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Oncology > 10 - Hematopoietic Stem Cell Transplantation > Flashcards

10 - Hematopoietic Stem Cell Transplantation Flashcards

1
Q

Two types of stem cell transplantation

A

Allogeneic

Autologous

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2
Q

Allogeneic Stem Cell Transplant

A

Donor is not recipient

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3
Q

Autologous Transplant

A

Donor is recipient

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4
Q

3 sources for hematopoietic progenitor cells

A

Bone Marrow
Peripheral Blood
Umbilical Cord Blood

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5
Q

Top Indications for autologous hematopoietic stem cell transplants

A

Multiple Myeloma (though it does not cure)
Non-Hodgkin Lymphoma
Hodgkin’s Disease

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6
Q

Top indications for allogeneic hematopoietic stem cell transplants

A

AML
ALL
MDS/MPD

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7
Q

Peripheral Blood Stem Cell Transplant (PBSCT)

A

Stem cells collected peripherally (using apheresis)
Outpatient procedure
Results in more rapid hematopoietic recovery than bone marrow
No difference in treatment outcome
Quickly replacing traditional bone marrow

Cytokine stimulation (G-CSF injections)
Bone Marrow releases large number of CD34 stem cells into circulation
Stem cells harvested via peripheral line

Increased graft vs. host disease, though, so for things like sickle cell, bone marrow is still preferred

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8
Q

Stem Cell Mobilization

A

Granulocyte Colony Stimulating Factor (G-CSF)
Dislodges CD34+ Progenitor cell
Cells harvested via leukapheresis (mononuclear layer)

Side effect: Maybe hypocalcemia because of anticoagulants. Give calicum.

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9
Q

Bone Marrow - Hospital Stay

A

63% can be discharged same day
36% have to spend one night at the hospital
1% spend more than one night

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10
Q

Peripheral blood stem cell donation side effects

A 
Common:
Headache
Bone or muscle pain
Nausea
Trouble sleeping
Tiredness
Decrease in blood platelet count
Less common:
Allergic reactions
Rapid heart rate
Dizziness
Shortness of breath
Itching or rash
Eye swelling
Least common:
Shortness of breath and chest pain
Bleeding of the spleen
Bleeding in the head
Blood vessel swelling
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11
Q

Peripheral - When do we collect?

A

If we only have 10 CD34+ cells per microliter of blood, we ad a second drug.
Once we hit 20 CD34+ cells per microliter, we harvest

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12
Q

Peripheral - How many cells?

A

We need 2 million!!!

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13
Q

Autologous Stem Cell Procedure

A

5 days of SC cytokine injections to mobilize stem cells (G-CSF)
Days 5 & 6 - Peripheral blood collected and apheresed to isolate CD34+ Stem Cells
Volume 200mL cryopreserved in DMSO, stored cold
High dose chemo +/- TBI given over 2 - 5 days
2 - 3 days alter stem cells thawed and infused through central line
Bone marrow recovery takes 14 days
Patient supported with transfusions (PLT

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14
Q

How long after allogeneic transplant can the patient be taken off of immunosuppression?

A

3 months-ish

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15
Q

Mechanisms of Immunological Tolerance - Allo Transplant

A

Central:
Deletional - Cells reactive against the donor are deleted in the thymus

Peripheral:
Active suppression - Regulatory T cells suppress effector cells which may reject the graft.

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16
Q

Within a family - Match Probability

A

25% - Full Match
50% - Half Match
25% - No Match

17
Q

Allo Transplant - HLA Matching

A 
HLA-A
HLA-B
HLA-C
DRB1
DQB1
DPB1

Each has 2 loci

Best is 12/12 match

18
Q

Allo Transplant - Donors

A 
Matched sibling (best for major and minor antigens)
Matched unrelated (BMT bank now over 22 million donors)
Mismatched (Single mismatch 9/10, or haploidentical 5/10)
19
Q

Allo Transplant - Racism

A

White people have more donors than minorities

20
Q

2 intensities of transplant

A

Myeloablative

Non-myeloablative (Transplant Lite)

21
Q

Classic acute Graft Vs Host

A

Gut
Skin
Liver

3 phases:
Tissue damage (gut)
Translocation of LPS into circulation
Cytokine release
Donor T cells activated
Migration of those into target organs, organ damage
22
Q

Classic Chronic Graft Vs host

A 
Skin
Eyes
Mouth
GI
Liver
Musculoskeletal
Lungs
GU
23
Q

Graft Vs. Leukemia

A

Convenient. Not explained how it happens as opposed to Graft Vs Host

24
Q

Gut GVHD

A 
Diagnosed histologically
DDX for diarrhea
drug toxicity
CMV
GVHD

Treat with steroids

25
Q

Therapy of acute GVHD

A

PPX
Cyclosporine +/0 MTX
T-Cell depletion of the graft
In vivo T-cell depletion

1st line:
1mg/kg BID prednisone or methylprednisone

26
Q

Cause of death after autologous transplant

A

Primary underlying disease recurring

27
Q

Cause of death after HLA-identical sibling transplant

A

Primary disease recurring

Maybe GVHD, but probably not

28
Q

Cause of death after unrelated donor transplants

A

Probably primary disease but maybe GVHD

Oncology (23 decks)

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