Homoepoetic Stem Cell Transplantation

Oncology Nursing

Homoeopathic Stem Cell Transplantation

Today I learnt lot of interesting things from my guest lecture. I will share you about

Homoeopathic Stem Cell Transplantation , the latest intervention that used worldwide to help cancer patient that need stem cell transplant.

Stem Cell Transplant

There are 2 type of transplant that are used currently in health care systems that are bone marrow transplant and Stem Cell Transplant. To further describe stem cell, it is defined as unspecialized cell that do not yet have any function. It will develop to be specialized cell and when it proliferate, it will become mature cell such as blood cells and other type of human body cells. This stem cells can be found in large amount in bone marrow and less amount in blood circulation.

Bone Marrow Transplant (BMT)

In treating disease using BMT, damaged bone marrow will be replaced with normal bone marrow. However, because of the bizarre side effects and expensive treatment, BMT is not currently used and will only applied when chance of cure is high. BMT is now replaced with Peripheral Blood Stem Cell Transplantation ( PBSC). Al tough the site for extraction is different, the transplant procedure and methods remain the same.

Type of Transplant

There are 2 types of transplant that are autologous and allogenic . Autologous transplant transplant is the term used when patent's own bone marrow or stem cells are harvested and placed in the frozen storage (cyropreserved) and re-infused into the patient. Alogenic in other hand, refer to transplant received from someone's else bone marrow or stem cells. Transplants can be found in bone marrow cavities and peripherals blood .

Disease treated with BMT & Stem Cell Transplant
Example: Acute Mylegenous Leukemia, Acute lymphocyte leukemia, Chronic Mylegenic leukemia , Mielodyplastic syndrome, Hodgkin's disease, Non- Hodgkin's lymphoma, Neuroblastoma and etc. However, in the advent of technology, these transplant is aimed to treat other disease such as diabetes and others.

Peripherals Blood Stem Cell Transplant (PBSC)

In peripherals blood, the amount of stem cell are low and need to be stimulated by a process called Mobilization. This process will create more stems cells proliferation's. Peripherals blood stems, although found in low quantity then found in bone marrow, are more easily harvested and implanted.

The advantages of PBSC

Among the advantages of PBSC are it can be done as outpatient. This means patient do not need to have a hospital stay to get treatment. PBSC is done under Local analgesic and cause lesser pain than BMT. It also can be done although the patent's bone marrow are fibrotic, hypercellular or have disease. Tumour cells also has less ability to proliferate. Patient undergoing PBSC have rapid recovery, pay less amount of cost, and decreased possibility of having infections due to procedure. As the risk of infection is low, patient will have shorter lenght of stay in the hospital and consume less blood product and antibiotics.

The Disadvantages of PBSC

PBSC is a very complex procedure that uses a lot of labour using processing. The stem cells harvested need to be cryopreseve and may present with malignant cells. It also requires a large bore double lumen central venous control.

Process of PBSC

There two process of PBSC that are Mobilization and Apheresis. During mobilization, peripheral blood are stimulated to produce more stem cells for collection. This can cause side effect to patient such as pain, headache, fatigue and insomnia. These symptoms however, can be treated with oral analgesic.

Apheresis refers to the process of how peripheral blood stem cells are collected.. It utilize the peripheral vein at anticubital vein for venous process. The side effects of Apheresis is 30% to 50% drop in platelet count. Apheresis take 1 to 10 minutes time to perform and can be done for 3 to 4 hour a day and platelets count will take 1 week to recover.

Stages of PBSC

1) Pretreatment Workout

All recipients and donors have to be assessed to ensure that they are fit physically and psychosocially. For Allogenic transplant, assessment is done in outpatient and variety of test and procedures will be carried out such as history taking. physical examination and various blood tests.

2) Conditioning Regimen (1-10 days)

Process of preparing the patient to receive bone marrows or stem cells. It serves three important function that are:

a-Obliterates malignant disease

b- it destroy pre-existing immunologic state

c-Create space in bone marrow cavity for the proliferation of the transplanted cell.

As conditioning regimen will destroy all patient own bone marrow, proliferation of new eritrocytes, leukocytes, platelet cant occurs unless new functioning bone marrows or stem cells are given to patient. After completion of regime, patient must receive bone marrow or stem cells or patient will die.

Regimens used:

Radiotherapy and chemotherapy such as: Cyclophosphamide, Etoposide, Bussulfan and other chemotherapy drugs. Regimen are choose based on type of disease, amount and response to previous treatments of radiation or chemotherapy. Patient will experience side effect that varies according to chemotherapy drug used. Common side effects are mylosuppression, nausea and vomiting, diarrhoea and hair loss. The stem cell must be infused within 72 hours after completing conditioning regimen.

3) Transplantation

This process will take 20 to 30 minutes, depends on volume of cells transplanted. Among problem that are encountered during transplant are:Shortness of breath (Because rapid transfusion of stem cells) and Nausea and vomiting. Total time need for infusion is 5 to 10minutes and side effects from allogenic transplant same as blood transfusion such as chest pain and shortness of breathe.

4)Engraftment Period

Time immediately after transplant when stem cells start to migrate and started the regeneration process. It will takes 2 to 3 hours. During the process, patient will encounter pancytopenia and immunosuppression that will lead to infection and bleeding.

Well, that's all I can share this time as the class will start in any minute from now.

See you again!

Nursenoorazlin.