Fisiopatologia e tratamento da leucemia mielóide crônica: novos conceitos e perspectivas
DOI:
https://doi.org/10.32635/2176-9745.RBC.1996v42n2.2894Palabras clave:
Leucemia Mielóide Crônica, Cromossomo Philadelphia, Translocação BCR/ABL, Transplante De Medula Óssea, Interferon-AlfaResumen
Descobertas recentes sobre a atividade do gene quimérico BCR/ABL têm auxiliado na elucidação de diversos mecanismos envolvidos na gênese e progressão da leucemia mieloide crônica (LMC). Apesar de a LMC ser ainda, uma doença incurável para os pacientes que não podem submeter-se a um transplante alogênico de medula óssea, a sobrevida geral tem aumentado progressivamente, devido especialmente a medidas capazes de prolongar a fase crônica. A técnica de reação da polimerase em cadeia (PCR) para a detecção do gene quimérico BCR/ABL tem sido um teste bastante valioso para a identificação de casos Philadelphia negativos que apresentam o rearranjo genético ao nível molecular e para a detecção de doença residual mínima, especialmente em indivíduos transplantados. Novas formas de tratamento devem traduzir-se em maior sobrevida nos próximos anos quando utilizadas em estágios precoces da doença: transplante autólogo de células-tronco com células mobilizadas e coletadas após quimioterapia em altas doses, o uso de interferon e a terapia gênica. O interferon já é a droga de escolha para o tratamento da maioria dos pacientes. O transplante autólogo é um procedimento promissor que tem sido aplicado por vários centros como uma alternativa ao transplante alogênico. Os resultados de diferentes estratégias de terapia gênica têm sido desapontadores até o momento, mas a melhoria tecnológica neste campo do conhecimento será extremamente interessante para o tratamento da LMC, considerando-se o papel biológico central do gene BCR/ABL nas células malignas.
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