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Bone Marrow Transplant in Oncology

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1 Bone Marrow Transplant in Oncology
Dr S D Moodley Wits Donald Gordon Medical Centre

2 Source

3 Pathology Treat Leukemia by chemotherapy Regeneration of normal marrow
Chemotherapy alone cannot eliminate all malignant cells Stem cell transplants.

4 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

5 Procedure Bone Marrow versus Peripheral Stem Cells Accessibility Cost
Sample size Donor/Patient factors Expertise

6 Adult Stem Cell Transplant

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 Harvesting

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 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 Cord Blood

Handling services & Intensive care for: Mobilization / stem cell collection & infusion. Chemotherapy for pre - transplant Pre & post care for Transplant patients.

13 Transplantation   Autologous   Allogeneic Syngeneic

14 Indications Hematological diseases
Benign : Thallassaemia, Aplastic Anaemia Malignant : Leukemia Lymphoma Myeloma Immune deficiency disorders Pediatric and Adult Neurological Disease (MS)

15 Auto Transplant

16 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

17 Allotransplant

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 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 is important Expertise Facility Isolation
Phoresis Platelet and blood support Motivated patient

21 Problems Intensive process that consumes resources HIV
Donor registry limited Other health care priorities

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