bone marrow transplant in oncology dr s d moodley wits donald gordon medical centre
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Pathology
Treat Leukemia by chemotherapy Regeneration of normal marrow Chemotherapy alone cannot eliminate
all malignant cells Stem cell transplants.
Tranplant
Patient's bone marrow stem cells are replaced with healthy cells
Existing bone marrow and abnormal leukocytes killed
Chemotherapy and radiation Next bone marrow containing healthy
stem cells re-infused
Procedure
Bone Marrow versus Peripheral Stem Cells
Accessibility Cost Sample size Donor/Patient factors Expertise
Procedure
Most blood stem cells reside in the bone marrow and a small number are present in the bloodstream
Multipotent peripheral blood stem cells
Can be obtained from drawn blood PBSCs are easier to collect than bone
marrow stem cells
Umbilical Cord Blood Stem Cell Transplant
Umbilical cords have traditionally been discarded as a by-product of the birth process.
Pluripotent-stem-cell-rich blood found in the umbilical cord rich in marrow stem cells and PBSC’s.
Umbilical Cord Tx Umbilical cord transplants are less prone
to rejection. Cells have not yet developed the
features that can be recognized and attacked by the recipient's immune system.
Umbilical cord blood lacks well-developed immune cells, there is smaller incidence of graft versus host disease.
THE FUNCTION OF BMT UNIT
Handling services & Intensive care for:
Mobilization / stem cell collection & infusion.
Chemotherapy for pre - transplant Pre & post care for Transplant
patients.
Indications
Hematological diseasesBenign : Thallassaemia, Aplastic
Anaemia Malignant : Leukemia Lymphoma
Myeloma Immune deficiency disorders
Pediatric and Adult Neurological Disease (MS)
Recovering from the transplant
Recovery of normal levels cells is called engraftment
Day 8 - 12 Neutrophil engraftment important (GCSF)
may be given to accelerate the process Platelets are the next to return with red cells
last. Commonly patients require transfusion of red
cells and platelets following a transplant. Discharge upon neutrophil & platelet
engraftment
Graft Verses Host Disease (GVHD) GVHD sometimes occurs with allogeneic
transplantation. Lymphocytes from the donor graft attack the cells of
the host GVHD can usually be treated with steroids or other
immunosuppressive agents. Acute GVHD occurs before day 100 post-transplant Chronic GVHD occurs beyond day 100 Recent advances have reduced the incidence and
severity of this post-transplant complication, but GVHD, directly or indirectly, still accounts for approximately 15% of deaths in stem cell transplant patients
Chronic GVHD can develop months or even years post-transplant
GVHD Skin/Hair Rash, scleroderma, lichenoid skin changes, dyspigmentation,alopecia Eyes Dryness, abnormal Schirmer's Test, cornealerosions, conjunctivitis Mouth Atrophic changes, lichenoid changes, mucositis,ulcers, xerostomia, dental
caries Lungs Bronchiolitis obliterans GI tract Esophageal involvement, chronic nausea/vomiting, chronic diarrhea,
malabsorption, fibrosis, abdomina l pain/cramps Liver Abnormal LFTs, biopsy abnormalities Genitourinary Vaginitis, strictures, stenosis, cystitis Musculoskeletal Arthritis, contractures, myositis, myasthenia, fascities Hematologic Thrombocytopenia, eosinophilia, autoantibodies
Transplantation Unit is important Expertise Facility
IsolationPhoresisPlatelet and blood supportMotivated patient