and the number of pre-AHSCT induction is still a controversial subject, however, opting for at least three to four cycles of chemotherapy including a drug with immunomodulatory action, a protea­some inhibitor, with a corticosteroid, are advised as the first line before AHSCT.

Objective: The success of autologus hematopoietic stem cell transplantation relies on CD34+ cells' availability in peripheral blood (PB), which is affected by several factors as age, sex, type of the disease, treatments, and others. In that regard, this prospective study aimed to evaluate the influence of these factors, correlating them with the pre-apheresis CD34+ cell count. Method: Before autologous hematopoietic stem cell transplantation, CD34+ cells were quantified in the pre-apheresis PB and the final product. Then, after the determination of minimum CD34+ value, clinical and laboratory parameters were compared between patients with higher and lower CD34+ cells count. Results: Out of the 34 patients, 29 presented more than 20,000 leukocytes/μl. Patients who failed in the mobilization presented

Objectives: To compare the severity of oral mucositis and the frequency of gastrointestinal mucositis, and to observe if there is impact of these adverse effects on overall survival (OS), in patients who underwent CBV (carmustine, BCNU, and VP-16) and LEAM (lomustine, etoposide, Ara-C, and melphalan) conditioning for autologous hematopoietic cell transplantation (aHCT). Method: We collected retrospective data from medical records (n = 120) of transplantation and mucositis in the digestive tract of Hodgkin’s and non-Hodgkin’s lymphoma patients. Results: The frequency of OM grade 1 was higher in LEAM (36.76%) than in CBV (19.72%, p=0.038). There were no significant differences between the frequency of gastrointestinal mucositis in the two regimens (CBV - 52.11% and LEAM - 63.27%, p=0.305). CBV regimen exhibited lower 1-year overall survival (OS) than did LEAM (p=0.003). Oral mucositis grade ≥2 was associated with reduced OS in the CBV group (p=0.013). CBV regimen (HR=2.98, p 0.005) and oral mucositis grade ≥2 (HR=2.17, p=0.013) interfered negatively on the OS rate. Conclusion: Oral mucositis was more severe in CBV than in LEAM, decreasing the OS rate. Further studies with comprehensive follow-up and toxicity analyses must be undertaken to clarify the safety of LEAM conditioning in the digestive tract.