RECIPIENTS AND DONORS OF BONE-MARROW TRANSPLANTS SUFFERING FROM CHAGAS-DISEASE - MANAGEMENT AND PREEMPTIVE THERAPY OF PARASITEMIA

We report the clinical course of five adult patients with chronic Chag as' disease (Cd) who underwent BMT, Two patients with non-Hodgkin's ly mphoma and one with ALL received an ABMT, Allogeneic BMT was performed in two patients with AML and CML respectively, One donor had chronic Cd, Samples of peripheral blood for parasite investigation by the Stro ut method, blood culture, and immunological studies by indirect immuno fluorescent assay, ELISA and indirect hemagglutination tests were perf ormed weekly from the start of chemotherapy until day +60 for ABMT and during the period of immunosuppression for allogeneic BMT. No prophyl axis was given to any of these patients, In only one ABMT patient were trypomastigotes detected early by blood culture without symptoms of r eactivation, Benznidazole as preemptive treatment was administered at 5-8 mg/kg/daily for 30 days, Parasitemia was rapidly cleared and at th e end of therapy xenodiagnosis was negative, The other Cd patients sho wed no evidence of relapse of parasitemia or signs and symptoms of rea ctivation, In brief, evidence of Cd should be sought in all BMT patien ts coming from endemic areas because parasitemia and reactivation are potential complications during the period of neutropenia and immunosup pression, The strategy used for early detection and treatment of paras itemia and reactivation was safe and effective.