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Bone Marrow Transplant in Oncology

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Patient's bone marrow stem cells are replaced with healthy cells ... Autologous. Allogeneic. Syngeneic. Indications. Hematological diseases ... – PowerPoint PPT presentation

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Title: Bone Marrow Transplant in Oncology


1
Bone Marrow Transplant in Oncology
  • Dr S D Moodley
  • Wits Donald Gordon Medical Centre

2
Source
3
Pathology
  • Treat Leukemia by chemotherapy
  • Regeneration of normal marrow
  • Chemotherapy alone cannot eliminate all malignant
    cells
  • Stem cell transplants.

4
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

5
Procedure
  • Bone Marrow versus Peripheral Stem Cells
  • Accessibility
  • Cost
  • Sample size
  • Donor/Patient factors
  • Expertise

6
Adult Stem Cell Transplant
7
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

8
Harvesting
9
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
    PBSCs.

10
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.

11
Cord Blood
12
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.

13
Transplantation
  •   Autologous
  •   Allogeneic
  • Syngeneic

14
Indications
  • Hematological diseases
  • Benign Thallassaemia, Aplastic Anaemia
  • Malignant Leukemia Lymphoma Myeloma
  • Immune deficiency disorders
  • Pediatric and Adult
  • Neurological Disease (MS)

15
Auto Transplant
16
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

17
Allotransplant

18
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

19
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

20
Transplantation
  • Unit is important
  • Expertise
  • Facility
  • Isolation
  • Phoresis
  • Platelet and blood support
  • Motivated patient

21
Problems
  • Intensive process that consumes resources
  • HIV
  • Donor registry limited
  • Other health care priorities
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