BUCHAREST

FUNDENI CLINICAL INSTITUTE

The Medullar Transplant Department was started in March 20th 2000 as the first bone marrow transplant center in Romania. It provides this type of procedure for both adults and children.

Centrul de Hematologie si Transplant Medular “Stefan Berceanu”
Departamentul de Transplant Medular
Sos. Fundeni 258, Sector 2, 022328 Bucharest
Phone: (+) 4021 318 04 16 ; (+) 4021 318 04 25/ ext. 1235
Fax: (+) 4021 318 04 23
E-mail: dtm@icfundeni.ro

The Department has 7 single-bed rooms which respect the international containment and sterility standards which these patients require (air and water filtering devices).

Adjacent to the sterile sector there is a pretransplant sector, useful for pre and posttransplant evaluation and treatment, including stem cells mobilization treatments.

Its activity is coordinated by Prof. Dr. Dan Colita and Prof. Dr. Constantin Arion, as bone marrow transplant programme-coordinators in Fundeni Clinical Institute.

Clinical teams have the following composition:

Adults:

  • Prof. Dr. Dan Colita
  • Dr. Alina Tanase
  • Dr. Zsofia Varady
  • Dr. Ruxandra Fota – ATI (anesthesia and intensive care) primary medic

Children:

  • Prof. Dr. Constantin Arion
  • Dr. Anca Colita
  • Dr. Luminita Dumitrache

Bone marrow transplantation requires team work.

Collaborators: transplantologists (4 doctors with bone marrow transplant specialization)
harvest bone marrow graft and cryopreservation compartment, and laboratories:

  • morphology
  • histopathology
  • biochemistry
  • flow cytometry
  • cell culture
  • microbiology
  • virology
  • HLA
Sections/Labs Reason
ICU/Intensive Care and Surgery – Positioning central venous catheters (operating room)
– Intensive maneuvers if necessary
a. Hemo-biology – transfusion
Bone marrow graft preparation
– Harvest of hematopoietic stem cells from peripheral blood
– Providing irradiated blood products
b. Hematology laboratory – Blood tests execution
c. Microbiology laboratory – Performing microbiological control
d. Biochemistry laboratory – Performing biochemical examinations
e. Flow cytometry laboratory – Diagnosis and classification of hematological diseases
– Diagnosis of minimal residual disease (MRD)
– Graft quality control
f. Cytogenic laboratory – Cytogenetic examination
– MRD Diagnosis
g. Hematopoiesis laboratory (cell culture) – Viability graft control
h. Pathology laboratory – Histological control for allografts. Access to laboratory pathologist experienced in diagnosing graft versus host disease
i. HLA laboratory – Histocompatibility testing for allograft
j. Epidemiology – Epidemiological control
k. Imaging department – Execution of imaging exams (X-ray, ultrasound, CT, MRI)
l. Pharmacy – Ensuring medication, infusion solutions and solutions for parenteral nutrition
m. Functional exploration department – Functional exploration ventilator, EKG, heart ultrasound, etc.
n. Digestive endoscopy department – Making digestive endoscopy, biopsy
o. Respiratory endoscopic exploration department – Making bronchoscopy and bronchoalveolar lavage
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PROCEDURE

Specific activity in Bone Marrow Transplantation Center consists of hematologic malignancies treatment protocols high-dose chemotherapy followed by restoring hematopoiesis in previously harvested stem cell transplantation from the patient or from a donor.

The main stages of stem cell transplantation are:

  1. stage of stem cell mobilization: administration of chemotherapy + growth factors to the patient, or only growth factors for healthy donor, followed by
  2. apheresis procedure: cytapheresis harvesting device using peripheral blood stem cells; procedure is performed in the Department of Hemobiology and preparation of bone marrow graft.
  3. conditioning stage: myeloablative doses of chemotherapy administration, under protocols approved by the National Bioethics;
  4. peripheral stem cell transplantation: graft is administered intravenously as a blood transfusion
  5. hematologic recovery stage to capture graft: sterile isolation room plus administration of growth factors, labile blood products irradiated and ensure complete antimicrobial protection (antibacterial, antiviral, antifungal) assisted with sterile food nutrition.

Administered blood cell growth and recovery lasts about 2-3 weeks.

Post transplant stage:

Clinical and laboratory control provided by the transplant team permanent, full vaccination

There are two types of bone marrow transplant, each with specific indications for various types of hematological diseases:

Autograft: situation in which bone marrow cells harvested from the patient and are re after a specific treatment at an interval of 1-2 months.

Allograft: situation in which the cells are harvested from healthy donor compatible with the patient, and the patient will be given specific treatment after conditioning

  • Allograft  family donor: healthy donor compatible, can come from the patient’s family (brother / sister HLA);
  • Unrelated donor allograft with: healthy donor compatible, can be a volunteer donor registries International.

In compartment bone marrow transplant is performed autograft and allograft procedures currently with family donor.

Because there is no national registry of bone marrow donors, volunteers, unrelated donor allograft procedure can not be performed in Romania.

One of our goals in the near future is the establishment of a national registry of bone marrow donors and international affiliation of this registry records to ensure a chance and patients without family donors.

In September 2005, the national premiere, we conducted a special type of allograft, called miniallogreft, new procedure introduced in international practice, with the aim of reducing toxicity and transplant related mortality.

Performing these procedures auto and allograft provides a real opportunity for cure of patients with incurable diseases. Each case solved, is to us a remarkable professional success but a personal joy.

Informed consent

Bone marrow transplantation is a treatment with many complications and side effects.

A first consequence is that the doctor is obliged to inform the patient and / or the donor of these side effects, and to provide all the details of the transplant procedure.

Once informed, the patient / donor will have to sign a consent to agree to the transplant procedure and the risks it assumes.

Activity of Bone Marrow Transplantation Department – I.C. Fundeni 2013:

  • 131 grafts (116 adults and 15 children)
  • 104 autografts (49 mm, 53 lymphomas, neuroblastomas 2)
  • 27 allografts [(7 children); (16 siblings, 11 unrelated)]