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2018, Número 1

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Rev Hematol Mex 2018; 19 (1)


Eficacia de un tratamiento dinámico “inspirado en adultos” para la reducción de recaídas tempranas en pacientes adultos con leucemia linfoblástica aguda

Ramos-Peñafiel C, Castellanos-Sinco H, Olarte-Carrillo I, Santoyo-Sánchez A, Rozen-Fuller E, León-González G, Kassack-Ipiña JJ, Montaño-Figueroa E, Collazo-Jaloma J, Martínez-Tovar A

Idioma: Español
Referencias bibliográficas: 43
Paginas: 5-16
Archivo PDF: 504.74 Kb.


RESUMEN

Antecedentes: El perfeccionamiento del tratamiento de la leucemia linfoblástica aguda del adulto ha permitido que los pacientes jóvenes (menores de 39 años) se beneficien al ser tratados con esquemas intensivos. Desafortunadamente su implementación es difícil y requiere una curva de aprendizaje, que puede comprometer el éxito terapéutico.
Objetivo: Identificar la eficacia en las recaídas de un protocolo inspirado en los principales esquemas prescritos para tratar las neoplasias linfoides en comparación con el registro histórico.
Material y Método: Estudio retrospectivo, observacional, efectuado de diciembre de 2013 a septiembre de 2017 en adultos con leucemia linfoblástica aguda atendidos en el Hospital General de México acorde con un protocolo intensivo (HGMLAL13) modificable según la enfermedad mínima residual. Los resultados se compararon con la cohorte histórica (HGMLAL07).
Resultados:De 340 pacientes, 75 fueron tratados de acuerdo con el protocolo intensivo (HGMLAL13) y se compararon con 265 casos correspondientes al registro histórico (57.4%). La media de edad fue de 32 años (16-79 años), en su mayoría de riesgo elevado (62.7%). La expresión del oncogén BCRABL1 se registró en 3.2% (n = 11). La frecuencia de recaídas a médula ósea fue menor en el protocolo intensivo en comparación con la cohorte histórica (21.3 vs 45.3%), la recaída aislada al sistema nervioso central fue semejante en los dos protocolos (2.7 vs 1.9%). La persistencia de una enfermedad mínima residual positiva en cualquier etapa de tratamiento (semana 12, 24 o 36) se asoció con incremento en el riesgo de recaída (OR: 2.05, 2.00 y 5.66, respectivamente). Por último, el tratamiento intensivo se comportó como factor protector contra la recaída (OR: 0.3604).
Conclusión: La implementación de esquemas intensivos y modificables acorde con el nivel de expresión de la enfermedad mínima residual es útil para el tratamiento de la leucemia linfoblástica aguda del adulto.


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