Al Amal Centre H.K.Jordan BMT Transplantation in AL-Amal Cancer Center The Bone Marrow Transplantation (BMT) provides a comprehensive treatment approach for adult and children with life threatening conditions. It becomes the promising treatment options and in some cases a ”First Line “ form of therapy for patients with acute and chronic leukemia, Non –Hodgkin’s lymphoma, Hodgkin’s disease; multiple myeloma, breast cancer, aplastic anemia, some combined immune deficiency syndrome, Thalassemia and sickle cell anemia. Treatment and follow–up care take place in the inpatient isolated units, and BMT clinic, this unit has seven beds, four of them equipped with HEPA filtration. Medical team, nurse practitioners, pharmacist and nutritionist closely monitor patients. Daily team meetings are held to discuss the course of treatment and to coordinate discharge plans. Patient s and family education and support is offered during the procedure. At present time I do adult patients who are 16 years or more. Clinical Indication Marrow Transplantation (Stem Cell Transplantation) has been employed clinically for the therapy of a wide variety of acquired malignant and non malignant disordered and of inherited hematological and metastatic diseases as: 1st) Malignant diseases: 1. Acute Leukemia (lymphoblastic and myelogenous). 2. Chronic Myeloid leukemia (CML). 3. Myelodysplastic Syndrome (MDS). 4. Lymphoma. 5. Hodgkin disease. 6. Multiple myeloma (MM). 7. Selected Solid Tumors as; breast cancer, germ cell tumor, and ovarian cancer. 8. Neuroblastoma 2nd) Non Malignant diseases. 9.Aplastic anemia. 10.Thalassemia. 11. Sickle cell anemia. 12. Others. Types of Transplantation: 1st) Allogenic bone marrow transplantation is a grafting of marrow or stem cell from donor into a patient who are genetically matched with him. It may be either sibling (brother or sister) or unrelated matched donor. 2nd) Autologous Bone Marrow Transplantation is a grafting of patient’s own marrow or stem cell, are employed to”rescue” the patient from the lethal effect of high dose chemotherapy. Sources of stem cells: 1st) Bone marrow. 2nd) Peripheral blood. 3rd) Cord blood. Steps of Bone Marrow Transplant: 1) Pre Transplant; Patients are evaluated for eligibility for this therapy that includes full clinical and radiological evaluation. In addition to screening tests for virus as hepatitis B&C, HIV infection and herpes infection, in addition to full evaluation for renal, hepatic pulmonary and cardiac function. In case of allogenic transplantation also the siblings (brother & sister) should be evaluated for proper matching as well as for their fitness for donation. 2) BMT and or peripheral blood stem cell collection. In this phase the patient or the donor is given either chemotherapy with growth factor that stimulate the production of “stem cell” in case of autologas transplantation or growth factors alone in case of Allogenic transplantation. After proper collection these stem cells are stored and freezed in liquid nitrogen up to -180?C. these cells can be kept in storage up to 20-25 years. or even more. 3) High dose chemotherapy + high dose radiotherapy. We use lethal doses of chemo that killed all cancer cell in addition to cells of bone marrow that are responsible for production of immunity cells, red blood cells, and platl. 4) Infusion of stem cells; in this phase the marrow or peripheral blood are rapidly thawed at the patient bed side and infused intravenously without further processing. 5) Post transplant support which include blood products antibiotics, nutritional support using a growth factors engraftment of bone marrow, where the patient will have adequate number of white cell and platelets. Complications: 1) Infection; bacterial, fungal, viral. 2) Liver toxicity; veno occlusive liver diseases. 3) Interstitial pneumonias. 4) Graft versus host diseases (GVHD) both acute and chronic. 5) Mucositis. 6) Death.