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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.