Bone Marrow and Stem

Cell Transplant
Bone marrow or Hematopoietic Stem
Cell

➢ Thesoft spongy tissue found in the

inner cavities of the bone and
peripheral blood.
 Stem cell proliferate into mature
erythrocytes , leucocytes and platelets
Hematopoietic Stem Cell
Transplantation
 Isa process of replacing diseased or
damage bone marrow with normally
functioning bone marrow
 Used in the treatment of a wide variety of
malignant and nonmalignant diseases.
The 2 Main Types of Transplant
Autologous
 Is a transplant in which the patient’s own bone marrow or
stem cells are collected (harvested), placed in frozen
storage (cryopreserved) and reinfused into the patient
after the conditioning regimen.
 The Patient is his own donor.
Allogenic
 a transplant in which the patient’s receives someone
else’s bone marrow or stem cells.
Types of Allogenic Transplant

Syngeneic
 A patient is given stem cells from their twin or
triplet
Related
 The donor related to the recipient’s, usually a
sibling
Unrelated
 The donor is no relation to the recipient
Sources of Stem Cells

 Peripheral Blood ( PBSC)

 Bone Marrow
 Umbilical Cord
Bone Marrow Harvest
 aspirated from the donor's pelvis.
 Thisprocedure occurs in the operating room under
patients general anesthesia.
 Bonemarrow is obtained by performing multiple puntures
with a large-bore needle into the patient’s posterior and
occasionally the anterior iliac crests.
 Less common
Peripheral Blood Stem Cells
More Common
 requires growth factors (G-CSF)
 apheresis procedure
 no anesthesia
 stem cells engraft faster
 Higher chance of GVHD
Umbilical Cord Blood Stem Cells
 removed from the umbilical cord and
placenta after the baby no longer needs
them
 birth, collected, tissue-typed,
processed and stored frozen
 no access to donor
 unknown genetic disease
 Expensive!
Diseases Treated with Hematopoietic Stem
Cell
Malignant:
➢ Acute / Chronic Myelogenous Leukemia(AML)(CML)
➢ Acute Lymphocytic Leukemia(ALL)
➢ Juvenile Myelomonocytic Leukemia(JMML)
➢ Myelodysplastic syndrome(MDS)
➢ Hodgkin’s disease
➢ Non-Hodgkin’s Lymphoma(NHL)
➢ Multiple Myeloma
➢ Renal Cell Carcinoma
➢ Neuroblasto ma
➢ Testicular Cancer
➢ Ewing’s Sarcoma
Diseases Treated with Hematopoietec Stem
Cell
Malignant:
 Rhabdomyosarcoma
 Wilm’s Tumor
 Malignant Melanoma
 Lung Cancer
 Brain Tumor
 Ovarian Cancer
Diseases Treated with Hematopoietec
Stem Cell
Non malignant:
➢ Aplastic Anemia
➢ Myelofibrosis
➢ Wiskott-Aldrich Syndrome
➢ Severe Combined Immunodeficiency Syndrome(SCIDS)
➢ Munopolysacharoidosis
➢ Osteopetrosis
➢ Lipid Storage Diseases
➢ Thalassemia
➢ Paroxysmal Nocturnal Hemoglobinuria
Symptoms of Leukemia
YOUNG LEUKEMIA PATIENT
LYMPHOMA
APLASTIC ANEMIA
Severe Combined Immunodeficiency
Syndrome(SCIDS)
Severe Combined Immunodeficiency
Syndrome(SCIDS)
HLA Typing
 Donor and Recipient (Patient) Has to Match Each
Other
 HLA-Matching.
 We Have 6 numbers (3 from Father +3 from Mother)
 Brothers/Sisters Have the Highest Chance to Match
 More Siblings You Have More Chance You Have to
Match
 If no matched sibling, Unrelated matched person can
be a donor
Autologous transplantation
First collect stem cells from donor
 1. Conditioning Regimens: chemo +/-
radiation
 2.stem cell infusion
 3. Engraftment period
Engraftment Period

 Bone Marrow ( 2-3 weeks )

 PBSCmay engraft as early as 5 days
however, the average is 11-16 days after
stem cell reinfusion.
 CordBlood takes 26 days but may take as
long as 42 days to engraft
Engraftment Period
 During
engraftment, patient experiences severe
pancytopenia and immunosuppression.
 Immediate complications include infection and
bleeding, and patient care focuses on prevention and
early treatment.
 Patients
typically receive antibiotics and blood
components during this time.
GOAL: To shorten the length of the pancytopenic period
and curtail these complications.
Early Complications
 Acute GVHD
 Bacterial & Viral Infection
 Nausea & Vomiting
 VENO-OCCLUSIVE DISEASE(VOD)
 Pulmonary Complications
 Recurrence of disease
Late Complications
 Gonodal dysfunction
 Growth Failure
 Hypothyrodism
 Cataract
 Secondary Malignancy
 Quality of life and Survivorship