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