Haematopoietic Stem Cell Transplantation (Previously Bone Marrow Transplantation)
Related Subjects:
| Oncological Emergencies
| Acute Myeloid Leukaemia (AML)
| Acute Lymphoblastic Leukaemia (ALL)
| Chronic Lymphocytic Leukaemia (CLL)
| Chronic Myeloid Leukaemia (CML)
| Immune Thrombocytopenic Purpura (ITP)
| Multiple Myeloma
| Graft-versus-Host Disease (GVHD)
| Cytomegalovirus (CMV) Infections
|Flow Cytometry
|Haematology Laboratory Values
|Indications for Irradiated Blood Products
🧬 About Bone Marrow Transplantation (BMT)
- 🩸 Also known as Hematopoietic Stem Cell Transplantation (HSCT).
- 🔄 Involves replacing damaged or destroyed bone marrow with healthy stem cells.
- 🎯 Used to treat malignant and non-malignant haematological disorders.
- 🏥 Performed in highly specialised transplant centres with intensive supportive care.
⚙️ Mechanism of Action
- 💥 High-dose chemotherapy ± radiotherapy destroys diseased marrow (myeloablation).
- 💉 Healthy stem cells are infused intravenously (like a blood transfusion).
- 🧫 Stem cells migrate to bone marrow niches and begin repopulation.
- 📈 Engraftment occurs over 2–4 weeks → recovery of neutrophils and platelets.
- 🦠 Profound neutropenia leads to high infection risk early post-transplant.
🔬 Types of Bone Marrow Transplantation
- 🧑🤝🧑 Allogeneic BMT
- Uses stem cells from an HLA-matched donor (sibling or unrelated).
- 📊 Sibling match probability ≈ 25%.
- ✨ Offers graft-versus-tumour effect.
- ⚠️ Risk of graft-versus-host disease (GVHD).
- 👤 Autologous BMT
- Uses patient's own stem cells.
- ❌ No risk of GVHD.
- 💊 Mobilisation with G-CSF or GM-CSF.
- ⚠️ Risk of reinfusing malignant cells.
- 🧬 Syngeneic BMT
- From identical twin.
- ✅ No GVHD.
- 📉 Extremely rare.
- 👶 Umbilical Cord Blood Transplant
- Collected at birth.
- 🛡️ Lower GVHD risk.
- 📦 Limited cell dose.
- 👧 Mainly paediatric use.
⚠️ Major Complications
- 🦠 Infections
- Bacterial, fungal (Aspergillus, Candida), viral (CMV, EBV).
- Highest risk before engraftment.
- 🔥 Graft-versus-Host Disease (GVHD)
- Acute: skin rash, diarrhoea, jaundice.
- Chronic: dry eyes, lung fibrosis, skin thickening.
- Managed with steroids and immunosuppression.
- 📉 Graft Failure – persistent pancytopenia.
- 🫀 Organ Toxicity
- Liver: VOD/SOS.
- Lungs: interstitial pneumonitis.
- Heart: cardiomyopathy.
- 🧬 Secondary Malignancy – therapy-related leukaemia, skin cancer.
- ⚰️ Transplant Mortality – depends on age, disease, donor match.
- 🩺 Supportive Care
- Blood products.
- Antimicrobial prophylaxis.
- Nutritional and psychological support.
🎯 Indications for BMT
- 🧪 Leukaemias – ALL, AML, CML.
- 🟣 Lymphomas – Hodgkin & Non-Hodgkin.
- 🦴 Multiple Myeloma.
- 🧬 Myelodysplastic Syndromes.
- 💉 Aplastic Anaemia.
- 🌍 Sickle Cell Disease.
- 🩸 Thalassaemia Major.
- 🌙 PNH.
- 🎗️ Selected Solid Tumours – Neuroblastoma, Ewing’s sarcoma.
📚 Clinical Case Examples
🧑⚕️ Case 1: Acute Myeloid Leukaemia
- 45-year-old man with relapsed AML.
- Achieves second remission.
- Has HLA-matched sister.
- ➡️ Undergoes allogeneic BMT.
- Develops mild acute GVHD → treated with steroids.
👩⚕️ Case 2: Multiple Myeloma
- 62-year-old woman with symptomatic myeloma.
- Responds well to induction therapy.
- Stem cells harvested.
- ➡️ Autologous transplant performed.
- Enters long-term remission.
👶 Case 3: Thalassaemia Major
- 7-year-old child with transfusion-dependent anaemia.
- Iron overload despite chelation.
- Matched sibling donor available.
- ➡️ Allogeneic transplant.
- Cured of disease.
📖 References
