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Bone marrow transplantation

Stem cell transplantation
The basis of treatment with stem cell transplantation is the ability of the hematopoietic stem cell to completely restore bone marrow function and formation of all blood components, as well as the ability to re-form the immune system.
  1. Autologous stem cell transplantation:  
    1. Hematopoietic stem cells are collected from the patient and then re-infused after chemotherapy.
  2. It is the treatment of choice for lymphomas such as
    1. Diffuse large B-cell lymphomas                            
    2. For relapsed Hodgkin lymphoma
    3. Mantle cell lymphomas                                          
    4. Multiple myeloma.
Allogeneic Stem Cell Transplantation:
  1. It Is a treatment in which the source of hematopoietic stem cells to restore bone marrow and immune function are derived, not from the patient, but from a different donor.
  2. In allogeneic stem cell transplantation, the allo-immune graft verus malignancy (GVM) effect derived from the donor immune system.
  3. Allogeneic stem cell transplantation is the treatment of choice for high-risk acute leukemias. Myelodysplasia and for CML. CLL and follicular lymphoma.
Infection during recovery from bone marrow transplantation (BMT)
Infection Time after BMT Management
Herpes simplex 0 – 4 weeks Acyclovir
Bacterial, fungal 0 – 4 weeks As for acute leukemia
Cytomegalovirus 7 – 12 weeks             If patient is CMV – negative, use CMV – negative blood products
Hyperimmune immunoglobulin and ganciclovir for documented infections
Varicella zoster After 13 weeks Acyclovir i.v.
Pneumocystic jiroveci 8-26 weeks Co-trimoxazole
Interstitial pneumonitis (Non – infective) 6 – 18 weeks No specific therapy
Prednisolone may be tried

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