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

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Presentation on theme: "Bone Marrow Transplant in Oncology Dr S D Moodley Wits Donald Gordon Medical Centre."— Presentation transcript:

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

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 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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