Bone Marrow Transplant in Oncology

SK REJAULDEPARTMENT OF BIOMEDICAL ENGINEERING

NETAJI SUBHASH ENGINEERING COLLEGE

Source

Pathology Treat Leukemia by chemotherapy Regeneration of normal marrow Chemotherapy alone cannot eliminate

all malignant cells Stem cell transplants.

Transplant 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

Adult Stem Cell Transplant

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

Harvesting

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.

Cord Blood

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.

Transplantation

  Autologous   Allogeneic Syngeneic

Indications Hematological diseases

Benign : Thallassaemia, Aplastic Anaemia

Malignant : Leukemia Lymphoma Myeloma

Immune deficiency disorders Pediatric and Adult

Neurological Disease (MS)

Auto Transplant

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

Allotransplant

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

Problems Intensive process that consumes

resources HIV Donor registry limited

Other health care priorities