A presentation about Allogeneic HSCT

1. Ashraf Mohammad Alsuhebah, RN, CNC, MSC
King Fahad Specialist Hospital-Dammam, Saudi Arabia

2. Transplant process
 Conditioning phase
 Infusion phase
 Pancytopenia phase
 Engraftment phase
 Post engraftment phase

3. Roadmap for transplant
 Simple and feasible tool works as a reference for the team
 Prevents missing important steps in the care plan

4. Patient Demographics

6. Conditioning phase
 The conditioning regimen typically lasts 7-10 days.
 It is the use of a high doses of chemotherapy/Radiotherapy or both aiming to:
 Eliminate residual malignancy
 Provide immune suppression to prevent the rejection of the new stem
cells
 Create space for the new cells

7. Stem Cell Infusion
 It takes 20 minutes to one hour, depending on the volume infused.
 It has to be through Central Venous Access Device.
 Premedication with Acetaminophen and Diphenhydramine to prevent anaphylaxis.
 Anaphylaxis and volume overload are the most common complications.
 Stem cell products that have been cryopreserved contain Dimethyl sulfoxide
( DMSO) as a preservative, it is potentially can cause renal failure, in addition to
the unpleasant smell and taste.

8. Pancytopenia phase
 It is about the massive reduction of the neutrophils, HgB, and the platelets.
 It is a critical period in which poor healing, infections, and bleeding are highly
susceptible.
 Supportive care and empiric antimicrobials are the mainstays of successful
passage through this phase.
 It lasts for about 2-4 weeks.

9. Engraftment phase
 During this period (several weeks), the healing process begins with resolution
of mucositis and other lesions acquired.
 Fever begins to subside, and infections often begin to clear.
 The greatest challenges at this time are management of GVHD and
preventions of infections, especially viral, such as CMV and EBV.

10. Post engraftment phase
 This period lasts for months to years.
 Hallmarks of this phase include :
 Gradual development of tolerance
 Weaning off the immunosuppressant
 Management of chronic GVHD
 Documentation of immune reconstitution

11. Graft Versus Host Disease(GVHD)

12.  If the donor cells see the host cells as foreign, the donor cells will attack the
host
 Skin, gut, and liver are most likely to be affected
 Acute < 100 days after the transplant date
 Chronic > 100 days

14. Multidisciplinary team approaches
Patient
Doctors
Nurses
Laboratory
Blood bank
Social
workers
Dental
psychiatry
Pharmacy
Dietitian
Others
Safe
Effective
Timely
EfficientEquitable
Patient-
centered