30 - HSCT Flashcards
what needs to be done to the donor first before collecting peripheral blood HSCs?
inject G-CSF
uses for autologous HSCT
myeloma NHL hodgkin lymphoma acute leukemia autoimmune dz - maybe
“mini’ HSC transplants
use reduced intensity of non-myeloablative conditioning
initial mixed chimerism followed by full chimerism > graft vs tumor effect
also less toxicity in older pts
pros and cons of peripheral blood HSCs as compared to marrow
peripheral blood: has faster engraftment no inc in acute GVHD inc incidence of chronic GVHD (not best for unrelated donors, but for related may be better for poor prognosis pts)
pros and cons of cord blood as HSC source
available immediately
may induce less GVHD
cell numbers may be limiting for larger pts
slower engraftment
is ABO match needed for HSCT?
no
which source of HSCs has highest risk of rejection?
cord blood
3 prerequisites for GVHD
graft contains immunocompetent cells
recipient expresses antigens not present in donor
recipient immunosuppressed > cant reject donor immunocompetent cells
manifestations of acute GVHD
maculopapular rash
diarrhea/ abd pain/ nausea
cholestasis
fever
acute GVHD prophylaxis
block activation/expansion of T cells - steroids, methotrexate, cyclosporine/tacrolimus
deplete mature T cells ex vivo - CD34 selection, T cell monoclonal abs
deplete T cells in vivo - campath, ATG
Acute GVHD therapy
steroids ATG T Cell Abs - daclizumab anti cytokine Abs - infliximab mycophenolate mofetil pentostatin
chronic GVHD pathophys
like auto immune dz - epithelial injury > autoantibodies > fibrosis
chronic GVHD tx
cyclosporine and prednisone tacrolimus and prednisone MMF rapamycin azathioprine
