BMT

Question 1

pros and cons of cord blood transplant

Answer 1

pros = risk free collection, less HLA matching required, low risk of infection, low GVHD risk

cons = very slow to engraft, longer neutropaenia, small amounts avail, DLI not avail

Question 2

pros and cons of peripheral blood transplant

Answer 2

pros = low risk collection, quicker to engraft, only CD34+ collected, can DLI

cons = high HLA matching required, GVHD +++

Question 3

pros and cons of BMT

Answer 3

pros = moderate GVHD risk (same acute risk as PBSC, but lower chronic risk), quite quick to engraft (slower than PBSC), can DLI

cons = high HLA matching required, high risk collection, collects all marrow cells

Question 4

phases of transplant

Answer 4

a. Pre-engraftment = from transplantation to neutrophil recovery (day 20-30)
b. Early post-engraftment = from engraftment to day 100
c. Late post-engraftment = after day 100

Question 5

why does the type of preparative regime matter for transplants?

Answer 5

risk of graft failure e.g. reduced intensity has higher risk, whereas myeloablative has less

Question 6

prefered types of donors and tissue types - most to least

Answer 6

1) Matched sibling: marrow > PBSCS
2) Matched unrelated: marrow > cord
3) Mismatched family (haploidentical): marrow
4) Matched unrelated: PBSC
6) Mismatched unrelated: cord > marrow > PBSC

Question 7

matched sibling vs matched unrelated - which is better and why?

Answer 7

matched sibling better - less GVHD risk

Question 8

strongest influencing factors for survival with HSCT?

Answer 8

donor age (and HLA matching)

Question 9

graft vs host compared with host vs graft

Answer 9

graft vs host: host is the problem, has the allele
host vs graft: graft is the problem

Question 10

which blood antigens are not required to be matched?

Answer 10

ABO and Rh

Question 11

autologous vs allogenic transplant

Answer 11

autologous = own cells
- less GVHD
- but no graft vs cancer effect, and risk of redeveloping cancer is higher (own cancer cells might be present)

allogenic = someone else’s cells
- more GVHD, but have graft vs cancer effect

Question 12

GVHD - what happens?

Answer 12

graft T cells react against host tissue

Question 13

acute GVHD vs chronic GVHD

Answer 13

acute = <3mo:
1) skin - rash
2) liver
3) GIT - diarrhoea, GI bleeding

chronic = >3mo:
1) skin - thick
2) eyes - burn, photophobia
3) mouth - dry, burn
4) lungs - cough - bronchiolitis obliterans
5) muscles - cramps

Question 14

risk factors for GVHD

Answer 14

1. Older age of recipient/ donor
2. Female donor (esp if multiparous) > have minor antigen to Y
3. Advanced disease
4. Cell source: PBC > BM > CB

Question 15

GVHD classic finding on biopsy

Answer 15

apoptotic bodies

Question 16

what three factors is included in GVHD grading criteria?

Answer 16

1. BSA%
2. bilirubin level
3. stool output (MKD)

Question 17

Rx for GVHD

Answer 17

steroids

Question 18

key features of VOD

Answer 18

1. within 20 days of tx, pre-engraftment
2. triad of: weight gain, ascites, TENDER hepatomegaly
3. high bili, with transfusion refractory thrombocytopaenia

Question 19

Rx of VOD

Answer 19

defibrotide

Question 20

VOD vs Budd-Chiari

Answer 20

VOD = occlusion of terminal venules
BC = of hepatic vein and IVC

Question 21

clinical manifestations of engraftment syndrome

Answer 21

1. cutaneous eruption
2. fever
3. capillary leak e.g. weight gain, pulmonary oedema

Question 22

most common cause of encephalitis post engraftment

Answer 22

HHV6

Question 23

Rx for the different major viral infections in BMT suite

Answer 23

1. HSV = aciclovir/valaciclovir
2. VZV = aciclovir
3. CMV = gan/valgan, foscarnet
4. EBV = ritux
5. HHV6 = gan

Question 24

pre vs post engraftment: which bacteria/viruses/fungi are more likely

Answer 24

• gram neg, gram pos > encapsulated / nocardia (late post)
• HSV / enteric (pre) > resp viruses (pre/post) > CMV + HHV6 (post) > VZV
• candida > aspergillus > PJP (late post)
• BK post

Question 25

hepatitis post transplant - VOD or aGVHD?

Answer 25

VOD pre-engraftment
aGVHD post-engraftment

Question 26

diarrhoea post transplant - possible causes?

Answer 26

pre-engraftment:
- infection: c.diff
- other: mucositis, meds e.g. Mg, typhilits

post-engraftment:
- c.diff, CMV, enteroviruses
- aGVHD

Question 27

what phase of transplant is encephalitis most common?

Answer 27

early post-engraftment

Question 28

viral haemorrhagic cystitis most common in which phase of transplant? two most common causes?

Answer 28

pre-engraftment.
1st BK, 2nd adeno