Bone marrow transplant

Question 1

Process of autologous transplant

Answer 1

o GCSF given and obtain a CD34+ population of cells from the bone marrow (the stem cells)
o These are preserved in the freezer
o A high dose of chemotherapy is given to eradicate the bone marrow  reinfuse the stem cells

Question 2

Process of allogenic transplant

Answer 2

o Used when patient’s disease is unlikely to be eradicated from the bone marrow by standard chemotherapy
o Give them high dose chemoradiotherapy to ablate the bone marrow (malignant and normal cells)
o Then give them some bone marrow from a healthy donor
o Issue with BM transplantation is that donor immune cells recognise patient as foreign…

Question 3

Infection risks with allogenic BM transplants

Answer 3

 Aspergillosis- • Invasive aspergillosis = high mortality (10-15% deaths due to aspergillosis  92% mortality)

 CMV
• Remains latent because T cells are able to keep it under control

Question 4

Symptoms of GvHD

Answer 4

• Acute GvHD (<100 days) effects:
o Skin -rash, itchy, red
o GI tract -diarrhoea
o Liver -hepatitis, jaundice

Chronic- dry eyes, arthritis, SoB

Question 5

Treatment of GvHD

Answer 5

Corticosteroids

Ciclosporin A

Question 6

Goal of allogenic and autogenic HSCT

Answer 6

• Autologous HSCT  goal to kill all leukaemia with radio/chemo
• Allogenic HSCT  accepted you cannot kill leukaemia from radio/chemo  rely on BM from donor

Question 7

Overview of CAR-T therapy

Answer 7

 (1) Leukapheresis (T-cells are collected)
 (2) T-cell activation (engineered chimeric-TCR put into a virus which infects the collected T-cells)
 (3) Modified T-cell expansion (new T cells are expanded)
 (4) Quality and release testing: potency checks and infection checks
 (5) Chemotherapy
 (6) Modified T-cell infusion

Question 8

CAR-T toxicity/SE?

Answer 8

Tumour lysis syndrome
Cytokine release syndrome
Neurologic toxicity, cytopaenia

Question 9

Use of autologous Transplant

Answer 9

Acute leukaemia
Solid tumours
AI diseases

Myeloma, lymphoma, CLL

Question 10

Use of autogenic transplants

Answer 10

Acute leukaemia
Chronic 
Myeloma
Lymphoma
BMF

Thalassaemia§
SCD