Bone Marrow-dont Erase
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5/2/12
Pre
Bone MarrowTransplantation
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What is a bone marrowtransplantation?
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Bone marrow transplantation(BMT) is a special therapy forpatients with cancer or otherdiseases which affect the bonemarrow. A bone marrow
transplant involves taking cellsthat are normally found in thebone marrow (stem cells),
filtering those cells, and givingthem back either to the patientor to another person. The goal ofBMT is to transfuse healthy bonemarrow cells into a person after
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Bone marrowtransplantation
is not yet astandardtreatment
therapy, but
has been usedsuccessfully totreat diseases
such as
leukemias,lymphomas,aplasticanemia,
immune
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What is bone marrow?
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Bone marrow is thesoft, spongy tissuefound inside bones. Itis the medium fordevelopment andstorage of about 95percent of the body'sblood cells.
The blood cells thatproduce other bloodcells are called stemcells. The mostprimitive of the stemcells is called thepluripotent stem cell,which is different thanother blood cells with
.
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Why is a bone marrow transplant
needed?
The goal of a bone marrow transplant is to cure manydiseases and types of cancer. When a person's bone
marrow has been damaged or destroyed due to adisease or intense treatments of radiation orchemotherapy for cancer, a marrow transplant may beneeded.
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What are somediseases thatmay benefit
from bonemarrowtransplantation?
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The following diseases are the onesthat most commonly benefit from bone
marrow transplantation:
leukemias
aplastic anemia
lymphomas
multiple myeloma
immune deficiency disorders
solid-tumor cancers, such as breast or ovarian
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What are the different types ofbone marrow transplants?
a.) Autologous bone marrowtransplantb.) Allogeneic bone marrow
transplantc.)Umbilical Cord BloodTransplant
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b.) Allogeneic bonemarrow transplant
The donor shares thesame genetic type asthe patient. Stem cells
are taken either by bonemarrow harvest orapheresis (peripheralblood stem cells) froma genetically-matcheddonor, usually a brotheror sister.
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c.) Umbilical Cord BloodTransplant
Stem cells are taken from an umbilical cordimmediately after delivery of an infant. Thesestem cells reproduce into mature, functioning
blood cells quicker and more effectively than dostem cells taken from the bone marrow of anotherchild or adult. The stem cells are tested, typed,
counted, and frozen until they are ready to betransplanted.
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How are a
donor andrecipient
matched?
hi i l i h
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Matching involves typing humanleukocyte antigen (HLA) tissue. Theantigens on the surface of these specialwhite blood cells determine the geneticmake-up of a person's immune system.
There are at least 100 HLA antigens,however, it is believed that there are afew major antigens that determine
whether a donor and recipient match.The others are considered "minor" and
their effect on a successful transplant isnot as well defined.
Medical research is still investigatingthe role all antigens play in the process
of a bone marrow transplant.The moreanti ens that match the better the
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The bone marrowtransplant team:
The group of specialistsinvolved in the care of patientsgoing through transplant isoften referred to as the"transplant team." Eachindividual works together to
provide the best chance for a
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The team consists of the following:
a. physicians
B. bone marrow transplant nurse coordinator
c. social workers
d. dietitians
e. physical therapists
f. pastoral care
g. other team members
pharmacists
respiratory therapists
lab technicians
infectious disease specialists
dermatologists
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Preparation for the recipient:
1. For a patient receiving the transplant, the followingwill occur in advance of the procedure:
2. Prior to the transplant, an extensive evaluation iscompleted by the bone marrow transplant team. All
other treatment options are discussed and evaluatedfor risk versus benefit.
3. A complete medical history and physicalexamination are performed, including multiple teststo evaluate the patient's blood and organ functions(i.e., heart, kidney, liver, lungs).
4. A patient will often come into the transplant center
up to 10 days prior to transplant for hydration,
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Preparation for the donor:1. Donor sources available include: self, sibling,parent or relative, non-related person, or umbilicalcord from a related or non-related person. There arenational and international registries for non-related
persons and cord blood. For family members, theymay be typed because of the desire to help. Theserelatives may or may not elect to have their typeregistered for use with other recipients.
2. If the potential donor is notified that they may be amatch for a patient needing a transplant, they willundergo additional tests. Tests related to their health,exposure to viruses, and complete genetic analysis
will be done to determine the extent of the match.
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How are the stem cellscollected?
A bone marrow transplant isdone by transferring stem cells
from one person to another.Stem cells can either becollected from the circulating
cells in the blood (the peripheralsystem) or from the bonemarrow.
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How are the stem cells
collected?a.) Peripheral blood stemcells (PBSCs)
b.) bone marrow harvest
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a.) peripheral blood stem cells(PBSCs)
Peripheral blood stem cells (PBSCs)
are collected by a apheresis, a process in which
the donor is connected to a special cell separation machinevia a needle inserted in the vein. Blood is taken from onevein and is circulated though the machine which removesthe stem cells and returns the remaining blood and plasmaback to the donor through another needle inserted into the
opposite arm. Several sessions may be required to collectenough stem cells to ensure a chance of successfulengraftment in the recipient.
A medication may be given to the donor for about
one week prior to apheresis that will stimulate the bonemarrow to increase roduction of new stem cells. These
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b.) bone marrow harvest
Bone marrow harvesting
involves collecting stem cells with a needleplaced into the soft center of the bone, the marrow.Most sites used for bone marrow harvesting arelocated in the hip bones and the sternum. Theprocedure takes place in the operating room. Thedonor will be anesthetized during the harvest and will
not feel the needle. In recovery, the donor mayexperience some pain in the areas where the needlewas inserted.
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The bone marrow
transplant procedure:
The preparations for a bone
marrow transplant vary depending onthe type of transplant, the diseaserequiring transplant, and your
tolerance for certain medications.Consider the following:
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a.) Most often, high doses of chemotherapy and/or radiationare included in the preparations. This intense therapy is
required to effectively treat the malignancy and make roomin the bone marrow for the new cells to grow. This therapyis often called ablative, or myeloablative, because of theeffect on the bone marrow. The bone marrow produces all
the blood cells in our body. Ablative therapy prevents thisprocess f cell production and the marrow becomes empty.An empty marrow is needed to make room for the new stemcells to grow and establish a new production system.
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b.) After the chemotherapy and/or radiation
is administered, the marrow transplant isgiven through the central venous catheterinto the bloodstream. It is not a surgicalprocedure to place the marrow into the
bone, but is similar to receiving a bloodtransfusion. The stem cells find their wayinto the bone marrow and begin reproducing
and establishing new, healthy blood cells.
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c.) Supportive care is given to
prevent and treat infections,side effects of treatments, andcomplications. This includes
frequent blood tests, closemonitoring of vital signs, strictmeasurement of input andoutput, daily weigh-ins, andproviding a protected and
sterile environment.
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During infusion of bonemarrow, the patient may
experience the following:
pain
chills fever hives
chest pain
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After infusion, the patient may:
spend several weeks in the hospital.be very susceptible to infection.Experience excessive bleeding.have blood transfusions.be confined to a sterile environment.
take multiple antibiotics and other medications.be given medication to prevent graft-versus-hostdisease - if the transplantation was allogeneic. Thetransplanted new cells (the graft), tend to attack thepatient's tissues (the host), even though the donor is
a relative, such as a brother, sister, or parent.undergo continual laboratory testing.experience nausea, vomiting, diarrhea, mouth sores,and extreme weakness.
experience temporary mental confusion andemotional or s cholo ical distress.
When does engraftment
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. When does engraftmentoccur?
Engraftment of the stem cells occurs whenthe donated cells make their way to themarrow and begin reproducing new bloodcells. Depending on the type of transplant
and the disease being treated, engraftmentusually occurs around day +15 or +30.Blood counts will be performed frequentlyduring the days following transplant to
evaluate initiation and progress ofengraftment. Platelets are generally thelast blood cell to recover.
Engraftment can be delayed because of
infection, medications, low donated stem
M What complications
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M. What complicationsand side effects may
occur following BMT?Complications may vary, depending on thefollowing:type of marrow transplant
type of disease requiring transplantpreparative regimen
age and overall health of the recipient
variance of tissue matching between donorand recipient
presence of severe complications
Th f ll i li ti th t ith b
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The following are complications that may occur with a bonemarrow transplantation. However, each individual may experiencesymptoms differently. These complications may also occur alone,or in combination:
infectionsInfections are likely in the patient withsevere bone marrow suppression. Bacterialinfections are the most common. Viral and
fungal infections can be life threatening.Any infection can cause an extendedhospital stay, prevent or delayengraftment, and/or cause permanent
organ damage. Antibiotics, anti-fungalmedications, and anti-viral medications areoften given to prevent serious infection inthe immunosuppressed patient.
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low platelets and low red blood cellsThrombocytopenia (low platelets) and
anemia (low red blood cells), as a result ofa non-functioning bone marrow, can be
dangerous and even life threatening. Lowplatelets can cause dangerous bleeding inthe lungs, gastrointestinal (GI), and brain.
pain
Pain related to mouth sores andgastrointestinal (GI) irritation is common.High doses of chemotherapy and radiationcan cause severe mucositis (inflammation
of the mouth and GI tract).
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fluid overloadFluid overload is a complication that canlead to pneumonia, liver damage, and highblood pressure. The primary reason for fluid
overload is because the kidneys cannotkeep up with the large amount of fluidbeing given in the form of intravenous (IV)medications, nutrition, and blood products.
The kidneys may also be damaged fromdisease, infection, chemotherapy,radiation, or antibiotics.
respiratory distress
Respiratory status is an important function
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organ damageThe liver and heart are important organs
that may be damaged during thetransplantation process. Temporary or
permanent damage to the liver and heartmay be caused by infection, graft-versus-host disease, high doses of chemotherapyand radiation, or fluid overload.
graft failureGraft failure is a potential complication.Graft failure may occur as a result ofinfection, recurrent disease, or if the stem
cell count of the donated marrow was
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graft-versus-host diseaseGraft-versus-host disease (GVHD) can be aserious and life-threatening complication ofa bone marrow transplant. GVHD occurs
when the donor's immune system reactsagainst the
recipient's tissue.
The new cells do not recognize the tissuesand organs of the recipient's body. Themost sites for GVHD are GI tract, liver,skin, and lungs.
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References:
http://www.umm.edu/blood/bonemarr.htm
http://www.cumc.columbia.edu/dept/medicine/
http://www.umm.edu/blood/bonemarr.htmhttp://www.cumc.columbia.edu/dept/medicine/bonemarrow/bmtinfo.htmlhttp://www.cumc.columbia.edu/dept/medicine/bonemarrow/bmtinfo.htmlhttp://www.umm.edu/blood/bonemarr.htm