Bone Marrow Transplant

Question 1

What is the main reason why Stem Cell transplants are needed

Why is Chemotherapy alone not sufficient?

Answer 1

To limit toxic effects, Chemotherapy generally limited to 4-6 cycles

This might not be enough to cure leukaemia

Question 2

At what disease point is the survival prognosis after Stem-cell transplant best?

Answer 2

Generally, the earlier the better

(Best survival outcomes, with patients in full remission)

Question 3

What role does the genomic makeup play in Stem cell transplantation?

Answer 3

The more aggressive the disease/ the worse the prognosis, the earlier the transplant is dersirable
Generally earlier transplantation is desirable

Question 4

How is a Haematological stem cell donor chosen?

Answer 4

• HLA types
• Ideally sibling (1/4 chance of matching)
• volunteer unrelated donor/ minimally mismatched family member
• Now: haploidentical family member can donate aswell

Question 5

What is an Autologous Haematological stem cell transplant?

Answer 5

• Self-cells (generally frozen from patient when in remission

Question 6

In which situations is autologous stem cells transplant is used?

Answer 6

• Acute Luekaemias
• solid tumours (e.g. germ cell)
• autoimmune disease

Also in
* myeloma (as elderly bad with graft vs host disease) –> buys time and QOL
* Lymphoma (often BM sparring, especially High Grade)
* CLL (but not preferred) - same as Myeloma

Question 6

Explain the Process of Allogenic Stem Cell Transplant

Answer 6

Question 7

For treatment of what conditions can allogenic bone marrow transplants be used?

Answer 7

• Acute and Chronic leukaemia
• thalassaemia
• Myeloma
• Lymphoma
• Bone Marrow failure
• Congenital immuen deficienceis

Question 8

Where can Haematopoietic Stem Cells can be harvested?

Answer 8

• Bone Marrow
• Peripheral Blood (with gCSF given before)
• Umbillical Cord

Question 9

What is the CD Marker for Stem cells?

Answer 9

CD34+

Question 10

What are Complications of Stem Cell Transplant

Answer 10

• Graft Failure (1%)
• Infections
• Graft-versus-host disease (GVHD) (only in allografting)
• Relapse

Question 11

What is Acute Graft vs host disease? How does it present?

Answer 11

Graft vs host disease within 3 months of transplant

Affects mainly skin, GI tract and liver

Question 12

What is Chronic Graft vs host disease? How does it present?

Answer 12

Presents within 6 months after transpnat, lasts 2-5 years

presents with immune disregulaiton
immune deficiency
imparied end-organ function ettc.

Question 13

What are risk factors for actue GvHD?

Answer 13

• Degrere of HDL disparity
• Recipient age
• conditioning regimen
• gender combination
• stem cell source
• disease phase (later in disease)
• viral infections

Question 14

How is GvHd prevented?

Answer 14

Immunosupression via

• Methotrexate
• Corticosteroids
• Calcineurin inhibitors
• CsA plus MTx
• T-cell depletion (monoclonal antibodies added to donor cell bag before transplantation)
• Or: Post-transplant cyclophosphamide (4 days post-transplant) –> allows to use half-identical transplants

Question 15

What are risk factors for developing chronic GvHD?

Answer 15

50% of pt surviving >1 year have chronic GvHD

Prior acute GvHD
Increased degree of HLA disparity
Male recipient: female donor
Stem cell source (PB>BM>UCB)
T-cell replete
Older donor age

Question 16

What are the main sources of bacterial infections in BM transplanted?

Answer 16

• Gram +ve: indwelling blood lines
• Gram -ve : GI tract (dangerous, most deaths)

Question 17

What is Graft vs Leukaemia( inserty any other ) effect

Answer 17

Donors immune system plays a big role in inducing remission and curing leukaemias (not just irradiation of cancer cells)

Question 18

What factors make a Haematopoietic stem cell transplant more likely to succeed?

Answer 18

1. Age young: (donor+recipient)
2. Early in disease phase
3. NOT female donor into male recipient (higher risk)
4. Sibling donor (no unrelated stranger)