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Colegio de Medicina Interna de México.

2006, Number 2

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Med Int Mex 2006; 22 (2)

The Mexican method to perform bone marrow transplantation broke dogmas and favored a lot of patients

Ruiz AGJ, Suárez GL, Gómez AD

Language: Spanish
References: 66
Page: 128-138
PDF size: 248.51 Kb.


ABSTRACT

Several dogmas have been broken as a consequence of the evolution of knowledge in the area of allogeneic hematopoietic stem cell transplantation. It is now clear that: a) for the successful engraftment of hematopoietic stem cell transplantation bone marrow ablation of the recipient is not required, b) hematopoietic stem cell transplantation create its own space through graft versus host reactions, c) several malignancies can be eradicated by the graft versus tumor effect, d) hematopoietic stem cell allografting can be conducted on an outpatient basis, e) hematopoietic stem cell allografting can be done in aged or debilitated individuals, f) hematopoietic stem cell allografting can be achieved without transfusion of blood products, and g) the costs of the allografting procedures can be substantially diminished. The use of non-myeloablative conditioning for stem cell allografting has been the main reason to break these dogmas: using the “Mexican” non-ablative conditioning regimen, we have allografted over 300 individuals in five different Latin American countries. With a median cost of 20,000 US dollars, we have allografted individuals with malignant and benign hematological diseases. The best results have been obtained in chronic myelogenous leukemia in chronic phase (92% survival at 750 days), whereas the worse results were obtained in relapsed acute lymphoblastic leukemia (22% survival at 1,600 days), with intermediate results for aplastic anemia (91% survival at 1,500 days) and acute myelogenous leukemia (66% survival at 860 days). Despite the fact that hematopoietic stem cell allografting with reduced intensity conditioning may be related with several disadvantages, such as mixed chimerism and relapse of the malignancy, breaking these dogmas has resulted in availability of hematopoietic stem cell allografting to a larger number of individuals worldwide, thus offering true curative therapeutic options to patients who otherwise would not qualify to be given these opportunities. Interestingly, the “Mexican method” to conduct bone marrow transplantation has not escaped the “Matthew effect”; our method, which has been used in several countries, and is endowed with several advantages over other procedures is frequently overlooked in reviews or papers dealing with the topic.


REFERENCES

  1. Alarcón-Segovia D, Ruiz-Argüelles A, Llorente L. Broken dogma: penetration of autoantibodies into living cells. Immunol Today 1996;17:163-4.

  2. Thomas ED. Hematopoietic stem cell transplantation. Sci Am 1995;272:38-47.

  3. Odom LF, August CS, Githens JH, Humbert JR, et al. Remission of relapsed leukaemia during a graft-versus-host reaction. A “graft-versus-leukaemia reaction” in man? Lancet 1978;2(8089):537-40.

  4. Weiden PL, Sullivan KM, Fluornoy N, Storb R, Thomas ED. Antileukemic effect of chronic graft versus host disease. Contribution to improved survival after allogenic marrow transplantation. N Engl J Med 1981;304:1529-33.

  5. Lichtman MA, Spivak JL, Boxer LA, Shattil SJ, Henderson ES. Hematology: landmark papers of the twentieth century. San Diego: Academic Press, 2000;pp:741-7.

  6. Kolb HJ, Mittermüller J, Clemm CH, Holler E, et al. Donor leukocyte transfusions for treatment of recurrent chromic myelogenous leukemia in marrow transplant patients. Blood 1990;76:2462-5.

  7. Slavin S, Naparstek E, Nagler A, Ackerstein A, et al. Allogeneic cell therapy for relapsed leukemia after bone marrow transplantation with donor peripheral blood lymphocytes. Exp Hematol 1995;23:1553-62.

  8. Slavin S, Naparstek E, Nagler A, Ackerstein A, et al. Allogeneic cell therapy with donor peripheral blood cells and recombinant human interleukin-2 to treat leukemia relapse after allogeneic bone marrow transplantation. Blood 1996;87:2195-204.

  9. Giralt S, Estey E, Albitar M, van Besien K, et al. Engraftment of allogeneic hematopoietic progenitor cells with purine analog-containing chemotherapy: harnessing graft-versus-leukemia without myeloablative therapy. Blood 1997;89:4531-6.

  10. Slavin S, Nagler A, Naparstek E, Kapelushnik Y, et al. Nonmyeloablative stem cell transplantation and cell therapy as an alternative to conventional bone marrow transplantation with lethal cytoreduction for the treatment of malignant and nonmalignant hematological diseases. Blood 1998;91:756-63.

  11. Quesenberry PJ, Stewart FM, Becker P, Emmons R, et al. Stem cell transplantation without myeloablation in immunocompetent recipients. In: Giralt S, Slavin S, editors. Non-myeloablative stem cell transplantation. Oxford: Darwin Scientific Publishing, 2000;pp:11-16.

  12. Khouri IF, Keating M, Korbling M, Przepiorka D, et al. Transplant-lite: induction of graft-versus-malignancy using fludarabine-based nonablative chemotherapy and allogeneic blood progenitor-cell transplantation as treatment for lymphoid malignancies. J Clin Oncol 1998;16:2817-24.

  13. Champlin R. Non-myeloablative chemotherapy with allogeneic hematopoietic transplantation as adoptive immunotherapy for malignancies. In: Schechter GP, Hoffman R, Cthrier SL. Hematology. Washington: The American Society of Hematology Education Program Book, 1999;pp:413-6.

  14. Feinstein L, Sandmaier B, Maloney D, McSweeney PA, et al. Non-myeloablative hematopoietic stem cell transplantation. Replacing high-dose cytotoxic therapy by the graft-versus-tumor effect. Ann N Y Acad Sci 2001;938:328-37.

  15. Storb R, Champlin R, Riddell SR, Murata M, et al. Non-myeloablative transplants for malignant disease. In: Cthechter GP, Broudy VC, Williams ME, editors. Hematology. Washington: The American Society of Hematology Education Program Book, 2002;pp:375-91.

  16. Childs R, Barrett J. Graft-versus-tumor effects following non-myeloablative stem cell transplantation. In: Giralt S, Slavin S, editors. Non-myeloablative stem cell transplantation. Oxford: Darwin Scientific Publishing, 2000;pp:113-26.

  17. Childs R, Clave E, Tisdale J, Plante M, et al. Successful treatment of metastatic renal cell carcinoma with a non-myeloablative allogeneic peripheral blood progenitor cell transplant: evidence for a graft-versus-tumor effect. J Clin Oncol 1999;17:2044-51.

  18. Ruiz-Argüelles GJ. Allogeneic stem cell transplantation using non-myeloablative conditioning regimens: results of the Mexican approach. Int J Hematol 2002;76(Suppl 1):376-9.

  19. Georges GE, Storb R. Review of “minitransplantation”: non-myeloablative allogeneic hematopoiteic stem cell transplantation. Int J Hematol 2003;77:3-143.

  20. Ruiz-Argüelles GJ, Ruiz-Argüelles A, Gómez-Almaguer D, López-Martínez B, et al. Features of the engraftment of allogeneic hematopoietic stem cells using reduced-intesity conditioning regimens. Leuk Lymphoma 2001;42:145-50.

  21. Ruiz-Argüelles GJ, Gómez-Almaguer D, López-Martínez B, Ponce-de-León S, et al. No cytomegalovirus-related deaths after non-ablative stem cell allografts. Hematology 2002;7:95-99.

  22. Ruiz-Argüelles GJ, Gómez-Rangel JD, Ponce-de-León S, González-Déctor L, et al. The Mexican schedule to conduct allogeneic stem cell transplantation is related to a low risk of cytomegalovirus reactivation and disease. Am J Hematol 2004;75:200-4.

  23. Ruiz-Argüelles GJ, López-Martínez B, Santellán-Olea MR, Abreu-Díaz G, et al. Follow up of hemopoietic chimerism in individuals given allogeneic hemopoietic stem cell allografts using an immunosuppressive, non-myeloablative conditioning regimen: a prospective study in a single institution. Leuk Lymphoma 2002;43:1509-11.

  24. Ruiz-Argüelles GJ, Gómez-Almaguer D, López-Martínez B, Cantú-Rodríguez OG, et al. Results of an allogeneic non-myeloablative stem cell transplantation program in patients with chronic myelogenous leukemia. Haematologica 2002;87:894-6.

  25. Gómez-Almaguer D, Ruiz-Argüelles GJ, Tarín-Arzaga LC, González-Llano O, et al. Reduced-intensity stem cell transplantation in children and adolescents: the Mexican experience. Biol Blood Marrow Transplant 2003;9:157-61.

  26. Ruiz-Argüelles GJ, López-Martínez B, Gómez-Rangel D, Estrada E, et al. Decreased transfusion requirements in patients given stem cell allografts using a non-myeloablative conditioning regimen: a single institution experience. Hematology 2003;8:151-4.

  27. Ruiz-Argüelles GJ, Morales-Toquero A, López-Martínez B, Tarín-Arzaga LC, Manzano C. Bloodless (transfusion-free) hematopoietic stem cell transplants: the Mexican experience. Bone Marrow Transplant 2005;36:715-20.

  28. Gómez-Almaguer D, Ruiz-Argüelles GJ, Ruiz-Argüelles A, González-Llano O, et al. Hematopoietic stem cell allografts using a non-myeloablative conditioning regimen can be safely performed on an outpatient basis. Bone Marrow Transplant 2000;25:131-3.

  29. Ruiz-Argüelles GJ, Gómez-Almaguer D, Morales-Toquero A, Gutiérrez-Aguirre CH, et al. The early referral for reduced-intensity stem cell transplantation in patients with Ph1 (+) chronic myelogenous leukemia in chronic phase in the imatinib era: results of the Latin American Cooperative Oncohematology Group (LACOHG), prospective, multicenter study. Bone Marrow Transplant 2005;36:1043-7.

  30. Ruiz-Argüelles GJ, Gómez-Almaguer D, Gómez Rangel JD, Vela-Ojeda J, et al. Allogeneic hematopoietic stem cell transplantation with non-myeloablative conditioning in patients with acute leukemia eligible for conventional allografting: a prospective study. Leuk Lymphoma 2004;45:1191-5.

  31. Gutiérrez-Aguirre CH, Cantú-Rodríguez OG, González-Llano O, Salazar-Riojas R, et al. Non-myeloablative allogeneic hematopoietic stem cell transplantation in patients with acute myelogenous leukemia: the significance of the remission status. Biol Blood Marrow Transpl 2005;11(Suppl 1):61-62.

  32. Ruiz-Argüelles GJ, Morales-Toquero A, Gómez-Rangel JD, López-Martínez B. Trasplante de células hematopoyéticas alogénicas en niños y adolescentes empleando esquema de acondicionamiento no mieloablativo. Experiencia en una sola institución. Bol Med Hosp Infant Mex 2005;62:88-95.

  33. Spitzer TR. The expanding applications of non-myeloablative stem cell transplantation. Pediatr Transplant 2003;7:95-100.

  34. Cantú-Rodríguez O, Gutiérrez H, Barrera D, González O, et al. Outpatient stem cell transplantation: the Mexican experience with 132 patients. Haematologica 2005;90(Suppl 2):281.

  35. Gómez-Almaguer, González-Llano. Trasplante de células hematopoyéticas en niños. Bol Med Hosp Infant Mex 2005;62:85-87.

  36. Ruiz-Argüelles GJ, Gómez-Rangel D, Sánchez-Anzaldo J, Ruiz-Argüelles A, et al. Trasplante de células de cordón umbilical: informe de dos casos. Medicina Univ 2002;4:233-5.

  37. Ruiz-Argüelles GJ, Reyes-Núñez V, Garcés-Eisele J, Warwick RM, et al. Acquired hemoglobin S trait in an adult patient with secondary acute myelogenous leukemia allografted with matched unrelated umbilical cord blood cells using a non-ablative conditioning regimen. Haema 2005;8:492-6.

  38. Ruiz-Argüelles GJ, López-Martínez B, López-Ariza B. Successful allogeneic stem cell transplantation with nonmyeloablative conditioning in patients with relapsed Hodgkin’s disease following autologous stem cell transplantation. Arch Med Res 2003;34:242-5.

  39. Ruiz-Argüelles GJ, Gómez-Almaguer D, Ruiz-Argüelles A, González-Llano O, et al. Results of an outpatient-based stem cell allotransplant program using non-myeloablative conditioning regimens. Am J Hematol 2001;66:241-4.

  40. Ruiz-Argüelles GJ. Outpatient programs of myeloablative chemotherapy, autologous and allogeneic bone marrow transplantation. Haematologica 2000;85:1233-4.

  41. Ruiz-Argüelles GJ. Non-myeloablative bone marrow transplantation. Arch Med Res 2003;34:554-7.

  42. Ruiz-Argüelles GJ. The Mexican approach to conduct allogeneic stem cell transplantation: braking dogmata and facing the Matthew effect. Hematology 2005;10(Suppl 1):154-60.

  43. Gómez-Almaguer D. The simplification of the stem cell transplantation procedures in developing countries has resulted in cost-lowering and availability to more patients. Int J Hematol 2002;76(Suppl 1):380-2.

  44. Ruiz-Argüelles GJ, Gómez-Almaguer D. Nephrotic syndrome after non-myeloablative stem cell transplantaton. Br J Haematol 2006 (en prensa).

  45. Ruiz-Argüelles GJ, López-Martínez B, Manzano C, Gómez-Rangel JD, Lobato-Mendizabal E. Significance of one human leukocyte antigen mismatch on outcome of non-myeloablative allogeneic stem cell transplantation from related donors using the Mexican schedule. Bone Marrow Transplant 2005;35:335-9.

  46. Ruiz-Argüelles GJ, Gómez-Almaguer D, Vela-Ojeda J, Morales-Toquero A, et al. Extramedullary leukemic relapses following hematopoietic stem cell transplantation with non-myeloablative conditioning. Int J Hematol 2005;82:262-5.

  47. Ruiz-Argüelles GJ. Simplification, not demystification nor trivialization of stem cell transplantation. Haematologica 2001;86:E07.

  48. Barr RD. The importance of lowering costs of stem cell transplantation in developing countries. Int J Hematol 2002;76(Suppl 1):365-7.

  49. Ruiz-Argüelles GJ, Ruiz-Reyes G. El tratamiento de las leucemias en países en desarrollo. En: Ruiz-Argüelles GJ, San-Miguel JF, editores. Actualización en leucemias. México: Médica Panamericana, 1996;pp:147-51.

  50. Ruiz-Argüelles GJ, Gómez-Almaguer D. Braking dogmata to help patients: non-myeloablative hematopoietic stem cell transplantation. Expert Opin Biol Ther 2004;4:1693-9.

  51. Chandy M. Management of hematological diseases in developing countries: socio-economic aspects. In: Schechter GP, Hoffman R, Schrier SL, editors. Hematology 1999. Washington: The American Society of Hematology Education Program Book, 1999;pp:73-76.

  52. Merton RK. The Matthew effect in science. The reward and communication systems of science are considered. Science 1968;159:56-63.

  53. Gibbs WW. Lost science in the Third World. Sci Am 1995;273:76-83.

  54. Ruiz-Argüelles GJ, Gómez-Almaguer D. El efecto Mateo en la medicina mexicana. Bol Med Hosp Infant Mex 2003;60:452-3.

  55. Rivera Luna R. Los problemas de la hemato-oncología pediátrica en México. Bol Med Hosp Infant Mex 2003;60:125-31.

  56. Borbolla JR, González-Avante M, Siller AJ. Demystyfication versus trivialization of stem cell transplantation. Haematologica 2001;86:E06.

  57. Giralt S. Reduced-intensity conditioning regimens for hematologic malignancies: what have we learned over the last 10 years? In: Berliner N, Lee SJ, Linenberger M, Vogelsang GB, editors. Hematology 2005. Berkeley: The American Society of Hematology Education Program Book, 2005;pp:384-9.

  58. Ruiz-Argüelles GJ, Gómez-Almaguer D. The Mexican approach to conduct non-ablative stem cell transplantation should not be overlooked. Int J Hematol 2003;77:526-7.

  59. Vindelov L. Allogeneic bone marrow transplantation with reduced conditioning. Eur J Haematol 2001;66:73-82.

  60. Ruiz-Argüelles GJ. “The Mexican approach” to conduct non-myeloablative stem cell transplantation. Eur J Haematol 2001;67:5-6.

  61. Couriel DR, Saliba RM, Giralt S, Khouri I, et al. Acute and chronic graft-versus-host disease after ablative and nonmyeloablative conditioning for allogeneic hematopoietic transplantation. Biol Blood Marrow Transplant 2004;10:178-85.

  62. Diaconescu R, Flowers CR, Storer B, Sorror ML, et al. Morbidity and mortality with nonmyeloablative compared with myeloablative conditioning before hematopoietic cell transplantation from HLA-matched related donors. Blood 2004;104:1150-8.

  63. Pérez-Simón JA, Díez-Campelo M, Martino R, Brunet S, et al. Influence of the intensity of the conditioning regimen on the characteristics of acute and chronic graft-versus-host disease after allogeneic transplantation. Br J Haematol 2005;130:394-403.

  64. Ruiz-Argüelles GJ. Introducción e historia del trasplante de médula ósea en México. Rev Hematol 2004;5:80-85.

  65. Gómez-Almaguer D, Ruiz-Argüelles GJ, Gutiérrez-Aguirre CH, Jaime-Pérez JC. Trasplante no mieloablativo de células progenitoras hematopoyéticas: mitos y realidades. Rev Invest Clin 2005;57:291-7.

  66. Kassim AA, Chinratanalab W, Ferrara JL, Minseishi S. Reduced-intensity allogeneic hematopoietic stem cell transplantation for acute leucemias: what is the best recipe? Bone Marrow Transplant 2005;36:565-74.




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