Browsing by Author "Sotomayor, Cristian"

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    Individualized dose of anti-thymocyte globulin based on weight and pre-transplantation lymphocyte counts in pediatric patients: a single center experience
    (Springer Nature, 2024) Barriga, Francisco; Wietstruck Pena, Maria Angelica; Schulze Schiappacasse, Clara Edith; Catalan Martinez, Paula Valentina; Sotomayor, Cristian; Zuñiga Contreras, Pamela Alejandra; Aguirre Rioseco, Noemi Doris; Vizcaya Altamirano, Maria Cecilia; Le Corre Perez, Monique Nicole; Villarroel, Luis
    Anti-thymocyte globulin (ATG) has become a standard in preventing GVHD in related and unrelated donor transplantation, but there is no consensus on the best administration schedule. The PARACHUTE trial reported excellent CD4 immune reconstitution (CD4 IR) using a dosing schedule based on the patient's weight and pre-conditioning absolute lymphocyte count (ALC). In 2015 we introduced the PARACHUTE dosing schedule for pediatric patients at our center. One hundred one patients were transplanted for malignant and non-malignant diseases. In this non-concurrent cohort CD4 IR+, defined by a single CD4 count >50/µL on day 90, was seen in 81% of patients. The incidence of grade II-IV and III to IV aGvHD was 26.6% and 15.3% and 5% for cGvHD with no severe cases. We found no difference in aGvHD between donor type and stem cell sources. Five-year EFS and OS were 77.5% and 83.5%. Grade III-IV GFRS was 75.2%. CD4 IR+ patients had better EFS (93.1% vs. 77.7%, p = 0.04) and lower non-relapse mortality (2.7% vs. 22.2%, p = 0.002). The PARACHUTE ATG dosing schedule individualized by weight and ALC results in good early immune reconstitution, low incidence of cGvHD, and favorable survival for patients with different disease groups, donor types, and stem cell sources.
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    Ovarian reserve and premature ovarian failure in girls and adolescents after hematopoietic stem cell transplantation
    (2022) Paris, Claudia; Zepeda, Ana; Munoz, Monica; Camus, Adela; Catalan, Paula; Sotomayor, Cristian; Luengo, Rosario; Schulin-Zeuthem, Carolina; Brieba, Mariela; Romero, Patricia
    The increased survival of children and adolescents after Stem Cell Transplantation (SCT) has allowed us to gain a better understanding of the late effects that this procedure might have. Objective: to measure ovarian function and reserve after SCT. Patients and Method: A descriptive, observational, and cross-sectional study of girls and adolescents with SCT between 1999 and 2011. External gynecologic examination, hormone tests, and abdominal gynecologic ultrasound were performed, observing pubertal development pre-SCT. The following data from the clinical record were recorded: baseline pathology, type of conditioning, use of radiotherapy in conditioning, age at the time of SCT, and history of acute or chronic graft-versus-host disease (GVHD). Hormonal tests included folliclestimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin (PRL), thyroid-stimulating hormone (TSH), free thyroxine, total testosterone, sex hormone-binding globulin (SHBG), and anti-Mullerian hormone (AMH). Statistical analysis included the chi-square or Fisher's Exact test with a p-value < 0.05. Results: 41 patients were evaluated. The median age at the time of SCT was 6.8 years (1.5-14.1) and the median age at evaluation was 14.8 years (range: 4-25.4 years). 93% of the transplants were in patients with oncological disease and with myeloablative conditioning regimens. All patients presented decreased ovarian reserve, and 72% showed Premature Ovarian Failure (POF). Conclusions: All patients had decreased ovarian reserve and most of them had a high prevalence of POF. Before SCT, a gynecological evaluation and subsequent follow-up for hormone monitoring and initiation of hormone replacement are essential.