Bone Marrow Transplants

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Bone Marrow Transplants
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Facts about BMTs

• New procedure first done in 1968
• Treats leukemia, aplastic anemia, lymphomas,
  multiple myeloma, immune deficiency disorders,
  and some solid tumors
• Over 10,000 people a year have BMTs
• Suitable donors are never found for around 70 of
  those needing the treatment

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What is Bone Marrow

• Bone marrow is the spongy tissue found within
  bones
• The breast, skull, hips, ribs, and spine contain
  stem cells that produce the bodys blood cells
• Blood cells fight infection, carry oxygen,
  remove waste from our tissues

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Stem Cell Maturation

• Normally interleukins and colony stimulating
  factors regulate number of stem cells and blood
  cells
• Failure of any regulatory mechanism can lead to
  immature cell proliferation

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Why BMTs

• These diseases cause the malfunction of the stem
  cells cause them to produce abnormal blood
  cells
• Abnormal cells must be killed with chemotherapy
  or radiation which carries risk of damaging
  normal bone marrow
• A BMT is then needed to replace damaged cells

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More BMT Info

• New bone marrow should migrate to bones, settle
  in, and begin producing healthy cells
• Donor match must be as genetically similar as
  possible
• Graft versus host disease (GVHD)
• Graft rejection
• Allogeneic, syngeneic or autologous

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Bone Marrow Harvest

• General anesthesia
• Little risk and discomfort
• Illiac crest
• 2 quarts (2)
• Allogeneic donors require T-cell removal

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Marrow Donors
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Marrow Donors cont.
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PSCHs

• 1/100,000 cell in bone marrow is a stem cell
• 1/100 amount of stem cells found in blood than in
  bone marrow
• Collection method analogous to platelet donation
• Used to augment normal collection or primary if
  bone marrow too contaminated

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Allogeneic Transplants

• HLA system
• 30 chance for siblings
• 1/1000 to 1/several million in general pop.
• 3 genetic loci A, B, and DR
• 24 possible antigens at HLA-A, 52 B, 20 DR
• 2 antigens at each site 600 million combinations

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Autologous Transplants

• Most common form
• Mainly for diseases not originating in marrow
• Risk for GVHD gone
• Large doses of immunosuppressants not needed

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Purging Bone Marrow

• Two different ways to do this
• Chemicals that are more toxic to cancerous cells
  are introduced
• Monoclonal antibodies that recognize malignant
  cells are introduced
• These are then recognized by complement
• Microspheres and electromagnets

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Prep. for Transplant

• Several days of aggressive chemo/rad
• Catheter inserted into vein just above heart
• Allows the 100s of blood tests and drugs to be
  done
• Chemo/rad much stronger than normal

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Actual Transplant

• Intravenously
• In patients room

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Physical Stress

• Severe flu-like symptoms
• Extreme weakness
• Nausea
• Mouth sores
• Opportunistic infections

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Emotional Stress

• News of life-threatening illness
• Severe Isolation
• Helplessness
• Dependence on strangers
• Constant medical jargon
• 2 months in hospital / year recovery at home
• Outpatient visits 3 times a week

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Disease Statistics

• Hodgkins - 5-10 to 25 to 50 long term
• IV Breast Cancer - 50 remissions of 3 years
• Neuroblastoma - 40-50 remissions of 2 years
• AMI - 50 remission long term
• ALL - 0-5 to 30-40 long term
• CML - 50-80 long term if done early. 10-30
  long term if detected later
• Aplastic Anemia - 50-70 long term

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Chance for Success

• Increased chance for long term survival
• Depending on form of cancer, stage of illness,
  age, prior health, etc.
• 10-50 (or more) chance of long term survival
• No sure things BMT adds time to your life
  amount of time unclear