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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2005, Número 2

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Rev Invest Clin 2005; 57 (2)


Trasplante de células progenitoras hematopoyéticas en síndromes mielodisplásicos

León-Rodríguez E

Idioma: Español
Referencias bibliográficas: 23
Paginas: 283-290
Archivo PDF: 66.27 Kb.


RESUMEN

Los síndromes mielodisplásicos (SMD) constituyen un grupo de enfermedades de las células progenitoras hematopoyéticas (CPH) caracterizadas por hematopoyesis ineficaz y una tendencia elevada a evolucionar a leucemia aguda. Hasta el momento actual el único tratamiento curativo lo representa el trasplante de CPH. Los resultados con esta terapia dependen de la variedad del SMD, de la edad de los pacientes al momento del trasplante y del índice pronóstico internacional. Los resultados de las principales series muestran una supervivencia libre de enfermedad (SLE) de 35-43%, con una recaída de 20 a 39% y una mortalidad asociada al trasplante (MRT) de 36 a 45%. Los mejores resultados se obtienen en SMD de buen pronóstico (anemia refractaria/anemia refractaria con sideroblastos en anillo) con SLE de 53-72% y una frecuencia de recaída de 13%, en contraste con los SMD avanzados (anemia refractaria con exceso de blastos [AREB], AREB en transformación y leucemia aguda secundaria) en los que la SLE es de ~ 33%, la recaída de 23-34% y la MRT de 37-60%. El trasplante de CPH con donador vivo no relacionado es una opción para los pacientes que carecen de un donador familiar, con SLE de ~30% pero con una elevada MRT que llega a ser hasta de 58%. Los trasplantes con acondicionamiento de intensidad reducida (minitrasplantes) son factibles de realizar en pacientes de edad avanzada, aunque su eficacia está aún por determinarse.


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