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Previous issue date: 2016-12-13 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / O Transplante de C?lulas-Tronco Hematopo?ticas (TCTH) ? utilizado como estrat?gia de tratamento para uma s?rie de agravos malignos e n?o malignos herdados ou adquiridos, com possibilidade de cura ou aumento da sobrevida livre da doen?a. O presente estudo objetivou caracterizar o perfil cl?nico e epidemiol?gico dos pacientes que realizaram TCTH em um servi?o de refer?ncia no estado do Rio Grande do Norte (RN), estimar a sobrevida global dos transplantados e identificar as terapias que favorecem o aumento da sobrevida global. A primeira parte ocorreu junto ao servi?o de refer?ncia do estado do RN para realiza??o do TCTH. Trata de um estudo de abordagem quantitativa, do tipo coorte retrospectiva, descritivo e anal?tico, de base hospitalar que abordou 272 pacientes que realizaram TCTH. Os dados foram coletados no Servi?o de Arquivo M?dico e Estat?stica entre os meses de mar?o e setembro de 2016 por meio dos prontu?rios registrados entre os anos de 2008 e 2015, oito anos de execu??o do procedimento. Para a an?lise descritiva foi utilizado software livre estat?stico R vers?o 3.0.0 e para o c?lculo das probabilidades de sobrevida foi empregado o m?todo Kaplan-Meier por meio do Statistic Package for Social Sciences (SPSS) vers?o 22.0. Para o c?lculo da probabilidade de associa??o entre as caracter?sticas analisadas e os ?bitos foi utilizado o teste do Qui-quadrado de tend?ncia. A segunda parte do estudo se deu pela constru??o de uma Revis?o Sistem?tica (RS) da literatura sobre as terapias que favorecem o aumento a sobrevida de pacientes que realizaram o TCTH. O Protocolo de Pesquisa foi aprovado em seus aspectos ?ticos e metodol?gicos pelo Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte, com aprova??o em 01 de julho de 2015, sob o parecer no. 1.132.720 e CAAE no. 46202715.7.0000.5537. Dos 272 prontu?rios analisados houve predom?nio do sexo masculino 52,94%, com m?dia de 38,69 anos, 18,38% eram pardos e 47,06% casados. De acordo com as caracter?sticas cl?nicas, 23,16% apresentou como diagn?stico principal o Mieloma M?ltiplo, as toxicidades mais desenvolvidas foram as gastrointestinais (93,38%), todos os pacientes receberam tratamento por meio de antineopl?sticos, o TCTH realizado com maior frequ?ncia foi o alog?nico (54,78%), com c?lulas do sangue perif?rico (77,94%) e doador aparentado (71,81%). Cerca de 9% dos pacientes realizaram mais de um TCTH, 4,04% desenvolveu a Doen?a do Enxerto Contra Hospedeiro (DECH), dentre estes 54,55% apresentou o tipo cr?nico, a causa de morte mais registrada nas declara??es de ?bito foi o choque s?ptico (48,19%) e a sobrevida global dos pacientes transplantados foi de 4,03 meses, sem diferen?a estatisticamente significativa quando comparados os pacientes de acordo com o sexo (p=0,859). Quanto aos achados da RS n?o foi poss?vel identificar um consenso para definir a melhor forma de tratamento para o favorecimento do aumento da sobrevida global nos estudos revisados. A escolha da terap?utica adequada depender? especialmente das caracter?sticas cl?nicas apresentadas pelos indiv?duos. Entretanto, de forma geral, os planos terap?uticos utilizados pelo bra?o experimento dos ensaios cl?nicos analisados obtiveram melhores respostas para o aumento da sobrevida global dos indiv?duos testados. Portanto, conclui-se que h? a necessidade de realiza??o de outros estudos do tipo multic?ntricos que apresentem os perfis epidemiol?gicos e cl?nicos do TCTH no Brasil, haja vista que estes possibilitam a problematiza??o da realidade e a publica??o de evid?ncias confi?veis para atualiza??o dos conhecimentos cient?ficos. / Hematopoietic stem cell transplantation (HSCT) is used as a treatment strategy for a series of inherited or acquired malignant and non-malignant diseases, with the possibility of cure or increase in disease-free survival. The objective of this study was to characterize the clinical and epidemiological profile of the patients who underwent HSCT at a referral service in the state of Rio Grande do Norte (RN), to estimate the overall survival of transplant recipients and to identify therapies that favor increased overall survival. The first part occurred with the reference service of the state of the RN to perform the HSCT. This is a quantitative, retrospective, descriptive and analytical, hospital-based quantitative study that addressed 272 patients who underwent HSCT. The data were collected in the Medical Record and Statistic Service between March and September 2016 through medical records recorded between the years 2008 and 2015, eight years of execution of the procedure. For the descriptive analysis, statistical free software R version 3.0.0 was used and the Kaplan-Meier method was used to calculate survival probabilities using the Statistic Package for Social Sciences (SPSS) version 22.0. The trend chi-square test was used to calculate the probability of association between the characteristics analyzed and the deaths. The second part of the study was the construction of a Systematic Review (SR) of the literature on the therapies that favor the increase in the survival of patients who underwent HSCT. 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 July 1, 2015, under no. 1,132,720 and CAAE no. 46202715.7.0000.5537. Of the 272 patient charts analyzed, there was a predominance of males 52.94%, with a mean of 38.69 years, 18.38% were brown and 47.06% married. According to the clinical characteristics, 23.16% had as main diagnosis Multiple Myeloma, the most developed toxicities were gastrointestinal (93.38%), all patients received treatment with antineoplastics, the most frequently performed HSCT was (54.78%) with peripheral blood cells (77.94%) and related donor (71.81%). About 9% of the patients had more than one HSCT, 4.04% developed the Graft versus Host Disease (GVHD), of which 54.55% presented the chronic type, the most registered cause of death in the death certificates was Septic shock (48.19%) and overall survival of transplanted patients was 4.03 months, with no statistically significant difference when patients were compared according to sex (p = 0.859). Regarding the SR findings, it was not possible to identify a consensus to define the best form of treatment to favor the increase in overall survival in the reviewed studies. The choice of appropriate therapy will depend especially on the clinical characteristics presented by individuals. However, in general, the therapeutic plans used by the experimental arm of the analyzed clinical trials obtained better answers to increase the overall survival of the individuals tested. Therefore, it is concluded that there is a need to carry out other multicenter studies that present the epidemiological and clinical profiles of HSCT in Brazil, since these make it possible to problematize reality and to publish reliable evidence to update scientific knowledge.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/22433 |
| Date | 13 December 2016 |
| Creators | Azevedo, Isabelle Campos de |
| Contributors | 81717881149, http://lattes.cnpq.br/0912795990605736, Vitor, Allyne Fortes, 91307570372, http://lattes.cnpq.br/1927801553508976, Santos, Viviane Euz?bia Pereira, 72339039053, http://lattes.cnpq.br/5808110442588994, Ivo, Maria L?cia, 88635864891, http://lattes.cnpq.br/7376401778397726, Ferreira J?nior, Marcos Antonio |
| Publisher | PROGRAMA DE P?S-GRADUA??O EM ENFERMAGEM, UFRN, Brasil |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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