267 - Stem Cell Transplantation Flashcards

1
Q

What is the chance that a sibling is a perfect HLA match?

A
  • 25%
  • Can do transplants with half-match (5/10) sibling; preferred over unrelated 8/10 or 9/10
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2
Q

What is CAR T-cell therapy?

A

Take out pt’s stem cells and alter them and put them back in so that they can recongize and fight malignancy

  • Use a virus to transduce cells with anti-CD19 CAR (chimeric antigen receptor)
  • -> T cells are dialed into CD19+ B-cell malignancy when transfused back to pt
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3
Q

If a patient has high-risk melanoma with a good response to chemotherapy, why would we also want to do an autologous stem cell transplant?

A

Prolonged survival and low mortality associated w/ the transplant

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4
Q

MHC class __ activates CD8+ cytotoxic T cells

MHC class __ activates CD4+ cytotoxic T cells

A

MHC class I activates CD8+ cytotoxic T cells

MHC class II activates CD4+ cytotoxic T cells

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5
Q

What are the HLA class I antigens?

A

HLA-A, B, C

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6
Q

When would an allogenic transplant be preferred over an autologus transplant?

A
  1. If we want to use donor graft to fight host leukemia (rare situation where graft vs. host disease is good)
  2. If there is something wrong with the patient’s stem cells
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7
Q

Why do we asess chimerism after transplantation?

A

Figure out what percentage of blood cells are derived form donor vs. pt

-> insight as to whether the graft remains viable

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8
Q

What can a mulitpotent hematopoietic stem cell differentiatie into?

A

Any blood cell

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9
Q

What is the general order of preference for HSCT donors?

A
  1. Fully matched sibling
  2. Fullly matched unrelated
  3. Alternative
    • Umbilical cord blood (less match required, but not much volume)
    • Half-matched (5/10) related donor
    • Unrelated donor 9/10 or 8/10 if necessary
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10
Q

List the key differences between acute and chronic graft vs. host disease

(parts affected, cause, timeline)

A
  • Acute
    • Skin, liver, gut
    • Donor T-cells activated by host inflammation from pre-transplant conditioning
    • Within 100 days of stem cell transplant
  • Chronic
    • Multi-organ
    • Immune dysregualtion, inflammation, fibrosis
    • Within 1-3 years (usually 4-6 months)
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11
Q

What is engraftment syndrome?

What is the treatment?

A

Fevers, rash, diarrhea, pulmonary infiltrates as the graft begins to take

Associated with growth factors given to shorten the neutropenic window

Tx = steroids (but try to keep them minimal; pt is already immunosuppressed)

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12
Q

Why do we perform autologus stem cell transplants?

(What kinds of treatments does it allow for?)

A
  • Harvest stem cells before chemo
  • Allows for high-dose chemo for specific blood cancers
  • Rescued by own stem cells = can grow back original bone marrow
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13
Q

What are the HLA class II antigens?

A

HLA DR, DQ, DP

In terms of matching importance, DR > DQ > DP

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