3Pathology Treat Leukemia by chemotherapy Regeneration of normal marrow Chemotherapy alone cannot eliminate all malignant cellsStem cell transplants.
4TranplantPatient's bone marrow stem cells are replaced with healthy cellsExisting bone marrow and abnormal leukocytes killedChemotherapy and radiationNext bone marrow containing healthy stem cells re-infused
5Procedure Bone Marrow versus Peripheral Stem Cells Accessibility Cost Sample sizeDonor/Patient factorsExpertise
7ProcedureMost blood stem cells reside in the bone marrow and a small number are present in the bloodstreamMultipotent peripheral blood stem cellsCan be obtained from drawn bloodPBSCs are easier to collect than bone marrow stem cells
9Umbilical 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.
10Umbilical Cord TxUmbilical 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.
16Recovering from the transplant Recovery of normal levels cells is called engraftmentDayNeutrophil engraftment important (GCSF) may be given to accelerate the processPlatelets 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
18Graft Verses Host Disease (GVHD) GVHD sometimes occurs with allogeneic transplantation.Lymphocytes from the donor graft attack the cells of the hostGVHD can usually be treated with steroids or other immunosuppressive agents.Acute GVHD occurs before day 100 post-transplantChronic GVHD occurs beyond day 100Recent 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 patientsChronic GVHD can develop months or even years post-transplant