28. Transplantation Flashcards
what are the 4 types of transplants that we discussed?
- blood
- marrow
- cord blood
- “mini” allogeneic transplant (NON myeloablative)
where can we find stem cells?
- marrow
- blood (peripheral blood stem cells)
- umbilical cord
what do 90% of transplant patients have?
hematologic malignancy (leukemia, lymphoma, myeloma)
autologous transplant means what?
pt receives OWN stem cells.
allogeneic transplant means what?
donor is sib or stranger.
generally, for stem cell disorders, what type of transplant do we do?
ALLOgeneic
which type of transplnat is more freq done (Auto v Allo)?
Auto.
what type of transplant would we do in multiple myeloma (allo or auto)?
stem cell dz, but would do AUTO. mortality with allo transplant is too high.
what are the molecules that we are interested in typing prior to transplant?
HLA (histocompatibility) aka MHC I and II. (present antigen to T cells)
how many parameters do we look at for matching? what is ideal?
we look at 6. ideal is to match all 6. still will see some rejection because we don’t look at everything.
GVHD: what parts of the body does it affect?
skin, liver, GI tract
what will we see with skin, liver, GI if GVHD?
skin: rash
liver: incr LFTs
GI: nausea, vom, diarr.
Autologous: how long will pt generally be in hosp? rate of engraftment?
3 wks. relatively faster engraftment.
Autologous: do we give immune suppression?
no
Autologous: do we see GVHD?
no
Autologous: do we see infections?
fewer than with allo.
Autologous: how soon can pts go back to work?
3-5 months
Allogeneic: source of transplant cells?
sib or stranger
Allogeneic: how long will pt generally be in hosp? rate of engraftment?
4+ weeks, relatively slower engraftment
Allogeneic: do we give immune suppression?
yes
Allogeneic: do we see GVHD?
yes, high likelihood
Allogeneic: incidence of infections?
high
Allogeneic: how soon can pts go back to work?
9-12 months
Similarities between Autologous and Allogeneic transplants?
- use blood or marrow cells
- high dose chemotherapy to kill marrow cells
what is the biggest change in the heme field lately?
doing stem cell transplant upfront for high-risk patients (if they have a high-risk genetic translocation)
advantages of PBSC collection vs marrow collection?
eliminates anesthesia, less discomfort, more rapid engraftment upon transplant
if you are receiving your own cells, is blood or marrow better? what about if you are receiving cells from someone else?
self: blood (more T cells, blood count returns more quickly)
other: marrow. (fewer T cells, less GVHD)
what is the main role for cord blood transplant now?
kids who have acute leukemia and don’t have another option for transplant. survival is 50% (better than 0%)
what is the theory behind non-myeloablative (mini-allogeneic) stem cell transplant?
treat patient with low dose chemo. infuse donor cells. pt now has 2 lines of cells, and self cells are weak. donor cells hopefully take over.
