Bone marrow transplantation ´ëÀå°æ Á¤¸®
1. Á¶Ç÷¸ð¼¼Æ÷ÀÇ À¯ÇüÀÇ ºÐ·ù
stem cell source: allogeneic vs autologous, BM vs PB vs umbilical cord
HLA : matched vs mismatched
donor : related vs nonrelated
purging: purged vs unpurged
T-cell: depleted vs not depleted
CD34+: cell negative selection vs not
2. umbilical cord blood transplantation
¾çÀÌ Àû¾î¼ ¼ºÀο¡°Ô´Â ºÎÁ·ÇÏ´Ù.
T cellÀÇ ¹Ì¼º¼÷°ú CD4/8ºñ°¡ ³ô¾Æ¼ GVHDÀÇ ºóµµ°¡ ³·´Ù.
À̽ÄÈÄ °¨¿°ÀÌ Àû´Ù.
graft failure°¡ ³ôÀº ´ÜÁ¡ÀÌ ÀÖ´Ù.
3. MHC ; chromosome 6ÀÇ short arm¿¡ À§Ä¡
class I: A, B, C - °ÅÀÇ ¸ðµç ¼¼Æ÷¿¡ ÀÖÀ¸³ª mature RBC¿¡´Â ¾ø´Ù.
class II: D: B lymphocyte, activated T lymphocyte, monocyte¿¡¼ ¹ßÇö
class III: complement(C2,4, Bf)
4. BMT¿¡¼ conditioningÀÇ ¸ñÀû
malignant cellÀÇ Á¦°Å, immune systemÀÇ ÆÄ±«(rejection¿¹¹æ)
5. allo-BMT¿¡¼ ABO ºÎÀûÇÕÀ» ±Øº¹ÇÏ´Â ¹æ¹ý
donor marrow¿¡¼ reactive RBCÁ¦°Å
recipient circulation¿¡¼ anti-A or anti-B antibodyÁ¦°Å(plasma exchange)
6. acute GVHD¿¹¹æ: cyclosporin A, MTX Ä¡·á: methylprednisolone
7. GVHD¿¡ °ü¿©ÇÏ´Â ¼¼Æ÷: cytotoxic T cell, natural killer cell,
LAK(lymphokine-activated killer) cell
8. GVHD¸¦ ÁÙÀ̱âÀ§ÇØ T-cellÁ¦°ÅÇϰí BMTÇßÀ» ¶§ »ý±â´Â ¹®Á¦Á¡
graft failure, relapse¡è
9. Rejection À§ÇèÀÎÀÚ
ÀÌÀü¿¡ ¼öÇ÷À» ¹ÞÀº °æ¿ì, T-cellÀ» Á¦°ÅÇÑ °æ¿ì
less intensive preparative regimen
* buffy coat infusionÀ¸·Î rejection ºóµµ´Â °¨¼Ò½Ãų¼ö ÀÖÀ¸³ª acute GVHD°¡ ³ªÅ¸³´Ù.
10. directed donation½Ã »ý±â´Â ÇÕº´Áõ 2°¡Áö
GVHD, alloimmunization
11. PBSCT°¡ auto-BMTº¸´Ù ³ªÀºÁ¡
±â¼úÀûÀ¸·Î ¿ëÀÌÇϰí ÀÔ¿øÀÌ ÇÊ¿ä¾ø´Ù.
engraftment°¡ ºü¸£´Ù.
ºñ¿ë ¹× µ¿¹ÝÀ§ÇèÀº °¨¼ÒÇÏ°í »ýÁ¸·üÀº Çâ»óµÈ´Ù.
* allo-PBSCT¿¡¼´Â chronic GVHD°¡ ´õ ¸¹´Ù.
12. antimicrobial prophylaxis in allo-BMT
bacteria : neutropenia¿¡¼ºÎÅÍ engraftmentµÉ¶§±îÁö
fungus(fluconazole) -7ÀϺÎÅÍ engraftmentµÉ¶§±îÁö
P. carini(bactrim) engraftmentºÎÅÍ 180Àϰ±îÁö
virus +- HSV(acyclovir) -1ÀÏ¿¡¼ engraftmentµÉ¶§±îÁö
+- CMV(ganciclovir) engraftmentºÎÅÍ 100ÀϱîÁö
13. CMV pneumoniaÄ¡·á¿¡ »ç¿ëÇÏ´Â ¾àÁ¦: foscarnet, ganciclovir
14. Veno-occlusive disease
BMTÈÄ Ã¹ ¼öÁÖ³»¿¡ ¹ß»ýÇϸç hepatomegaly, jaundice, wt gain, ascites ¹ß»ý
BMTÀü conditioning chemotherapy°¡ hepativ venulesÀ» ¼Õ»ó½ÃÄÑ ¹ß»ý
10-60%¿¡¼ ¹ß»ýÇϸç ÀÌÁß 70%´Â ȸº¹µÇ°í 30%´Â »ç¸ÁÇÑ´Ù.
¿¹¹æÀûÀ¸·Î heparin, PGE1, pentoxyphyllineÀ» »ç¿ëÇÒ¼ö ÀÖÀ¸¸ç Ä¡·á·Î r-tPA¸¦ »ç¿ëÇÑ´Ù.
AST°¡ Áõ°¡ÇÏ¸é ¿¹Èİ¡ ³ª»Ú´Ù.
15. autologous stem cell transplantation(auto PBSCT, auto BMT) ÀûÀÀÁõ
AML, ALL 1st remissionÈÄ
NHL, multiple myelom = °¡Àå ¸¹ÀÌ ½Ãµµ
breast cancer, neuroblastoma, testicular cancer
¾Ç¼ºÇ÷¾×Á¾¾ç¿¡¼´Â allo-BMT or auto-BMT°¡ °¡´ÉÇϳª °íÇüÁ¾¾ç¿¡¼´Â
auto-BMT¸¸ ÀÌ¿ëµÈ´Ù.
16. BMTÈÄ Àç¹ßÈ®·ü
syngeneic > T-depleted > No GVHD > acute GVHD > chronic GVHD
> acute & chronic GVHD
17. engraftmentÈ®Àιæ¹ý
sex chromosomeÈ®ÀÎ(cytogenetic study)
ABO typing
RFLP
PCR
18. Vaccination
MMR : 24°³¿ù Áö³ÈÄ(GVHD°¡ ¾ø´Â »óÅ¿¡¼)
VZV : ±Ý±â
H. influenza, poliomyelitis, DTP: À̽ÄÈÄ 12-24°³¿ùÈÄ
19. BMTÈÄ ¼öÇ÷
ABO Ç×ü°¡ Çü¼ºµÇ±â Àü±îÁö´Â RBC´Â OÇü, Ç÷¼ÒÆÇÀº ABÇüÀ» ¼öÇ÷ÇÑ´Ù.