UČESTALOST SLABOSTI KALEMA NAKON ALOGENE TRANSPLANTACIJE MATIČNIH ĆELIJA HEMATOPOEZE
Sažetak
Uvod: Slabost kalema predstavlja jednu od mogućih komplikacija nakon alogene transplantacije matičnih ćelija hematopoeze (alo-TMĆH). Manifestuje se kao pancitopenija ili bicitopenija, sa potpunim ili nepotpunim donorskim himerizmom. Tri entiteta slabosti kalema su: slaba funkcija kalema (engl. poor graft function – PGF), slabost kalema u užem smislu (engl. graft failure – GF) i odbacivanje kalema (engl. – graft rejection – GR).
Cilj: Cilj ovog istraživanja je da pokaže učestalost slabosti kalema kod pacijenata, nakon alogene transplantacije matičnih ćelija hematopoeze, u periodu od 20. decembra 2017. godine do 25. decembra 2020. godine, na Klinici za hematologiju Univerzitetskog kliničkog centra Srbije (UKCS), kao i učestalost svake vrste slabosti pojedinačno, radi boljeg rešavanja i razumevanja ove ozbiljne komplikacije.
Materijali i metode: U retrospektivnu kohortnu studiju je uključeno 58 bolesnika. Slabost kalema je dijagnostikovana kao pancitopenija (granične vrednosti: hemoglobin < 70g/l; ANC < 0,5 x 109/L; broj trombocita < 20 x 109/L), tri dana zaredom, od D+28, pri isključenju teškog oblika GvHD-a i relapsa, sa potpunim donorskim himerizmom kod PGF-a, a sa nepotpunim donorskim himerizmom kod GF-a. GR je dijagnostikovan prilikom akutnog odbacivanja kalema od strane recipijenta sa aplazijom koštane srži ili pancitopenijom.
Rezultati: Slabost kalema je imalo 13 (22,4%) pacijenata. Najveću zastupljenost je imao PGF sa sedam slučajeva (12,1% od 58 pacijenata; 53,8% od 13 pacijenata), dok je GF bio zastupljen sa tri slučaja (5,2% od 58 pacijenata; 23,1% od 13 pacijenata), kao i GR, koji se takođe desio u tri slučaja (5,2% od 58 pacijenata; 23,1 % od 13 pacijenata). Preživljavanje pacijenata sa slabošću kalema je bilo pet meseci, dok je za pacijente bez slabosti kalema bilo 57 meseci.
Zaključak:Sva tri tipa slabosti moraju se jasno diferencijalno dijagnostikovati u odnosu na himerizam, jer definisanje tačnog tipa slabosti može značajno da utiče na terapijski pristup pacijentu i konačni ishod.
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