Oncologic

Nursing

Oncology: Overview
TUMOR

– NEOPLASM
Benign
Malignant
Theories

1. Cellular differentiation theory

2. Failure of the immune response theory
Cellular differentiation theory

– Benign Growth Patterns

Hypertrophy
Hyperplasia
Metaplasia
Dysplasia
- Precursor of cancer
Anaplasia
Benign and Malignant Tumor
Characteristics Benign
Differentiation Well differentiated, structure
maybe typical of tissue of
origin
Rate of growth Usually progressive and slow,
may come to standstill or
regress, mitotic figures are
rare and normal
Local invasion Usually cohesive and
expansile, well demarcated
masses that do not invade or
infiltrate surrounding tissues
Metastasis Absent
Malignant
Some lack of differentiation
with anaplasia, structure is
often atypical
Erratic and may be slow to
rapid, mitotic figure maybe
numerous and abnormal
Locally invasive infiltrating
surrounding normal tissues,
sometime maybe seemingly
cohesive and expansile
Present
Failure of the immune response theory

– Kaposi’s sarcoma in HIV – AIDS patients

Tumor terminology

– Suffix : -OMA
Classification of human tumors

Tumor type Cell tissue of origin Benign Tumors Malignant tumors

Mesenchymal cells Fibroblast Fibroma Fibrosarcoma
Fat cells Lipoma Liposarcoma
Bone cells Osteoma Osteosarcoma
Epithelial tumors Squamous epithelium Epithelioma Squamous cell
carcinoma
Glandular or ductal Adenoma Adenocarcinoma
epithelium
Internal organs Liver cell Liver cell adenoma Liver cell carcinoma

Germ cell tumors Embryonic cells Teratoma Embryonal carcinoma

Carcinogenesis

– Initiation – exposure to initiating agents (carcinogens)

– Promotion – carcinogens cause unregulated accelerated growth in previously
initiated cells: reversible
– Progression – tumor cells acquire malignant characteristics
Acquired (environmental) NORMAL CELL
DNA damaging agents Successful DNA repair
Chemicals DNA damage
Radiation
viruses
Failure of DNA repair Inherited mutations in:
Genes affecting DNA repair
Genes affecting cell growth and
Mutation in the genome of apoptosis
somatic cells

Activation of growth Inactivation of tumor Alterations in genes that

promoting oncogenes suppressor genes regulate apoptosis

Unregulated cell proliferation Decreased apoptosis

Clonal expansion
Angiogenesis
Escape from immunity Additional mutation
Tumor progression

Malignant neoplasm Invasion and metastasis

Characteristic of cancer cells

– Altered cell differentiation

Characteristics of cancer cells

– Appearance changes
– Cancer cells vary in size and shape (Pleomorphism)
– Abnormal nuclei or multiple nuclei
– Abnormal number of chromosomes (Aneuploidy))
– Abnormal chromosome arrangement
– The more undifferentiated, the more aggressive a malignant cells
Characteristics of cancer cells

– Altered metabolism
– Production of surface enzymes that aid in invasion and metastasis
– Higher rate of anaerobic glycolysis
– Production of abnormal growth factor
– Inappropriately secrete hormone or hormone like substance resulting in
paraneoplastic syndrome
Characteristic of cancer cells

– Tumor specific antigens

– Proteins marking the cancer cells as “non – self ”
Characteristics of cancer cells

– Altered Cellular function

– Normal control mechanisms fail to stop proliferation of cancer cells
– Loss of contact inhibition
– Cancer cells are less genetically stable -> increasing malignant mutations
– METASTASIS – hallmark of cancer
Tumor Growth

– Cell cycle

Go or Resting phase – cells perform all functions other than proliferation, non dividing
cells are not considered to be in the cell cycle
Tumor growth

– Cell – cycle time : the amount of time required for a cell to move from one
mitosis to another. The sum of M,G1, S and G2.
– The length of Go phase is the major factor in determining the cell cycle time
Tumor Growth

– Doubling time: the length of time it takes for a tumor to double its volume.
– Average doubling time for solid tumor is 2 months. Vary in different types of
tumor
– A tumor is clinically undetectable until it has doubled 30 times and contained 1
billion cells, at this point is approximately 1 cm in size and equals 1 gram in
weight
Tumor growth

– Growth fraction: the ratio of the total number of cells to the number of dividing
cells. Tumor with large growth factors increase their tumor volume more
quickly. As tumor volume increases, growth factor decreases as a result of
hypoxia, decreased nutrient availability and toxins
Carcinogenic Factors

– Heredity
– Hormonal factors
– Bacteria and parasites
– Oncogenic viruses
– Immune system deficiency
– Environmental factors
– Chemicals
– Radiation
Route of spread

– Lymphatics
– Blood vessels
– Direct seeding
Most common cancer in the
Philippines
– Breast
– Lung
– Cervical
– Colorectal
– Prostate
– Adult leukemia
– Head and Neck
– Thyroid
Retrievedfromhttps://www.doh.gov.ph/philippine-cancer-control-program,2012
Levels of Care

– Primary level of care

– Secondary level of care
– Tertiary level of care
Prevention, Screening and Detection

– Identify risk factors

Prevention, Screening and Detection

– Warning signs of cancer

– C
– A
– U
– T
– I
– O
– N
– U
– S
Prevention, Screening and Detection

– Lung Cancer
– Breast cancer
– Prostate cancer
– Colorectal cancer
– Cervical cancer
Prevention, Screening and Detection

– Diagnostic tests
Tumor Markers
a. Prostate specific antigen
b. S – 100 – melanoma cells
c. Thyroglobulin
d. CA 15 – 3 / CA 27 – 29 – breast cancer
e. Carcinoembronic antigen(CEA)/CA 19 -9 – colorectal cancer
f. CA 125 – ovarian cancer
Prevention, Screening and Detection

Tumor markers
g. HCG – germ cell tumors
f. AFP (Alpha fetoprotein) – liver cancer
g. Beta 2 macroglobulin (B2M) - multiple myeloma, lymphocytic leukemia an some
lymphomas
h. Chromogranin A (CgA) – neuroendocrine tumors, most sensitive for carcinoid
tumors
Prevention, Screening and Detection

Diagnostic Imaging
1. X ray
2. Mammography
3. CT scan
4. Ultrasound
5. Nuclear medicine
6. Positron Emission Tomography
7. Lymphoscintigraphy
8. MRI
Prevention, Screening and Detection

– BIOPSY – the most definitive diagnostic test for cancer

– Histopathology
Staging of cancer

– Process of describing the extent or spread of a disease from its origin

– Surgical staging – utilizes invasive surgical techniques to actually visualize structures
and assess the extent of the disease
– Clinical staging – based on professional judgment and measurement of primary
tumor’s size, location in the body and evidence of the disease through physical
examination
– Pathologic staging – the practice of examination of the tissue of interest both grossly
and microscopically to evaluate its characteristics and make an assessment a to the
aggressiveness of the malignant tumor.
Staging of cancer

– TNM staging
Staging of cancer

– Staging
Stage 0 – the cancer is where it started (in-situ) , it has not spread
Stage 1 – confined to the tissue and small, it has not spread
Stage 2 – with increase growth of cancer, has not spread
Stage 3 – larger and has spread to surrounding tissues and LN
Stage 4 – with distant metastasis
Grading of cancer

– Grading of cancer
Grade 1
Grade 2
Grade 3
Modalities of treatment

– Surgery
– Chemotherapy
– Radiation therapy
– Biotherapy
– Stem cell therapy
Surgery

– Surgery- is the branch of medicine that uses manual and instrumental to deal
with the diagnosis and treatment of injury, deformity, and disease
Surgical oncology

• defined as the branch of surgery focusing on the surgical management of

malignant, neoplasm including biopsy, staging and surgical resection.
Surgical oncology

• Surgical oncology procedures used to:

a. prevent a cancer occurrence in the high-risk patient.
b. diagnose a primary or metastatic site of malignancy
c. Provide a primary or secondary treatment of an identified malignancy
Surgical oncology

d. Provide a route of administration of therapy.

e. To rehabilitate by means of reconstruction intervention.
f. To offer palliative care through symptom management in advance cancer.
Surgical oncology

Nursing roles in the care of surgical oncology :

a. To identify risk factors or behaviors that prompt a preventive surgical

procedure.
b. Nurses must understand the fundamentals of surgical oncology.
c. Play a role during the initial assessment and evaluation of symptoms, testing,
and diagnosis throughout the preoperative, intraoperative and post-
operative care of primary or secondary surgical procedure
Surgical oncology

d. Nurses must be instrumental in the Identification, planning, implementation

and evaluation phases of surgical treatment.
e. To provide a comprehensive plan of care and enhance patient outcomes.
Surgical oncology

– Principles:
• The principles of surgical oncology, are based in the foundations of surgery,
oncology, nursing, and medicine.
– Principles create the basic framework, but rapidly advancing scientific and
technologic methods may change the identification or ranking of principle
related to new and possibly unidentified needs of the cancer patient.
Surgical oncology

– Prevention and identification of risk factors:

1. The age and specific risk related to age must be considered.
2. Survival and quality adjusted survival curves for the preventive measures
should be discussed.
3. Routine screening with increased frequency of clinical examination should be
established
Surgical oncology

4. Hereditary- the family may alert and educate the potential of certain cancer
and possible occurrence in other family members.
5. Comorbid conditions.
6. Debilitation due to cancer.
7. Paraneoplastic syndrome
Surgical oncology

– Types
1. Diagnostic Surgery
2. Prophylactic surgery
3. Curative surgery
4. Palliative surgery
5. Reconstructive surgery
Diagnostic Surgery

– Biopsy
1. Fine needle aspiration biopsy
2. Core needle biopsy
3. Incision biopsy
4. Excision biopsy
5. “Frozen section” biopsy
Fine needle aspiration biopsy
Core needle biopsy
Incision biopsy
Excision biopsy
Frozen section biopsy

– For rapid microscopic analysis and diagnosis of specimen

Prophylactic surgery
Curative surgery

1. Definitive surgery for primary cancer, local therapy, integration with other
adjuvant modalities.
2. Surgery for residual disease.
3. Surgery for metastatic disease.
4. Surgery for oncologic emergency
Palliative Surgery
Reconstructive surgery
Oncologic surgery

– Minimally invasive procedures

a. Ductal lavage and fine needle aspiration – identify cytologic and molecular
changes overtime that correlate with breast cancer development for early
diagnosis
b. Sentinel LN biopsy – intraoperative mapping of lymph node with dye or
radioactive tracer, the sentinel LN is dissected, the first draining LN of the
tumor, if negative for tumor, no LN dissection is necessary
Oncologic surgery

– Minimally invasive procedures

c. Radio-guided surgery
ex. Radioguided parathyroidectomy – neoprobe is used to localize parathyroid
tissues that may otherwise be difficult to identify thus reducing operative tissue
time and frozen sections
Oncologic surgery

– Minimally invasive procedures

d. Video-assisted thoracosurgery (VATS)
e. Light amplification by stimulated emission of radiation (LASER) – light is an
intense, narrow beam that enables the performance of precise surgery to remove
precancerous or cancerous tissues, or to relieve symptoms of cancer
f. Cryosurgery – or cryotherapy – utilizes cold effect of liquid nitrogen to destroy
precancerous or cancerous tissues, it is applied externaly to a skin or through a
cryoprobe instrument
Oncologic surgery

– Minimally invasive procedures

g. Radiofrequency ablation (RFA)- to eradicating cancerous tissueby thermal
coagulation and protein denaturation
h. Laparoscopy- to diagnose intraperitoneal and retroperitoneal masses, lymph
nodes and visceral lesions.
CHEMOTHER
APY

CHEMOTHERAPY
DEFINITION

– Chemotherapy is the use of cytotoxic drugs in the

treatment of cancer.
– Its function is to kill tumor by interfering with
cellular functions and reproduction
– Systemic Treatment rather than localized
treatment.
Goals

– CURE- To cure tumor and cancer, to disappear and do not

re-occur
– CONTROL- To control or to stop the cancer from growing
and spreading.
– PALLIATION- If / when cure and control is no longer
possible, its goal is to relieve symptoms caused by
cancer.
Cell cycle generation

G1 Phase- the phase where RNA and protein synthesis

occur.
S Phase- the phase where DNA synthesis occur.
G2 Phase- pre-mitotic phase. For further protein synthesis
in preparation for mitosis
M Phase- Mitosis and cell division.
G0 Phase- resting phase
Chemotherapeutic agent

– 1. Adjuvant therapy- chemotherapy used in conjunction with

another treatment modality and aimed to treat micrometastases.
– 2. Neoadjuvant chemotherapy- done to shrink a tumor before it is
removed surgically.
– 3. Primary therapy- treatment for patient who have localize cancer,
alternative way but less than completely effective treatment.
– 4. Induction chemotherapy- primary treatment for patients who
have cancer for which no alternative treatment exist.
Chemotherapeutic agent

– 5. Combination therapy- combination of 2 or

more agents / drugs to treat cancer.
– 6. Myeloablative therapy- dose intensive therapy
used in preparation for peripheral blood stem cell
transplantation.
 Chemotherapy drug classification

– Cell Cycle Phase- specific

- Most effective against actively growing tumors that have
greater proportion of cell cycling. (the drugs attack the cell).
- Mostly affect the cell in S phase by interfering DNA & RNA.
anti-metabolites= interfere or block essential enzymes
necessary for DNA and RNA synthesis
 Chemotherapy drug classification
– Cell Cycle Phase- Non specific
- Active in all phases of the cycle and maybe effective in large tumors that have few active
cells dividing at the time of administration.
- It has long acting effect on the cells. Resulting damage or death to the T- cells.
– Alkylating agents – preventing mitosis. Bond to nucleic acid that interfere its
duplication.
Carboplatin
– Antibiotic (anti-tumor agents) – disrupt DNA transcription and inhibit DNA and RNA
synthesis.
Dactinomycin
 Chemotherapy drug classification

– Hormonal Agents
-secreted by the endocrine glands
Affecting the cell membrane permeability, manipulating hormone levels, tumor growth can
be suppressed.
-not cytotoxic and not curative and its purpose is to prevent cell division and prevent
further growth of hormone-dependent tumors.
-anti-androgen, antii-estrogen
Chemotherapy drug classification

– Nitrousoureas
- Action is similar to alkylating agents, inhibits synthesis of
DNA & RNA
Carmustine
Routes of administration

– ORAL- most convenient

- Needs patients compliance with the prescribed
schedule.
- Plan for drugs with emetic potential to be taken
with meals.
Routes of administration

– Subcutaneous and Intramuscular

- Drugs is injected into the muscle
- Injection site should be rotated for each dose and
log kept on the dose schedule.
 Routes of administration
– Intravenous (IV)
- most common
- Medication is given directly to the vein
- In some drug it is the most feasible according to their chemical
structure
- It has the faster effect
- Can be perform “Bolus” or “Short or Long term infusion”
- Peripheral venous access
- Central venous access
- Percutaneous line
- Peripherally inserted central catheters (PICC)
- Implantable devices (port-a- caths)
- Tunneled venous access devices (Hickman catheter)
Routes of administration

– Intrathecal / Intraventricular
- Ommaya reservoir or implantable pump
- Agents are administered directly into the
cerebrospinal fluid. Usually as prophylaxis in
leukemia or lymphoma.
Routes of administration

– Intra arterial
- Catheter placement in artery near the tumor
 Routes of administration
– Intracavitary
- Instill the drug into the bladder through the catheter or into
pleural cavity via chest tube.

– Intravesical
- Therapy for bladder cancer, drugs are puut directly into the
bladder through a catheter.
– Topical
- Cover surface area w/ a thin film of medication, instruct
the patient to wear loose fitting cotton clothing, wear
gloves and wash hands thoroughly after the procedure.
- Commonly prepared as ointments and usually used to
treat sun cancers.
Safe administration of chemo drugs

1. Chemo drugs are dangerous

2. There should be NO CONTACT with it
3. Pregnant should not undergo Chemotherapy
 Preparing chemotherapy drugs

1. Prepare in well-ventilated area

2. Wash hands before and after procedure
3. Wear gloves at all times
4. Wear gown
5. Wear face shields
6. Wrap gauze or alcohol pad around ampules neck
7. Label prepared medication
8. Wrap gauze around injection site when withdrawing
syringe
9. Dispose in a leak and puncture proof container
10. Do not eat, chew and smoke when preparing medications
Management of chemotherapy spills

1. Should be clean up immediately by properly

protected personnel and must be trained.
2. A spill should be identified w/ warning sign so
that other people will not be contaminated.
1. Procedure for spill on hard surface, linen, personnel or
patient.
- Restrict the area of spill
- Obtain the drug spill kit
- Put on PPE and if powder spill involved use respirator mask
- Open waste disposal (double the bag and put a label on it)
 Management of chemotherapy spills
Spill on linen
- remove soiled, contaminated linen from the patient.
- Place the linen in an appropriate, approved, especially marked,
impervious laundry bag.
- should be washed twice and laundry personnel must wear latex gloves
and gown when handling this material
- clean contaminated area with absorbent and detergent solution.
 Management of chemotherapy spills

Spill n Personnnel or Patient

- immediately remove any contaminated protective garments or linen.
- wash the affected area of skin with soap and water.
- follow proocedure for contaminated linen.
- notify the physician if there is a drug spill oon the patient.
- place all contaminated materials in doubled-bag waste disposal bag.
- discard the waste bags and contents in approved container.
- then wash your hands thoroughly with soap and water.
Management of chemotherapy spills

– Eyes Exposure
- Immediately flood the affected eyes with water
for at least 5 minutes.
- Follow agency guidelines regarding follow up
care with a clinical eye exam
 Common side effects of chemotherapy

– Nausea and Vomiting

- Most common for the first 24-48 hours
- Delayed N&V ! Week after chemotherapy
- Cause unknown
- Activation receptor
- Stimulation of the peripheral autonomic and vestibular pathways
- Serotonin
Management
1. Oral hygiene
2. Assess for dehydration ( anti emetic)
3. Ice chips
4. Round the clock medication
Common side effects of chemotherapy

Alopecia
- Begins 2-3 weeks
- Ends after 3 months / regrowth of the hair may begin in 8 weeks.
Management
- Wigs for female, cap for male
- Pre - emptive hair cut
 Common side effects of chemotherapy
Stomatitis
Management
- Inspect mouth routinely
- Oral care (saline)/ soft bristle toothbrush/ do not use listerine
- Avoid spicy and citrus foods
- Provide ice chips and popsicles
- Soft bland diet
- Viscous lidocaine (adult)
contraindicated to child, it reduces gag reflex
Common side effects of chemotherapy

Anorexia
- Makes the food taste metallic (meat)
Management
- Place patient in comfortable position
- Maintain good hygiene
- Serve food atractively
- Provide general comfort
Common side effects of chemotherapy

Anemia
Management
- Assess skin for pallor
- Schedule activities w/ rest periods
- Administer erythropoietin as ordered
Common side effects of chemotherapy

Neutropenia
Management
- Assess sign of infection - Fever
- Abnormal lung sound - Cough
- Practice cleanliness - Handwashing before and after
procedures
- No flowers, fish, fruits, vegetables and raw fruits
Common side effects of chemotherapy

Thrombocytopenia
Management
-Assess skin and mouth for sign of bleeding
-Check stool and urine for blood
-No shaving
-No suppositories and enema
-Gentle oral care
-AVOID SEX
Watch out for

– Vesicant Etravasation
- Leak of chemo drugs to subcutaneous tissue that causes pain,
necrosis and sloughing of tissues
- Flare
- Localized allergic reaction, without pain and marked with red
blotches along the vein line.
– Phlebitis (venipuncture) (48 hours)
 Watch out for

– Anaphylaxis
– Aminophyline, Dipenhydramine hydrochloride, Dopamine, Epinephrine, Heparin,
Hydrocortisone
– O2 set-up, tubing cannula or mask and airway devices
– Suction equipment
– IV fluids – isotonic solutions
– IV tubings and supplies for venous access
– - anxiety, hypotension, urticaria, cyanosis, respiratory distress, abdominal
cramping, flushed appearance and chills.
= stop the drug infusion
= maintain IV line, isotonic saline
= Position comfortably to promote perfusion of the vital organs
= notify the physician
= maintain airway and anticipate the need for cardiopulmonary resuscitation
= monitor vs
= administer medication as prescribed
= follow the institution protocol for follow up care
= document the incident in patients medical record.
MANAGEMENT

1. Check for Phlebitis and Vesicant extravasation (leak of drug into subcutaneous
tissue) (pain, necrosis, sloughing of tissues)
2. High calorie and high protein diet
3. Encourage hydration
4. Monitor cbc
5. Oral examination for stomatitis
1. Teratogenic
2. Hair loss concerns
3. Encourage counseling
4. Report complications
5. Administer anti emetic drugs
6. Practice aseptic techniques at all time
RADIATION THERAPY
RADIATION
THERAPY &
RADIATION
ONCOLOGY
RADIOTHERAPY
PRINCIPLES
TUMORS AND TISSUES
RADIOSENSITIVITY
TYPES OF RADIATION THERAPY &
ADMINISTRATION
EXTERNAL
RADIATION
THERAPY
CONSULTATION
PLANNING
TREATMENT
GENERAL SIDE EFFECTS
SKIN
SITE-SPECIFIC SIDE EFFECTS
HEAD & NECK
CHEST
ABDOMEN

RINV:
RADIATION-
INDUCED
NAUSEA &
VOMITING
PELVIS
BRAIN
BRACHYTHERAPY – Gynecological
Cancers

– Pt w/ LDR placed on low-fiber diets

– Diphenoxylate atropine – to prevent a bowel movement
– Post-op pain – oral/IV medications
HDR
– Provide instructions on possible side effects, when to contact Dr, self-care
measures
– Use of water-based lubricant
– Routine vaginal dilatation – 1 year (if not sexually active)
BRACHYTHERAPY – Head &
Neck Cancers
– Minimize airway obstruction

– Pain management

– Oral care

– Facilitate communication

– Multidisciplinary care: dietary & occupational consults

BRACHYTHERAPY –
Prostate Cancers
– Filter urine for dislodged radioactive seeds
– Condom use
– Avoid close contact with pregnant women & children for designated period
 NURSING MANAGEMENT

– Patient & family education

– Assessment & management of symptoms

– Coordination of care

– Providing emotional support

– Allow patients to verbalize fears

Bone Marrow and
Stem Cell
Transplant
Bone marrow or Hematopoietic Stem
Cell

The soft 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
– Is a 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.
– This procedure occurs in the operating room under patients
general anesthesia.
– Bone marrow 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
 Non-Hodgkin’s Lymphoma(NHL)
Malignant:
 Multiple Myeloma
 Acute / Chronic Myelogenous
Leukemia(AML)(CML)  Renal Cell Carcinoma
 Acute Lymphocytic Leukemia(ALL)  Neuroblastoma
 Juvenile Myelomonocytic  Testicular Cancer
Leukemia(JMML)  Ewing’s Sarcoma
 Myelodysplastic syndrome(MDS)
 Hodgkin’s disease
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
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 )

– PBSC may engraft as early as 5 days however, the
average is 11-16 days after stem cell reinfusion.
– Cord Blood 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 focuse
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