1. Bone Marrow Transplant in Oncology
Dr S D Moodley
Wits Donald Gordon Medical Centre

2. Source

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

4. 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

5. Procedure Bone Marrow versus Peripheral Stem Cells Accessibility Cost
Sample size
Donor/Patient factors
Expertise

6. Adult Stem Cell Transplant

7. 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

8. Harvesting

9. 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 PBSC’s.

10. 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.

11. Cord Blood

12. 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.

13. Transplantation
  Autologous
  Allogeneic
Syngeneic

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

15. Auto Transplant

16. Recovering from the transplant
Recovery of normal levels cells is called engraftment
Day
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

17. Allotransplant

18. 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

19. 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

20. Transplantation Unit is important Expertise Facility Isolation
Phoresis
Platelet and blood support
Motivated patient

21. Problems Intensive process that consumes resources HIV
Donor registry limited
Other health care priorities