Chagas disease in bone marrow transplantation: an approach to preemptive therapy

Abstract

Summary:The efficacy of preemptive therapy was evaluated in bone marrow transplantation (BMT) recipients associated with Chagas disease (CD). The criterion to include patients in the protocol was the serological reactivity for CD in recipients and/or donors before transplant. After BMT, the monitoring was performed using the direct Strout method (SM), which detects clinical levels of Trypanosome cruzi parasitemia, and CD conventional serological tests. Monitoring took place during 60 days in ABMT and throughout the immunosuppressive period in allogeneic BMT. Reactivation of CD was diagnosed by detecting T. cruzi parasites in blood or tissues. In primary T. cruzi infection, an additional diagnostic criterion was the serological conversion. A total of 25 CD-BMT patients were included. Two ABMT and four allogeneic BMT recipients showed CD recurrences diagnosed by SM. One patient also showed skin lesions with T. cruzi amastigotes. Benznidazole treatment (Roche Lab), an antiparasitic drug, was prescribed at a dose of 5 mg/kg/day during 4-8 weeks with recovery of patients. Primary T. cruzi infection was not observed. This report proves the relevance of monitoring CD in BMT patients and demonstrates that preemptive therapy was able to abrogate the development of clinical and systemic disease.

2 nd Brazilian Consensus on Chagas Disease, 2015

“…The rate of reactivation in recipients of allogeneic hematopoietic stem cell (184) and liver (185) transplants is 27.3%, and 18.7%, respectively. The use of corticosteroids in association with increased parasitemia and a possible effect with immunosuppressive drugs to treat mesenchymal diseases have been recorded, without a well-defined causal relationship (186) .…”

Profilaxis de enfermedad de Chagas en niños y adultos sometidos a trasplante de órganos sólidos y de precursores hematopoyéticos

“…En trasplante de corazón, D(-) R(+), se reporta reactivación en 70% de los casos 8 . En relación a otros órganos sólidos y TPH, la reactivación estimada es de 17 a 40% 9,10 .…”

“…• En el receptor infectado existe controversia de cuál estrategia es más eficaz 9 , profilaxis universal o terapia anticipada, siendo esta última la preferida en los países que cuentan con mayor experiencia como Brasil y Argentina. En estos pacientes y debido a la alteración de la inmunidad humoral existente, se recomienda el tamizaje con técnicas directas de detección, siendo el óptimo, MicroStrout.…”

“…El tratamiento pre-trasplante de los R (+) es recomendable pero su factibilidad debe ser evaluada con precaución por un especialista dada la posibilidad de efectos secundarios e interacciones medicamentosas 9 .…”

Chagas disease in a recipient of cord blood transplantation

“…3,4 Recently, the efficacy of pre-emptive therapy has been evaluated in hemopoietic transplant recipients. 5 It is important to develop programs to control this disease in blood donors, stem cell donors and recipients by screening to prevent adverse outcomes in immunosuppressed patients. …”