Banca de DEFESA: ISABELLE CAMPOS DE AZEVEDO
Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.DISCENTE : ISABELLE CAMPOS DE AZEVEDO
DATA : 31/10/2019
HORA: 14:00
LOCAL: Departamento de Enfermagem
TÍTULO:
FACTORS ASSOCIATED WITH HEMATOPOETIC STEM CELL RETRANSPLANT: A CASE-CONTROL STUDY
PALAVRAS-CHAVES:
Graft Rejection; Recurrence; Hematopoietic Stem Cell Transplantation; Bone Marrow Transplantation; Survival Analysis.
PÁGINAS: 100
GRANDE ÁREA: Ciências da Saúde
ÁREA: Enfermagem
RESUMO:
This research has as object of study the cases of hematopoietic stem cell retransplantation (HSCR) performed in patients previously transplanted in a reference service for this procedure of high complexity in the state of Rio Grande do Norte. In this context, the present study aimed to analyze the factors associated with failure of hematopoietic stem cell transplants (HSCT) in patients undergoing retransplantation in a referral service in the state of Rio Grande do Norte from 2008 to 2018. The study It consisted of a quantitative, case-control, descriptive and analytical research. Data were collected from secondary sources, from the medical records of patients treated by the study service and were analyzed in order to verify the association between clinical and sociodemographic variables and the performance of HSCR among patients undergoing previous transplantation. To calculate the probability of association between the analyzed characteristics and gender, the chi-square trend test, Fisher's exact test and Mann Whitney test were used, according to each case. Bivariate and multivariate analyzes were used to assess the association between the selected variables and to estimate the magnitude of the odds ratio, respectively, using the Statistical Package for Social Sciences version 25.0. The significance level adopted was 0.05. The first part of the study was the construction of an analysis of the concept of HSCR. The Research Protocol was approved in its ethical and methodological aspects by the Research Ethics Committee of the Federal University of Rio Grande do Norte, with approval on April 12, 2019 under opinion 2,596,384 and CAAE: 80927417.9.0000.5537. For the concept analysis, the sample consisted of 31 studies. As a substitute term, “Second Transplant” and the related concept “Secondary Graft” were highlighted. The most frequent attributes, antecedents and consequences were, respectively: only option / form of treatment for graft rejection or failure; graft failure; and increased survival. Of the 84 patients surveyed in the case-control study, 28 (33.33%) were classified as cases and 56 (66.67%) as controls, with a mean age of 34.11, 51 (60.71%) were male, 65 (77.38%) lived in Rio Grande do Norte, 41 (48.81%) were married, 42 (50.00%) received care in the transplant sector for about 21 months, 43 (51, 19%; p <0.001) waited for up to 15 days from the beginning of the conditioning regimen until the first HSCT, the mean time to perform the HSCR was 14.74 months and 42 (50.00%) had a survival of about At 17 months, 35 (41.67%) died and the most prevalent causes were sepsis (28; 33.34%), multiple organ failure (14; 16.67%) and pulmonary infection (8; 9.52 %). Graft versus host disease (OR = 9.17; CI = 95%: 0.97-86.38; p = 0.040) proved to be a risk factor for HSCR. Bile acid is also directly related to HSCR (OR = 16.12; CI = 95%: 2.05-128.12; p = 0.001) and the use of immunosuppressive is a protective factor for HSCT (OR = 4.50; CI = 95%: 1.38-14.69; p = 0.009). The chance of patients with sepsis (OR = 6.03; 95% CI: 1.386-26.205; p = 0.017) using bile acid (OR = 24.32; 95% CI: 2.853-261-608; p = 0.004) and anticoagulant (OR = 3.12; 95% CI: 1.023-10.756; p = 0.046) performing HSCR is higher compared to patients who did not develop sepsis and do not use these medications. The average overall survival (SG) was 26.97 (p <0.001). This study provides relevant scientific evidence regarding risk factors for HSCR and patient survival. Sepsis, GVHD and bile acid are directly related to retransplantation and sociodemographic factors are also related to HSCR.
MEMBROS DA BANCA:
Externa à Instituição - ELEN FERRAZ TESTON - UFMS
Interna - 1552864 - ALLYNE FORTES VITOR
Presidente - 1352508 - MARCOS ANTONIO FERREIRA JUNIOR
Externo à Instituição - OLECI PEREIRA FROTA - UFMS
Interna - 1220598 - VIVIANE EUZEBIA PEREIRA SANTOS