allogeneic bone marrow transplantation

Allogeneic bone marrow transplantation is pretreated with high-dose chemoradiotherapy or other immunosuppressive agents to remove tumor cells and abnormal clonal cells from the recipient, block the pathogenesis, and then transplant allogeneic hematopoietic stem cells to the recipient, so that the recipient can reconstruct normal hematopoiesis. Immunization, a treatment for therapeutic purposes. It requires a bone marrow transplant between siblings, sisters or family members, such as parents and children, matched with the patient's human leukocyte antigen (HLA), and a heterogeneous bone marrow entered by a very small number of unrelated donors; or with patients HLA does not match the bone marrow of the unrelated donor. Or a very small number of identical twin twins born between brothers or sisters. The human leukocyte antigen (HLA) gene locus is present on both short arms of chromosome 6, each of which consists of closely linked complex loci. Each locus consists of one of several or dozens of alleles. On the cell membrane, there are currently about 200 antigens found. The HLA antigens currently detected in the laboratory are only HLA-ABC and -D/DR. The laboratory determined that the two antigens were consistent between the two, which did not mean that there was no inconsistency in the total antigens of the two individuals. In the siblings and sisters, each of the parents receives one of each gene on a chromosome, so it is a haploid gene. The identical rate of genetic cooperation between siblings and siblings is only 25%. There is always a different type of HLA A and B on the single type chromosome between parents and offspring, so except for the twin brothers or sisters of the same egg, There is very little chance of matching HLA between family members and unrelated donors. Best time: early detection and early treatment. If you have special circumstances, please follow the doctor's advice. Postoperative recovery: This treatment can improve the curative effect, improve the prognosis, and obtain long-term survival and even cure. Treatment of diseases: juvenile chronic myeloid leukemia, childhood, adult, chronic myeloid leukemia, acute leukemia, malignant lymphoma Indication 1. First, there must be a suitable bone marrow provider, preferably with a full-blend gene provider. 2, must require complete relief of chemotherapy. 3, the age is generally under 45 years old. 4, no serious liver, kidney, heart, lung, brain and other important organ damage; no heavier diabetes, hepatitis, hypertension, cerebral infarction, heart disease; no serious mental disorders. Contraindications 1. Those who are over 45 years old. 2, there are serious liver, kidney, heart, lung, brain and other important organ damage; no heavier diabetes, hepatitis, hypertension, cerebral infarction, heart disease; no serious mental disorders. 3, did not match the bone marrow Preoperative preparation 1. Routine examination: assess your general condition by necessary physical examination and some laboratory tests before transplantation to ensure the safety of subsequent transplantation and provide reference for future evaluation. The examination items include eyes (trauma, etc.), oral cavity (caries, etc., must be repaired or removed), otolaryngology examination, general surgery (acne, anal fissure, etc.), examination of heart and lung function, and bone wear, waist wear, chest X line and so on. These checks reveal potential problems that need to be addressed before migration. 2. Signing the consent form: The consent form is a legal document that ensures that the doctor must inform you of any risks and complications that may occur during or after the transplant. The doctor will have an in-depth conversation with you or your family before signing the consent form. 3, deep vein catheter: under a local anesthesia, a soft thin catheter into the deep vein, after a long time through the venous catheter without pain, blood samples, drugs and so on. 4. Collect bone marrow or stem cells: Stem cells can be collected from the donor's bone marrow or peripheral blood. If you are doing autologous transplantation, you will pre-emptively mobilize and collect stem cells. Surgical procedure (1) Select donors with HLA (Human Leukocyte Antigen) that are completely compatible. The selection order is the coincidence of HLA genotypes, followed by HLA phenotypes of family members, and again a family member or HLA with HLA loci. Type-matched irrelevant donors, and finally choose one of the unrelated donors or two or three HLA loci that do not fit in the HLA locus. (2) The preparation of the recipient should verify and determine the diagnosis and classification of leukemia. The general age should be limited to 45-50 years old. The function of important organs is basically normal. It is necessary to remove multiple infections in the body for a comprehensive experience. The necessary tests and auxiliary inspections are generally more than a dozen items. The recipient entered the sterile laminar flow ward one week earlier. (3) Perform histocompatibility antigens and gene matching. (4) BMT pretreatment should be up to three months. One is to destroy the original hematopoietic cells in the recipient and prepare the implanted hematopoietic stem cells for implantation. The second is to inhibit the immune cells and functions in the recipient, which is beneficial to the engraftment of the bone marrow. The third is to eliminate and kill leukemia cells in the recipient. (5) Collection, treatment and infusion of bone marrow: On the day of infusion of bone marrow, donor bone marrow is collected under sterile conditions in the operating room, and after filtration, intravenously infused to the recipient to avoid loss of hematopoietic stem cells. The bone marrow of patients with ABO blood group incompatibility should be treated before infusion. (6) Nutrition and supportive care that are often necessary during the BMT process. (7) Early prevention and treatment of BMT complications, elimination of gastrointestinal toxicity, control of multiple infections, bleeding and other major complications. (8) Prevention and treatment of late complications of BMT, such as chronic graft-versus-host disease. complication 1, infection 2. Host rejection of allogeneic bone marrow 3. Immunodeficiency

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