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Disclosures• Financial disclosures
–None• Advisory Boards
–Novartis
ObjectiveProvide an overview of Bone Marrow
Transplantation
Principles of SCT
• Allows the administration of high-dose therapy
• Takes advantage of graft-versus-leukemia effect
Principles of SCT
• Source of stem cells– Autologous
– Allogeneic• HLA-matched sibling• Matched, unrelated donor• Umbilical cord blood
– Cells• Bone marrow• Peripheral blood
Bone marrow
• 750-1500mL harvested from posterior iliac crests– general anesthesia– generally well tolerated
• NMDP– 6 deaths from normal
donors– 1/10,000 risk
Peripheral Blood
• CD34+ cells circulate in the peripheral blood– Increase following
administration of chemotherapy and/or growth factors
• NMDP– 3 deaths amongst PB
donors
Indications for SCT
• Hematologic malignancies
• Other– Solid tumors – Immunodeficiencies– Autoimmune diseases– Hemoglobinopathies
What type of transplant?
AllogeneicAplastic anemiaAutologousMyelomaAllogeneicCLLAutologous/AllogeneicIndolent lymphomaUsually autologousHodgkin lymphomaUsually autologousAggressive lymphomaAllogeneicMDSAllogeneicCMLAllogeneicALLAllogeneicAML
Indications for Transplant
3,000
5,500
2,000
1,500
5000
1,000
2,500
3,5004,0004,5005,000
Indications for hematopoietic stem cell Indications for hematopoietic stem cell transplant in North Americatransplant in North America
20082008
SUM10_11.pptSlide 9
Num
ber
of
Tra
nsp
lants
MultipleMyeloma
NHL AML HD ALL MDS/MPD AplasticAnemia
CML OtherLeuk
OtherCancer
Non-Malig
Disease
Allogeneic (Total N=6,672)
Autologous (Total N=10,302)
Indications for TransplantIndications for allogeneic hematopoietic stem Indications for allogeneic hematopoietic stem
cell transplantation in North Americacell transplantation in North America20082008
SUM10_13.pptSlide 11
3,000
2,000
1,500
500
0
1,000
2,500
Num
ber
of
Tra
nsp
lants
MultipleMyeloma
NHLAML HDALL MDS/MPD AplasticAnemia
CML OtherLeuk
OtherCancer
Non-Malig
Disease
Related Donor (Total N=3,282)
Unrelated Donor (Total N=3,389)
What type of transplant?
5-10%Non-myeloablative
30-40%MUD
20%Sibling allogeneic
5-10%Autologous
Risk of TRMType of transplant
VOD
• Clinical features– sudden weight gain
– hepatomegaly (tender)
– jaundice
– peripheral edema and ascites
Long-term Complications• Toxicities from treatment
regimens
• Immune deficiency
• Autoimmune syndromes
• Infectious complications
• Endocrine disturbances
• Chronic GVHD
• Second malignancies
• Cognitive dysfunction
• Psychosocial adjustment
• Decreased quality of life
Causes of Death
Causes of death Causes of death after transplantations after transplantations
done in 2003done in 2003--20082008
SUM10_22.pptSlide 20
Infection (17%)Other Cause
(19%)
Organ Failure (12%)
Primary Disease(35%)
IPn* (5%)
GVHD (12%)Infection(14%)
Other (22%)
GVHD (10%)
Primary Disease (43%)
IPn* (3%)
Organ Failure (8%)
Infection (5%)
Other Cause (17%)
Organ Failure (4%)
IPn* (1%)Primary Disease (73%)
*IPn = Idiopathic pneumonia syndrome
AutologousAutologous
Unrelated donorUnrelated donor
HLAHLA--identical siblingidentical sibling