BY DR IHEANACHO O.E..  Biodata  Male, 15years, student.  Diagnosis  SCA  Treatment  HSCT  HLA-matched sibling donor.  RIC using Flu/Bu.

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Presentation transcript:

BY DR IHEANACHO O.E.

 Biodata  Male, 15years, student.  Diagnosis  SCA  Treatment  HSCT  HLA-matched sibling donor.  RIC using Flu/Bu

Date Conditioning Doses Route Immunsuppr. 10mg/kg Isolation Heparin CsA 200mg/d MMF i.v mg/ m2 Acyclor 1500 mg/ m2 Gut decontamination Tue Catheter -7Wed Thu Fludarabine40 mg/m 2 IV.ATGAM 500mg -5Fri Fludarabine Busulphan 40 mg/m 2 4mg/kg/d IV PO ATGAM 500mg -4Sat Fludarabine Busulphan 40 mg/m 2 4mg/kg/d IV PO ATGAM 500 mg -3Sun Fludarabine Busulphan 40 mg/m 2 4mg/kg/d IV PO -2Mon Fludarabine Busulphan 20 mg/m 2 4mg/kg/d IV PO Tue Rest day 0Wed BMT +1Thu Fri Sat Stem Cell Unit, Dept of Haematology, Blood Transfusion and Stem Cell Transplantation. Physician:Bazuaye G. N Patient: Matthew Ebenezer, DOB: Diagnosis: Sickle Cell Anaemia Donor: Matthew Naomi (MSD), Genotype: AA Conditioning: Flu 180 mg/m 2, Bu 16mg/kg, ATG (ATGAM) 1500mg total dose over 3days, CSA 5mg/kg/day. (analog EBMT 2005 Sykora und Sauer et al.) Weight. 48 kg, Height 175 cm, BSA 1.53 m 2 PROTOCOL

CHART FOR MONITORING PROCEDURES

 Isolation & catheterization (from day-8)  Isolation room for (reverse) barrier nursing.  Catheterization for easy & steady IV access.  Adequate hydration (1800ml/m 2 )from day-8  VOD prophylaxis/ thromboprophylaxis  Heparin (cont IVF) 100IU/day  From day -7  Gut decontamination  Oral neomycin, vancomycin, gentamycin, ampho B.

 Conditioning regimen (RIC)  IV Fludarabine 180mg/m 2 over 5days (-6 to -2)  Busulfan PO 16mg/kg over 4days (-5 to -2)  ATG 1500mg over 3 days(-6 to -4)  Day -1 is a rest day (chemo drug holiday).  Day 0: infusion of donor HSC (transplantation)

 GVHD prophylaxis  Ciclosporin A (PO) from day -3  Mycophenolate mofetil 1200/m 2 from day0  Antimicrobial/ antihelminthic prophylaxis  Viral (acyclovir)  Fungal (fluconazole), Pneumocystis jiroveci (septrin)  Protozoal (fansidar, paludrine)  Helminths (albendazole)

 Prophylaxis for some drug S/E  Seizure (clonazepam)  Supplement  KCl, Ca 2+, MgSO 4  Blood product transfusion (no mismatch)  O Rh pos/neg blood products.  Leukodepleted, irradiated  Red cells from AA (genotype) donor.

 Protocol was adopted from EBMT 2005, Sykora et al.  Individualized to fit our recipient & setting.  Open to constructive criticisms/amendments.

THANK YOU