Curriculum standards

Knowledge guides

LG20: Bone marrow transplantation

Clinical sciences

Advanced Trainees will describe the principles of the foundational sciences.

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Eligibility considerations

Advanced Trainees will assess the patient’s current condition and plan the next steps.

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Less common or more complex patient considerations

Advanced Trainees will understand the resources that should be used to help manage patients.

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Undertaking therapy

Advanced Trainees will monitor the progress of patients during the therapy.

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Post therapy

Advanced Trainees will know how to monitor and manage patients post-therapy.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management, and integrate these into care.

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Cause and incidence of transplant-related mortality for:
- allogenic stem cell transplantation (SCT)
- autologous SCT
Choice of allogeneic stem cell donor, and type of stem cells for transplantation
Indications for allogeneic stem cell transplantation:
- experimental indications
- standard indications
Indications for autologous SCT:
- experimental indications
- standard indications
Normal haematopoiesis and stem cell biology
Patterns of haematopoietic reconstitution following stem cell transplantation
Potential toxicity and side effects of cytokines for mobilisation
Stem cell sources, and mechanisms of stem cell mobilisation

Choice and impact of conditioning regimen for different clinical scenarios
Differences in efficacy and toxicity of autologous transplants
Donor health assessment
Donor–recipient matching
Graft versus leukaemia (GVL) effect
Histocompatibility
Recipient health assessment, including end organ function assessment
Relative risks of graft-versus-host disease (GVHD) and contribution of severity to morbidity and mortality risks:
- acute
- chronic
Stem cell source identification for different clinical scenarios
Suitability of family members or unrelated volunteers as donors
Suitable allogeneic donor identification
Veno-occlusive disease (VOD) or sinusoidal obstruction syndrome (SOS) and interstitial pneumonitis diagnoses
Volunteer donors’ assessment, and explanation of the process of stem cell collection, including risks

Management of patients in context of disease status
Management of patients with co-morbidities and patients of older age

Acute toxicities of high-dose chemotherapy and chemoradiotherapy on organ systems, including:
- diagnosis and management of GVHD
- interstitial pneumonitis
- SOS
Conditioning chemotherapy and radiotherapy
Immunosuppression prescription of appropriate doses of chemotherapy and immunosuppressive therapies
Importance of collaborating with specialists and services from other disciplines, especially infectious diseases and intensive care
Stem cell collection:
- bone marrow harvesting
- leukapheresis
- peripheral blood mobilisation
- umbilical cord blood collection and storage
Stem cell manipulation:
- cryopreservation
- enumeration post-thaw
- T-cell depletion

Management of infections in immunocompromised patients:
- assess prognosis in patients with multi-organ failure
Supportive care:
- diagnosis and treatment of late toxicities from SCT
- prevention and management of opportunistic infection
- throughout stages, such as:
  - during long-term immunosuppression
  - during the neutropenic phase
  - following engraftment
- use of analgesics, antiemetics, and haemostatic agents
- use of blood components

Curative potential of allogeneic and autologous SCT in different disease settings
New knowledge in basic haemopoietic biology and future improvements in SCT
Patterns of treatment failure related to disease or complications of transplantation
Prognostic indicators of disease responsiveness and treatment-related mortality to decision making
Selection of appropriate stem cell source
Toxicity and quality-of-life issues in long-term survivors