autologous bone marrow transplantation

Allogeneic transplantation has a good effect on acute leukemia, but most patients lack a suitable donor and high transplantation cost, which is greatly limited. Best time: It is generally recommended to treat after the initial diagnosis of the disease. Special surgery should be prescribed. Postoperative recovery: postoperative recovery of good treatment of diseases: pediatric chronic myeloid leukemia acute myeloid leukemia adult type chronic myeloid leukemia congenital leukemia secondary leukemia acute leukemia leukemia Indication Autologous bone marrow transplantation is suitable for acute leukemia, chronic myeloid leukemia, malignant lymphoma, multiple myeloma, lung cancer, breast cancer, testicular cancer, ovarian cancer, neuroblastoma and the like. Preoperative preparation 1. Choose the right case, try to strengthen chemotherapy as much as possible, so that the tumor cells in the patient's bone marrow are reduced to the minimum level. Age can be appropriately relaxed compared to allogeneic bone marrow transplantation. 2. Explain the advantages and disadvantages of treatment to patients and their families to obtain the cooperation between doctors and patients. 3. Develop a careful implementation plan. 4. Comprehensive physical examination, pay special attention to the presence or absence of infected lesions. 5. Hematology, immunology and examination of heart, lung, liver and kidney function. 6. Develop a model to determine the dose of radiation. 7. The collection time of the bone marrow should be determined according to the preservation conditions of the bone marrow cells and whether it is purified in vitro. 8. Start taking intestinal sterilization drugs 10 days before surgery. 9. Hairdressing 8 days before surgery, enter the sterile room after the medicated bath, and start a sterile diet. 10. Indwelling the intravenous catheter 7 days before surgery. 11. The collection of self-myelin cells cryopreservation, radiotherapy and chemotherapy pretreatment schedule can refer to allogeneic bone marrow transplantation. If stored at 4 ° C, the pre-processing schedule can be adjusted to ensure that the storage time does not exceed 72h. Surgical procedure Bone marrow infusion (1) On the day of autologous bone marrow reinfusion, if the bone marrow cell line is cryopreserved, it should be quickly thawed in a 40 °C water bath before being returned. (2) dexamethasone 5 mg was given intravenously before bone marrow infusion. (3) Start full vein nutrition. complication 1. Immunodeficiency infection: After transplantation, the patient is in a state of severe neutropenia and immunodeficiency. The granulocyte deficiency is most prominent within 1 month after transplantation. In this period, bacterial infection is common, especially Gram-negative bacilli sepsis is more common. Fungal infections can also occur, and patients in this period should be admitted to the laminar flow ward for environmental protection. Immune function takes a year or more to fully recover. From March to 1 year after transplantation, life-threatening infections mainly come from viruses, especially interstitial pneumonia caused by cytomegalovirus, but also bacteria and fungi. And parasitic infections, etc. 2. Interstitial pneumonia: The median time to interstitial pneumonia is 60 days after transplantation, 45% is related to cytomegalovirus (CMV), 15% is caused by other viruses, and serum is CMV antibody-positive receptors, or A donor who receives a CMV antibody-positive donor has a greater chance of developing a CMV infection after transplantation. In view of the high mortality rate of CMV interstitial pneumonia, CMC antibody-positive patients can be intravenously administered ganciclovir (5 mg/(kg·d), qd, -8 days to -1 day before transplantation. Or foscarnet (Foscarnet), after the recovery of leukocytes and platelets after transplantation, 7 to 14 days after the prevention of CMV interstitial pneumonia. If interstitial pneumonia has occurred, in addition to the above antiviral drugs, intravenous infusion of propanol can be added to 5 mg/kg, q12h. In addition, anti-CMV immunoglobulin can also be used. 3. Veno-occlusive disease (VOD): a syndrome caused by intrahepatic venous occlusion with hepatocyte damage around the center of the lobules and sinusoids, and slowing of sinusoidal blood flow, the incidence rate is 30% about. The pathogenesis is unclear, and it is considered to be the pathological and physiological processes of vascular endothelial cell injury caused by high dose radiotherapy and chemotherapy, leading to multiple factors such as immunity, inflammation and coagulation mechanism. Clinical manifestations include hepatomegaly, jaundice, ascites, and weight gain. The course of severe VOD is sinister, may be associated with encephalopathy, high mortality, and multiple organ failure is the main cause of death. VOD should be based on prevention, commonly used prostaglandin E1, 100mg intravenous infusion, q12h. At present, the treatment still mainly uses prostaglandin E1 intravenous drip, plasma expansion maintains effective blood flow, dopamine improves renal blood perfusion, proper diuresis, and maintains water-electrolyte balance. Patients should measure their body weight and abdominal circumference daily.

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