BM Transplants

Question 1

How do haematopoeic SC react to radiation?

Answer 1

They are easily destroyed

Question 2

What is the key marker for haematopoeic SC?

Answer 2

CD34

Question 3

Explain how Graft vs Host Disease (GvHD) occurs

Answer 3

Patient rejects incoming stem cells
BUT
Donor marrow also recognises that the WHOLE PATIENT is foreign
This causes an awful reaction, as the entire patient is the target

Question 4

How do haematopoeic SC from the umbilical cord differ?

Answer 4

They are less likely to cause GvHD as the HLA is not filly developed yet

Question 5

What is the probability of two siblings being an HLA match?

Answer 5

1 in 4

Question 6

What is the general formula for probability of one sibling being a match?

Answer 6

1 - (3/4)^n

Question 7

How do you perform an autologous transplant?

Answer 7

1. Treat patient to point of remission
2. Give G-CSF to stimulate marrow production
3. Take either peripheral blood SC / BM and preserve in freezer
4. Give high dose chemo to eradicate BM
5. Reinfuse SC

Question 8

What are reasons for autologous SC transplantatioN?

Answer 8

Myeloma, lymphoma, CLL

When patient is too weak for allogeneic transplant

Question 9

What is indication for allogeneic SC transplant?

Answer 9

Patient’s disease unlikely to be eradicated with standard chemo

Question 10

How do you perform allogeneic SC transplant?

Answer 10

Give pt high dose chemoradiotherapy to completely ablate ALL bone marrow
Then give healthy BM from donor

Question 11

How do you chose a donor for SC transplant?

Answer 11

HLA match (sibling/volunteer related donor)
Recently - half donor

Question 12

What kind of patients is it very difficult to find a donor for?

Answer 12

Non-caucasian patients esp mixed race

Question 13

How is bone marrow sampling performed?

Answer 13

Anaesthesise the patient
Puncture bone (usually iliac crest) to extract BM
Keep re-puncturing the bone, as the medulla will get damaged quick and blood will flood the site each time

Question 14

How do you perform peripheral SC sampling?

Answer 14

Give G-CSF to stimulate granulocyte production
This leads to BM releasing some WBC alongside SC
Harvest cells on the 5th day of G-CSF
Connect patient to centrifuge device, extract WBC and rein fuse plasma and RBC into pt

Question 15

When do you harvest umbilical cord stem cells?

Answer 15

at time of delivery

Question 16

What is the problem with umbilical cord SC?q

Answer 16

There are a lot less SC to harvest from a cord

Therefore they can only be given to those who weight less, so CHILDREN

Question 17

What are complications of SC transplant?

Answer 17

Graft failure
Infection
Graft v host disease
Relapse

Question 18

What risk score criteria is used for factors affecting transplant outcome?

Answer 18

EBMT Risk Score

Question 19

What kind of storm triggers GvHD?

Answer 19

CYTOKINE storm

Question 20

How does the cytokine storm work?

Answer 20

Cytokines active APCs
APCs present the antigens to donor lymphocytes
This results in an immune reaction against the host tissue q

Question 21

How do you treat GvHD?

Answer 21

corticosteroids
cyclosporin
FK506
Mycophenolate mofetil
Monoclonal antibodies 
Photophoresis 
Total lymph irradiation

Question 22

How do BM transplants actually cure patients?

Answer 22

The T cells from donor recognise leftover leukaemia cells

They destroy them