Bone Marrow transplant

Question 1

Autologous Transplant :

1. Where do the cells come from?
2. Where can you collect these stem cells from ?
3. What are some cons for using bone marrow harvest (BMT) for autologous transplants? (4)
4. What are the indications for bone marrow harvest?

Answer 1

1. a person’s own body
2. BM or peripheral blood
3. Painful for pt
   risks of general anesthesia
   infection risks
   slower engraftment (platelets and WBCs)
4. Poor autologous collection
   allogeneic transplant - donor preference and aplastic anemia (Sometimes donors dont wanna take GCSF would rather donate bone marrow)

Question 2

What are some indications for autologous transplant ? (4)

What is conditioning chemotherapy?
Why do u give this conditioning chemotx?

Answer 2

1. Refractory HD (hodgins lymphoma)
2. refractory NHL
3. Multiple Myeloma
4. refractory testicular cancer

Chemotx given 2-9 days before stem cell transplant depending on regimen

Kill any remaining cancerous cells still present at time of transplant

Question 3

What’s the conditioning chemo therapy regimen?

State the DLT for the following
1. Carmustine (BCNU)
2. Etoposide
3. Cytarabine
4. Melphalan

Answer 3

BCNU, Etoposide, Cytarabine, Melphalan

1. Pulm fibrosis and BM suppression
2. BM suppression
3. BM suppression
4. BM suppression

Question 4

What are some autologous transplant complications?

Prophylactic Medications for Autologous Transplant :

1. Antifungal
2. Antibacterial
3. Antiviral
4. PJP

Answer 4

1. relapse
2. infection
3. transplant related mortality
4. AE’s from Chemo (Mucositis, constipation, diarrhea)
5. Fluconazole 400mg daily (start if signs of mucositis)
6. levoflox 500mg qd start when ANC < 500
7. acyclovir 400mg BID Day +1 through Day +90
8. Bactrim 1DS tab daily on M/W/F Day21+-DAy90+

Question 5

Autologous Transplant :
1. Advantages? (3)
2. Disadvantages?

Answer 5

1. No donor search needed, less tx related mortality , no GVHD
2. Higher rate of relapse bc no graft vs cancer effect

Question 6

Allogeneic Transplant :
1. Describe the stem cell collection process
2. Describe back bone agents used in high dose conditioning chemo
3. Toxicities and DLT for Busulfan
4. Toxicities and DLT for Fludarabine

**Same prophylactic meds as autologous*

5. What’s a risk of this type of transplant?

Answer 6

1. Donor injected with GCSF 4 days prior to collection –> collection on 5th day (Apheresis)
2. Busulfan and Fludarabine
3. Neurotoxic, DLT = veno occlusive disease and pulm
4. DLT = Neurotoxic . Toxicities = infection risk and CINV
5. Acute graft Vs host disease

Question 7

Whats an advantage for Allogeneic Transplant

What’s a disadvantage?

In Allogeneic Prophylactic meds : Whats the slight difference from Autologous?

Answer 7

1. Curative, GV cancer
2. More TRM , donor search, GVHD
3. acyclovir 800mg BID