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Jornal de Pediatria
On-line version ISSN 1678-4782
CASTRO JR., Cláudio Galvão de; GREGIANIN, Lauro José and BRUNETTO, Algemir Lunardi. Clinical and epidemiological analysis of bone marrow transplantation in a pediatric oncology unit. J. Pediatr. (Rio J.) [online]. 2003, vol.79, n.5, pp. 413-422. ISSN 1678-4782. http://dx.doi.org/10.1590/S0021-75572003000500008.
OBJECTIVES: To describe the demographics and the most important acute clinical complications in patients undergoing bone marrow transplantation in the Pediatric Oncology Unit at Hospital de Clínicas de Porto Alegre, Brazil. MATERIAL AND METHODS: A retrospective analysis was performed including 41 patients treated between August 1997 and June 2002. Twenty patients received allogeneic transplants (AG) and 21 received autologous transplants (AT). RESULTS: The mean age of AG patients was 8.9 + 5.4 years. Twelve patients were male. Stem cell sources were: bone marrow in 12 patients; peripheral blood in 5; and unrelated cord blood in 3. The diseases were acute lymphoid leukemia in 7 patients; acute myeloid leukemia in 4; chronic myeloid leukemia in 2; myelodysplastic syndrome in 2; Burkitt's lymphoma in 1; severe combined immunodeficiency in 1; Chediaki-Higashi syndrome in 1; Fanconi anemia in 1; and aplastic anemia in 1. One patient developed grade II acute graft-versus-host-disease (GVHD), and three patients had grade IV GVHD. Three patients developed chronic GVHD. In all of them, the cell source was peripheral blood. Survival in this group was 70.0 + 10.3%. The main cause of death was GVHD in three patients and sepsis in another three. All deaths occurred before day 100. One of the patients who received unrelated cord blood is alive 3.5 years after the transplantation. In AG patients, mean age was 8.7 + 4.3 years. Eleven patients were male. The stem cell sources were: peripheral blood in 16; bone marrow in 3; and peripheral blood + bone marrow in 2. The diseases were: Wilms' tumor in 5 patients; Ewing's sarcoma family tumors in 4; neuroblastoma in 3; Hodgkin's disease in 3; non-Hodgkin's lymphoma in 1; rhabdomyosarcoma in 2; neuroectodermic tumor of the central nervous system in 2; acute myeloid leukemia in 1. Survival in this group was 59.4 + 11.7%. Five patients died due to tumor relapse, 2 patients due to sepsis and one patient died in remission 20 months after bone marrow transplantation due to infection. In the whole group, the most common toxicities were vomiting, mucositis, diarrhea and abdominal pain. Infections were recorded in 58.5% of the patients. In 46.9%, at least one pathogen was isolated in the blood culture. The time required for neutrophil and platelet engraftment was correlated to the number of hematopoietic stem cell infused. CONCLUSION: The overall survival in our patients is similar to that reported in the literature. We did not find differences between AT and AG patients regarding acute toxicities and infections.
Keywords : Bone marrow transplantation; pediatric cancer; umbilical cord blood; hematopoietic stem cell.