BONE MARROW transplantation

BONE MARROW transplant
definition procedure
conditioning
indications complications GVHD

1. Bone marrow transplantation (for undergraduates 3 rd year Integrated Medicine) Compiled by Ahmed Redwan, 2021 © copyrighted Assist. Lecturer Int. Med. Depart. El- Minia University

2. Bone marrow transplantation It involves replacement of damaged or diseased bone marrow with stem cells derived from healthy bone marrow . Procedure :procedure that infuses healthy blood-forming stem cells into patient’s body to replace damaged or diseased bone marrow, it  involves taking cells that are normally found in the bone marrow (stem cells), filtering those cells, and giving them back either to the donor (patient) or to another person. Treatment for: Aplastic Anemia · Sickle Cell Anemia · Neutropenia · Lymphoma · Leukemia and more (see Later). Type of procedure: Minimally invasive. Recovery time: Can take several weeks. Duration: About 20-30 minutes. Hospital stay: Typically a few days.

3. Indications Acute leukemia Adrenoleukodystrophy Aplastic anemia Bone marrow failure syndromes Chronic leukemia Hemoglobinopathies Hodgkin's lymphoma Immune deficiencies Inborn errors of metabolism Multiple myeloma Myelodysplastic syndromes Neuroblastoma Non-Hodgkin's lymphoma Plasma cell disorders POEMS syndrome Primary amyloidosis Sickle cell anemia Thalassemia Myelofibrosis Myeloproliferative disorders Germ cell tumors Sarcoma Some autoimmune diseases such as lupus Bone marrow damage:  Cancer treatments, like high doses of chemotherapy or radiation

4. Risks T he particular risks depend on many factors, including the disease or condition that caused the need a transplant, the type of transplant, and the age and overall health. Possible complications from a bone marrow transplant include: Graft-versus-host disease (allogeneic transplant only) Stem cell (graft) failure Organ damage bleeding Infections Cataracts Infertility New cancers Death

5. Graft-versus-host disease: A potential risk when stem cells come from donors It occurs in transplant that uses stem cells from a donor (allogeneic transplant). This condition occurs when the donor stem cells that make up the new immune system see recipient body's tissues and organs as something foreign and attack them.

6. GVHD GVHD may happen at any time after the transplant. Many people who have an allogeneic transplant get GVHD at some point. The risk of GVHD is a bit greater if the stem cells come from an unrelated donor, but it can happen to anyone who gets a bone marrow transplant from a donor.

7. GVHD Types There are two kinds of GVHD: acute and chronic. Acute GVHD usually happens earlier, during the first months after the transplant. It typically affects the skin, digestive tract or liver. Chronic GVHD typically develops later and can affect many organs .

8. Chronic GVHD signs and symptoms include: Joint or muscle pain. Shortness of breath, Persistent cough. Vision changes, such as dry eyes. Skin changes, including scarring under the skin or skin stiffness, Rash. jaundice, Dry mouth, Mouth sores. Diarrhea, Nausea, Vomiting.

9. Pretransplant tests and procedures: The recipient undergo a series of tests and procedures to assess his general health and the status of the condition , and to ensure that he is physically prepared for the transplant. The evaluation may take several days or more . Also, central line insertion , usually remains in place for the duration of the t reatment . the transplant team will use the central line to infuse the transplanted stem cells, medications and blood products into recipient body .

10. Who can be a bone marrow donor ? A suitable (HLA matched) donor may be : Matched related donor (MRD ) is when a donor is an HLA matched, relative. Brothers/sisters are the most preferred choices for genetic match donors. Matched unrelated donor (MUD):  The HLA matched marrow is from an unrelated donor which are found through bone marrow registries. Partially matched related  – The Donor is from the patient’s family but is partially matched. Haploidentical stem cell transplant  – A suitable donor may also be a Parent / Child.

11. Collecting stem cells for autologous transplant: If a transplant using patient ‘s own stem cells (autologous transplant) is planned, the patient will undergo a procedure called apheresis ( af -uh-REE-sis) to collect blood stem cells. Before apheresis, patient will receive daily injections of growth factor to increase stem cell production and move stem cells into patient’s circulating blood so that they can be collected. During apheresis, blood is drawn from a vein and circulated through a machine. The machine separates the blood into different parts, including stem cells. These stem cells are collected and frozen for future use in the transplant. The remaining blood is returned to patient’s body .

12. Collecting stem cells for allogeneic transplant (allogeneic transplant ) Stem cells can come from the donor's blood or bone marrow. The transplant team decides which is better for the patient based on his situation. Another type of allogeneic transplant uses stem cells from the blood of umbilical cords (cord blood transplant). Mothers can choose to donate umbilical cords after their babies' births. The blood from these cords is frozen and stored in a cord blood bank until needed for a bone marrow transplant.

13. The conditioning process After the patient complete the pretransplant tests and procedures, the patient begins a process known as conditioning. During conditioning, the patient will undergo chemotherapy and possibly radiation to: Destroy cancer cells if the patient is being treated for a malignancy Suppress the patient’s immune system Prepare the patient’s bone marrow for the new stem cells The type of conditioning process The patient receive depends on a number of factors, including the patient’s disease , overall health and the type of transplant planned.

14. The patient may have both chemotherapy and radiation or just one of these treatments as part of the conditioning treatment . Side effects of the conditioning process can include : Nausea and vomiting, Diarrhea Hair loss, Mouth sores or ulcers Infection, Bleeding Infertility or sterility Anemia, Fatigue, Cataracts, Organ complications, such as heart, liver or lung failure. The patient may take medications or other measures to reduce such side effects.

15. Reduced-intensity conditioning Based on patient’s age and health history, the doctor may recommend lower doses or different types of chemotherapy or radiation for patient’s conditioning treatment. This is called reduced-intensity conditioning. Reduced-intensity conditioning kills some cancer cells and suppresses patient’s immune system. Then, the donor's cells are infused into patient’s body . Donor cells replace cells in patient’s bone marrow over time. Immune factors in the donor cells may then fight patient’s cancer cells.

16. Procedure: During the bone marrow transplant the bone marrow transplant occurs after The patient complete the conditioning process. On the day of the transplant, stem cells are infused into the body through the central line. The transplant infusion is painless. The patient will be awake during the procedure.

17. A fter the bone marrow transplant: When the new stem cells enter the body, they travel through the blood to the bone marrow. In time, they multiply and begin to make new, healthy blood cells. This is called engraftment. It usually takes several weeks before the number of blood cells in the body starts to return to normal. In some people, it may take longer. In the days and weeks after the bone marrow transplant, The patient will has blood tests and other tests to monitor the condition. The patient may need medicine to manage complications, such as nausea and diarrhea.

18. A fter the bone marrow transplant (cont.): After the bone marrow transplant, The patient will remain under close medical care. If The patient is experiencing infections or other complications, The patient may need to stay in the hospital for several days or sometimes longer. Depending on the type of transplant and the risk of complications, The patient will need to remain near the hospital for several weeks to months to allow close monitoring. The patient may also need periodic transfusions of red blood cells and platelets until the bone marrow begins producing enough of those cells on its own. The patient may be at greater risk of infections or other complications for months to years after the transplant. The patient will has periodic lifelong follow-up appointments with the doctor to monitor for late complications.

19. Medications, Diet and other lifestyle factors If the bone marrow transplant is using stem cells from a donor (allogeneic transplant), the doctors may prescribe medications to help prevent graft-versus-host disease and reduce the immune system's reaction (immunosuppressive medications). After the transplant, it takes time for the immune system to recover. During this time, The patient may be given medications to prevent infections . Diet and other lifestyle factors: After the bone marrow transplant, The patient may need to adjust the diet to stay healthy and to prevent excessive weight gain. the nutrition specialist (dietitian) and other members of the transplant team will work with The patient to create a healthy-eating plan that meets the needs and complements the lifestyle. the dietitian can also give The patient food suggestions to control side effects of chemotherapy and radiation, such as nausea.

20. Some of the dietitian's recommendations may include: Following food safety guidelines to prevent foodborne infections Eating a wide variety of healthy foods, including vegetables; fruits; whole grains; lean meats, poultry and fish; legumes; and healthy fats, such as olive oil Limiting salt intake Restricting alcohol Avoiding grapefruit and grapefruit juice due to their effect on a group of immunosuppressive medications ( calcineurin inhibitors) After the bone marrow transplant, regular physical activity helps The patient control the weight, strengthen the bones, increase the endurance, strengthen the muscles and keep the heart healthy. As The patient recover, The patient can slowly increase the physical activity. Taking steps to prevent cancer is even more important after the transplant. Don't smoke. Wear sunscreen when The patient is outside, and be sure to get the cancer screenings the doctor recommends.

21. B.M.T complications development: Natural history:

22. Immune-Suppressive Asociated Multi systemic dysfunctions:

23. Thank You تم بحمد الله