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Transplantation of Hematopoietic Stem Cells for Primary Immunodeficiencies in Brazil: Challenges in Treating Rare Diseases in Develo** Countries

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Abstract

The results of hematopoietic stem cell transplant (HSCT) for primary immunodeficiency diseases (PID) have been improving over time. Unfortunately, develo** countries do not experience the same results. This first report of Brazilian experience of HSCT for PID describes the development and results in the field. We included data from transplants in 221 patients, performed at 11 centers which participated in the Brazilian collaborative group, from July 1990 to December 2015. The majority of transplants were concentrated in one center (n = 123). The median age at HSCT was 22 months, and the most common diseases were severe combined immunodeficiency (SCID) (n = 67) and Wiskott-Aldrich syndrome (WAS) (n = 67). Only 15 patients received unconditioned transplants. Cumulative incidence of GVHD grades II to IV was 23%, and GVHD grades III to IV was 10%. The 5-year overall survival was 71.6%. WAS patients had better survival compared to other diseases. Most deaths (n = 53) occurred in the first year after transplantation mainly due to infection (55%) and GVHD (13%). Although transplant for PID patients in Brazil has evolved since its beginning, we still face some challenges like delayed diagnosis and referral, severe infections before transplant, a limited number of transplant centers with expertise, and resources for more advanced techniques. Measures like newborn screening for SCID may hasten the diagnosis and ameliorate patients’ conditions at the moment of transplant.

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Acknowledgments

The authors thank all the nurses, physicians, and multidisciplinary staff of the participating centers.

Authorship Contribution

JFF designed the study, enrolled and cared for patients, reviewed and analyzed data, and wrote the paper. CB and SN designed the study, enrolled and cared for patients, and reviewed the paper. All the other authors contributed to data collection, patient care, and reviewed the paper.

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Authors and Affiliations

  1. Instituto da Criança – Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil

    Juliana Folloni Fernandes, Luiz F. Mantovani & Magda Carneiro-Sampaio

  2. Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

    Juliana Folloni Fernandes, Fábio R. Kerbauy, Luiz F. Mantovani, Andreza F. Ribeiro & Nelson Hamerschlak

  3. Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil

    Samantha Nichele, Adriana Koliski, Gisele Loth, Lisandro L. Ribeiro, Ricardo Pasquini & Carmem Bonfim

  4. Hospital de Clínicas de Porto Alegre – Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Liane E. Daudt

  5. Instituto Nacional do Cancer, Rio de Janeiro, Brazil

    Rita B. Tavares

  6. Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo, São Paulo, Brazil

    Adriana Seber & Victor G. Zecchin

  7. Hospital de Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

    Ana K. Vieira

  8. Hospital das Clínicas da Universidade de São Paulo, Ribeirão Preto, Brazil

    Luiz G. Darrigo-Junior

  9. Hospital Sírio Libanês, São Paulo, Brazil

    Vanderson Rocha & Alessandra A. Gomes

  10. Churchill Hospital, University of Oxford, NHS-BT, Oxford, UK

    Vanderson Rocha

  11. Hospital Amaral Carvalho, Jaú, São Paulo, Brazil

    Vergílio Colturato

  12. Hospital Nossa Senhora das Graças, Curitiba, Brazil

    Lisandro L. Ribeiro, Ricardo Pasquini & Carmem Bonfim

  13. Hospital Infantil Pequeno Príncipe, Curitiba, Brazil

    Cilmara Kuwahara, Ana L. M. Rodrigues & Carmem Bonfim

  14. Grupo Brasileiro de Imunodeficiências, BRAGID, São Paulo, Brazil

    Beatriz T. Costa-Carvalho

  15. Consórcio Brasileiro de Centros de Referência em Imunodeficiências Primárias, CoBID, São Paulo, Brazil

    Magda Carneiro-Sampaio

  16. Department of Immunology, Institute of Biomedical Sciences, and Institute of Tropical Medicine, University of São Paulo, São Paulo, SP, Brazil

    Antonio Condino-Neto

  17. Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden

    Anders Fasth

  18. Great North Children’s Hospital, Newcastle-Upon-Tyne, United Kingdom

    Andrew Gennery

Authors
  1. Juliana Folloni Fernandes
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  2. Samantha Nichele
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  3. Liane E. Daudt
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  4. Rita B. Tavares
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  14. Luiz F. Mantovani
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  18. Ana L. M. Rodrigues
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  20. Beatriz T. Costa-Carvalho
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  23. Anders Fasth
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  24. Andrew Gennery
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  25. Ricardo Pasquini
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  26. Nelson Hamerschlak
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  27. Carmem Bonfim
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Corresponding author

Correspondence to Juliana Folloni Fernandes.

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This study was approved by the Institutional Review Boards of each center and performed in accordance with the 1964 Declaration of Helsinki.

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The authors declare that they have no conflict of interest.

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Fernandes, J.F., Nichele, S., Daudt, L.E. et al. Transplantation of Hematopoietic Stem Cells for Primary Immunodeficiencies in Brazil: Challenges in Treating Rare Diseases in Develo** Countries. J Clin Immunol 38, 917–926 (2018). https://doi.org/10.1007/s10875-018-0564-1

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