|Herpes Varicella-Zoster (Shingles) Infection
|Chickenpox Varicella Infection
|Varicella Cerebral Vasculopathy
|Herpes Zoster Ophthalmicus (HZO) Shingles
|Rubella (German Measles)
|Epstein-Barr Virus infection
| Cytomegalovirus (CMV) infections
| CMV retinitis infections
| Oncological emergencies
- Haematopoietic stem cell transplantation
- BMT works on the principles of destroying and replacing existing bone marrow cells
- Replaced with stem cells or bone marrow from a donor or from self
- This can be done using chemotherapy and/or radiotherapy (MYELOABLATION).
- Myeloablation e.g. Cyclophosphamide with busulfan or total body irradiation is used
- There is induced bone marrow failure.
- The patient has then infused donor bone marrow stem cells which populates the now vacant marrow.
- After 3-4 weeks the new haemopoietic cells begin to produce red cells, platelets, and granulocytes
- There is a high risk of opportunistic infections
- Uses HLA matched donor - from a related HLA identical donor or a volunteer unrelated donor
- Donors cells are collected from their bone marrow and infused into the recipient.
- The chance of a match from a sibling is 1 in 4.
- Re infusing the patient's own bone marrow stem cells after ablation of the marrow
- Has the added bonus of no GVHD.
- Stem cells are harvested from peripheral blood after G-CSF or GM-CSF
- Alternatively in children stored umbilical cord blood is obtained when parents elect to harvest and store the blood from a newborn's umbilical cord and placenta after birth. Cord blood has a higher concentration of Haemopoietic Stem Cells than is normally found in adult blood.
- Severe neutropenia with acute infection is the most worrying development.
- Graft versus host disease can be useful in haematological disease as the donor cells attack the remaining tumour cells. In fact, infusion of T cells from the donor can boost the response. This is called donor lymphocyte infusion (DLI)
- The overall mortality from the procedure is 30% and it is usually restricted to those under the age of 45.
- Other significant complications include CMV infection and acute and chronic GVHD.
- Supportive care is needed for several weeks until the new marrow engrafts.
- Patients develop mucositis, gastroenteritis and may need parenteral feeding.
Some Conditions for which BMT is contemplated
- ALL, AML
- Paroxysmal nocturnal haemoglobinuria
- Sickle-cell disease
- Myelodysplastic syndrome
- Ewing's Sarcoma
- Desmoplastic small round cell tumour
- Hodgkin's disease
- Multiple myeloma