Transplante Autólogo de Células-Tronco Hematopoiéticas no Tratamento da Esclerose Múltipla: Começo de uma Nova Era?
DOI:
https://doi.org/10.46531/sinapse/AR/220018/2023Palavras-chave:
Esclerose Múltipla/tratamento, Transplante Autólogo, Transplante de Células-Tronco HematopoéticasResumo
O transplante autólogo de células-tronco hematopoéticas (AHSCT) tem vindo a ganhar destaque nos últimos 20 anos no âmbito das doenças autoimunes, em particular da esclerose múltipla. Este procedimento permite a erradicação do sistema imunológico autorreativo e a sua posterior reconstituição a partir de células-tronco hematopoiéticas, constituindo um processo de “reiniciação imunológica”, através da diversificação do repertório de células T e da restauração da sua rede regulatória, redução da resposta da interleucina-17 e normalização da expressão de microRNAs e perfis de expressão génica. Evidências crescentes sugerem que o AHSCT pode suprimir totalmente a atividade da doença em 70%-92% dos casos, aos 2 anos, uma taxa superior à das atuais terapêuticas aprovadas. A sua eficácia foi também demonstrada a nível da atrofia cerebral, biomarcadores séricos e do líquido cefalorraquidiano, cognição, fadiga e qualidade de vida. Com o aumento da experiência e desenvolvimento dos protocolos, os riscos do procedimento têm vindo a diminuir para níveis considerados aceitáveis. Os eventos adversos mais comuns são precoces e correspondem a toxicidades orgânicas, citopenias e infeções, porém, a longo prazo, está descrita a possibilidade de autoimunidade secundária e malignidade. Nos estudos mais recentes, a mortalidade relacionada com o tratamento é estimada em 0,2%. A eficácia máxima verifica-se em doentes mais jovens, com menor duração da doença, menos comorbilidades e evidência de doença muito ativa ou refratária ao tratamento. Assim, o AHSCT surge como uma nova alternativa de tratamento na EM, em centros especializados que assegurem adequada seleção do protocolo e correto acompanhamento do doente para otimizar a segurança do mesmo. A presente revisão, baseada em estudos publicados entre 2016 e 2021, que incluíram 20 ou mais doentes, pretende esclarecer e sistematizar a informação existente sobre o AHSCT tanto no que diz respeito aos mecanismos de ação subjacentes, procedimentos e protocolos existentes, bem como benefícios e riscos associados.Downloads
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