By H. Joachim Deeg M.D., Hans-Georg Klingemann M.D., Gordon L. Phillips M.D. (auth.)
In 1988 we awarded our advisor to Bone Marrow Transplan tation. The reception has been enthusiastic and we've re ceived a flood of serious reviews, feedback and requests to supply an replace in due time. even if numerous books on marrow transplantation have lately been released, their scope and aim have regularly been diverse. consequently, we now have determined to arrange a moment version of the advisor. Our objective used to be to take care of a brief, concise textual content which by no means theless might contain adjustments that experience happened over the last 4 or 5 years. we've got streamlined the outline of pretransplant issues, by way of condensing sections into one (Treatment making plans and Timing of Transplantation). This additionally facilitated the evaluation of debatable symptoms for marrow transplantation, for instance in sufferers with acute myelogenous leukemia in first chemotherapy-induced remission. we've got up-to-date the bankruptcy facing conditioning regimens and feature improved the part on donor choice, specifically in regard to the present point of tissue typing and the identity of unrelated volunteer donors. within the bankruptcy on assortment, processing, and infusion of marrow, we have now included fresh advancements, for instance, using closed platforms for marrow harvesting and processing and using stable part separation of stem cells.
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Additional info for A Guide to Bone Marrow Transplantation
In any case, the key aspects of transplantation should be discussed fully with the patient and their family. Repetition and complete documentation of such discussions are necessary. Despite this requirement, the first contact should be simple and straightforward as the patient's ability to absorb large quantities of unfamiliar information during an initial (and often stressful) visit is often limited. In addition to further discussions, pamphlets and other resource materials are helpful in imparting information to the patient; of particular benefit is a videocassette describing the marrow transplant procedure that the patient may borrow, if such is available.
Obviously, identifying such patients and obtaining appropriate consultation pre-transplant is vital. Donor Preference Autologous Versus Allogeneic Marrow Although autologous marrow transplants are most often considered in the context of patients without histocompatible donors, there are circumstances in which using autologous marrow may be preferable to using allogeneic marrow. In general, auto transplants are preferred in older patients, regardless of the presence of suitable donors. Also, for most malignant solid tumors (perhaps excluding neuroblastoma), the probability of cure is low with current conditioning regimens and the risks associated with allogeneic marrow transplantation do not appear to routinely justify the use of this modality.
Anthracyc1ines, cisplatin, bleomycin and radiation), as well as any evidence of existing toxicity from these agents (see below). Co-Morbid Medical Problems A careful history and subsequent evaluation concerning this aspect should be performed. Specifically, a previous history of cardiac, renal, endocrine or hepatic disease must be solicited, as underlying disease in these organs may complicate transplantation. 52 Pretransplant Considerations Organ Toxicity Screening Patients should not have impairment of any organ system that would might jeopardize an otherwise-successful transplant.
A Guide to Bone Marrow Transplantation by H. Joachim Deeg M.D., Hans-Georg Klingemann M.D., Gordon L. Phillips M.D. (auth.)