Epidemiological characterization of patients submitted to hematopoietic stem cell transplantation at a reference center in Curitiba, Paraná, Brazil, 2011-2015
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Abstract
Introduction: Hematopoietic stem cell transplantation (HSCT) is the only alternative for the treatment of some diseases. However, there is a shortage of studies in Brazilian population. Objective: To identify the profile of patients submitted to HSCT at the Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), between 2011 and 2015, based on demographic variables, diagnosis, duration of hospitalization and the mortality ration in the institution. Methods: Time Series Studies research based on data from the Hospital Information System. The trend in the distribution of proportions over the years was evaluated through Cochran‑Armitage test and negative binomial regression. The presence of serial autocorrelation was tested by the Durbin‑Watson test. Results: From 2011-2015 Paraná was responsible for 9.2% of HSCT performed in Brazil. HC/UFPR accounted for 46.0% of these procedures performed in Paraná. There were no significant variations in the sex distribution (p=0.788) and number of HSCT (p=0.213). 59.5% of the patients were from PR, 49.4% were between 0 and 17 years old, 79.9% were white, and 63.5% were male. The allogeneic HSCT was the most performed procedure (88.5%). 58.5% were hospitalized from 31 to 60 days (mean=37.6 days). 9.1% died. Acquired aplastic anemia was the most common underlying disease (31.9%). Conclusion: HSCT is a procedure of high cost and complexity. The study and the understanding of the determinants of its success are of extreme importance for the best planning, risk estimation and elaboration of public health policies.
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Wingard JR, Vogelsang GB, Deeg HJ. Stem call transplantation: supportive care and long-term complications. Hematology Am Soc Hematol Educ Program. 2002;2002(1):422-44. http://dx.doi.org/10.1182/asheducation-2002.1.422
Oliveira-Cardoso EA, Mastropietro AP, Voltarelli JC, Santos MA. Qualidade de vida de sobreviventes do transplante de células-tronco hematopoéticas: um estudo prospectivo. Psic Teor Pesq. 2009;25(4):621-8. http://dx.doi.org/10.1590/S0102-37722009000400018
Ortega ETT, Lima DH, Veran MP, Kojo TK, Neves MI. Compêndio de enfermagem em transplante de células tronco hematopoéticas: rotinas e procedimentos em cuidados essenciais e em complicações. Curitiba: Editora Maio, 2004; p.435.
Castro JR CG. Análise Clínica e Epidemiológica do Transplante de Medula Óssea no serviço de oncologia pediátrica do Hospital de Clínicas de Porto Alegre. Dissertação (Mestrado) - Faculdade de Medicina, Universidade Federal do Rio Grande do Sul. Porto Alegre: 2002; p.161.
Brasil. Ministério da Saúde. Portaria MS no 931, de 02 de maio de 2006. Aprova o Regulamento técnico para transplante de células-tronco hematopoéticas. Diário Oficial da União. 2006;48-52.
Hodgkinson KM, Kiernan J, Shih AW, Solh Z, Sheffield WP, Pineault N. Intersecting Worlds of Transfusion and Transplantation Medicine: An International Symposium Organized by the Canadian Blood Services Centre for Innovation. Transfus Med Rev. 2017;31(3):183-92. http://dx.doi.org/10.1016/j.tmrv.2017.03.001
Niederwieser D, Baldomero H, Szer J, Gratwohl MAM, Aljurf M, Atsuta Y, et al. Hematopoietic stem cell transplantation activity worldwide in 2012 and a SWOT analysis of the Worldwide Network for Blood and Marrow Transplantation Group including the global survey. Bone Marrow Transplant. 2016;51(6):778-85. http://dx.doi.org/10.1038/bmt.2016.18
Associação Brasileira de Transplante de Órgãos (ABTO). Dimensionamento dos transplantes no Brasil e em cada estado (2008-2015). Registro Bras Transp. 2015;21(4):6-81.
Sousa, AM. Fatores prognósticos para sobrevivência após transplante de células-tronco hematopoéticas em portadores de anemia aplástica. Tese (Mestrado) - Escola Nacional de Saúde Pública Sérgio Arouca. Rio de Janeiro: 2012; p.113.
Yanagi Y, Assunção JV, Barrozo LV. The impact of atmospheric particulate matter on cancer incidence and mortality in the city of São Paulo, Brazil. Cad Saúde Pública. 2012;28(9):1737-48. http://dx.doi.org/10.1590/S0102-311X2012000900012
Andrade CT, Magedanz AMPCB, Escobosa DM, Tomaz WM, Santinho CS, Lopes TO, et al. A importância de uma base de dados na gestão de serviços de saúde. Einsten. 2012;10(3);360-5. http://dx.doi.org/10.1590/S1679-45082012000300018
Corgozinho MM, Gomes JRAA, Garrafa V. Transplantes de medula óssea no Brasil: Dimensão Bioética. Rev Latinoam Bioet. 2012;12(1):36-45.
Azevedo IC. Perfil clínico, epidemiológico e sobrevida dos transplantados com celúlas-tronco hematopoéticas em um serviço de referência no Rio Grande do Norte. Tese (Mestrado) - Universidade Federal do Rio Grande do Norte. Natal: 2016; p.77.
Cabral DCP, Silva RCP, Lacerda ACT, Diniz JMT, Guedes DBB. Análise dos transplantes de medula óssea realizados em pernambuco no período de 2011 a 2012. Rev Bras Med. 2014;71(Esp. 1):2-10.
Antunes JLF, Cardoso MRA. Uso da análise de séries temporais em estudos epidemiológicos. Epidemiol Serv Saúde. 2015;24(3):565-76. http://dx.doi.org/10.5123/S1679-49742015000300024
Empresa Brasileira de Serviços Hospitalares (EBSERH). HC em números. Disponível em: http://www.ebserh.gov.br/web/chc-ufpr/hcnumeros. Acesso em: 03 Maio 2017.
Hospital de Clínicas, Universidade Federal do Paraná (UFPR). 50 anos. Rev Hospital. 2011;(Ed esp.):10-20.
Silva LCL, Pasquini R. Análise da rejeição nos pacientes transplantados por anemia aplástica severa condicionados com ciclofosfamida ou a associação desta ao bussulfano. Rev Bras Hematol Hemoter. 2005;27(1):5-11. http://dx.doi.org/10.5123/S1679-49742015000300024
Eckrich M, Pasquini M. Hematopoietic cell transplantation in Latin America. Hematology. 2012;17(Supl. 1):189-92. http://dx.doi.org/10.1179/102453312X13336169157059
Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Portaria SAS/MS nº 1300, de 21 de novembro de 2013. Aprova o protocolo clínico e diretrizes terapêuticas da Anemia Aplástica Adquirida. Diário Oficial União. 2013;66-68.
Tabak DG, Pereira SCM, Nogueira MD. Transplante de célula-tronco hematopoética para síndrome mielodisplásica. Rev Bras Hematol Hemoter. 2010;32(Supl. 1):66-70. http://dx.doi.org/10.1590/S1516-84842010005000016
Wildes TM, Stirewalt DL, Medeiros B, Hurria A. Hematopoietic stem cell transplantation for hematologic malignancies in older adults: geriatric principles in the transplant clinic. J Natl Compr Cancer Netw. 2014;12(1):128-36.
Federmann B, Faul C, Meisner C, Vogel W, Kanz L, Bethge WA. Influence of age on outcome after allogeneic hematopoietic cell transplantation: a single centar study in patients aged ≥ 60. Bone Marrow Transpl. 2015;50(3):427-31. http://dx.doi.org/10.1038/bmt.2014.292
Jagasia M, Arora M, Flowers M, Chao NJ, McCarthy PL, Cutler CS, et al. Risk factors for acute GVHD and survival after hematopoietic cell transplantation. Blood. 2012;119(1):296-307. http://dx.doi.org/10.1182/blood-2011-06-364265
Azevedo W. Doença enxerto versus hospedeiro aguda A-GVHD. Rev Bras Hematol Hemoter. 2010;32(Supl. 1):16-21. http://dx.doi.org/10.1590/S1516-84842010005000060
Joshua TV, Rizzo JD, Zhang MJ, Hari PN, Kurian S, Pasquini M, et al. Access to Hematopoietic Stem Cell Transplantation Effect of Race and Gender. Cancer. 2010;116(14):3469-76. http://dx.doi.org/10.1002/cncr.25297
Volochko A, Vidal N de P. Desigualdades raciais na saúde: mortalidade nas regiões de saúde paulistas, 2005. Bol Inst Saúde. 2010;12(2):143-53.
Switzer GE, Bruce JG, Myaskovsky L, DiMartini A, Shellmer D, Confer DL, et al. Race and ethnicity in decisions about unrelated hematopoietic stem cell donation. Blood. 2013;121(8):1469-76. http://dx.doi.org/10.1182/blood-2012-06-437343
Little MT, Storb R. History of haematopoietic stem-cell transplantation. Nat Rev Cancer. 2002;2(3):231-8. http://dx.doi.org/10.1038/nrc748
Bicalho MG. HLA e minorias étnicas : quando menos significa muito. Rev Bras Hematol Hemoter. 2010;32(2):101. http://dx.doi.org/10.1590/S1516-84842010000200006
Ruiz TM, Costa SM, Ribas F, Luz PR, Lima SS, Bicalho MG. Human leukocyte antigen allelic groups and haplotypes in a brazilian sample of volunteer donors for bone marrow transplant in Curitiba, Paraná, Brazil. Transplant Proc. 2005;37(5):2293-6. http://dx.doi.org/10.1016/j.transproceed.2005.03.036
Watanabe AM, Omotto CA, Colli LD, Hayashi VMH. Percepção da comunidade nipo-brasileira residente em Curitiba sobre o cadastro de medula óssea. Rev Bras Hematol Hemoter. 2008;32(2):136-140. http://dx.doi.org/10.1590/S1516-84842010005000042
Andrade AM, Castro EAB, Soares TC, Santos KB. Vivências de adultos submetidos ao transplante de células-tronco hematopoéticas autólogo. Ciência Cuid Saúde. 2012;11(2):267-74. http://dx.doi.org/10.4025/cienccuidsaude.v11i2.15180
Brasil. Ministério da Saúde. Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos e Órteses, Próteses e Materiais especiais do SUS. Disponível em: http://sigtap.datasus.gov.br/tabela-unificada/app/sec/inicio.jsp. Acesso em: 25 jan. 2017.
Campos LG, Paz AA, Silla LMR, Daudt LE. Sobrevida de pacientes submetidos a transplante alogênico de medula óssea. Rev HCPA. 2009;29(2):127-32.
Santos KBS. Infecções no transplante de células-tronco hematopoéticas no hospital universitário da UFJF: a incidência dos principais microorganismos e os fatores de risco associado. Tese (Mestrado) - Universidade Federal de Juiz de Fora. Juiz de Fora: 2010.
Medeiros LA, Pasquini R. Anemia aplástica adquirida e anemia de Fanconi – Diretrizes Brasileiras em transplante de células-tronco hematopoéticas. Rev Bras Hematol Hemoter. 2010;32(Supl. 1):40-5.http://dx.doi.org/10.1590/S1516-84842010005000064
Passweg JR, Baldomero H, Bader P, Bonini C, Cesaro S, Dreger P, et al. Hematopoietic stem cell transplantation in Europe 2014 : more than 40 000 transplants annually. Bone Marrow Transplant. 2016;51(6):786-92. http://dx.doi.org/10.1038/bmt.2016.20