The bone marrow is the soft, fatty tissue inside bones that produces blood cells. It contains stem cells that give rise to red blood cells, white blood cells, and platelets. A bone marrow transplant replaces damaged or destroyed bone marrow with healthy stem cells from either the patient (autologous transplant) or a donor (allogenic transplant). Proper donor matching through HLA typing is important for success of an allogenic transplant to reduce graft-versus-host disease.

1. Moderated by:- Presented by:-
Dr. Maitrayee Roy Suchit Kumar
(Asst. Prof. ) Msc(mlt) 1st year
Department of pathology (MMISR)
M.M. Deemed to be university

2.  Bone Marrow is the soft spongy tissue that fills the
cores of larger bones.
 It serves an active function in the body by producing
all three types of blood cells, as well as lymphocytes,
which support the immune system.

3.  There are two types of bone marrow :-
1.Red bone marrow-
That is responsible for producing RBC’s ,
WBC’s and platelets.
2. Yellow bone marrow-
It consisting mainly of fat cells (adipocyte).

4. The bone marrow is removed from the back of
both hip bones.

6.  Stem cell can be collected from the
peripheral blood , bone marrow ,
umbilical cord blood.

7.  The donor is given a general anesthetic and
500-1200 ml marrow is harvested from pelvis.

8.  Fetal blood is a rich source of stem cells which
may be collected from cord blood.
 Because of the relatively small numbers of stem
cells collected from a single cord , they are
most useful for children who do not have a
fully matching sibling or unrelated donor
 Less stringent HLA matching is needed.

9.  A bone marrow transplant is a procedure to replace
damaged or destroyed bone marrow with healthy bone
marrow stem cells. Bone marrow is the soft, fatty tissue
inside your bones.
 The bone marrow produces blood cells. Stem cells are
immature cells in the bone marrow that give rise to all
of your different blood cells.

10.  It involves eliminating a patient’s hemopoietic
and immune system by chemotherapy and
replacing it with stem cells either from another
individual or with a previously harvested
portion of the patient’s own stem cells.
 The term bone marrow transplantation(BMT) ,
in which stem cells are collected from bone
marrow.

11.  Therearetwo main types ofbone marrow transplantation :
 Autologous bone marrow transplant:
Stem cells are removed from your body before you
receive chemotherapy and stored in a freezer. After
chemotherapy is done, your stem cells are put back in
your body to add to your normal blood cells. This is called
a «rescue» transplant
 Allogeneic bone marrow transplant:
Stem cells are removed from another person, called a
donor. Most times, the donor must at least partly match
you genetically, a brother or sister is most likely to be a
good match.

13.  A bone marrow transplant is a medical
procedure performed to replace bone
marrow that has been damaged or destroyed
by disease, infection, or chemotherapy.
 This procedure involves transplanting blood
stem cells, which travel to the bone marrow
where they produce new blood cells and
promote growth of new marrow.

14. 1. Allogenic
transplants about
73%, Leukemia
28% for CML,
24% for AML:
20% for ALL and
1% for other
malignancies or
premalignant
disorders.
2. Autologous BMT : is
used only for malignancies,
NHL 25%;
Breast cancer,24%;
Hodgkin's disease 17%;
AML,11%;
Multiple myeloma, 4%;
ALL, 3%;
Neuroblastome 3%;
other Cancers, 13%.

15.  1. Fully matched sibling: Matching is
performed by serological typing of class I and
Class II MHC, as well as, bidirectionally
negative mixed lymphocyte culture.
 2.Other family donors: Including parents or
other sibling non- identical in one A or one B
class I MHC locus. For such cases typing of
class II MHC has to be performed both
serologically and at the DNA level.

16.  Prior to transplant, dental, ENT and
gynecological examinations are done for all
patients to exclude septic foci. Liver and
kidney function tests, respiratory function
tests, ECG, Echocardiography, chest X-ray and
abdominal sonography are performed to
exclude any organ function impairment.
 Serological tests for toxoplasmosis and the
following viruses: HBV, CMV, HIV, HCV,
EBV, HSV, and HZV are also performed.
Patients with recent infections are excluded.

17.  The major histocompatibility complex (MHC) is
a set of cell surface proteins essential for
the acquired immune system to recognize
foreign molecules in vertebrates, which in turn
determines histocompatibility.
 The MHC determines compatibility of donors
for organ transplant.

18.  The MHC molecules are classified in to three
classes namely :-
1. MHC class I
2. MHC class II
3. MHC class III

19.  MHC class I :-
In this molecule are a group of major histocompactibility
antigen. They are present on the surface of all
nucleated cells except nervous tissue and platelets. It
present antigen(HLA-A,-B,-C) to CD8+ T cells.
 MHC class II:-Class II molecule are present on the
surface of antigen presenting(HLA-DR, HLA-DQ, HLA-
DP) to CD4+ T cells.
 MHC class III :-The molecules include complements like
C2 and C4 and Bf (factor B).

20.  The natural role of HLA molecules is in
directing T- lymphocyte responses and the
greater the HLA mismatch the more severe is
the immune response b/w transplanted cells.
HLA typing is critical in donor selection for
allogeneic SCT.
 HLA typing may be carried out by serological
or molecular techniques. Serological testing
involves the use of antibodies that are specific
for individual HLA alleles or small families
alleles.

21.  This is caused by donor derived immune cells ,
particularly T – lymphocytes, reacting against
recipient tissues.
 In this , Lymphocytes from the donor graft
attack the cells of the host.
 GVHD can usually be treated with steroids or
other immunosuppressive agents.

22. These are two types :-
1. Acute GVHD :- In this , usually occurring in the
first 100 days, the skin , gastrointestinal tract
or liver are affected.
The skin rash typically affects the face ,
palms, soles and ears but may in several
cases affect the whole body.
2. Chronic GVHD :-which usually occurs after 100
days and may evolve from GVHD infections.
Malabsorption and pulmonary abnormalities
are frequent.

23.  Aplastic anemia, which is a disorder in which the
marrow stops making new blood cells
 cancers that affect the marrow, such as leukemia,
lymphoma, and multiple myeloma
 Damaged bone marrow due to chemotherapy
 Congenital neutropenia, which is an inherited disorder
that causes recurring infections
 Sickle cell anemia, which is an inherited blood disorder
that causes misshapen red blood cells
 Thalassemia, which is an inherited blood disorder
where the body makes an abnormal form of
hemoglobin, an integral part of red blood cells