BONE MARROW TRANSPLANTATION

1. SUDESHNA BANERJEE
M.SC (N) 1ST YEAR
HFCON
POST-BONE MARROW
TRANSPLANTATION
CARE

2.  A bone marrow transplant is usually done in a
hospital or medical center that specializes in such
treatment
Most of the time, patient stay in a special bone
marrow transplant unit in the center. This is to limit
the chances of getting an infection

3. A two- to four-week waiting period follows the marrow
transplant before its success can begin to be judged
The marrow recipient is kept in isolation during this
time to minimize potential infections
The recipient also receives intravenous antibiotic,
antiviral, and antifungal medications, as well as blood
and platelet transfusions to help fight off infection and
prevent excessive bleeding
Blood tests are performed

4. Daily to monitor the patient's kidney and liver
function, as well as nutritional status
Further side effects, such as nausea and vomiting,
can be treated with other medications

5. SIDE EFFECTS OF BONE MARROW STEM
CELL TRANSPLANTATION
• Mucositis (mouth sores) and diarrhea
• Nausea and vomiting
• Loss of hair
• Infertility
• Organ toxicity
• Secondary cancers
• Graft failure
• Risk of death

6. POST BMT INFECTION
CAUSES
Month 1 — bacteria, fungi, herpes
simplex virus
Month 2 — cytomegalovirus (CMV),
bacteria, and fungi
Month 3 — varicella zoster virus,
bacteria, fungi

7. PREVENTING INFECTION
PAY CLOSE ATTENTION TO HYGIENE:
Patient may shower or bathe normally, as long as
he don’t submerge his central venous catheter
under water
To help minimize infection and gum bleeding, daily
oral (mouth) care is necessary

8. PREVENT INFECTIONS TRANSMITTED BY DIRECT
CONTACT:
Wash hands with antimicrobial(antibacterial) soap and
warm water
Before and after any central venous catheter care
or intravenous infusions
Before taking oral medicines
After touching soiled linens or clothes

9. PREVENT RESPIRATORY INFECTIONS:
Avoid close contact with people who have respiratory
illnesses (cough, cold, etc.)
Avoid crowded areas where you are unable to control the
distance between you and others. Some might feel "safer"
wearing a mask
Avoid tobacco and marijuana use. The use of these
substances increases risk for bacterial, viral, and fungal
infections
Avoid the use of a room humidifier due to the water-
harboring bacteria

10. WATER SAFETY:
Avoid drinking well water from private wells or from public
wells in small communities because tests for microbial
contamination are performed too infrequently
A boil-water advisory means that all tap water should be
boiled for at least 1 minute before drinking

11. NURSING MANAGEMENT
Nursing care for patients undergoing BMT is
complex & demands a high level of skill. The
success rate of BMT is greatly influenced by
nursing care through out the transplantation
process
IMPLEMENTING
PRETRANSPLANTATION CARE:
 Nutritional assessment, physical
examinations, organ function tests,
psychological evaluations are performed.

12. NURSING MANAGEMENT CONT…
 Blood works include assessing past exposure to any disease
caused by cytomegalovirus, hepatitis virus, HIV, herpes
simplex virus
 Patient’s social support system and financial conditions are
also evaluated
 Informed consent & patient teaching about the procedure
& pre-transplantation & post-transplantation care are vital

13. PROVIDING CARE DURING TREATMENT:
Monitoring vital signs of the patient, oxygen saturation
Assessing for any adverse effects like fever, SOB, chest
pain, nausea-vomiting, hypotension, tachycardia
During transplant patient may get adverse reactions due
to the cryoprotectant dimethyle sulfoxide used to preserve
harvested stem cells; so ongoing support and patient
teaching is needed

14.  During first 30 days following transplant the patient is
most at risk for developing reactivations of viral infections
including HPV, Epstein-barr, cytomegalovirus.
Nursing assessment for signs of these complications is
essential for early identification & treatment

15. PROVIDING POST-TRANSPLANTATION
CARE:
Caring for recipients:
Ongoing nursing assessment in follow-up visits is
to detect late effects of therapy after BMT which occurs
days or more after the procedure
Sterility often results due to total body irradiation as
of the ablative regimen
Psychological assessments must be ongoing

16. Caring for donors:
Donors also need nursing care. They commonly
experiences mood alterations, decreased self-esteem,
& guilt from feelings of failure if the transplantation
fails
Family members must be educated & supported to
reduce anxiety & promote coping during this difficult
time

17. TARGETED
THERAPIES

18. Biological response therapy:
Biological response modifiers (BRMs)
are substances that modify immune responses
They can be both endogenous and exogenous and
they can either enhance an immune response
or suppress it
Thus they serve as immunomodulators in
immunotherapy (therapy that makes use of immune
responses), which can be helpful in treating cancers

19. Immunotherapy makes use of BRMs to enhance the
activity of the immune system to increase the body's
natural defense mechanisms against cancer. The goal is to
destroy or stop the malignant growth

20. Non-specific biological response
modifiers:
Some of the early investigations of the stimulation of
the immune system involved nonspecific agents such
as Bacillus Calmette-Guérin (BCG)
BCG stimulates a general immune response when it is
injected into the patient
However, use of non-specific agents in advanced
cancer remains limited & research is ongoing to
identify other uses & other agents

21. Monoclonal antibodies:
MAbs stimulate an immune response that destroys
cancer cells. MAbs “coat” the cancer cell surface,
triggering its destruction by the immune system
MAbs stimulates an anticancer immune response by
binding to receptors on the surface of immune cells
and inhibiting signals that prevent immune cells from
attacking the body’s own tissues, including cancer cells

22. Cytokines:
Cytokines are signaling proteins that are produced
by white blood cells. They help mediate and
regulate immune responses, inflammation, and
hematopoiesis (new blood cell formation)
Two types of cytokines are used to treat patients with
cancer: interferons(INFs) and interleukins (ILs).
A third type, called hematopoietic growth factors, is
used to counteract some of the side effects of
certain chemotherapy regimens

23. Cytokines cont…
 One type of INF, INF-alfa, can enhance a patient’s
immune response to cancer cells by activating certain
white blood cells, such as natural killer cells
and dendritic cells
INF-alfa may also inhibit the growth of cancer cells or
promote their death. INF-alfa has been approved for
the treatment of melanoma, Kaposi sarcoma, and
several hematologic cancers

24. Gene therapy:
Replacing an altered tumor suppressor gene that
produces a nonfunctional protein with a normal version
of the gene
Inserting genes into cancer cells to make them more
sensitive to chemotherapy, radiation therapy, or other
treatments
Inserting genes into healthy blood-forming stem cells
to make them more resistant to the side effects of
cancer treatments, such as high doses of anticancer
drugs

25. Cancer vaccines:
Cancer treatment vaccines contain cancer-
associated antigens to enhance the immune
system’s response to a patient’s tumor cells
The cancer-associated antigens can
be proteins or another type of molecule found
on the surface of or inside cancer cells that can
stimulate B cells or killer T cells to attack them

26. Retinoids:
Retinoids have many important functions throughout
the body including roles in vision, regulation of cell
proliferation and differentiation, growth of bone tissue,
immune function, and activation of tumor suppressor
genes

27. REHABILITATION AFTER
BONE MARROW
TRANSPLANT

28. PLATELET LEVELS:
*Platelets are blood cells that help your blood to clot and
prevent spontaneous bleeding
* If your platelet count is low (below 5,000), exercise may
cause internal bleeding and so should be avoided
*If your platelet count is above 10,000 but under 50,000,
exercise is permitted, but should be limited

29. PRECAUTIONS TO HELP PREVENT
BLEEDING:
Avoid forceful blowing of your nose
Be very aware of your surroundings to avoid falls, cuts, or
bumping into objects
Do not lift weights; do not carry or move heavy objects
If you feel weak or unsteady, use appropriate support (for
example, a walker or cane), and do not get out of bed
without someone to help you.

30. EXERCISING AFTER YOUR STEM
CELL TRANSPLANT
BREATHING EXERCISES
 Place a hand on your chest or stomach. Count the number
of times your chest or stomach rises and falls in 15 seconds
— each rise and fall counts as 1 — then multiply that
number by 4
 You should be able to talk while exercising. If you have
difficulty talking, you are exercising too hard. Slow down
until you can talk comfortably while exercising

31. SUPINE EXERCISES
Elbow flexion
Elbow extension
Shoulder abduction: Lie with the arms straight at
sides. Breathe in through nose, slide the arms out to
the sides, and raise them over head. Breathe out
through mouth while lowering the arms back to
sides

32. Shoulder flexion: Lie with arms straight at your sides.
Slowly raise one arm over head and back as far as it
comfortably will go. Elbow should be straight. Slowly
return the arm to the starting position. Repeat with the
other arm
Ankle flexion
Straight leg raises

33. Glut sets: Recline on your back. Keep both legs out
straight. Squeeze your buttocks together as tightly as
possible. Hold for 5 seconds. Relax
Short arc quads: Place a rolled towel under knee to
bend it about 6 inches. Raise foot until your knee is straight.
Hold for 5 seconds, then relax
Hip flexion (marching): Lift the knees up toward chest
while keeping the back straight. Return to the starting
position. Repeat with the other knee

34. CERVICAL (NECK)
EXERCISES
Neck flexion
Neck Rotation
Lateral (side) neck flexion

35. LOW-BACK EXERCISES
Knee to chest
Double knee to chest
 Trunk rotation: Bend the knees and place both feet
flat on the bed or floor. Roll knees to one side, keeping
the shoulders flat on the bed or floor. Hold for 8
seconds. Return legs to the starting position and repeat
to the other side. Hold for 8 seconds

36. AEROBIC EXERCISE
Walking
Stationary bicycle: Begin by riding at a comfortable pace
with low pedal resistance, meaning the bicycle can be
pedaled without difficulty, for 15 minute(s). Gradually
increase
Good Posture:
i. Keep head level.
ii. Tuck in chin.
iii. Relax shoulders.

37. SUCCESS RATES OF BMT
The Stem Cell Therapy success rate is currently being
monitored for aplastic anaemia, Parkinson’s disease, retinal
disorders and Type 2 diabetes
A study published in the Journal of Clinical Oncology in 2013
goes further to state that survival rates among patients who
received blood Stem Cell transplants are significantly high

38. SUCCESS RATES CONT…
The study assessed treatment outcomes for about 38,000
patients who had received blood Stem Cell transplants, and
was mapped over a period of 12 years
The outcomes were heartening: 100 days after the
transplant, the survival rates of patients suffering from
Acute Myeloid Leukemia (AML), Acute Lymphoblastic
Leukemia (ALL) and Myelo-displastic Syndrome (MDS) were
all in the range of 65% and above