DESFECHOS CLÍNICOS EM PACIENTES COM LMA TRATADOS COM QUIMIOTERAPIA, TRANSPLANTE DE MEDULA E NOVAS TERAPIAS
DOI:
https://doi.org/10.56238/levv16n52-036Palavras-chave:
Leucemia Mieloide Aguda, Quimioterapia, Transplante de Medula Óssea, Novas Terapias, Desfechos Clínicos, PrognósticoResumo
A leucemia mieloide aguda (LMA) é uma neoplasia hematológica agressiva caracterizada pela proliferação descontrolada de células mieloides imaturas na medula óssea, levando à falência hematopoiética e elevadas taxas de morbidade e mortalidade. O manejo da LMA evoluiu significativamente, incorporando abordagens clássicas, como a quimioterapia intensiva e o transplante de células-tronco hematopoéticas (TCTH), bem como novas terapias-alvo e imunoterapias. No entanto, os desfechos clínicos desses tratamentos variam conforme fatores prognósticos individuais, incluindo idade, mutações genéticas e resposta inicial ao tratamento. O objetivo deste estudo foi analisar os desfechos clínicos de pacientes com LMA tratados com quimioterapia, transplante de medula óssea e novas terapias, avaliando a eficácia dessas abordagens no prognóstico e na sobrevida dos pacientes. De forma específica, foram comparadas as taxas de remissão, sobrevida e recidiva entre os diferentes tratamentos, além da investigação de fatores prognósticos que influenciam a resposta terapêutica. Para isso, foi realizada uma revisão bibliográfica utilizando as bases de dados SciELO, Google Acadêmico e PubMed, com artigos publicados entre 2017 e 2025. Foram selecionados estudos originais, revisões sistemáticas e meta-análises que apresentassem dados quantitativos sobre os desfechos clínicos dos tratamentos. Estudos sem fundamentação estatística, relatos de caso e artigos indisponíveis foram excluídos da análise. Os dados foram organizados e analisados de forma comparativa para identificar padrões nos desfechos clínicos. Os resultados indicaram que a quimioterapia intensiva continua sendo a abordagem inicial padrão, proporcionando remissão completa em 60-80% dos pacientes jovens, porém com altas taxas de recaída. O transplante de medula óssea foi associado a melhores taxas de sobrevida global, atingindo 59% em dois anos, sendo considerado a única abordagem potencialmente curativa para pacientes de alto risco. No entanto, sua aplicabilidade é limitada por complicações graves, como toxicidade e doença do enxerto contra o hospedeiro. Já as novas terapias, incluindo inibidores de FLT3, IDH1/IDH2 e imunoterapias, demonstraram aumentar a sobrevida mediana de 7 para 11 meses, representando uma alternativa promissora para pacientes inelegíveis ao transplante. Conclui-se que, apesar dos avanços terapêuticos, a LMA ainda apresenta desafios clínicos significativos, sendo necessária uma abordagem personalizada baseada em fatores prognósticos individuais. O transplante de medula óssea continua sendo a estratégia mais eficaz para pacientes de alto risco, enquanto novas terapias emergem como alternativas viáveis para grupos específicos. A otimização das estratégias terapêuticas e o aprimoramento da estratificação prognóstica são essenciais para melhorar a sobrevida e a qualidade de vida dos pacientes.
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