1. Human Health and Disease
Lecture 8

2. Functions of stem cells

3. Stem cell/bone marrow transplant
It is a procedure that infuses healthy cells, called stem cells, into the body to replace damaged or diseased bone marrow.
A bone marrow transplant may also be used to treat certain types of cancer.
A bone marrow transplant may be necessary if your bone marrow stops working and doesn't produce enough healthy stem cells.
Bone marrow transplants may use cells from your own body (autologous transplant) or from a donor (allogeneic transplant).

4. Autologous Transplant

5. Allogeniec transplant

6. Why it is done? A bone marrow transplant may help you by:
Safely allowing treatment of your condition with high doses of chemotherapy or radiation
Replacing diseased or damaged marrow with new stem cells
Providing new stem cells, which can help kill cancer cells directly

7. Why it is done?
Stem cell transplants can benefit people with a variety of both malignant (cancerous) and nonmalignant (noncancerous) diseases, including:
Acute leukemia
Adrenoleukodystrophy
Aplastic anemia
Bone marrow failure syndromes
Chronic leukemia
Hemoglobinopathies
Hodgkin's lymphoma
Immune deficiencies
Inborn errors of metabolism
Multiple myeloma
Myelodysplastic syndromes
Non-Hodgkin's lymphoma
Plasma cell disorders
POEMS syndrome
Primary amyloidosis

9. Risks
Complications that can arise with a stem cell transplant include:
Graft-versus-host disease (allogeneic transplant only)
Stem cell (graft) failure
Organ damage
Infections
Cataracts
Infertility
New cancers
Death

10. Graft-versus-host disease: A potential risk when stem cells come from donors
If you receive a transplant that uses stem cells from a donor (allogeneic stem cell transplant), you may be at risk of graft-versus-host disease (GVHD).
This disease happens when the donor stem cells that make up your new immune system see your body's tissues and organs as something foreign and attack them.
GVHD may happen at any time after your transplant.
However, it's more common after your marrow has started to make healthy cells. Many people who have an allogeneic stem cell transplant get GVHD at some point.
The risk of GVHD is a bit greater with unrelated donors, but it can happen to anyone who gets a stem cell transplant from a donor.

11. Types and Symptoms of GVHD
There are two kinds of GVHD: acute and chronic. Acute GVHD usually happens earlier, during the first months after your transplant. It typically affects your skin, digestive tract or liver. Chronic GVHD typically develops later and can affect many organs.
Mouth sores
Abdominal pain
Diarrhea
Nausea
Vomiting
Joint or muscle pain
Shortness of breath
Persistent cough
Vision changes, such as dry eyes
Skin changes, including scarring under the skin
Rash
Yellow tint to your skin or the whites of your eyes (jaundice)
Dry mouth

12. Pre-transplant tests and procedures
A series of tests and procedures are involved to ensure that the patient is eligible for the transplant.
n addition, a surgeon or radiologist will implant a long thin tube (intravenous catheter) into a large vein in the chest or neck.
The catheter, often called a central line, usually remains in place for the duration of the treatment.
The transplant team will use the central line to infuse the transplanted stem cells and other medications and blood products into your body.

13. Collecting stem cells for transplant
If an autologous stem cell transplant is planned, patient undergoes a procedure called apheresis to collect blood stem cells. Before apheresis, he receives daily injections of growth factor to increase stem cell production and move stem cells into his circulating blood so they can be collected.
During apheresis, blood is drawn from a vein and circulated through a machine. The machine separates the blood into different parts, including stem cells. These stem cells are collected and frozen for future use in the transplant. The remaining blood is returned to your body.
If an allogeneic stem cell transplant is planned, he will need a donor. Stem cells are gathered from that person for the transplant. This process is often called a stem cell harvest or bone marrow harvest. Stem cells can come from the donor's blood or bone marrow. The transplant team decides which is better for the patient based on his situation.

14. The conditioning process
After the completion of pre-transplant tests and procedures, the conditioning process begins.
During conditioning, the patient undergoes chemotherapy and possibly radiation to:
Destroy cancer cells if treated for a malignancy
Suppress the immune system
Prepare the bone marrow for the new stem cells
The type of conditioning process depends on a number of factors, including the disease, overall health and the type of transplant planned. The patient may have both chemotherapy and radiation or just one of these treatments as part of the conditioning treatment.

15. Side effects of conditioning process
Nausea and vomiting
Diarrhea
Hair loss
Mouth sores or ulcers
Infection
Bleeding
Infertility or sterility
Anemia
Fatigue
Cataracts
Organ complications, such as heart, liver or lung failure

16. Stem cell transplant procedure
On the day of transplant, called day zero, the patient is given the stem cells through his central line using a process known as infusion.
The transplant infusion is painless and a patient is awake during the procedure.
The transplanted stem cells make their way to the bone marrow, where they begin creating new blood cells.
It can take a few weeks for new blood cells to be produced and for the blood counts to begin recovering.

17. Side effects of DMSO
Bone marrow or blood stem cells that have been frozen and thawed contain a preservative called dimethyl sulfoxide (DMSO) that protects the cells. Just before the transplant, the patient may receive medications to reduce the side effects the preservative may cause. He'll also likely be given IV fluids (hydration) before and after the transplant to help rid the body of the preservative. Side effects of DMSO may include:
Nausea
Fever
Diarrhea
Chills
Hives
Red urine

18. After Stem Cell Transplant
When the new stem cells enter the body, they begin to travel to the bone marrow.
In time, they multiply and begin to make new, healthy blood cells. This is called engraftment. It usually takes several weeks before the number of blood cells in the body starts to return to normal. In some people, it may take longer.
In the days and weeks after the stem cell transplant, the patient will have blood tests and other tests to monitor his condition. He may need medicine to manage complications, such as nausea and diarrhea.
After the stem cell transplant, the patient will remain under close medical care. If he is experiencing infections or other complications, he may need to stay in the hospital for several days or sometimes longer.
Depending on the type of transplant and the risk of complications, he'll need to remain nearby for several weeks to months to allow close monitoring.
He may also need periodic transfusions of red blood cells and platelets until his bone marrow begins producing enough of those cells on its own.
He may be at greater risk of infections or other complications for months to years after your transplant.

19. Case Study:
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