Bone Marrow Transplant in Oncology

Source

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

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

Adult Stem Cell Transplant

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

Harvesting

Transplantation  Autologous  Allogeneic  Syngeneic

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

Auto Transplant

Allotransplant

Who can be the donor Bone marrow donors can be any normal person who is willing to donate. Even the comatose patient can be donor. Donor can not be the cadaver. Preferable if siblings or parents can donate. This is done just prior to time of transplant

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

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