1. Peripheral Blood Stem Cell Rescue. Multiple Myeloma.
Liz Higgins
BMT Co-ordinator
St James’s Hospital, Dublin

2. (BMT/ PBSCT)
BMT/ PBSCT involves eliminating an individual’s bone marrow stem cells. They are then replaced with bone marrow/ stem cells either from another individual or with a previously harvested portion of the individuals own bone marrow or peripheral blood stem cells.

3. Reasons for PBSCT
To facilitate high dose therapy in some malignant conditions e.G. Lymphoma, testicular cancer, Multiple Myeloma.

4. Autologous rescue / PBSCT involves two processes.
PBSCH/ BMH
PBSCT/ BMT

5. Sources of Bone Marrow Stem Cells
Bone marrow (BM) - aspirated from the posterior iliac crests under GA, usually mls in volume
Peripheral blood stem cells (PBSC) - following the administration of growth colony stimulating factor (G-CSF) + / - chemotherapy

6. Pathway
Referral / Review
PBSCH
PBSCT
Follow up

7. PBSC Mobilisation Initial Review
Bloods
Consider venous access – peripheral/centra
Medical assessment
Nursing Assessment
Discussion

8. PBSC Mobilisation Regimens for MM
G-CSF 10mcg/kg x 4 days
Cyclophosphamide 2g/m2 + G-CSF 10mcg/kg

9. Cyclophosphamide 2g/m2 Chemo on Monday Commence G-CSF Tuesday
Leucapheresis day 8-10

10. GSCF ( Neupogen) 10Mcg / kg Round up. Commence on Saturday.
CD34 Count Tuesday +/- Gcsf
PBSCH

11. Apheresis
1-3 Days
5-6 Hours
Inpatient or Transfer as day patient

12. Stem Cell Red Cell or White Cell or Platelet
Once the ‘decision’ is made it is probably irreversible

15. COBE

16. Autologous Stem Cell Rescue
Approximately 4-6 weeks post Harvest

17. Pre Autograft work-up Pulmonary function tests
Echocardiogram or MUGA scan
Dental Assessment
BM Aspirate & Bx
Skeletal survey (if applicable)
Insertion of PICC or CVC
24 hour urine collection

18. Conditioning Regimens
Melphalan

19. Denis Burkitt

24. Shared care
National referral centre.
Facilitation.