Bone marrow transplantation
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This document outlines the key phases and processes involved in a stem cell transplant, including conditioning, infusion, pancytopenia, engraftment, and long-term post-engraftment care. It describes the goals and timeline of the conditioning phase, stem cell infusion procedures, and the risks of pancytopenia. It also discusses engraftment, immune reconstitution, graft-versus-host disease management, and the multidisciplinary team approach required for a successful transplant.
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Bone marrow transplantation
- 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
- 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