Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-10-29T11:10:52Z No. of bitstreams: 2 Dissertação - Hugo César Pereira Santos - 2015.pdf: 3535564 bytes, checksum: 4fc7d88b1da6008bc42c01f46e4f8d7a (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-10-29T11:20:29Z (GMT) No. of bitstreams: 2 Dissertação - Hugo César Pereira Santos - 2015.pdf: 3535564 bytes, checksum: 4fc7d88b1da6008bc42c01f46e4f8d7a (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-10-29T11:20:29Z (GMT). No. of bitstreams: 2 Dissertação - Hugo César Pereira Santos - 2015.pdf: 3535564 bytes, checksum: 4fc7d88b1da6008bc42c01f46e4f8d7a (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-03-19 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The human adenoviruses (HAdV) infect people of all ages worldwide, causing a wide range of clinical syndromes, depending on the viral type. In immunocompromised hosts, as transplanted patients, HAdV infection can result in a bad prognosis. Some aspects of viral pathogenesis, such as the association between viremia and/or viral load with disseminated disease and the optimal moment to start the therapy, are still not well established in adult patients that have undergone allogeneic hematopoietic stem cell transplantation (ASCT). Therefore, the main objective of this study was to monitor ASCT recipients for HAdV occurrence, and also correlate viral positivity, viral load and molecular variant with clinical symptoms and patients’ prognosis. For this, stool and serum from 21 patients were monitored in a 2 years period (from October/2012 to October/2014). Serum and fecal samples were screened by Nested-PCR, using primers targeting a partial region of the hexon gene (143bp). Fecal samples were further screened by a commercial enzyme immunoassay (EIA). In total, 57% of the patients had at least one positive sample (serum or stool) for HAdV. Patients presented high viral load (varying from 7,7x103 to 2x108 copies/mL), with a higher viral load in stool when compared to serum. Positive samples were submitted to genomic sequencing, revealing the occurrence of HAdV from C, D and F species. The main clinical symptom presented by infected patients was diarrhea, and graft-versus-host disease was the main intercurrence; however it was not possible to directly associate viral positivity to cause of death. We hope to contribute for a better understanding of the HAdV infection pattern in patients submitted to ASCT. Our data highlights the importance of the inclusion of HAdV testing in the routine laboratory exams of this group of patients. / Os adenovírus humanos (HAdV) podem infectar pessoas de todas as idades, causando uma ampla gama de quadros clínicos. Em pacientes imunocomprometidos, como os indivíduos que receberam transplante, a infecção por esses vírus pode resultar em pior prognóstico para o paciente. Determinados aspectos da patogenia viral, como a associação entre viremia e/ou carga viral com a doença disseminada, bem como o melhor momento para o início da terapia, não estão ainda bem esclarecidos em pacientes que foram submetidos ao transplante de células progenitoras hematopoiéticas (TACPH), principalmente em indivíduos adultos. Dessa forma, o principal objetivo deste estudo foi realizar o monitoramento da infecção por HAdV e a caracterização molecular das variantes virais em pacientes submetidos ao TACPH, bem como determinar a carga viral e correlacionar a infecção com o quadro clínico e prognóstico dos pacientes. Foram analisadas amostras de soro e fezes de 21 pacientes submetidos ao TACPH no período de dois anos (de outubro/2012 a outubro/2014). As amostras de fezes foram triadas por ensaio imunoenzimático e por Nested-PCR, enquanto as amostras de soro foram triadas somente por Nested-PCR de uma região parcial do gene hexon (produto esperado de 143 pb). Foram detectadas amostras positivas de soro e/ou fezes de 57% dos pacientes. De forma geral, os pacientes do presente estudo apresentaram elevadas cargas virais (variando de 7,7x103 à 2x108 CG/mL), que foram mais elevadas nas fezes. As amostras positivas foram submetidas ao sequenciamento genômico e resultados revelaram a ocorrência de adenovírus das espécies C, D e F. O principal quadro clínico apresentado pelos pacientes foi a diarreia e a principal intercorrência observada, a doença do enxerto contra o hospedeiro (DECH). Dez pacientes foram a óbito durante o período de estudo, entretanto, não foi possível associar a infecção por HAdV diretamente à causa mortis. Esperamos que os dados obtidos possam auxiliar no melhor entendimento do padrão da infecção dos HAdVs em pacientes submetidos ao TACPH, de forma a contribuir para que a pesquisa de adenovírus seja incluída na rotina de exames desses pacientes.

No description available.

Allogeneic Hematopoietic stem cell transplants (HSCT) are used for the treatment of bone marrow aplasias. Allogeneic HSCT is performed by treating the patient with chemotherapy drugs and irradiation and then transplanting hematopoietic stem cells from a healthy donor to restore the immune system and hematopoietic cells. Allogeneic HSCTs has the added benefit of the graft vs leukemia effect (GvL), whereby donor allogeneic T cells are able to mount immune responses against any residual cancer cells. However, alloreactivity towards the mismatched minor and major histocompatibility antigens the patient's healthy tissues leads to graft vs host disease (GvHD). This process is also mediated by Macrophages, Dendritic cells, B cells. Furthermore, a decrease in the number of NK, B, and T regulatory cells exacerbates GvHD. This leads to a state of systemic inflammation, tissue damage and multiorgan fibrosis. Current therapies designed to suppress the immune system have been shown to be efficacious in preventing GvHD but patients become susceptible to infection or experience cancer relapse through the elimination of the GvL response as well. In this thesis, we explore two strategies for targeting T cell activation in two mouse models of GvHD. In the first model, we examined the contribution of donor-derived complement C5 on the induction GvHD. We observed that recipient mice were only protected from GvHD when donor cells were deficient for complement protein C5. Our second strategy involves selective targeting of alloreactive T cells using peptide immunotherapy. For this approach, we first developed a humanized mouse model of GvHD whereby cells from donor mice expressing human class II HLA were reconstituted into recipient mice expressing human class I HLA. We then tested peptide immunotherapy using peptides derived from the human class I HLA. Our initial results were inconclusive and require further optimization. / Thesis / Doctor of Philosophy (PhD) / Graft vs Host Disease is an unwanted side effect of mismatched bone marrow transplant. Donor T cells recognize and attack mismatched tissues of the recipient and this leads to systemic inflammation and tissue scarring. Current treatments primarily target T-cell activation by suppressing the immune system, however, this leaves the patients susceptible to recurrent infections. In this thesis we describe the creation of two mouse models of Graft vs Host Disease and then examine two ways of specifically targeting donor T cell activation that is designed not to affect normal immune responses.

Deficiency in β-glucuronidase activity (EC 3.2.1.31) leads to the lysosomal storage disease mucopolysaccharidosis type VII not only in humans but also in a recently discovered murine mutant, the gus^mps/gus^mps mouse. Clinical and pathologic abnormalities common to the human and mouse phenotypes include shortened life span, dwarfism, dysmorphic facial features, skeletal deformities, corneal clouding, mental retardation and abnormal lysosomal storage material in the brain and peripheral organs. In the first part of this thesis, neonatal gus^mps/gus^mps mice and their normal littermates were transplanted with syngeneic normal bone marrow. Neurological function was then evaluated with two behavioral tests: the grooming test, a developmentally regulated and genetically based activity, and the Morris water maze test, which assessed spatial learning abilities. The results of these tests indicated that the behavioral deficits in the mutant mice were not restored to normal. Treated normal mice also showed significant functional deterioration, indicating the detrimental consequence of this therapy in the neonatal period. The second part of this thesis focused on a novel approach to somatic gene therapy using microcapsules. A non-autologous fibroblast cell line engineered to secrete high levels of β-glucuronidase was enclosed in perm-selective and immuno- protective microcapsules and implanted into the peritoneal cavity of gus^mps/gus^mps mice. During the 4 weeks of therapy, the biochemical and histological abnormalities of the mutant mice had significantly improved. β-Glucuronidase activity was restored to >50% of normal in the plasma and 11.3%-65.8% in the kidney, liver and spleen. No significant activity was found in the brain. As well, the secondary elevations of other lysosomal enzymes such as β-hexosaminidase and α-galactosidase had decreased in the kidney, liver, and spleen. Urinary glycosaminoglycan content had decreased in the treated mutants indicating that the β-glucuronidase was exerting a therapeutic effect. However, after three and a half weeks of therapy, the treated mutants became severely ill and developed haemorrhagic ascites. Since normal mice treated with similar microcapsules showed no adverse effects, we hypothesized that an immune response had been generated against the foreign protein (β-glucuronidase) by the mutants, leading to the high morbidity. Thus in spite of the biochemical and histological correction observed after bone marrow transplantation and somatic cell gene therapy, the long term efficacy of these treatments needs to be further evaluated. / Thesis / Master of Science (MS)

O principal fator de risco para tuberculose (TB) em receptores de transplante de células-tronco hematopoiéticas (TCTH) é viver em regiões de alta endemicidade da doença, uma vez que a imunossupressão favorece a reativação da tuberculose latente (TBL). O diagnóstico da TBL pela prova tuberculínica (PT) tem limitações nos imunocomprometidos e testes de detecção de interferon gama podem ser vantajosos. Os objetivos do presente estudo foram comparar a PT com o QuantiFERON® TB-Gold In-Tube (QFT-GIT) no diagnóstico da TBL e determinar a incidência de TB em duas coortes de pacientes submetidos ao TCTH. Duas coortes foram analisadas prospectivamente. Coorte1: receptores de TCTH incluídos desde o período pré-transplante. Coorte 2: receptores de TCTH com doença do enxerto contra o hospedeiro (DECH) crônica em atividade. A PT e o QFT-GIT foram realizados imediatamente após a inclusão em ambas as coortes. Pacientes na coorte 1 com diagnóstico de TBL receberam profilaxia com isoniazida (INH) por nove meses. Na coorte 2, os pacientes foram acompanhados clinicamente, sem receber profilaxia. TB ativa foi investigada prospectivamente de acordo com definição de caso e por coletas periódicas de escarro. Entre os candidatos ao TCTH, a prevalência de TBL detectada pela PT foi de 4,7% e de 7,1% pelo QFT-GIT. Entre os receptores com DECH crônica a prevalência de TBL detectada pela PT foi de 5,3% e de 12,5% pelo QFT-GIT. A comparação entre as técnicas revelou boa concordância (kappa=0.60). Não houve casos de TB na coorte 1. A incidência cumulativa de TB na coorte 2 foi de 3%. Em comparação com alguns estudos, nossos resultados apresentaram menor prevalência de TB, com menos resultados indeterminados pelo QFT-GIT e melhor concordância entre ambos os testes. É provável que a introdução de profilaxia com INH seja benéfica também para os pacientes com DECH crônica. / The main risk factor for tuberculosis (TB) in hematopoietic stem cell transplant recipients (HSCT) is to live in regions of high endemicity of the disease, since immunosuppression favors the reactivation of latent tuberculosis infection (LTBI). The diagnosis of LTBI by the tuberculin test (TT) has limitations in the immunocompromised hosts and the interferon gamma release assays (IGRAs) may be advantageous. The objectives of the present study were to compare the TT with QuantiFERON® TB-Gold In-Tube (QFT-GIT) in the diagnosis of LTBI and to determine the incidence of TB in two cohorts of patients undergoing HSCT. Two cohorts were analyzed prospectively. Cohort 1: HSCT recipients included since the pre-transplant period. Cohort 2: TCTH recipients with active chronic graft versus host disease (GVHD). TT and QFT-GIT were performed immediately after inclusion in both cohorts. Patients in cohort 1 with diagnosis of LTBI received prophylaxis with isoniazid (INH) for 9 months. In cohort 2, the patients were followed up clinically, without receiving prophylaxis. Active TB was investigated prospectively according to a case definition criteria and periodic sputum sampling. Among the HSCT candidates, the prevalence of LTBI detected by TT was 4.7% and 7.1% by QFT-GIT. Among the recipients with chronic GVHD, the prevalence of LTBI detected by TT was 5.3% and 12.5% by QFT-GIT. The comparison between the techniques showed good agreement (kappa = 0.60). There were no cases of TB in cohort 1. The cumulative incidence of TB in cohort 2 was 3%. Compared with some studies, our results showed a lower prevalence of LTBI, with less indeterminate results by QFT-GIT and better agreement between both tests. It is likely that prophylaxis with INH is also beneficial for patients with chronic GVHD.

O principal fator de risco para tuberculose (TB) em receptores de transplante de células-tronco hematopoiéticas (TCTH) é viver em regiões de alta endemicidade da doença, uma vez que a imunossupressão favorece a reativação da tuberculose latente (TBL). O diagnóstico da TBL pela prova tuberculínica (PT) tem limitações nos imunocomprometidos e testes de detecção de interferon gama podem ser vantajosos. Os objetivos do presente estudo foram comparar a PT com o QuantiFERON® TB-Gold In-Tube (QFT-GIT) no diagnóstico da TBL e determinar a incidência de TB em duas coortes de pacientes submetidos ao TCTH. Duas coortes foram analisadas prospectivamente. Coorte1: receptores de TCTH incluídos desde o período pré-transplante. Coorte 2: receptores de TCTH com doença do enxerto contra o hospedeiro (DECH) crônica em atividade. A PT e o QFT-GIT foram realizados imediatamente após a inclusão em ambas as coortes. Pacientes na coorte 1 com diagnóstico de TBL receberam profilaxia com isoniazida (INH) por nove meses. Na coorte 2, os pacientes foram acompanhados clinicamente, sem receber profilaxia. TB ativa foi investigada prospectivamente de acordo com definição de caso e por coletas periódicas de escarro. Entre os candidatos ao TCTH, a prevalência de TBL detectada pela PT foi de 4,7% e de 7,1% pelo QFT-GIT. Entre os receptores com DECH crônica a prevalência de TBL detectada pela PT foi de 5,3% e de 12,5% pelo QFT-GIT. A comparação entre as técnicas revelou boa concordância (kappa=0.60). Não houve casos de TB na coorte 1. A incidência cumulativa de TB na coorte 2 foi de 3%. Em comparação com alguns estudos, nossos resultados apresentaram menor prevalência de TB, com menos resultados indeterminados pelo QFT-GIT e melhor concordância entre ambos os testes. É provável que a introdução de profilaxia com INH seja benéfica também para os pacientes com DECH crônica. / The main risk factor for tuberculosis (TB) in hematopoietic stem cell transplant recipients (HSCT) is to live in regions of high endemicity of the disease, since immunosuppression favors the reactivation of latent tuberculosis infection (LTBI). The diagnosis of LTBI by the tuberculin test (TT) has limitations in the immunocompromised hosts and the interferon gamma release assays (IGRAs) may be advantageous. The objectives of the present study were to compare the TT with QuantiFERON® TB-Gold In-Tube (QFT-GIT) in the diagnosis of LTBI and to determine the incidence of TB in two cohorts of patients undergoing HSCT. Two cohorts were analyzed prospectively. Cohort 1: HSCT recipients included since the pre-transplant period. Cohort 2: TCTH recipients with active chronic graft versus host disease (GVHD). TT and QFT-GIT were performed immediately after inclusion in both cohorts. Patients in cohort 1 with diagnosis of LTBI received prophylaxis with isoniazid (INH) for 9 months. In cohort 2, the patients were followed up clinically, without receiving prophylaxis. Active TB was investigated prospectively according to a case definition criteria and periodic sputum sampling. Among the HSCT candidates, the prevalence of LTBI detected by TT was 4.7% and 7.1% by QFT-GIT. Among the recipients with chronic GVHD, the prevalence of LTBI detected by TT was 5.3% and 12.5% by QFT-GIT. The comparison between the techniques showed good agreement (kappa = 0.60). There were no cases of TB in cohort 1. The cumulative incidence of TB in cohort 2 was 3%. Compared with some studies, our results showed a lower prevalence of LTBI, with less indeterminate results by QFT-GIT and better agreement between both tests. It is likely that prophylaxis with INH is also beneficial for patients with chronic GVHD.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2015-07-20T17:28:32Z No. of bitstreams: 1 Ernesto Stangueti.pdf: 896090 bytes, checksum: bf6900280e54b4847ee7b0f318f12749 (MD5) / Made available in DSpace on 2015-07-20T17:28:32Z (GMT). No. of bitstreams: 1 Ernesto Stangueti.pdf: 896090 bytes, checksum: bf6900280e54b4847ee7b0f318f12749 (MD5) Previous issue date: 2014-11-28 / Government agencies, in Brazil and in developed countries, have established guidelines for water safety in the community, in particular in the health care of immunocompromised pacients, in this case environments hospitals that receive such patients should provide higher standards for water quality by taking immediate action to prevent waterborne infections. This paper aims to assess how hospitals that perform bone marrow transplantation (BMT) manage the critical success factors in the prevention of water contamination of their patients and extract from these assessments a model of management of hospital logistics in relation to administrative processes needed for effective control of such infection. To this end, it was chosen a case study. The interviews were conducted with professional members of Commissions Infection Control in four hospitals located in São Paulo who perform BMT. The data were analyzed using the methodology of the Collective Subject Discourse (CSD) described by Lefèvre & Lefèvre (2003). The main management practices related to water contamination were: cleaning and disinfection of water tanks and bacteriological control, installation of filters for high power filtering at the point of use (taps and showers), supply of mineral water industrialized for consumption of patients of BMT unit, institution management committee comprising representatives from all areas involved in the operations of the BMT unit. Thus, this work contributes to technological and social practice through the development of a model of hospital logistics management, collaborating in preventing Related Infections at Health Care (IRAS) in units of BMT. / As agências governamentais, no Brasil e nos países desenvolvidos, têm estabelecido diretrizes para a segurança da água na comunidade, em específico nos ambientes de atendimento à saúde de pessoas imunocomprometidas, no caso, os hospitais que cuidam de tais pacientes devem fornecer padrões mais elevados para a qualidade da água tomando medidas imediatas na prevenção de infecções transmitidas pela água. Este trabalho tem como objetivo, avaliar a forma como os hospitais que realizam transplante de medula óssea (TMO) gerenciam os fatores críticos de sucesso na prevenção da contaminação hídrica de seus pacientes e extrair dessas avaliações um modelo de gestão de logística hospitalar em relação aos processos administrativos, necessários ao efetivo controle desse tipo de contaminação. Para tanto, optou-se pela estratégia de pesquisa de estudo de caso, com a realização de entrevistas junto a profissionais membros de Comissões de Controle de Infecção Hospitalar em quatro hospitais localizados no Município de São Paulo e que realizam TMO. As informações coletadas foram analisadas através da metodologia do Discurso do Sujeito Coletivo (DSC), baseado em Lefèvre & Lefèvre, (2003). Foram elencadas as principais práticas de gestão desses hospitais em relação à contaminação hídrica, sendo: limpeza e desinfecção de reservatórios de água e controle bacteriológico, instalação de filtros de alto poder de filtragem nos pontos de uso (torneiras e chuveiros), fornecimento de água mineral industrializada para consumo dos pacientes da unidade de TMO, instituição de comissão de gestão composta por representantes de todas as áreas envolvidas na manutenção das atividades da unidade de TMO. Dessa forma, este trabalho contribui com a prática tecnológica e social, através da estruturação de um modelo de gestão de logística hospitalar, colaborando na prevenção das Infecções Relacionadas à Assistência à Saúde (IRAS) em unidades de TMO.

No description available.

A Mucosite Oral é uma das principais e mais debilitantes complicações do Transplante de Medula Óssea. (Schubert et al., 1986; Borowski et al., 1994; Sonis, 1998; Peterson, 2004; Sonis, 2004; Scully, 2006; Sonis, 2009). Nessa terapia sua incidência varia entre 75-100%. (Wardley et al., 2000; Barasch; Peterson, 2003; Schubert et al., 2007; Blijlevens, 2008; Vokurka et al., 2009 ). A extensão e a severidade da Mucosite Oral estão significativamente correlacionadas com dias de narcótico injetável, alimentação parenteral, febre, risco de infecção importante, dias de hospitalização, custos hospitalares e mortalidade. (Sonis et al., 2001; Vera-Llonch et al., 2007). Nosso trabalho trata-se de um estudo de avaliação clínica e econômica, retrospectivo, de pacientes submetidos ao transplante de medula óssea no Hospital Israelita Albert Einstein, entre os anos de 2000 e 2008. Foram avaliados 167 pacientes, que foram divididos em dois grupos: Grupo I, composto por 91 pacientes que receberam atendimento odontológico e Laserterapia durante o TMO e Grupo II, composto por 76 pacientes que não receberam atendimento odontológico nem Laserterapia. Dados como idade, sexo, diagnóstico da doença de base, protocolo quimioterápico, tipo de transplante, uso de medicação para dor, dias de febre, utilização de alimentação parenteral, dias de internação, presença de infecção e grau de mucosite oral, com e sem atendimento odontológico, foram coletados e analisados. Uma análise descritiva, com base em tabelas de frequências e testes Qui-quadrado (ou exato de Fisher, quando este se mostrou mais apropriado), foi feita com o objetivo de verificar a associação estatística entre as variáveis de interesse. Estimativas dos riscos relativos, com intervalos de confiança de 95%, foram calculadas para avaliar a associação entre o desfecho (grau máximo) e as variáveis explicativas de interesse e o tempo médio de internação (em dias) nos diferentes grupos e tipos de transplantes foi comparado por meio de um modelo de análise de variância. Valores de p menores que 0,05 foram considerados como estatisticamente significantes. Pudemos concluir com esse trabalho que a extensão e a severidade da Mucosite Oral foram maiores no grupo sem atendimento Odontológico, sendo que o risco do paciente desse grupo apresentar grau III ou IV foi de 13 vezes maior que o grupo com Cirurgião-Dentista. Além disso, observamos que atendimento odontológico durante o TMO, quando praticado da forma descrita nesse estudo, é custo-efetivo, sendo capaz de reduzir as morbidades clínicas do TMO e que os benefícios do atendimento odontológico excederam os custos e, portanto, devem ser adotados. Foi constatado também que os pacientes que tiveram o acompanhamento do Cirurgião-Dentista apresentaram melhor qualidade de vida durante TMO e que o atendimento odontológico durante o TMO gerou economia para o hospital. / Oral mucositis is one of the main and most debilitating complications of Bone Marrow Transplants. In this therapy its incidence ranges between 75-100%. The extent and severity of Oral Mucositis are significantly correlated with the days of receiving injectable narcotics, parenteral feeding, fever, and risk of important infection, number of days of hospitalization, hospital costs and mortality. This study is a retrospective clinical and economic evaluation of patients submitted to bone marrow transplant at the \"Hospital Israelita Albert Einstein\", between the years 2000 and 2008. A total of 167 patients were evaluated, and were divided into two groups: Group I, composed of 91 patients who received dental treatment and Laser therapy during the BMT and Group II, composed of 76 patients who did not receive dental attendance or laser therapy. Data such as age, sex, diagnosis of the underlying disease, chemotherapy protocol, type of transplant, use of pain relief medication, days of fever, use of parenteral feeding, days of hospitalization, presence of infection and degree of oral mucositis, with and without dental attendance were collected and analyzed. A descriptive analysis, based on Frequency tables and Chi-square tests (or Fishers exact test, when this was shown to be more appropriate), was performed with the aim of verifying the statistical association among the variables of interest. Estimates of relative risks, with confidence intervals of 95% were calculated to evaluate the association between the outcome (maximum degree) and the explicative variables of interest and the mean time of hospitalization (in days) in the different groups and types of transplants was compared by means of an analysis of variance model. p- Values lower than 0.05 were considered statistically significant. By means of this study, it could be concluded that the extent and severity of Oral Mucositis were greater in the group without Dental attendance, as the risk of the patient in this group presenting Grade III or IV was 13 times higher than it was in the group attended by a Dentist. Moreover, it was observed that dental attendance during BMT, when performed in the manner described in this study, is cost-effective, as it is capable of reducing the clinical morbidities of BMT. Furthermore the benefits of dental attendance outweighed the costs, and therefore, must be adopted. It was also found that patients that were followed-up by the Dentist presented a better quality of life during BMT and that dental attendance during BMT resulted in savings for the hospital.

A Mucosite Oral é uma das principais e mais debilitantes complicações do Transplante de Medula Óssea. (Schubert et al., 1986; Borowski et al., 1994; Sonis, 1998; Peterson, 2004; Sonis, 2004; Scully, 2006; Sonis, 2009). Nessa terapia sua incidência varia entre 75-100%. (Wardley et al., 2000; Barasch; Peterson, 2003; Schubert et al., 2007; Blijlevens, 2008; Vokurka et al., 2009 ). A extensão e a severidade da Mucosite Oral estão significativamente correlacionadas com dias de narcótico injetável, alimentação parenteral, febre, risco de infecção importante, dias de hospitalização, custos hospitalares e mortalidade. (Sonis et al., 2001; Vera-Llonch et al., 2007). Nosso trabalho trata-se de um estudo de avaliação clínica e econômica, retrospectivo, de pacientes submetidos ao transplante de medula óssea no Hospital Israelita Albert Einstein, entre os anos de 2000 e 2008. Foram avaliados 167 pacientes, que foram divididos em dois grupos: Grupo I, composto por 91 pacientes que receberam atendimento odontológico e Laserterapia durante o TMO e Grupo II, composto por 76 pacientes que não receberam atendimento odontológico nem Laserterapia. Dados como idade, sexo, diagnóstico da doença de base, protocolo quimioterápico, tipo de transplante, uso de medicação para dor, dias de febre, utilização de alimentação parenteral, dias de internação, presença de infecção e grau de mucosite oral, com e sem atendimento odontológico, foram coletados e analisados. Uma análise descritiva, com base em tabelas de frequências e testes Qui-quadrado (ou exato de Fisher, quando este se mostrou mais apropriado), foi feita com o objetivo de verificar a associação estatística entre as variáveis de interesse. Estimativas dos riscos relativos, com intervalos de confiança de 95%, foram calculadas para avaliar a associação entre o desfecho (grau máximo) e as variáveis explicativas de interesse e o tempo médio de internação (em dias) nos diferentes grupos e tipos de transplantes foi comparado por meio de um modelo de análise de variância. Valores de p menores que 0,05 foram considerados como estatisticamente significantes. Pudemos concluir com esse trabalho que a extensão e a severidade da Mucosite Oral foram maiores no grupo sem atendimento Odontológico, sendo que o risco do paciente desse grupo apresentar grau III ou IV foi de 13 vezes maior que o grupo com Cirurgião-Dentista. Além disso, observamos que atendimento odontológico durante o TMO, quando praticado da forma descrita nesse estudo, é custo-efetivo, sendo capaz de reduzir as morbidades clínicas do TMO e que os benefícios do atendimento odontológico excederam os custos e, portanto, devem ser adotados. Foi constatado também que os pacientes que tiveram o acompanhamento do Cirurgião-Dentista apresentaram melhor qualidade de vida durante TMO e que o atendimento odontológico durante o TMO gerou economia para o hospital. / Oral mucositis is one of the main and most debilitating complications of Bone Marrow Transplants. In this therapy its incidence ranges between 75-100%. The extent and severity of Oral Mucositis are significantly correlated with the days of receiving injectable narcotics, parenteral feeding, fever, and risk of important infection, number of days of hospitalization, hospital costs and mortality. This study is a retrospective clinical and economic evaluation of patients submitted to bone marrow transplant at the \"Hospital Israelita Albert Einstein\", between the years 2000 and 2008. A total of 167 patients were evaluated, and were divided into two groups: Group I, composed of 91 patients who received dental treatment and Laser therapy during the BMT and Group II, composed of 76 patients who did not receive dental attendance or laser therapy. Data such as age, sex, diagnosis of the underlying disease, chemotherapy protocol, type of transplant, use of pain relief medication, days of fever, use of parenteral feeding, days of hospitalization, presence of infection and degree of oral mucositis, with and without dental attendance were collected and analyzed. A descriptive analysis, based on Frequency tables and Chi-square tests (or Fishers exact test, when this was shown to be more appropriate), was performed with the aim of verifying the statistical association among the variables of interest. Estimates of relative risks, with confidence intervals of 95% were calculated to evaluate the association between the outcome (maximum degree) and the explicative variables of interest and the mean time of hospitalization (in days) in the different groups and types of transplants was compared by means of an analysis of variance model. p- Values lower than 0.05 were considered statistically significant. By means of this study, it could be concluded that the extent and severity of Oral Mucositis were greater in the group without Dental attendance, as the risk of the patient in this group presenting Grade III or IV was 13 times higher than it was in the group attended by a Dentist. Moreover, it was observed that dental attendance during BMT, when performed in the manner described in this study, is cost-effective, as it is capable of reducing the clinical morbidities of BMT. Furthermore the benefits of dental attendance outweighed the costs, and therefore, must be adopted. It was also found that patients that were followed-up by the Dentist presented a better quality of life during BMT and that dental attendance during BMT resulted in savings for the hospital.