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Resultados del trasplante de progenitores hematopoyéticos de donante no emparentado con o sin globulina antitimocítica como profilaxis de la enfermedad del injerto contra receptor en pacientes con leucemia aguda y síndrome mielodisplásico
Outcomes of unrelated donor stem cell transplantation with or without anti-thymocyte globulin used as graft-versus-host disease prophylaxis in patients with acute leukaemia and myelodysplastic syndrome
Georgina Genera,
Autor para correspondencia
ggener@iconcologia.net

Autor para correspondencia.
, Montserrat Batllea, Mireia Morgadesa, María-José Jiméneza, Christelle Ferràb, Josep-Maria Riberac
a Servicio de Hematología Clínica, Institut Català d’Oncologia-Hospital Germans Trias i Pujol, Institut de Recerca contra la Leucèmia, Josep Carreras, Barcelona, España
b Universitat de Vic, Universitat Central de Catalunya, Vic, España
c Universitat Autònoma de Barcelona, Badalona, España
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En algunos estudios&#44; se ha demostrado eficaz al reducir la incidencia de EICRc<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3-6</span></a>&#44; sin impacto significativo en la supervivencia libre de enfermedad&#44; la supervivencia global&#44; la incidencia acumulada de reca&#237;da&#44; la mortalidad no debida a reca&#237;da &#40;MNDR&#41; ni la incidencia de EICR aguda &#40;EICRa&#41;&#44; pero no se ha demostrado en otros<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; Por ello&#44; muchos centros han incluido la ATG en sus esquemas de profilaxis de la EICR&#46; Por otra parte&#44; su empleo se ha asociado a un aumento de infecciones&#44; aunque el balance riesgo&#47;beneficio sigue siendo controvertido<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En este estudio se han comparado 2<span class="elsevierStyleHsp" style=""></span>grupos de pacientes receptores de un alo-TPH de DNE&#44; en funci&#243;n de si recibieron o no ATG como profilaxis de la EICR&#44; y se han analizado par&#225;metros de supervivencia y de incidencia de EICR&#44; as&#237; como la frecuencia de infecciones&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todo</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se recogieron datos de pacientes diagnosticados de leucemia aguda o s&#237;ndrome mielodispl&#225;sico que recibieron un primer alo-TPH de DNE de sangre perif&#233;rica entre diciembre de 2007 y abril de 2019&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los pacientes se agruparon seg&#250;n hubieran recibido o no ATG como profilaxis de la EICR&#46; La supervivencia global se defini&#243; como el tiempo entre la fecha de infusi&#243;n de los progenitores hematopoy&#233;ticos y la fecha de &#250;ltimo control&#46; La incidencia acumulada de reca&#237;da y la MNDR se calcularon considerando que ambos son eventos competitivos&#46; Por su parte&#44; para el c&#225;lculo de la incidencia de EICRa y EICRc&#44; la reca&#237;da y la MNDR se consideraron eventos competitivos&#46; Para la estimaci&#243;n de EICRc solo se evaluaron los pacientes que sobrevivieron al d&#237;a<span class="elsevierStyleHsp" style=""></span>&#43;100 postrasplante&#46; Para el diagn&#243;stico de la EICR se usaron los criterios cl&#237;nicos internacionales establecidos&#46; Adem&#225;s&#44; se recogieron las infecciones documentadas microbiol&#243;gicamente desde la infusi&#243;n de los progenitores hematopoy&#233;ticos hasta los 6 meses post-TPH&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de la serie global&#46; La comparaci&#243;n entre grupos se llev&#243; a cabo seg&#250;n la prueba de la mediana &#40;variables continuas&#41; y de la &#967;<span class="elsevierStyleSup">2</span> de Pearson o el test exacto de Fisher &#40;variables categ&#243;ricas&#41;&#46; La probabilidad de supervivencia global se estim&#243; mediante el m&#233;todo de Kaplan-Meier y para la comparaci&#243;n de las curvas de supervivencia se utiliz&#243; la prueba de <span class="elsevierStyleItalic">log-rank</span>&#46; La incidencia acumulada de reca&#237;da&#44; MNDR y EICR se estim&#243; mediante las funciones de incidencia acumulada&#44; teniendo en cuenta la presencia de riesgos competitivos&#44; y par las comparaciones entre grupos se us&#243; la prueba de Gray&#46; La significaci&#243;n se estableci&#243; en <span class="elsevierStyleItalic">p</span>&#160;&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se incluy&#243; a 66 pacientes&#44; cuyas principales caracter&#237;sticas se describen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; La edad mediana fue 46&#44;5 a&#241;os &#40;rango 15-68&#41; y 35 &#40;53&#37;&#41; eran varones&#46; La mayor&#237;a presentaba buen estado general en el momento del TPH &#40;ECOG&#160;&#8804;&#160;1&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>64&#59; 97&#37;&#41; y 50 &#40;76&#37;&#41; pacientes hab&#237;an recibido una l&#237;nea de tratamiento previa al alo-TPH&#46; Ten&#237;an una leucemia aguda 53 enfermos &#40;80&#37;&#41;&#44; 45 &#40;68&#37;&#41; recibieron un alo-TPH con identidad HLA completa &#40;10&#47;10 alelos&#41; y 49 &#40;74&#37;&#41; recibieron un acondicionamiento mieloablativo&#46; Recibieron ATG en el esquema de profilaxis de la EICR 50 pacientes &#40;76&#37;&#41;&#44; en los que se us&#243; ATG a dosis bajas &#40;2&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg repartidos en 3<span class="elsevierStyleHsp" style=""></span>d&#237;as&#41; en TPH de HLA compatible y ATG a dosis altas &#40;6<span class="elsevierStyleHsp" style=""></span>mg&#47;kg repartidos en 3<span class="elsevierStyleHsp" style=""></span>d&#237;as&#41; en HLA incompatibles&#46; No hubo ning&#250;n fallo de injerto primario&#46; No hubo diferencias entre los grupos tratados con ATG o sin ella&#44; a excepci&#243;n del tipo de hemopat&#237;a y el tipo de acondicionamiento &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; La mediana de seguimiento de los pacientes vivos fue de 2&#44;78 a&#241;os &#40;rango 0&#44;73-11&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">No se observaron diferencias estad&#237;sticamente significativas entre el grupo de ATG &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41; y el no ATG &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41; en la probabilidad de supervivencia global a 5 a&#241;os &#40;25&#37;&#59; IC&#160;95&#37;&#58; 8-47&#37; frente a 28&#37;&#59; 15-44&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;646&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>a&#41;&#46; Hubo una tendencia en el l&#237;mite de la significaci&#243;n estad&#237;stica a una mayor incidencia acumulada de reca&#237;da a 5 a&#241;os en los pacientes con ATG &#40;34&#37;&#59; IC 95&#37;&#58; 20-50&#37;&#59; frente a 7&#37;&#59; IC&#160;95&#37;&#58; 0-28&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;054&#41;&#44; mientras que no hubo diferencias significativas en la MNDR a 5 a&#241;os &#40;39&#37;&#59; 24-54&#37; frente a 66&#37;&#59; 34-85&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;090&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>b-c&#41;&#46; Tampoco las hubo en la incidencia acumulada de EICRa a los 100 d&#237;as del alo-TPH entre el grupo de ATG y el de no ATG &#40;34&#37;&#59; IC&#160;95&#37;&#58; 21-47&#37; frente a 50&#37;&#59; IC&#160;95&#37;&#58; 23-72&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;234&#41; ni en de EICRc a los 12 meses del alo-TPH &#40;46&#37;&#59; IC&#160;95&#37;&#58; 30-61&#37; frente a 70&#37;&#59; IC&#160;95&#37;&#58; 27-91&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;156&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>d-e&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los pacientes presentaron como m&#237;nimo un episodio de infecci&#243;n dentro de los primeros 6 meses postrasplante &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>57&#59; 86&#37;&#41;&#44; independientemente de recibir o no ATG &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Sin embargo&#44; hubo una mayor&#237;a de pacientes que presentaron &#8805;2 episodios de infecciones documentadas microbiol&#243;gicamente en el grupo de ATG &#40;60 frente a 19&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; aunque no se hallaron diferencias con relaci&#243;n a su etiolog&#237;a &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">En este estudio retrospectivo de pacientes con leucemia aguda y s&#237;ndrome mielodispl&#225;sico que recibieron un primer alo-TPH de progenitores hematopoy&#233;ticos de sangre perif&#233;rica de DNE&#44; el uso de ATG no influy&#243; en los resultados del trasplante&#44; aunque los pacientes que recibieron ATG tuvieron un n&#250;mero significativamente mayor de infecciones&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La serie analizada incluye TPH por enfermedades de alto riesgo &#40;leucemia aguda y s&#237;ndrome mielodispl&#225;sico&#41; y se ha enfocado de modo exclusivo en TPH de DNE&#44; lo que explica que los resultados sean globalmente pobres&#46; Por otra parte&#44; destaca la elevada incidencia de EICRc&#44; comparada con lo publicado<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3-8</span></a>&#46; Una explicaci&#243;n ser&#237;a que un 32&#37; de alo-TPH eran HLA-incompatibles&#44; cuyo riesgo de presentar EICR es mayor y ello tiene un impacto negativo en la supervivencia global&#46; Asimismo&#44; cabe destacar que se usaron altas dosis de ATG en pacientes receptores de un alo-TPH sin identidad HLA completa&#44; lo que podr&#237;a favorecer la aparici&#243;n de infecciones&#44; algunas de curso fatal&#46; Hay estudios que plantean la posibilidad de disminuir la dosis de ATG y mantener la m&#237;nima posible para evitar la EICR y suspender de forma m&#225;s temprana el tratamiento inmunodepresor acompa&#241;ante<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>&#46; De igual forma&#44; ser&#237;a una alternativa plausible al uso de ATG la profilaxis de la EICR con ciclofosfamida post-TPH y pauta corta de inmunosupresi&#243;n&#44; dada su baja MNDR debido a una baja incidencia de EICR e infecciones en el contexto de TPH haploid&#233;ntico en particular<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#44; pero en uso creciente en TPH de DNE<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#44; seg&#250;n estudios recientes&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La diferencia significativa encontrada en el n&#250;mero de infecciones en los enfermos que recibieron ATG se explicar&#237;a por su efecto inmunodepresor&#44; que confiere un riesgo elevado de padecerlas&#44; con independencia de su etiolog&#237;a&#46; La combinaci&#243;n de efectos favorables del empleo de ATG&#44; como la menor frecuencia de EICR&#44; quedar&#237;a contrapesada por el mayor riesgo de reca&#237;da y la mayor frecuencia de infecciones&#46; Todo ello podr&#237;a explicar que&#44; al final&#44; la supervivencia global fuera equivalente entre ambos grupos de pacientes&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Aunque el estudio se ha limitado a alo-TPH realizados a un grupo homog&#233;neo de neoplasias hematol&#243;gicas &#40;leucemia aguda y s&#237;ndrome mielodispl&#225;sico&#41;&#44; su principal limitaci&#243;n&#44; aparte del car&#225;cter retrospectivo&#44; es el escaso tama&#241;o muestral y la distribuci&#243;n no balanceada de pacientes en ambos grupos&#44; con clara mayor&#237;a de enfermos que recibieron ATG&#46; Ello impide demostrar la eventual existencia de diferencias estad&#237;sticamente significativas en los resultados principales del alo-TPH analizados&#46; Pese a ello&#44; el uso de ATG se asoci&#243;&#44; tal como est&#225; descrito en la bibliograf&#237;a&#44; a una mayor frecuencia de infecciones&#44; aunque no se tradujo en una mayor MNDR&#46; Debido a la limitaci&#243;n del tama&#241;o muestral no pudimos demostrar el efecto beneficioso de la ATG sobre la incidencia de EICRc que se ha observado en otros estudios<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3-6</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Financiaci&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">Los autores declaran no haber recibido financiaci&#243;n&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicto de intereses</span><p id="par0080" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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            1 => "Globulina antitimoc&#237;tica"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamento y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La enfermedad del injerto contra el receptor &#40;EICR&#41; y las infecciones son complicaciones del trasplante alog&#233;nico de progenitores hematopoy&#233;ticos &#40;alo-TPH&#41;&#46; La globulina antitimoc&#237;tica &#40;ATG&#41; es una estrategia empleada para la profilaxis de la EICR&#46; Este estudio analiza los resultados y la frecuencia de infecciones en funci&#243;n del uso de ATG&#44; despu&#233;s de un alo-TPH de donante no emparentado &#40;DNE&#41; en pacientes con leucemia aguda y s&#237;ndrome mielodispl&#225;sico&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo de pacientes que recibieron un alo-TPH de DNE entre diciembre de 2007 y abril de 2019&#46; Se compararon los principales resultados en funci&#243;n del uso de ATG&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 66 pacientes&#46; No se encontraron diferencias significativas en el grupo ATG &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41; frente al no ATG &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41; en supervivencia global&#44; incidencia acumulada de reca&#237;da&#44; mortalidad no debida a reca&#237;da o incidencia acumulada de EICR aguda o cr&#243;nica&#46; Hubo mayor frecuencia de infecciones en el grupo ATG &#40;60 frente a 19&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En este estudio no se demostr&#243; diferencia en los principales resultados del alo-TPH en funci&#243;n del uso de ATG&#44; pero hubo m&#225;s infecciones en el grupo que recibi&#243; ATG&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and purpose</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Graft-versus-host disease &#40;GVHD&#41; and infections are complications after allogeneic stem cell transplantation &#40;alloSCT&#41;&#46; Anti-thymocyte globulin &#40;ATG&#41; is a strategy used as prophylaxis for GVHD&#46; The study analyses the outcomes and frequency of infections with or without ATG after an unrelated donor alloSCT in patients with acute leukaemia and myelodysplastic syndrome&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of patients receiving an unrelated donor alloSCT between December 2007 and April 2019&#46; The main outcomes were analysed according to use or not of ATG&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Sixty-six patients were included&#46; No significant differences were found between the ATG group &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41; vs&#46; no-ATG group &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41; in overall survival&#44; cumulative incidence of relapse&#44; cumulative incidence of non-relapse mortality or cumulative incidence of acute GVHD or chronic GVHD&#46; There was a greater frequency of infections in the ATG group &#40;60 vs&#46; 19&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In this study&#44; no differences were shown in the main outcomes of alloSCT based on the use of ATG&#44; although more infections were documented in the ATG group&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Background and purpose"
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            "identificador" => "abst0035"
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            "identificador" => "abst0040"
            "titulo" => "Conclusions"
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">a&#41; Supervivencia global&#46; b&#41; Incidencia de reca&#237;da&#46; c&#41; Mortalidad no debida a reca&#237;da&#46; d&#41; Incidencia de EICR aguda&#46; e&#41; Incidencia de EICR cr&#243;nica&#44; seg&#250;n el tratamiento recibido entre ATG vs&#46; no ATG&#46; El test de <span class="elsevierStyleItalic">log-rank</span> se us&#243; para la comparaci&#243;n de &#40;a&#41; y la prueba de Gray&#44; para b-e&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ATG&#58; globulina antitimoc&#237;tica&#46;</p>"
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        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Los datos est&#225;n presentados en n&#250;meros absolutos y porcentaje&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Profilaxis de la enfermedad injerto contra receptor &#40;todos los pacientes basados en un r&#233;gimen de CsA&#41;&#58; 49 pacientes con CsA&#44; metotrexato y ATG&#59; uno con CsA-micofenolato-ATG&#59; 11 con CsA-metotrexato&#59; 4 con CsA-alemtuzumab&#59; uno con CsA-metotrexato-micofenolato&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">&#43;&#58; positivo&#59; &#8722;&#58; negativo&#59; ATG&#58; globulina antitimoc&#237;tica&#59; AutoTPH&#58; trasplante aut&#243;logo de progenitores hematopoy&#233;ticos&#59; Bu-Cy&#58; busulf&#225;n y ciclofosfamida&#59; CMV&#58; citomegalovirus&#59; CsA&#58; ciclosporina&#59; Cy-TBI&#58; ciclofosfamida e irradiaci&#243;n corporal total&#59; D&#58; donante&#59; ECOG&#58; <span class="elsevierStyleItalic">Eastern Cooperative Oncology Group</span>&#59; Flu-Bu&#58; fludarabina y busulf&#225;n&#59; LA&#58; leucemia aguda&#59; R&#58; receptor&#59; RC1&#58; primera remisi&#243;n completa&#59; SMD&#58; s&#237;ndrome mielodispl&#225;sico&#59; TPH&#58; trasplante de progenitores hematopoy&#233;ticos&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediana a&#241;os &#91;rango&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;393&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">54 &#40;82&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;663&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">AutoTPH previo</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero previo de tratamientos</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;319&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estado de la enfermedad al TPH</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RC1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No RC1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Compatibilidad HLA</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No mismatch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;057&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mismatch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Acondicionamiento</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mieloablativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49 &#40;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;743&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No mieloablativo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">R&#233;gimen de acondicionamiento</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bu-Cy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;006</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Flu-Bu&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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Información del artículo
ISSN: 00257753
Idioma original: Español
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Octubre 5 0 5
2023 Marzo 3 0 3
2023 Febrero 1 0 1
2021 Diciembre 1 0 1
2021 Noviembre 1 0 1
2021 Octubre 4 0 4

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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos