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Bone Marrow Transplant in Oncology

A brief presentation on Bone Marrow Transplant in Oncology by S K Rezaul, proudly presented by Biomedicz (www.biomedicz.com).

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Bone Marrow Transplant in Oncology

  2. 2. Source
  3. 3. Pathology  Treat Leukemia by chemotherapy  Regeneration of normal marrow  Chemotherapy alone cannot eliminate all malignant cells  Stem cell transplants.
  4. 4. Transplant  Patient's bone marrow 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. 5. Procedure  Bone Marrow versus Peripheral Stem Cells  Accessibility  Cost  Sample size  Donor/Patient factors  Expertise
  6. 6. Adult Stem Cell Transplant
  7. 7. Procedure  Most blood stem 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
  8. 8. Harvesting
  9. 9. Umbilical Cord Blood Stem 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. 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.
  11. 11. Cord Blood
  12. 12. THE FUNCTION OF BMT UNIT Handling services & Intensive care for:  Mobilization / stem cell collection & infusion.  Chemotherapy for pre - transplant  Pre & post care for Transplant patients.
  13. 13. Transplantation     Autologous      Allogeneic      Syngeneic 
  14. 14. Indications  Hematological diseases Benign : Thallassaemia, Aplastic      Anaemia  Malignant : Leukemia Lymphoma         Myeloma  Immune deficiency disorders  Pediatric and Adult  Neurological Disease (MS)
  15. 15. Auto Transplant
  16. 16. Recovering from the transplant   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
  17. 17. Allotransplant
  18. 18. Graft Verses Host Disease (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. 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. 20. Transplantation  Unit is important  Expertise  Facility Isolation Phoresis Platelet and blood support Motivated patient
  21. 21. Problems  Intensive process that consumes resources  HIV  Donor registry limited  Other health care priorities