Altas Doses de VP-16, Ciclofosfamida e Irradiação Corpórea Total Hiperfracionada Seguida de Transplante Alogeneico de Medula óssea: Um Regime Agressivo e Bem Tolerado no Tratamento de Neoplasias Hematológicas de Mau Prognóstico – Resultados Preliminares
DOI:
https://doi.org/10.32635/2176-9745.RBC.1987v33n2.3204Palabras clave:
Altas Doses Quimioterapia, Transplante de Medula Óssea, Mucosite, LeucemiaResumen
No período de agosto/86 a fevereiro/87, três pacientes foram tratados com VP-16-1800mg/m2, em infusão única em 26 horas no dia -6, seguida por Ciclo fosfamida (EDX) 50mg/kg/d nos dias -4 e -3. Irradiação corpórea total (ICT) 1000 cGy em 5 frações de 200cG y nos dias -2, -1 e 0. O transplante de medula óssea (TMO) foi realizado no dia O utilizando doadores HLA compatíveis. O estudo incluiu três pacientes: um paciente portador de Leucemia Linfoblástica Aguda (LLA) em 1.ª recaída medular; um paciente portador de Leucemia Mielóide Crônica (LMC) em 2.ª fase crônica e um paciente portador de LLA em 2.ª remissão. A idade variou entre quatro e 29 anos. A principal toxicidade apresentada por este regime foi mucosite severa que ocorreu nos três pacientes. Todos os três pacientes apresentaram ulcerações orais e um deles apresentou diarréia hemorrágica com volume superiora dois litros. Em todos os pacientes o quadro se resolveu nas três semanas que se seguiram ao TMO. Um paciente apresentou alterações eletrocardiográficas significativas sem, entretanto, ocorrerem manifestações clínicas de cardiotoxicidade. A eficácia do regime pode ser testada no paciente em recaída que permanece em remissão 210 dias pós-TMO. No paciente portador de LMC houve eliminação do cromossomo Ph1. Concluímos que VP-16/EDX/ICT é um regime eficaz e bem tolerado no tratamento de neoplasias hematológicas.
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