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YR5 Haematology > Bone Marrow Transplant > Flashcards

Bone Marrow Transplant Flashcards

1
Q

Which CD marker is expressed on haematopoietic stem cells?

A

CD34

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2
Q

Recall the process of autologous transplant

A
  1. Give G-CSF: lots of stem cells leak into blood
  2. Freeze (drop temp + store in liquid N2)
  3. Pt has chemo/radio to permanently destroy their haematopietic system
  4. Re-infuse stem cells from freezer
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3
Q

What is autologous stem cell transplant used for?

A

To allow a higher dose of chemo/ radio to be given
Acute leukaemia, solid tumours, AI disease
Myeloma, Lymphoma + CLL

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4
Q

Describe the process of allogeneic stem cell transplant

A
  1. Give G-CSF to donor with normal BM
  2. Treat pt with high-dose chemo + radio to ablate their BM
  3. Give patient harvested cells
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5
Q

When should allogenic stem cell transplant be used?

A

Acute leukaemias
Chronic leukaemia
Myeloma
Lymphoma
BM failure
Congenital immune deficiencies
Thalassaemia
SCD

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6
Q

Recall some principles of donor choice for a bone marrow transplant

A
  1. HLA-matched
  2. Ideally a sibling (1 in 4 chance of matching with each sibling)
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7
Q

How is patient’s room pressure adjusted to prevent infection during BM transplant?

A

Make it a higher pressure than corridor so that air flows out rather than in

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8
Q

What kind of matching is preferential?

A

High resolution (DNA) vs low resolution (Serological)

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9
Q

Describe bone marrow sampling from the pelvis

A

Puncturing bone + getting to medulla damages it
First few ml contains stem cells, the rest is blood flowing into damaged site
Keep re-puncturing, collect small amount each time

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10
Q

Describe peripheral blood sampling

A

G-CSF used to stimulate granulocyte production
BM releases some white cells + stem cells
Donor connected to centrifuge which spins blood, removes the white cell component + re-infuses the rest

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11
Q

What proportion of CD34 can be harvested from each source?

A

Pelvis: 1.5L, 1% CD34 = 15ml CD34
Peripheral: 10L, 1%CD34 = 100ml CD34
Umbilical: 0.1L, 1% CD34 = 1ml CD34

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12
Q

Which patients can receive umbilical cord blood cells?

A

Only babies
As can only harvest a small volume Success depends on number of CD34 cells per kg of weight of recipient

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13
Q

List 4 complications of stem cell transplant

A

Graft failure
Infections
GVHD (Allografting only)
Relapse

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14
Q

Which 5 factors contribute to the EBMT risk score for the outcomes of transplants?

A

Age: <20, <40, 40+
Disease phase: Early, Int, Late
Gender of R/D
Time to BMT: <1 / >1
Donor: Sib / VUD

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15
Q

List 4 risk factors for infection post stem cell transplant

A

Neutropenia
Breakdown of protective barriers
Decreased antibody levels
Depressed T-cell immune responses

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16
Q

Name 2 infections commonly seen in SCT patients

A

Aspergillosis: high mortality if invasive
CMV: CMV pneumonia high mortality

17
Q

What is graft versus host disease?

A

An immune response when the donor cells recognise the patient as foreign

18
Q

What is the time frame for acute GvHD? What symptoms and signs arise?

A

<100d
Rash, itchy, red skin
Diarrhoea
Hepatitis + Jaundice

19
Q

What is the time frame for chronic GvHD? What symptoms and signs arise?

A

> 100d
Rash
Hepatitis + Jaundice
Dry mucous membranes + mouth ulcers
SOB
Dry eyes
Arthritis

20
Q

How does GvHD arise?

A

Damaging the skin, GIT + other tissues by giving chemo causes release of cytokines which activates APCs
These present the antigens to the donor lymphocytes
Immune reaction against host tissue

21
Q

Give 4 risk factors for GvHD

A

Degree of HLA disparity
Conditioning regimen
Stem cell source (BM, Periphery, Umbilical)
R/D gender combination

22
Q

What is the treatment for GvHD?

A

Corticosteroids
Ciclosporin
Monoclonal antibodies
Photophoresis

23
Q

Give 3 prophylactic measures for GvHD

A

Corticosteroids
Ciclosporin
Methotrexate

24
Q

How does the goal differ in autologous and allogenic BM transplant?

A

Auto: Kill all leukaemia with radio/ chemo
Allo: Accept cannot kill leukaemia from radio/ chemo, rely on BM from donor

25
Q

Which cells are thought to cause GvHD? Why can’t this be avoided?

A

Maturę lymphocytes in donor sample (rather than those produced by donor stem cells)
Impossible to select out specific T cells- some will be mature lymphocytes
But don’t want to isolate as donor lymphocytes are important in prevention of relapse

26
Q

What is considered to be the future in transplant therapy?

A

CAR-T cells
Engineer autologous T cells to recognise + destroy cancer cells

27
Q

Give 3 side effects of CAR-T therapy

A

Tumour lysis syndrome
Cytokine release syndrome
Neurologic toxicity

YR5 Haematology (20 decks)

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