{"id":117986,"date":"2018-03-11T10:47:44","date_gmt":"2018-03-11T10:47:44","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/aferesis-de-alto-volumen-en-el-trasplante-autologo-de-progenitores-hematopoyeticos-estudio-de-los-factores-que-influyen-en-su-eficacia\/"},"modified":"2018-03-11T10:47:44","modified_gmt":"2018-03-11T10:47:44","slug":"aferesis-de-alto-volumen-en-el-trasplante-autologo-de-progenitores-hematopoyeticos-estudio-de-los-factores-que-influyen-en-su-eficacia","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/hematologia\/aferesis-de-alto-volumen-en-el-trasplante-autologo-de-progenitores-hematopoyeticos-estudio-de-los-factores-que-influyen-en-su-eficacia\/","title":{"rendered":"Af\u00e9resis de alto volumen en el trasplante autologo de progenitores hematopoy\u00e9ticos. estudio de los factores que influyen en su eficacia."},"content":{"rendered":"<h2>Tesis doctoral de <strong> Raul Perez Lopez <\/strong><\/h2>\n<p>1 hipotesis de trabajo  est\u00e1 bien establecido en la literatura cient\u00edfica que existe una correlaci\u00f3n directa entre el n\u00famero de c\u00e9lulas cd34+ infundidas en el trasplante, el tiempo al injerto y la salida de la aplasia, por lo que es generalizada la recomendaci\u00f3n de infundir un n\u00famero m\u00ednimo de 2&#215;106 c\u00e9lulas cd34+ \/kg de peso del receptor. los factores conocidos que pueden afectar a la obtenci\u00f3n de un n\u00famero suficiente de c\u00e9lulas cd34+ son: la enfermedad de base, el tratamiento previo recibido, la edad o el sexo del paciente.  del mismo modo, est\u00e1 probado que la propia af\u00e9resis tiene un efecto movilizador de progenitores hematopoy\u00e9ticos a sangre perif\u00e9rica, lo que sugiere que las af\u00e9resis de alto volumen (aav), podr\u00edan aumentar la eficacia de la recolecci\u00f3n.  sin embargo, no existen estudios sobre los factores predictivos que pudieran incidir en la eficacia de este procedimiento (aav).  nuestra hip\u00f3tesis es que las aav son  eficaces y que con ellas se consigue recuperar el 100% de los progenitores cd34+ circulantes en la sp previa al procedimiento. Esto incluye particularmente a los pacientes &quot;malos movilizadores&quot; (aquellos con &lt;10 cd34+\/\u00c2\u00b5l circulantes en el momento pre-af\u00e9resis).  adem\u00e1s, hipotetizamos que la eficacia de las aav est\u00e1 influenciada por variables similares a las que afectan a las af\u00e9resis est\u00e1ndar de dos volemias. 2 objetivos 2.1 principal analizar la eficacia de las aav en el trasplante aut\u00f3logo de progenitores hematopoy\u00e9ticos en relaci\u00f3n con los siguientes factores: 1.\tEnfermedad de base. 2.\tN\u00famero de l\u00edneas de tratamiento quimioter\u00e1pico previas. 3.\tEstado de la enfermedad de base. 4.\tEsquema de movilizaci\u00f3n utilizado. 5.\tCifra de cd34+ circulantes pre-af\u00e9resis. 2.2 secundarios como objetivos secundarios nos planteamos: 1.\tEstudiar el efecto movilizador de las af\u00e9resis de alto volumen. 2.\tEstudiar la cin\u00e9tica del injerto en los distintos grupos de pacientes. 3.\tEstudiar la correlaci\u00f3n entre los progenitores hematopoy\u00e9ticos circulantes y en el producto de af\u00e9resis. 4.\tEn base a los datos obtenidos definir las variables que nos permita caracterizar aquellos pacientes que podr\u00edan beneficiarse de af\u00e9resis de alto volumen. metodolog\u00eda  se han estudiado 516 af\u00e9resis de 216 pacientes sometidos a af\u00e9resis de ph en el hospital virgen de la arrixaca durante los a\u00f1os 1996-2006, donde se analizaron los datos hematol\u00f3gicos tanto en los pacientes como en las bolsas de af\u00e9resis.  conclusiones 1.\tLas af\u00e9resis con procesamiento de cuatro volemias (af\u00e9resis de alto volumen) mantienen son eficaces para recuperar al menos el 100% de los progenitores circulantes pre-proceso incluso en los pacientes malos movilizadores.   2.\tLa eficacia de las af\u00e9resis de alto volumen no se ve afectada por el tipo de enfermedad de base, el n\u00famero de l\u00edneas de tratamiento recibidas, la respuesta a la enfermedad de base en el momento de la af\u00e9resis, el esquema de movilizaci\u00f3n utilizado ni la cifra basal de cd34+.    3.\tEl proceso de af\u00e9resis tiene efecto movilizador, ya en las af\u00e9resis de alto volumen el n\u00famero de c\u00e9lulas cd34+ obtenidas tras el procesamiento de la 3\u00aa y 4\u00aa volemia es superior al obtenido tras las dos primeras volemias. 4.\tLa realizaci\u00f3n de aav no influye en la cin\u00e9tica del injerto y consigue rescatar para trasplante aut\u00f3logo a pacientes malos movilizadores. 5.\tExiste una buena correlaci\u00f3n entre el n\u00famero de c\u00e9lulas cd34+ circulantes pre-af\u00e9resis y las cd34+ recolectadas. 6.\tLos subgrupo de pacientes que podr\u00edan beneficiarse m\u00e1s de las aav ser\u00edan las pacientes de sexo femenino, mayores de 49 a\u00f1os diagnosticados de lnh, eh, lma y llc tratadas con dos o m\u00e1s l\u00edneas de tratamiento que presenten &lt; de 100&#215;109\/l  plaquetas y 8,8 cd34+\/\u00c2\u00b5l pre-af\u00e9resis.   1 working hypothesis  it is well established in the scientific literature that there is a direct correlation between the number of cd34 + cells infused in the transplant, time to engraftment and output aplasia, so it is generally recommended to infuse a minimum of 2&#215;106 cd34 + \/ kg body weight of the recipient. known factors that can affect obtaining a sufficient number of cd34 + cells are the underlying disease, previous treatment received, age or gender. similarly, it is proved that the apheresis itself has a mobilizing effect on hematopoietic progenitors to peripheral blood, suggesting that the apheresis high volume (aav), could increase the efficiency of collection. however, no studies on the predictive factors that could influence the effectiveness of this procedure (aav). our hypothesis is that the aav are effective and that they are able to recover 100% of the cd34 + progenitors circulating in the sp after the procedure. This particularly includes patients&apos; poor mobilizers &quot;(those with &lt;10 cd34 + \/ ul circulating in the pre-apheresis time). moreover, we hypothesized that the efficacy of aav is influenced by similar variables that affect two volemias standard apheresis.  2 objectives  2.1 principal analyze the efficiency of aav in autologous hematopoietic stem cell transplantation in relation to the following factors: 1. Underlying disease. 2. Number of lines of prior chemotherapy. 3. Status of the underlying disease. scheme 4. Mobilization used. 5. Net circulating cd34 + pre-apheresis.  2.2 others as secondary objectives we set: 1. Study the mobilizing effect of high-volume apheresis. 2. To study the kinetics of graft in different groups of patients. 3. To study the correlation between circulating hematopoietic progenitors and the apheresis product. 4. Based on the data obtained define the variables that will allow us to characterize those patients who could benefit from high-volume apheresis. methodology we studied 516 patients undergoing apheresis apheresis 216 ph in the hospital virgen de la arrixaca during the years 1996-2006 where hematologic data in both patients and apheresis bags were analyzed. conclusions  1. Apheresis with four volemias processing (apheresis high volume) are maintained effective to recover at least 100% of circulating progenitors pre-process even in poor mobilizers patients. 2. The effectiveness of high-volume apheresis is not affected by the type of underlying disease, the number of lines received treatment, the answer to the underlying disease at the time of apheresis, mobilization scheme used or basal levels of cd34 +.   3. The process of apheresis has mobilizing effect, and in high volume apheresis the number of cd34 + cells obtained after processing of the 3rd and 4th blood volume is greater than that obtained after the first two volemias. 4. The performance of aav does not influence the kinetics of graft and autologous gets bail for mobilizing ill patients. 5. There is a good correlation between the number of cd34 + circulating cells pre-leukapheresis and harvested cd34 +. 6. The subset of patients who may benefit most from the aav would be the female patients, older than 49 years diagnosed with nhl, hd, aml and cll treated with two or more lines of therapy presenting &lt;of 100&#215;109 \/ l platelets and 8.8 cd34 + \/ ul pre-apheresis.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Af\u00e9resis de alto volumen en el trasplante autologo de progenitores hematopoy\u00e9ticos. estudio de los factores que influyen en su eficacia.<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Af\u00e9resis de alto volumen en el trasplante autologo de progenitores hematopoy\u00e9ticos. estudio de los factores que influyen en su eficacia. <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Raul Perez Lopez <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 30\/07\/2015<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Ana Mar\u00eda Garcia Hernandez<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Carlos Solano vercet <\/li>\n<li>Miguel Blanquer blanquer (vocal)<\/li>\n<li>aurelia Tejedor gutierrez (vocal)<\/li>\n<li>carmen Luisa Garcia de insausti (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Raul Perez Lopez 1 hipotesis de trabajo est\u00e1 bien establecido en la literatura cient\u00edfica que existe una 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