Presentation on theme: "Bone Marrow Transplant in Oncology Dr S D Moodley Wits Donald Gordon Medical Centre."— Presentation transcript:
Bone Marrow Transplant in Oncology Dr S D Moodley Wits Donald Gordon Medical Centre
Pathology Treat Leukemia by chemotherapy Regeneration of normal marrow Chemotherapy alone cannot eliminate all malignant cells Stem cell transplants.
Tranplant 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
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
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.
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.
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.
Recovering from the transplant Recovery of normal levels cells is called engraftment Day 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
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