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BONE MARROW TRANSPLANT UNIT (BMTU) in IKM-PPUKM

BMT Unit is a specialized center that cares for peripheral blood stem cell transplant patient (BMT). It is located at the 2nd floor in HUKM. We have been in operation on this floor since April 1999.

BMT is a process by which non-functioning, deficient bone marrow or malignant cells are eliminated using high dose chemotherapy with or without radiation therapy followed by peripheral blood stem cell (PBSC) replacement or rescue in order to restore haematologic & immunologic function.

THE FUNCTION OF BMT UNIT

	Mobilization / stem cell collection & infusion.
	Chemotherapy for pre – transplant
	Pre & post care for Transplant patients

The BMT Units consists of:

	4 Isolation rooms for immediate & critical care of bone marrow transplant.
	4 Isolation Rooms for bone marrow transplant and immediate care, takes about 2-3 weeks.
	8 Single Rooms for Post Transplant Care about 10-14 weeks
	1 Rooms as Clinic / for /Counseling / Mini Library
	1 Study Room
	1 Treatment Room
	1 Staff Room
	1 Pantry (Patients)
	1 Store Room
	1 Sluice Room
	4 Isolation rooms for Bone marrow transplant & Post Transplant Care.
	- Critical area 1:1
	- Semi critical area 1:2

Range of admissions is a between 4 to 8 patients at any one time.
The patients stay in BMTU about 2 months.

There is one doctor who is in charge of the ward, he/she makes a morning round and is contactable when the nurses need the doctor. She does another round in evening just before the doctor goes off duty.

There is one doctor from the Hematology list of doctors who will be on call at BMTU. Grand Ward Rounds are done on Tuesdays,Wednesdays and Fridays at BMTU, Male and Female Hematology Rooms in the male and female medical wards.
Cases for Transplant are selected from the ward rounds to see if they are autologus or allogenic.

FLOW CHART OF TREATMENT PROCESS:

Step 1	Patient/Donor is selected
Step 2	An Appointment with IMR for HLA (Human Leukocyte Antigen) typing class 1 & 2
Step 3	Recipient and 5 Siblings from the same mother and father is informed
Step 4	First Counseling done by doctor
Step 5	Blood HLA taken & sent to IMR (takes 3 weeks for the result)
Step 6	If HLA Class 1 is matching (100%) only one donor is selected for class 2
Step 7	Appointment for HLA Class 2 is made with IMR
Step 8	Doctor does the 2nd counseling with Recipient & Donor
Step 9	Blood HLA Class 2 is taken & sent to IMR (3 weeks for the result)
Step 10	Date scheduled for Transplant when class 2 matches
Step 11	Recipient & Donor informed

Note: If Class 2 fails then MUD (Match Unrelated Donor) search is made through IMR.

STEM CELL
Cells that can give rise to other types of cells; they are produced both during embryonic development and in the adult body. Embryonic stem cells begin with the ability to become any cell type, and quickly differentiate into cells committed toward a certain type of tissue, e.g., blood, skin, or neural stem cells.

About BONE MARROW & PERIPHERAL BLOOD STEM CELL TRANSPLANTATION.

A bone marrow transplant is a procedure for replacing blood-forming cells in the bone marrow that have been destroyed by chemotherapy with healthy bone marrow, while peripheral blood stem cell transplantation is a method of replacing blood-forming cells destroyed by cancer treatment (also called peripheral stem cell support). In a peripheral blood stem cell transplant, immature blood cells in the circulating blood that are similar to those in the bone marrow are given to the patient after treatment to help the bone marrow recover and continue producing healthy blood cells.

There are three categories of bone marrow and peripheral blood stem cell transplantation:

AUTOLOGUS bone marrow & peripheral blood stem cell transplantation An autologous transplant is when a patient receives their own stem cells that were removed and stored before treatment rather than receiving cells from a donor (allogeneic transplant) or from an identical twin (syngeneic transplant).

ALLOGENIC bone marrow and peripheral blood stem cell transplantation An allogeneic transplant is when the patient receives stem cells from someone other than the patient (autologous transplant) or identical twin (syngeneic transplant). The donor may be the patient's sister, brother, or sometimes a person not related to the patient.

Syngeneic

BMTU CLINIC DAYS
Clinic days are every Wednesdays from 8.00 am to lunch time.
Cases that are seen are the post transplant patients.

CLINICS	We have dedicated follow-up clinics for transplant patients to deal with side-effects which can occur many years after the transplant procedure. This clinic operates every Wednesday from 8.00am to 1.00pm at HUKM (Daycare Heamatology).
MEN	A common side-effect is men can become infertile and most will have had the opportunity to freeze sperm prior to treatment.
WOMEN	Some women (particularly if they have had irradiation treatment) will experience an early menopause and part of regular follow-up will be to monitor for this.

GLIVEC PROGRAMME
Glivec Programme by the Novartis Pharmaceutical Company was started in May 2003 on trial basis for the chronic myeloid leukimia and patients who have no donors. They are on 400mg daily for a month, and the patients are followed up every month to see how they are responding to the drug.

Support Services

Bone Marrow Transplant Ward/ Wad Pemindahan Sum-Sum Tulang