Indications and complications

Indications for Transplantation

• Nonmalignant diseases
  Inherited metabolic disorders - Adrenoleukodystrophy, Hurler syndrome, metachromatic leukodystrophy, osteopetrosis, and others.
• Inherited immune disorders -Severe combined immunodeficiency, Wiskott-Aldrich syndrome, and others
• Inherited red cell disorders - Pure red cell aplasia, sickle cell disease, beta-thalassemia, and others
• Marrow failure states - Severe aplastic anemia, Fanconi anemia, and others
  Autoimmune diseases (experimental) - Systemic sclerosis, severe systemic juvenile rheumatoid arthritis, lupus, multiple sclerosis, and others

Malignant/premalignant diseases

• Acute lymphoblastic leukemia (ALL)
• Acute myelogenous leukemia (AML)
• Chronic myelogenous leukemia (CML)
• Juvenile myelomonocytic leukemia
• Myelodysplastic syndromes
• Plasma cell disorders
• Hodgkin and non-Hodgkin lymphoma

Complications

• Mucositis: neutropenia seems to have the greatest relationship to mucositis. Great variability in mucositis amongst patients but there seems to be a minimal relationship to drug doses, schedules, duration of treatment, and impairment of renal and hepatic function. It can occur as early as 4-7 days after initiation of conditioning phase and last 10-14 days o. it generally starts with the nonkeratinized surfaces of buccal and lingual mucosa
• Pain management: Young infants frequently need narcotic analgesics. Older children are given paitent controlled analgesics of sedative meds. Local analgesics include viscous lidocaine 2% and dyclonine HCl are effective topical agents. Ice packs and ice pops increase comfort level of patients.
• Oral bleeding: oral manifestations of thrombocytopenia include bruising , petechiae, purpura and oozing of mucosal tissues which can be potentiated by local irritating factors like calculus, plaque, etc. Ulcerations, infections, spontaneous bleeding occurs when platelets are <20000cells/mm3>
• Infections: Candida is the most common oral infection in BMT patients. Nystatin solutions and clotrimazole troches are effective. Ketoconazole, miconozole and flucononazole are ingested and amphotericin B IV is for aggressive treatment. HSV is the main viral pathogen. Patients with a + serotype receive low dose acyclovir up to 28 days post BMT. CMV seropositive patients receive genocidovir for at least 100 days post BMT. Lastly bacterial infections are less common.
• Xerostomia and taste disturbances usually last for a few weeks with the exeption of radiation patients. Salivary flow can be stimulated with sugar free gum or hydration. Avoid coarse foods and spicy foods and consult with a nutritionist.
• Acute GVHD occurs when transplanted T Lymphocytes treat host tissues as foreign causing injury to several parts of the body. Acute GV-HD occurs within the first 100 days post BMT with the median onset at 19 days. Most common oral changes include erythema (dorsal and ventral surface of tongue, floor of mouth) and lichenoid changes. Prevention includes good oral hygiene, steroid rinses, treatment of concurrent infections and topical analgesics.
• Neurotoxicity: Vinblistine and vincristine in the conditioning phase can cause peripheral neuropathy including jaw pain and lower molar toothaches. Treatment is palliative as it disappears after the drugs are discontinued.