Multiple myeloma and Chagas disease: qPCR as a marker for preemptive antiparasitic therapy: a case reports series and review

Autor(es):Mostrar menos -

Noemia Barbosa Carvalho ^[1] ; Vera Lúcia Teixeira de Freitas ; Fernanda Salles Seguro ; Rita Cristina Bezerra ^[4] ; Giancarlo Fatobene ; Érika Yoshie Shimoda Nakanishi ^[6] ; Helena Visnadi ^[7] ; Gracia Martinez ^[8] ; Marjorie Vieira Batista ; Vanderson Rocha ; Frederico Luis Dulley ^[11] ; Sílvia Figueiredo Costa ; Maria Aparecida Shikanai-Yasuda

Afiliação do(s) autor(es):Mostrar menos -

^[1] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[4] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[6] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[7] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[8] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

^[11] Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas - Brasil

• Tipo de documento: Artigo Científico
• Fonte: Revista do Instituto de Medicina Tropical de São Paulo; v. 66, 2024-02-05.

Resumo

ABSTRACT Multiple myeloma (MM) associated with Chagas disease is rarely described. This disease and its therapy suppress T cell and macrophage functions and increase regulatory T cell function, allowing the increase of parasitemia and the risk of Chagas Disease Reactivation (CDR). We aimed to analyze the role of conventional (cPCR) and quantitative Polymerase Chain Reaction (qPCR) for prospective monitoring of T. cruzi parasitemia, searching for markers of preemptive antiparasitic therapy in MM patients with Chagas disease. Moreover, we investigated the incidence and management of hematological diseases and CDR both inside and outside the transplant setting in the MEDLINE database. We found 293 studies and included 31 of them. Around 1.9–2.0% of patients with Chagas disease were reported in patients undergoing Stem Cell Transplantation. One case of CDR was described in eight cases of MM and Chagas disease. We monitored nine MM and Chagas disease patients, seven under Autologous Stem Cell Transplantation (ASCT), during 44.56±32.10 months (mean±SD) using parasitological methods, cPCR, and qPCR. From these patients, three had parasitemia. In the first, up to 256 par Eq/mL were detected, starting from 28 months after ASCT. The second patient dropped out and died soon after the detection of 161.0 par Eq/mL. The third patient had a positive blood culture. Benznidazole induced fast negativity in two cases; followed by notably lower levels in one of them. Increased T. cruzi parasitemia was related to the severity of the underlying disease. We recommend parasitemia monitoring by qPCR for early introduction of preemptive antiparasitic therapy to avoid CDR. (AU)

• Processo FAPESP: 12/50273-0 - Monitoramento de pacientes imunodeprimidos com Doenças de Chagas: níveis de parasitemia e associação com o perfil, poliformismo de citonas sobrevidas e características dos isolados Trypanosoma cruzi em transplante de órgãos, uso de drogas imunossupressoras e co-infecção com o vírus da imunodeficiência humana
• Beneficiário: Maria Aparecida Shikanai Yasuda
• Modalidade de apoio: Auxílio à Pesquisa - Regular