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Bone Marrow Transplant in Oncology
- 1. Bone Marrow Transplantin Oncology SK REJAUL DEPARTMENT OF BIOMEDICAL ENGINEERING NETAJI SUBHASH ENGINEERING COLLEGE
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- 3. Pathology Treat Leukemiaby chemotherapy Regeneration of normal marrow Chemotherapy alone cannot eliminate all malignant cells Stem cell transplants.
- 4. Transplant Patient's bonemarrow 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 Marrowversus Peripheral Stem Cells Accessibility Cost Sample size Donor/Patient factors Expertise
- 6. Adult Stem CellTransplant
- 7. Procedure Most bloodstem 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
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- 9. Umbilical Cord BloodStem 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 PBSC’s.
- 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.
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- 12. THE FUNCTION OFBMT UNIT Handling services & Intensive care for: Mobilization / stem cell collection & infusion. Chemotherapy for pre - transplant Pre & post care for Transplant patients.
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- 14. Indications Hematological diseases Benign : Thallassaemia, Aplastic Anaemia Malignant : Leukemia Lymphoma Myeloma Immune deficiency disorders Pediatric and Adult Neurological Disease (MS)
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- 16. Recovering from thetransplant 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
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- 18. Graft Verses HostDisease (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 isimportant Expertise Facility Isolation Phoresis Platelet and blood support Motivated patient
- 21. Problems Intensive processthat consumes resources HIV Donor registry limited Other health care priorities