STEM CELL transplant Courtesy of Dr Chew Lee Ping

blood storage is new technology, scientists don’t know whether blood taken at birth will be useful if a family member develops a disease treatable by ...

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STEM CELL transplant

Organ Donation

Existing cord stem cell in malaysia

What is STEM CELL?

What is STEM CELL? • All of the blood cells in your body start out as young (immature) cells called hematopoietic stem cells. Hematopoietic means blood-forming. (Different from embryonic stem cells used in cloning) • Blood forming stem cells mostly live in the bone marrow (the spongy centre of certain bones).

What is STEM CELL? •

Blood stem cells produce three important types of blood cells: 1. red blood cells – carry oxygen around the body 2. white blood cells – help fight infection 3. platelets – help stop bleeding • Once blood cells mature, they leave the bone marrow and enter the bloodstream. A small number of stem cells also get into and circulate in the bloodstream. These are called peripheral blood stem cells. • Stem cells – can be collected from marrow or blood

WHAT IS Stem Cell? • Cord blood is another good source of high number of stem cells • This is blood retained in the umbilical cord and placenta after delivery • Collecting it does not pose any health risk to the infant. After the umbilical cord is clamped and cut, the placenta and umbilical cord are cleaned. The cord blood is put into a sterile container, mixed with a preservative, and frozen until needed. • Cord blood transplants use blood that would otherwise be thrown away. Has been used in stem cell transplants since the late 1980’s – Most often used in children – Dual cord transplants in adults

DIRECTED CORD BLOOD COLLECTION Some things to think about private storage: • A single cord blood unit might not have enough stem cells for most adults, so personal cord blood use could be limited. • Some diseases that can be treated with transplant require stem cells that come from another donor (allogeneic). Infusing your own cord blood stem cells that contain the same defect would not cure the disease. • “shelf life” of cord blood is not known. Cord blood storage is new technology, scientists don’t know whether blood taken at birth will be useful if a family member develops a disease treatable by stem cell transplant 50 years later. • Expensive: collection fee - few thousand dollars, and few hundred dollars per year to store

What is Stem Cell Transplant • A Process where by Healthy stem cell from donated bone marrow, peripheral blood or cord are transplanted into patients to give back stem cells when the bone marrow has been destroyed by disease, chemotherapy (chemo), or radiation. • A transplant could be the best treatment option, and for some patients, offers the only potential cure. • Depending on where the stem cells come from, this procedure may be called:

What disease do we treat with a STEM CELL transplant? • Diseased or damaged bone marrow including: 1. Leukemias and lymphomas, including: a) Acute lymphoblastic leukemia (ALL)—Can affect people of any age, but is the most common type of leukemia in children under 15. b) Acute myelogeneous leukemia (AML)—can affect people of any age, but is most common in adults. c) Chronic myeloid leukaemias (CML) d) Juvenile myelomonocytic leukaemia (JMML)

What disease do we treat with a STEM CELL transplant? 2. 3. 4. 5.

Bone marrow failure (severe aplastic anaemia) Genetic blood disorders eg thalassaemia Immune system disorders such as “boy in the bubble” Non-Hodgkin's lymphoma – cancer of the lymphatic system 6. Marble bone disease (osteopetrosis) 7. Myelodysplastic syndromes. MDS are a group of diseases that affect the bone marrow and blood mainly in adults 8. Multiple myeloma in adults

Highlights in Stem Cell Transplant • 1957: marrow safely infused intravenously • 1958: reports of successful identical twin transplants • 1970: bone marrow harvests perfected to obtain stem cells • 1989: peripheral blood stem cells harvested

Thomas et al J Clin Invest 1959

Haematopoietic Stem Cell Transplant (HSCT) • Infusion of stem cells from a DONOR/ SELF, into patient who has received chemotherapy.

1. Allogeneic

is when cells from a family member, unrelated donor or umbilical cord blood unit are used for transplant. – Related donor transplant - donor is a family member – Unrelated donor transplant - donor is not a family member.

2. Autologous

is when a person’s own cells are used. These cells are collected from the patient’s bloodstream and stored for transplant.

What is a stem cell transplant? • Patient receive high doses of chemotherapy to prepare their body for the transplant. • On transplant day, the patient receives the donated cells in a process that is like getting blood or medicine through

What is a STEM CELL transplant? • The stem cells begin to grow and make healthy red blood cells, white blood cells and platelets. • Whole process where the stem cells grow can take from 1 month to 3 months (called engraftment)

Problems in STEM CELL transplant • Infection – High dose chemo before transplant kills off normal and cancer cells. – Loss of major defence eg. Phagocytosis – Prone to Infections: fungal, bacteria, viruses -CMV, EBV associated post transplant lymphoproliferative disease.

Problems in stem cell transplant • Infections due to: – Damaged mucocutaneous barriers – Gut contains bacteria, fungi which becomes a reservoir for infection. – Usage of indwelling catheters for weeks to months. Catheters may become portal of entry for skin commensal infection – Commonest cause of death in transplant, as high as 30%.

• Graft rejection, • GVHD affecting destruction of

why Should I be a STEM CELL donor?

• 70% of patients do not have a matching donor in their family. • Doctor will turn to Malaysian or international registry for help finding an unrelated donor .

The need for donors • Ideally, healthy stem cells are best donated from a close family member, such as a brother or sister, because there needs to be a close match between tissue types. • Only around one in three people have a close relative with a matching tissue type. • Cells can also be donated from someone else – either from an adult

The need for donors • Bone marrow registers eg Tzu Chi in Taiwan have been set up listing people who are willing to donate bone marrow stem cells if required. • When a donation is needed, doctors search the bone marrow register to try to find a donor with a matching tissue type.

Malaysia stem cell registry • First started in Year 2000 • Current registered donor: 32123 MSCR members • Sarawak only 688 members

• Joining Malaysian Stem Cell Registry (MSCR) is the first step to become a stem cell donor.

Steps towards being a donor • Bone marrow donors must have a tissue type compatible with the person who is going to receive their bone marrow. • Also known as human leukocyte antigens (HLA) . To check if the tissue type is compatible, doctors check how many proteins on the surface of the blood cells match.

Steps towards being a donor • First you will be asked to provide either a buccal swab or a small sample of blood to determine your HLA type. • This information is kept on the register. • You cannot choose who will receive your bone marrow and your donation will remain anonymous. • You will be contacted if you are a

Contraindication to donate Medical conditions include: • HIV and AIDS • hepatitis B and hepatitis C • heart attack/ failure • kidney failure/disease • cancer including leukaemia now or in the past • Even if were suitable before, you will be given a full medical check-up before actual donation and will be rejected as a

Be a responsible donor • Being a Donor is an important commitment. • Voluntary with no monetary gain • If a person with a life-threatening condition thought that they were going to be saved as a result of your donation, and then you suddenly change your mind and refuse to provide a donation, it is likely to be very traumatic for that person and their loved ones.

Be a responsible donor • Not everyone on The Registry will match and be asked to donate to a patient. • The chances of donating are about 1 in 540, so you may be contacted at some point if you are in the registry. If you are asked to donate, the patient's doctor has chosen you as the best matched donor. • If you are asked to be a donor for a patient, you will receive all the information needed to make this decision.

Once you are a match • You will be asked to confirm your commitment to donate, and complete a thorough health questionnaire. • You will have many opportunities to ask questions and will be asked if you’re willing to proceed with the donation. • If you agree to donate, you will be asked to confirm your decision by signing a consent to donate form.

Once you are a match Undergo a physical exam • You will have a physical exam to see if donating would pose any risk to you or the patient. Give blood samples • Before you donate you will be asked to give several blood samples. This is usually done in two to four appointments. These will be scheduled by your donor center which in Sarawak is Kuching, Sibu, Miri and Bintulu.

Once you are a match Donate • You may be asked to travel for the donation or for any of the steps in the donation process. • Travel expenses are covered by transplant center. All medical expenses related to your donation are also covered. • After the above steps are completed successfully, you will proceed with donating peripheral blood stem cells (PBSC)or bone marrow.

Two donation methods: Peripheral blood stem cell (PBSC) and marrow • The doctor chooses the donation method that is best for the patient. Donating peripheral blood stem cells

Donating marrow stem cells

vs

Donating peripheral blood stem cells

• Peripheral blood stem cell (PBSC) donation is a nonsurgical procedure called apheresis to collect blood-forming cells . • Done at an experienced blood center or outpatient hospital facility that participates in PBSC collections – usually either HKL or KK for children

process of Donating peripheral blood stem cells

• For 5 days before donation, you will be given injections of a drug called neupogen. This is a growth-factor drug that causes the bone marrow to make and release a lot of stem cells into the blood. • You will have to visit the hospital or clinic for four days in a row to receive injections.

Donating peripheral blood stem cells • The machine usually collects the stem cells from your blood through a vein in one arm, returning the blood to your body through a vein in your other arm. • Takes about four or five hours and may need to be repeated the following day. • 90% of all PBSC donations are completed in 1 apheresis session. • Remaining 10% of the donations are completed in 2 apheresis sessions, which will take 4 to 6 hours each.

potential side effect OF peripheral blood stem cell donation • Headache or bone pain and muscle aches, similar to a cold or the flu, for several days before collection due to neupogen injections . • Nausea, trouble sleeping, and tiredness. • Other common side effects include bruising at the needle site, chills and a decrease in the blood platelet count. • Less than 1 percent (0.6) of donors

Donating bone marrow • Bone marrow donation is a surgical procedure that takes place in a hospital operating room. • Needles are used to withdraw liquid marrow (where the body’s blood-forming cells are made) from both sides of the back of your pelvic bone. • You will be given anesthesia and feel no pain during the donation. • After donation, your liquid marrow is infused into the patient for transplant.

Bone marrow donation • The donation will take place in a hospital that is experienced eg Hospital Ampang, UMMC, HUKM. • Common side effects of marrow donation reported 2 days after donation: • Back or hip pain 84%, • Fatigue 61%, • Throat pain 32%, • Muscle pain 24%, • Insomnia 15%, • Headache 14%, • Dizziness 10%, • Loss of appetite 10%, Nausea 9%.

Why should I be a donor in sarawak?

This means it is more difficult to find suitable donors for members of these communities who require a bone marrow transplant.

certain ethnic communities are under represented on the bone marrow registry.

Patients are most likely to match someone who shares their ancestry

You could be someone’s cure

It is best to join the bone marrow register at a young age. The younger you are when you join, the more chance there is of your stem cells being most suitable for someone in need.

Be a donor when you are young and fit.