Title Infekcije u djece liječene alogenom transplantacijom krvotvornih matičnih stanica
Title (english) Infections in children after bone marrow transplation
Author Nikolina Vincelj
Mentor Ljubica Rajić (mentor)
Committee member Dorian Tješić-Drinković (predsjednik povjerenstva)
Committee member Marija Jelušić (član povjerenstva)
Committee member Ljubica Rajić (član povjerenstva)
Granter University of Zagreb School of Medicine (Department of Pediatrics) Zagreb
Defense date and country 2014-07-15, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Pediatrics
Abstract Djeca oboljela od različitih zloćudnih tumora, nekih prirođenih i stečenih bolesti koštane srži te imunoloških bolesti danas se rutinski liječe alogenom transplantacijom krvotvornih matičnih stanica (alo-TKMS). Tom se metodom krvotvorne matične stanice darivatelja infundiraju bolesnom primatelju u cilju zamjene krvotvornog tkiva domaćina onim od darivatelja. Općenito, alo-TKMS je indicirana u bolesnika u kojih bi nastavak liječenja konvencionalnom kemoterapijom doveo do značajno kraćeg preživljenja bez znakova bolesti. U bolesnika sa zloćudnim tumorima krvotvornog sustava, alo-TKMS se obično primjenjuje kao oblik post-remisijskog liječenja koje bolesnicima pruža najbolje izglede za izlječenje i preživljenje. Pri tome je mehanizam učinka alo-TKMS na tumor imunološke prirode jer imunokompetentne stanice iz presatka prepoznaju antigene neoplastičnih stanica u sklopu antigena HLA i potom ih razaraju.
Glavni udio u sveukupnom morbiditetu i mortalitetu bolesnika s transplantiranim KMS zauzimaju teške infekcije, zatim reakcija presatka protiv primatelja (GvHD) te relaps osnovne bolesti. Napretkom tehnologije, djeca s malignim bolestima liječena postupkom alo-TKMS imaju manju smrtnost od osnovne bolesti, ali su zato pod povećanim rizikom obolijevanja od infekcijskih komplikacija. Značajni rizični čimbenici za razvoj infekcije su prolongirana neutropenija, centralni venski kateter i sporo prihvaćanje transplantiranih krvotvornih matičnih stanica. Kliničke manifestacije tih infekcija su vrlo različite, a uključuju asimptomatsku virozu, vrućicu, artralgije, hepatitis, hemoragijski cistitis, retinitis, ezofagitis, intersticijsku pneumoniju itd., a mogu ići sa stopom mortaliteta i do 80%. Infekcije mogu biti uzrokovane bakterijama, virusima, protozoama (npr. Toxoplasmom gondii i Pneumocystis jirovecii), kao i gljivicama, i plijesnima. Nakon četiri mjeseca od alo-TKMS bolesnici češće razvijaju infekcije inkapsuliranim mikroorganizmima.
Svrha ovog rada je analizirati učestalost i vrstu, kao i vrijeme pojave infekcije u djece nakon alogene transplantacije krvotvornih matičnih stanica.
Radom je obuhvaćeno 48 djece liječene alogenom transplantacijom krvotvornih matičnih stanica u Zavodu za hematologiju i onkologiju Klinike za pedijatriju Medicinskog fakulteta i Kliničkog bolničkog centra Zagreb. Post-transplantacijsko razdoblje podijeljeno je u tri dijela –na prvih trideset dana (do +30. posttransplantacijskog dana), razdoblje od 30. do 120. posttransplantacijskog dana i kasno posttransplantacijsko razdoblje (nakon 120. dana).
Abstract (english) Children with wide variety of malignant tumors, congenital and acquired diseases of bone marrow and immune diseases are commonly treated with allogeneic haemopoietic stem blood cell transplantation (allo-HSCT). In this method donor’s haematopoietic stem cells are infused to the sick recipient for the purpose of replacing the hematopoietic tissue of the host to those of the donor. Generally, allo-HSCT is indicated when patients can no longer be treated with conventional chemotherapy. It is a method used in patients with hematological malignancies after remission, with the best chances for survival. The important mechanism for the effect is based on immunology, where immunocompetent cells from the graft recognize antigens in the cells of malignant tumors in framework of human leukocyte antigen system (HLA system) and then destroy them.
A major proportion of the morbidity and mortality of transplanted occupy severe infections, then graft-versus-host disease (GvHD) and relapse of the underlying disease. With the advancement of technology, children with malignant diseases treated with allo-HSCT have a lower mortality rate from the underlying disease, but are at higher risk of infectious complications. Significant risk factors for the development of an infection are prolonged neutropenia, central venous catheter and slow acceptance of transplanted stem cells (engrafment). The clinical manifestations of these infections are different, including asymptomatic fever, arthralgia, hepatitis, retinitis, esophagitis, interstitial pneumonia etc., and they can go with high mortality rate of 80%. Appear infections by bacteria, viruses, protozoa, such as Toxoplasma gondii and Pneumocystis jirovecii and by fungi and molds. Four months after transplantation patinets are more likely to develop infections caused by encapsulated microorganisms.
The aim of this study was to analyze the frequency, time of occurrence and the type of infections in children after bone marrow transplantation.
The study included 48 children treated with allogenic stem blood cell transplantation at the Division of Hematology and Oncology, Department of Pediatrics, School of Medicine and University Hospital Center Zagreb.
Posttransplant period is divided into three parts –the first thirty days (up to +30. posttransplant days), the period from 30th to 120th posttransplant day and late posttransplant period (after 120 days).
Keywords
alogena transplantacija krvotvornih matičnih stanica
infekcije
neutropenija
posttransplantacijsko razdoblje
Keywords (english)
allogeneic stem blood cell transplantation
infections
neutropenia
posttransplant period
Language croatian
URN:NBN urn:nbn:hr:105:870571
Study programme Title: Medicine Study programme type: university Study level: integrated undergraduate and graduate Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resource Text
File origin Born digital
Access conditions Open access
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Created on 2016-03-10 10:12:44