Bone Marrow Transplant in Oncology

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Bone Marrow Transplant in Oncology
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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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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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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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Allotransplant

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Who can be the donorBone 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
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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