Avaliação do perfil epidemiológico, clínico e transfusional de pacientes oncológicos submetidos a transplante autólogo de medula óssea

Abstract

Bone marrow transplantation (BMT) is an established therapeutic approach for a wide range of hematologic and non-hematologic disorders, including neoplasms, aplastic anemia, immunodeficiencies, and autoimmune diseases. Among the available modalities, autologous bone marrow transplantation (ABMT) is noteworthy for using the patient’s own hematopoietic stem cells, previously mobilized, collected, and cryopreserved, for reinfusion after a myeloablative conditioning regimen. Mobilization is achieved with growth factors and/or chemotherapy, and cell collection is performed by apheresis. Despite major advances in both technique and therapy, the procedure remains associated with hematologic and immunologic complications, as well as long-term morbidities. In Brazil, there has been a marked increase in the use of ABMT, particularly in the Southeast region. This growth highlights the importance of characterizing patients undergoing transplantation to optimize treatment strategies and improve clinical outcomes. This study presents a retrospective observational analysis of the epidemiological, clinical, and laboratory characteristics of oncology patients who underwent ABMT at the Transfusion Agency (AGETRA) of the Clinical Hospital of the Federal University of Uberlândia (HC-UFU/EBSERH) between January 2020 and December 2024, based on the review of medical records. Over this period, 111 patients received ABMT at HC-UFU/EBSERH, with a progressive annual increase in procedures. Most patients were male (59.5%) with a median age of 59 years. Multiple myeloma was the most frequent diagnosis (58.6%), followed by non-Hodgkin lymphoma (27%). Approximately 72.1% of patients had comorbidities, most commonly hypertension, smoking, and diabetes. The predominant mobilization regimen was chemotherapy combined with G-CSF (58.5%), and the most commonly used conditioning protocol was MEL200 (53.2%). The mean length of hospital stay was 20 days, and healthcare-associated infections occurred in 38.7% of patients. The hospital discharge rate reached 97.3%, while overall mortality was 2.7%. Intensive care unit (ICU) admission was required for only 3.6% of patients, with a mortality rate of 50% in this subgroup. Neutrophil engraftment occurred on average at 10 days, with no statistically significant differences between patients receiving varying doses of CD34+ cells. Almost all patients (97.3%) required transfusion support during the first 30 days, primarily with platelet concentrates. Transfusion reactions were reported in only 3.7% of cases. Hematologic analyses showed an initial decline in erythrocyte, leukocyte, and platelet counts following ABMT, with progressive recovery beginning with the fifth post-transplant complete blood count, performed at an average of nine days post-procedure. Leukocyte and platelet levels exhibited more marked fluctuations, with an initial drop followed by gradual recovery, consistent with expected hematopoietic engraftment patterns. Hematimetric indices also varied in accordance with bone marrow regeneration and erythropoietic recovery. These findings reinforce the safety and effectiveness of ABMT conducted under structured protocols, contribute to expanding knowledge about the procedure, and support the development of improved therapeutic strategies. Furthermore, this study opens avenues for future research focusing on outcomes and the needs of this patient population.