Transcript Bone Marrow Transplant in Oncology

Bone Marrow Transplant in
Oncology
Dr S D Moodley
Wits Donald Gordon Medical Centre
Source
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
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 welldeveloped 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
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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
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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
Isolation
Phoresis
Platelet and blood support
Motivated patient
Problems
 Intensive process that consumes
resources
 HIV
 Donor registry limited
 Other health care priorities