doadores alternativos_iii_luciano costa

doadores alternativos_iii_luciano costa

ESTA PALESTRA NÃO PODERÁ
SER REPRODUZIDA SEM A
REFERÊNCIA DO AUTOR.
Haploidentical HCT:
TCD via CD34+ positive selection
Event Free Survival
ALL
•Survival rate higher if in CR at time of HCT
•Non relapse mortality = 41%
–Infection is leading cause
– CMV and Aspergillus
Non relapse mortality
AML
Aversa et al., Blood Cells, Molecules and Diseases 2008
Haploidentico com produto nao
manipulado e ciclofosfamida pos
transplante
• Median age = 51 y
• 28% prior BMT
• Dx: NHL, AML, ALL, myeloma,
MDS, CML
• Median f/u = 3 yrs
•
•
•
•
•
2-yr PFS :
34%
G2-4 GVHD: 27%
cGVHD:
13%
2-yr relapse: 51%
2-yr NRM: 15%
Kasamon et al, Blood 2011;118: abstr 840
Comparacao entre as duas
abordagens
Prep Regimen
Flu/Mel/TT
“
Post HCT CY:
CD34+ Sel:
GVH Prophylaxis Graft
Cy/MMF/Tac
BM
CD34+ graft/ATG
PB
Followup
11m
48m
n
Med
Age
1 Yr
OS
1 yr
PFS
Gr 2-4
aGVH
cGVH
NRM
Post
HCT
Cy
32
45y
64
50
20
7
16
CD34+
Sel
33
36y
30
21
11
18
42
.02
.02
.2
0.03
.02
p
Ciurea S, et al. BBMT 2012
BMT CTN PROTOCOL #0603
A Phase II Trial of Reduced Intensity Conditioning
and Transplantation of Partially HLAHLA-Mismatched Bone
Marrow for Patients with Hematologic Malignancies
BMT CTN PROTOCOL #0604
A Phase II Trial of Reduced Intensity Conditioning
and Transplantation of Umbilical Cord Blood from
Unrelated Donors in Patients with
Hematologic Malignancies
Brunstein, Fuchs, et al Blood 2011
45%
45%
31%
24%
7%
84%
74%
54%
46%
62%
48%
Brunstein, et al 2011
Treatment Schema –BMT CTN
1101
Patient
Eligibility including
Availability of both:
Two 4-6/6 HLA-matched UCB units and
a related Haploidentical donor
No Anti-donor HLA Antibodies
Randomization
Haplo-BM
Transplant
Double UCB
Transplant
Post-HCT Evaluations
for
3 years
Version 3.0
7
Vantagens
Haploidentico
Quase todos os pacientes tem ao menos um doador disponivel
Tempo de espera curto
Disponibilidade do doador para possivel DLI
Baixo custo (ciclofosfamida)
Desvantagens
Risco de infeccao e MRT (menos com ciclofosfamida)
Demora de pega medular
Possivel risco alto de recidiva
Alto custo e complexidade (manipulacao)
Disponibilidade de Doador para
Transplante Alogenico
• Aparentado, HLA compativel
25-30%
• Doador nao parentado
20-70%
• Cordao
40-80%
• Aparentado, com incompatibilidade HLA
1 Ag
10%
2 Ag
50%
3 Ag
90%
Obrigado!
[email protected]
[email protected]