Bone Marrow Transplant in Oncology

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Bone Marrow Transplant in Oncology

• Dr S D Moodley
• Wits Donald Gordon Medical Centre

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Source
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Pathology

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

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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

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Procedure

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

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Adult Stem Cell Transplant
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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

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Harvesting
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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
  PBSCs.

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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.

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Cord Blood
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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.

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Transplantation

•   Autologous
•   Allogeneic
• Syngeneic

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Indications

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

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Auto Transplant
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Recovering from the transplant

• Recovery of normal levels cells is called
  engraftment
• Day 8 - 12
• 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

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Allotransplant

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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

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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

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Transplantation

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

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Problems

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