Peripheral Blood Stem Cell Rescue. Multiple Myeloma. Liz Higgins BMT Co-ordinator St James’s Hospital, Dublin

(BMT/ PBSCT) BMT/ PBSCT involves eliminating an individual’s bone marrow stem cells. They are then replaced with bone marrow/ stem cells either from another individual or with a previously harvested portion of the individuals own bone marrow or peripheral blood stem cells.

Reasons for PBSCT To facilitate high dose therapy in some malignant conditions e.G. Lymphoma, testicular cancer, Multiple Myeloma.

Autologous rescue / PBSCT involves two processes. PBSCH/ BMH PBSCT/ BMT

Sources of Bone Marrow Stem Cells Bone marrow (BM) - aspirated from the posterior iliac crests under GA, usually 800-1200mls in volume Peripheral blood stem cells (PBSC) - following the administration of growth colony stimulating factor (G-CSF) + / - chemotherapy

Pathway Referral / Review PBSCH PBSCT Follow up

PBSC Mobilisation Initial Review Bloods Consider venous access – peripheral/centra Medical assessment Nursing Assessment Discussion

PBSC Mobilisation Regimens for MM G-CSF 10mcg/kg x 4 days Cyclophosphamide 2g/m2 + G-CSF 10mcg/kg

Cyclophosphamide 2g/m2 Chemo on Monday Commence G-CSF Tuesday Leucapheresis day 8-10

GSCF ( Neupogen) 10Mcg / kg Round up. Commence on Saturday. CD34 Count Tuesday +/- Gcsf PBSCH

Apheresis 1-3 Days 5-6 Hours Inpatient or Transfer as day patient

Stem Cell Red Cell or White Cell or Platelet Once the ‘decision’ is made it is probably irreversible

COBE

Autologous Stem Cell Rescue Approximately 4-6 weeks post Harvest

Pre Autograft work-up Pulmonary function tests Echocardiogram or MUGA scan Dental Assessment BM Aspirate & Bx Skeletal survey (if applicable) Insertion of PICC or CVC 24 hour urine collection

Conditioning Regimens Melphalan

Denis Burkitt

Shared care National referral centre. Facilitation.