Professional Documents
Culture Documents
tranplantation
Nanis Sacharina
A week-observation in
Centro Trapianti di Midollo Osseo,
Ospedale Microcitemico,
Cagliari, 7-16 Dec 2005
Ospedale Microcitemico
History – team work
Start in 1993
1 BMT unit, outpatient clinic
7 doctors, 10 nurses (+ 2 nurses for clinic)
molecular laboratory:
3 doctors
1 biologist
2 technicians
Every day meeting
Meeting
Indication
Thalassemia (110 patients)
leukemia
solid tumor
SCID
aplastic anemia
Survival rate
Familial donor
43 patients (1-15 yo), 120 months follow-up
• Disease free survival rate: 95%
• 2 deaths
32 patients (16-34 yo), 120 months follow-up
• Disease free survival rate 88%
Non familial donor
17 patients
• Disease free survival rate : 65%
CTMO, Ospedale Microcitemico, Cagliari
Survival rate (Thalassemia)
36 class 1 and 2 thalassemic patients, 72 mo
follow-up
Survival rate 96%
Thalasemia free survival rate 85%
Class 1: 100%, class 2: 75%
35 class 3 patients, 12 years follow-up
thalasemia free survival rate 50%
Risk classes in thalassemic
patients at the time of BMT
1
Nurse station
Doctor’ station
2
bagno
3
Mini lab
4
Patient’s room
cupboard
bathroom
Patient’s room
Parent’s room
BMT unit
Fausto with us
Patient’s room
Patient’s room
BMT Protocol (thalassemia)
Vena central catheter insertion under
general anesthesia (7 days before day -10),
day care
admission to the BMT unit on day -10
suppress the defected marrow and prevent
GvHD
hydration and alkalinitation start 12 hours
before administration of busulfan
Bone marrow suppression
Busulfan 4 days: 14 mg/kg
hydration 3 L/m2 until day -1
alkalinisation: NaHCO3
KCl
Furosemid
carbamazepine
Co-trimoxazole
CPA/ endoxan 4 days: 200 mg/kg
mesna
hydration
Other drugs
Colimicin
neomicin
nistatin
azyclovir
ondansetron
chlorpheniramin
GvHD prevention
Cyclosporin A
Methylprednisolone
ranitidine
Methotrexate if necessary
Monitoring
Every day
CBC
blood gas analysis, electrolyte (during
alkalinisation)
balance diuresis
Bone marrow harvesting &
retransfusion
Under general anesthesia
Operating room
20 ml/ kg recipient, nucleated cells 3.5-4 x
108/ kg
BM retransfusion as soon as possible
depends on ABO compatibility:
plasma removal: minor
red blood cell removal: major
After BMT
Grafted or not?
VNTR: before BMT and > +10 day
Usually take 12-20 ( to 30) days
Complication
Infection: special concern of IgG EBV and
CMV positive à reactivation?
Acute GvHD (familial donor 20%, non familial
60%)
Discharge criteria
Good condition overall
No infection, GvHD
Laboratory normal
Follow-up after discharge
First year: monthly
Afterwards: 2 monthly
Infection
Chronic GvHD
Chronic GvHD