骨髓移植/脐血移植/造血干细胞移植的术前准备（英语版）

Guidelines for PreTransplant Evaluation

 

Complete History

 A complete history with full details of the patient’s treatment and response including the following:

1. Hematologic findings at diagnosis with particular attention to cytogenetic and molecular markers, disease process and immunological criteria.郑州大学一附院血液内科万鼎铭

2. Patient exposure to steroids, radiation (total dose and field) and chemotherapy regimens (document response status). Particular attention should be paid to the number of cycles necessary to achieve remission.

3. History of previous transfusions, both random donor and from family members.

4. Current medical problems.

5. Current medications.

6. Female patients: Pregnancy history, menstrual history and date of last sexual intercourse.

7. Male patients: History of testicular involvement and treatment.

8. Episodes of extramedullary disease sites, treatment and response (leukemia patients). Episodes of metastatic disease sites, treatment and response (sold tumors/lymphoma).

Clinical Evaluation

1. A physical examination.

2. Two view chest x-ray (PA and LAT). Other x-rays as clinically indicated or directed by protocol.. If necessary, administered CT/MRI examination.

3. Bone Marrow Aspirations/Biopsies based on the following chart.

4. ECG on all patients and cardiac ejection fraction (EF) study in patients with a history of heart failure.

5. Oral medicine evaluation.

6. Baseline pulmonary function studies (patients ≥6 years of age) including baseline arterial blood gas.

7. Nutritional assessment including height, weight and body surface area.

8. Gynecology consult as clinically indicated for:

a.  History of dysfunctional uterine bleeding.

b. Active infection symptoms.

c.  History of uterine fibroids or ovarian cysts.

d. Receiving oral contraceptives.

Bone Marrow Aspiration and Biopsy Chart

Note: aspiration/biopsy samples may vary depending on research protocol requirements. Please refer to Protocol Books.  

Disease	Bone marrow aspiration (for pathology, Cytogenetics, and Flow Cytometry unless otherwise indicated)	Bone marrow biopsy (to pathology)
Acute lymphoblastic leukemia (ALL)	Unilateral	No*
Acute myelogenous leukemia (AML)	Unilateral	No*
Aplastic anemia (AA)	Unilateral	Unilateral
Chronic myelogenous leukemia (CML)	Unilateral	Unilateral
Lymphoma ?if previously stored	Bilateral  Unilateral	Bilateral  Unilateral
Multiple myeloma (MM) ?if previously stored	Bilateral  Unilateral	No*
Myelodisplasia	Unilateral	Unilateral
RAEB	Unilateral	Unilateral
Neuroblastoma	Bilateral	Bilateral
Solid tumor	Unilateral**	Unilateral
Breast cancer ?if previously stored	Bilateral**    Unilateral**	Bilateral  Unilateral

* Unless unable to obtain adequate bone marrow aspiration.

** Cytogenetics depending on specific patient’s history. 

Laboratory Evaluation 

1. CBC (complete blood count), Ret (reticulocyte count).

2. Biochemical Tests: Na (natrium/sodium), K (kalium/potassium), Cl (chlorine), Ca (calcium), Phos (phosphorus/phosphate), Mg (magnesium); Glu (Glucosis), BUN (blood urea nitrogen), CO₂CP (carbon dioxide combining power), UA (uric acid), Cr (creatinine); ALT (SGPT), AST (SGOT), A (albumin), G (globulin), A/G ratio, TP (total protien), TB (total bilirubin), DB (direct/conjugated bilirubin), IB (indirect/unconjugated bilirubin), LDH (lactate dehydrogenase), GGT (gamma glutamyl transpeptidase), ALP (alkaline phosphatase); Tg (triglycerides), Chol (cholesterol), et al.

3. ABO and Rh typing and two-way red cell crossmatch with a donor.

4. HLA serotyping of patient and donor and all immediate family members and potential blood product donors.

5. DNA/Sequence-specific oligonucleotide probe (SSOP) typing of the patient and donor.

6. For patient and donors who are suspected of being monozygotic twins 20ml of heparinized peripheral blood from each to CIL for DNA-VNTR analysis.

7. Leukocytotoxic and/or Florescence activated cell sorter crossmatch between the patient and donor.

8. 10ml clot tube from patient for serum storage.

9. For patients with sex-matched donor in whom chimerism cannot be documented by in situ hybridization, 20mls of heparinized peripheral blood from patient and donor for DNA storage.

10. 20ml heparinized blood sample for all patients and donors to Cytogenetics.

11. Antibody to HIV, HSV, CMV, VZV (patients ≤18 years of age) and toxoplasma determination.

12.  Hepatitis Virus testing:

a.  No hepatitis present (i.e., serum AST and ALT normal) but history of liver disease, prior transfusions, IV drug abuse or birthplace in Asia, especially in China: order all of these tests: ①Hepatitis B surface antigen (HBsAg)②(HBsAb)③(HBeAg)④(HbeAb)⑤(HbcAb)⑥Antibody to hepatitis C virus (anti-HCV)⑦Hepatitis C virus RNA by polymerase chain reaction (HCV RNA by PCR).

b. Hepatitis present (i.e., serum AST or ALT increased): order all of the tests above plus this test ?IgM antibody to hepatitis A virus [anti-HAV(IgM)].

c. No hepatitis present , negative history for all of the above: No tests are necessary.

13. Female patients age ≥10: Estradiol, FSH, HCG and estrone levels.

14. Sickle cell analysis (black patients and patients ≤20 years of age).

15. Urinalysis.

16. IgG, IgA, IgM.