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Colegio de Medicina Interna de México.

2006, Número 2

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Med Int Mex 2006; 22 (2)


El método mexicano para trasplante de células totipotenciales hematopoyéticas rompió dogmas y favoreció a muchos pacientes

Ruiz AGJ, Suárez GL, Gómez AD

Idioma: Español
Referencias bibliográficas: 66
Paginas: 128-138
Archivo PDF: 248.51 Kb.


RESUMEN

Durante mucho tiempo se consideró, de manera equívoca, que la razón por la que los trasplantes de médula ósea podían curar a los pacientes con hemopatías malignas era porque permitían la administración de cantidades elevadas de quimioterapia o radioterapia y porque la función de las células trasplantadas era sólo la de restablecer la hematopoyesis del paciente después de recibir el tratamiento mieloablativo. Ahora está claro que la razón principal por la que los trasplantes de células hematopoyéticas alogénicas pueden curar a los pacientes con neoplasias es por la inducción del efecto de injerto contra tumor, que es parte del efecto de injerto contra huésped. En el año de 1999 se diseñó en México un método para realizar trasplantes hematopoyéticos, conocido como método mexicano de acondicionamiento no mieloablativo, que utiliza fármacos accesibles y baratos, como la ciclofosfamida, el busulfano y la fludarabina. Con este método se han hecho trasplantes hematopoyéticos en más de 300 pacientes. Cerca de una cuarta parte de los pacientes no necesitó trasfusiones de glóbulos rojos y un tercio de éstos no necesitó trasfusión de plaquetas. En más del 80% de los casos el procedimiento del trasplante pudo completarse de manera extrahospitalaria. La mediana de supervivencia post-trasplante no se ha alcanzado y la supervivencia a 2,000 días es del 54%. La mortalidad a 100 días es del 16% y la mortalidad relacionada con el trasplante del 20%. Los mejores resultados se obtuvieron en la leucemia granulocítica crónica en primera fase crónica (92% de supervivencia a 750 días) y los menos halagüeños en la leucemia aguda linfoblástica (22% de supervivencia a 1,600 días), con cifras intermedias para la leucemia aguda mieloblástica (66% de supervivencia a 860 días) y la anemia aplástica (91% de supervivencia a 1,500 días). El costo promedio de cada trasplante es de 20 mil dólares americanos. Sin embargo, el método mexicano para realizar los trasplantes alogénicos no mieloablativos no se ha escapado del efecto Mateo. Dicho método, que se ha usado en varios países y que ha demostrado tener varias ventajas sobre otros, lo han ignorado de forma deliberada investigadores nacionales e internacionales y también lo han criticado de manera negativa algunos médicos nacionales. Se espera que con el paso del tiempo y con los resultados obtenidos se le pueda ubicar en el lugar que se merece.


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