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PRE-TRANSPLANT PROCESS and BASIC HLA DISCUSSION

Introduction to Bone Marrow Transplantation. PRE-TRANSPLANT PROCESS and BASIC HLA DISCUSSION . Dana Broadway RN, BSN, CHTC BMT Nurse Coordinator VCUHS Bone Marrow Transplant Program Staff Nurse 1989-1995 Coordinator 1995 - Present. OBJECTIVES.

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PRE-TRANSPLANT PROCESS and BASIC HLA DISCUSSION

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  1. Introduction to Bone Marrow Transplantation PRE-TRANSPLANT PROCESS andBASIC HLA DISCUSSION Dana Broadway RN, BSN, CHTC BMT Nurse Coordinator VCUHS Bone Marrow Transplant Program Staff Nurse 1989-1995 Coordinator 1995 - Present

  2. OBJECTIVES Describe the process and time line from the New Patient Consult to BMT Admission Describe the process and time line from Related Donor Identification to actual PBSC/BM donation Describe the importance of HLA typing and identify important unrelated donor identification characteristics

  3. Patient Process NP Consult Induction/Salvage Chemotherapy Restaging/Pre-testing Second Consult Stem Cell Collection BMT Admission

  4. New Patient Consult PA/NP History and Physical MD Review disease process Treatment options Coordinator Immediate specific needs identified - ?Social Work, ?Financial Coordinator Initial Plan Patient is discussed in weekly Clinical Conference

  5. Induction/Salvage Chemotherapy Insurance Donor Identification (tissue typing) Unrelated donor search if necessary Referring MD communication Patient education Housing/Environmental Issues Caregiver Identification Review of diagnostic slides 2 – 4 months depending on disease being treated

  6. Restaging/Pre-testing CT/PET/MRI BMBX Labwork to evaluation disease Organ Function (PFTs, MUGA/Echo, LFTs, KFTs, etc) Infection evaluation (gyn, dental, cultures, CT scans) Menses suppression Some insurance companies require mammogram, PSA screening, colonoscopy This phase can take up to 1 – 2 weeks

  7. Formal Second Consult MD review test results MD consent (standard of care and/or clinical trial if eligible, Advanced Medical Directive, NMDP consents) Meet with the rest of the BMT Team - Radiaton Oncology, Psych, Social Work, Financial Coordinator) Obtain preauthorization from insurance company Meet with Coordinator to put a tentative plan on the calendar This phase can take up to 1 – 2 weeks

  8. Stem Cell Collection Mobilization method Veinous access: line placement for majority of patients Apheresis or Bone Marrow Harvest Home Health for injections and/or line care Communication with apheresis/OR/BM Lab/Clinic This phase takes 1 – 3 weeks

  9. BMT Admission Insurance pre-certification High dose chemotherapy regimen identified and communicated to Pharmacy Final education session with patient Final planning session with patient Complete chart to Inpatient BMT Unit

  10. Related Donor Process HLA Typing Donor Evaluation Stem Cell/Bone Marrow Collection

  11. HLA Typing

  12. Donor Evaluation History & Physical Labwork (organ function, IDMs) CXR, EKG Risk Factor Assessment Social Work Evaluation Arm evaluation Education Consent This is all done in 1 day

  13. Related Donor Collection Generally starts about a week after evaluation day Communication with apheresis/OR/BM Lab/Clinic PBSC (Peripheral Blood Stem Cell) Collection Neupogen given x 3 days Start apheresis (stem cell collection) on the 4th Usually collect in 1-3 days Bone Marrow Harvest Outpatient

  14. HLA Basics • H = Human • L = Leukocyte • White Cells • Component of the immune system • Recognizes self from non-self • A = Antigen – a substance that when introduced into the body stimulates the production of an antibody. (ref: dictionary.com)

  15. HLA Basics HLA plays an important role in identifying self from non-self – VERY IMPORTANT IN TRANSPLANTATION Proteins on the outer surfaces on most cells of the body Inherited from our parents Located on chromosome 6

  16. 6 Different HLA Groups • A, B, DR important in related donors • A, B, C, DR important in unrelated donors • Role of DQ, DP still under investigation

  17. How you inherit DNA MOM B b DAD b b BbBbbbbb

  18. How you inherit DNA MOM A01, B44, DR07A02, B57, DR13 DAD A04, B08, DR03A05, B10, DR16 A01, B44, DR07A01, B44, DR07A02, B57, DR13 A02, B57, DR13 A04, B08, DR03 A05, B10, DR16 A04, B08, DR03A05, B10, DR16

  19. DNA Based HLA Typing Serologic: A01, B02, DR15 Low Resolution: A01XX, B02XX, DR15XX Intermediate Resolution: Results are narrowed to 2 or more alleles A 01AB (0101, 0102) B 02AC (0201, 0203) DR 15MN (1503, 1505) High Resolution: Identifies the specific allele A 0102 B 0103 DR 1503

  20. What is a Match? Related Allogeneic BMTs: 6/6 A, B, DR high resolution match preferred 5/6 mismatch acceptable Unrelated Allogeneic BMTs: 8/8 A, B, C , DR high resolution match preferred 7/8 mismatch acceptable Current practice prefers A mismatch, over B, over C, over DR mismatches Cord Blood Transplants: 4/6 match or better

  21. What Other Factors are Involved in Unrelated Donor Identification? Weight of donor/cell count of cord Age Gender CMV status Parity Number of previous donations Race ABO Group

  22. QUESTIONS? dbroadway@mcvh-vcu.edu 804-828-3554

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