Bone Marrow Transplant

Question 1

When host recogizes graft as foreign we get

Answer 1

rejection

Question 2

When graft recognized host as foriegn this is

Answer 2

GVHD

Question 3

T cells recognize:

Answer 3

histoINcompatability;

viruses, fungus, foreign substances

Question 4

What must we do to a host so they don’t reject a graph?

Answer 4

Conditioning: ~7 day process

immune suppression to get rid of disease and host BM via chemotherapy

Question 5

If you have lots of histoINcompatability you need______ conditioning during the conditioning phase

Answer 5

MORE

Question 6

Why is prenatal screening so important?

Answer 6

We can find primary immune deficiencies right away and tx child before their immue system devos (don’t need conditioning)

Question 7

Dr. Margolis referred to this as the ‘bane’ of a transplant doctors exsistance

Answer 7

Goals is working between GVH and GVL (graft vs leukemia) and we can’t separate those out yet

Question 8

What type of cell is starting to be used more commonly instead of T cells in transplant?

Answer 8

NK cells

T cells cause GVHD

Question 9

What type of cancer in a patient would BMT be an acceptable tx option in?

Answer 9

• Patients with cancers that start in the bone marrow (Leukemia).
• Patients with cancers that start elsewhere in the body (abdominal tumors, bone tumors).

Question 10

What is the difference btwn autologous vs. allogeneic transplant

Answer 10

autologous = self 
allogeneic = non self or donor

Question 11

What is the concept of an Auto Transplant?

Answer 11

its when you give pt back their own immune system or cells when they are going through chemotherapy so we can keep their chemo doses higher. (or if you have identical twin)

Question 12

• Patients with bone marrow failure such as ______or hemoglobin abnormalities such as ______ and ______ can benefit from BMT

Answer 12

(aplastic anemia)

(thalassemia or sickle cell anemia).

Question 13

• Patients with primary immune deficiency syndromes_____

* Patients with other inborn errors of metabolism like_____ benefit from BMT

Answer 13

SCID

Hurlers

Question 14

– Allogeneic Donor like an HLA matched sibling will likely have different:

Answer 14

Minor Histocompatibility antigens

Question 15

if mom is your BMT match how close of a match is she?

Answer 15

1/2 HLA match

Question 16

Order of increasing histoINcompatability

Answer 16

Autologous/identical twin –> matched sib –> unrelated donor –> Half matched paren

Question 17

Three sources of Hematopoietic Progenitor Cells

Answer 17

• Bone Marrow (Gold standard)
• Umbilical Cord Blood
• Peripheral Blood

Question 18

Benefit of umbilical cord match?

Answer 18

– Lower risk of GVHD for same tissue match

Question 19

Why is Peripheral blood donation less desirable?

Answer 19

Peripheral Blood
– Higher risk of GVHD for same tissue match
– The HPC cells may be manipulated to remove cells:

Question 20

lower doses of chemotherapy and radiation, which are too low to eradicate all the bone marrow cells of a recipient. run lower risks of serious infections and transplant-related mortality while relying upon the graft versus tumor effect to resist the inherent increased risk of cancer relapse

Answer 20

Non-myeloablative conditioning

Question 21

given immediately prior to a transplant is called the conditioning regimen, the purpose of which is to help eradicate the patient’s disease prior to the infusion of HSC and to suppress immune reactions. The bone marrow can be ablated (destroyed) with dose-levels that cause minimal injury to other tissues. increases GVHD

Answer 21

Myeloablative conditioning

Question 22

Three steps of BMT

Answer 22

• Conditioning with chemotherapy+/- radiation
therapy.
– Different packages based on the variables ofdisease and donor.
– Myeloablative vs. Non myeloablative
• Infusion of the HPC product.
• Regrowth of the new marrow

Question 23

After BMT we are susceptible to bacteria because:

Answer 23

neutrophils are low, as well anytime
you have broken barriers due to mucositis and CVL
– Gram Positive
• Alpha Strep, Staph, Streps
– Gram Negative
• Hard to Kill Gram Negative Rods
– Anaerobes
• Clostridium Species

Question 24

What are we more susceptible to fungal infection post BMT?

Answer 24

When neutrophils are low, as well as when
one is on steroids
Moulds: Inhaled and angioinvasive (Aspergillus,Mucor)
• Sinus, Chest, Disseminated in skin
– Yeasts: Leave the GI/GU tract and disseminate
• Candida species

Question 25

How long are CD4 counts low post BMT and what does this make us concerned about?

Answer 25

Viral:
– Herpes Virus Family: Latency and reactivation
• HHV1,2; CMV; EBV; VZV; HHV6
– Community Acquired Virus follow community patterns:
• RSV, Influenza, Adenovirus, Enterovirus

Question 26

Late effects of BMT:

Answer 26

Second cancers, relapse, infertility
End-Organ Function
– Heart
– Lung
– Kidneys
– Liver
– Brain and Neurocognitive Development