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Bone Marrow Transplantation

Bone Marrow Transplantation. The transfer of living cells, tissues, or organs from a donor to a recipient, with the intention of maintaining the functional integrity of the transplanted material in the recipient. Indications. Acute and chronic leukemias Aplastic anemia

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Bone Marrow Transplantation

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  1. Bone Marrow Transplantation The transfer of living cells, tissues, or organs from a donor to a recipient, with the intention of maintaining the functional integrity of the transplanted material in the recipient http://www.ctsnet.org/home/eyevstratov

  2. http://www.ctsnet.org/home/eyevstratov

  3. http://www.ctsnet.org/home/eyevstratov

  4. Indications • Acute and chronic leukemias • Aplastic anemia • Congenital immunodeficiency diseases • Lymphomas • Metabolic disease of childhood • Myelodisplasia • Thalassemia http://www.ctsnet.org/home/eyevstratov

  5. Donor Limitations • 25 – 30% of patients have an HLA-identical sibling. • Marrow procured from unrelated living donor • Marrow procured from related HLA-identical or HLA non –identical living donor • Autologous transolantation(marroe procured during remession) http://www.ctsnet.org/home/eyevstratov

  6. Recipient preparation • Cyclophosphamide 60 mg/kg/day During two days and Toal body irradiation • Busulfan 4mg/kg/day for fur days and Cyclophosphamide without irradiation • Etoposide ,Cyarabine as a maximizer antitumor properties,myeloblation,immunosuppression http://www.ctsnet.org/home/eyevstratov

  7. Transplantation Procedure http://www.ctsnet.org/home/eyevstratov

  8. Anesthesic Management • Intravenouse anesthesia sould be procured. • Intravenouse Thiopental,Fentanyl,Vecuronium can be used in common doses • Maintanance can be provide with Propofol and Isoflurane. http://www.ctsnet.org/home/eyevstratov

  9. Nota Bene Nitrouse Oxide should be avoided as an inactivator of Vit B12 wich is an essential coenzyme for methionine synthetase.This enzyme facilitate the conversion of homocystine and methyltetehydrofolate to methionine are essential for deoxyribonucleic acid (DNA) synthesis. http://www.ctsnet.org/home/eyevstratov

  10. Complications • Rejection by hte host of the marow graft • Acute graft-vs,-host disease (GVHD) • Infections • Chronic GVHD • Prolonged immunodeficiency • Disease recurrence http://www.ctsnet.org/home/eyevstratov

  11. Bone Marrow Transplantation • HLA antigens matched optimally • Autologous (marrow cancer free); Allogeneic • Peripheral Blood Stem Cell Transplantation • Hi-dose CTX +/- total body irradiation • ablate diseased marrow / cells ( risk rejection) • Infused healthy cells repopulate marrow • Immune function returns within 1 – 2 years if successful http://www.ctsnet.org/home/eyevstratov

  12. Bone Marrow Transplantation - Toxicity • GVHD – Graft Versus Host Disease ~50% risk in allogeneic Transplant • Donor T-cells attack normal host cells Acute GVHD rash  slough; mucositis; bronchiolitis • Intestinal:cramping, diarrhea, anorexia, ileus • Rare:Guillain-Barre Syndrome; Polymyositis • Chronic GVHD: 3 Months – 3 Years inflammation / fibrosis:skin; lung; GI • contractures; neuropathy; respiratory insuff http://www.ctsnet.org/home/eyevstratov

  13. Bone Marrow Transplantation - Toxicity • Chemotherapy • pancytopenia (during induction) • Peripheral Polyneuropathy:Cisplatin; MTX; 5FU; Vincristine; Paclitaxel; Docetaxel; Interferon • Cardiomyopathy (arrhythmia / pump failure): Doxorubicin; paclitaxel; cyclophos; (Herceptin) • Renal:electrolyte abnormality  MSΔ • Immunosuppressants (cyclo, MTX, FK506) • Renal Failure http://www.ctsnet.org/home/eyevstratov

  14. Bone Marrow Transplantation - Toxicity • hi-dose Steroids (Anti-inflammatory; Immunosuppression) • Myopathy; Osteoporotic compression Fx; AVN • Nutritional Insufficiency / Muscle Wasting • skin ulcers; mucositis; immobility-related weakness; loss of functional reserve • Graft Failure / Rejection • extremely poor prognosis http://www.ctsnet.org/home/eyevstratov

  15. Bone Marrow Transplantation Rehabilitation • Induction/Acute Post-Transplant: Prophylaxis Nutritional Counseling and Supplementation Skin: specialized pressure relief – bed and Pancytopenia – Hold Therapy if: • Hgb< ~8g (Arrhythmia; Exertional Intolerance;SaO2) • Plt (<50K - No PRE; <20K - bedside; <10K – no Tx) • ANC < 1500 – High Risk Infection:reverse isolation until day 100 (mask/gloves) – Public / Hospital • Remain Mobile / Maintain ADLsROM / limb & resp muscle PRE / Endurance Exercise http://www.ctsnet.org/home/eyevstratov

  16. Bone Marrow Transplantation Rehabilitation • Post-Acute Transplant • Home Exercise Program; Community Re-entry • Energy Conservation:Day 100 – 80% pts fatigued • “Incremental Treadmill walking after hi-dose CTX and PBSCT  maximal physical performance and  HR / report of fatigue & somatic complaints” GVHD • As above; splinting / casting (protect joints & skin) • Aggressive daily stretching (pec, IP, Ham, gastroc) http://www.ctsnet.org/home/eyevstratov

  17. The End. http://www.ctsnet.org/home/eyevstratov

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