Bone Marrow Transplant

Question 1

Bone Marrow Transplant

Answer 1

Give a patient a toxic drug and then give the patient stem cells can potentially help them recover their marrow and give them the best change to get rid of the cancer

Question 2

Hematopoietic Stem Cells are responsible for:

Answer 2

producing all of the cellular components for the blood

Question 3

Define Hematopoietic Stem Cell Transplant

Answer 3

Procedure in which HSCs are removed from donor and infused into a recipient (donor and recipient may be same person)

Question 4

HSC Lineage

Answer 4

Myeloid: what you see in the blood
Lymphoid: B cells and T cells

Question 5

Stem Cells + Lineage

Answer 5

• Can choose to go down the myeloid or lymphoid lineage and then it will commit
• It can also divide itself and continue to grow themselves within the marrow without losing their stem cell properties

Question 6

What are the ideal stem cells?

Answer 6

CD34 cells

Question 7

Indications for HSCT

Answer 7

Mostly hematologic cancers like leukemia, lymphomas, myelodysplastic syndrome, multiple myeloma and beta thalassemia

Question 8

Autologous Indications

Answer 8

Multiple Myeloma
Non-Hodgkin’s lymphoma
Hodgkin’s lymphoma

Question 9

Allogeneic Indications

Answer 9

AML
Acute lymphoblastic leukemia
CML

Question 10

3 sources of Stem Cells

Answer 10

o Bone Marrow
o Peripheral Blood Stem Cells (PBSC)
o Cord Blood

Question 11

Where is 95% of the marrow?

Answer 11

Ileac crest in the hip area

Very painful removal

Question 12

Bone Marrow Removal

Answer 12

o Multiple punctures/aspirations to get enough stem cell for transplantation

Question 13

Peripheral Blood Stem Cells

Answer 13

Collected by apheresis
o Giving a patient chemotherapy or specialized growth factor(such as GMCSF) at high doses (10-15mg/kg) to push the stem cells out into the peripheral blood
o Hook up to a machine to collect CD34 cells

Question 14

Cord Blood Stem Cells Process

Answer 14

o Consent donors → separate placenta → collect umbilical cord blood → isolate stem cells into 20 mL and 5 mL DMSO → overwrap 25 mL PCB unit and place in canister → Insert PCB unit into CRF module → Initiate automatic CRF and archival of PCB unit

Question 15

Cord Blood Stem Cells Amount

Answer 15

Very small amount but very rich in stem cells

Less risk of GVHD

Question 16

Autologous BMT Donor and Recipient

Answer 16

Donor and recipient are the same

Question 17

Autlogous BMT Use

Answer 17

 Primarily as a means to dose escalate
 Infusion of autologous stem cells serves to rescue the patient from the myelosuppressive effects of high dose chemotherapy

Question 18

Allogenic Donor and Recipient

Answer 18

Donor: non-cancer person
Recipient: cancer person

Question 19

Allogenic BMT Use

Answer 19

 To replace missing hematopoietic or lymphoid component in aplastic anemia or immune disorders
 To rescue the recipient from myeloablative therapy for treatment of malignant disease

Question 20

Define Graft-Versus-Tumor-Effect

Answer 20

• The donor cells actually attack the tumor cells and help get rid of it through immune response (improved outcome for that cancer)

Question 21

Autologous SCT Advantages

Answer 21

Availability
Able to perform in older patients
No GVHD

Question 22

Autologous SCT Disadvantages

Answer 22

Risk of reinfusion of disease

No GVT effect

Question 23

Autologous BMT in what Cancer

Answer 23

Lymphomas
Multiple myeloma
Solid tumors

Question 24

Allogenic SCT Advantages

Answer 24

No risk of reinfusion

GVT effect

Question 25

Allogenic SCT Disadvantages

Answer 25

Availability | GVHD

Question 26

Who is the best donator for allogenic SCT?

Answer 26

Sibilings

Question 27

General Characteristics of Acceptable Donors?

Answer 27

```  Minimal co-morbidities  Capable of tolerating collection  Negative for HIV, Hepatitis B, and Hepatitis C  No current malignancies  Willing to provide consent  18-30 years old  Less pregnancies ```

Question 28

Matched Related Donors

Answer 28

 Only requires an antigen match at HLA-A, B, and DR (6/6) |  Matched sibling donors (MSD) are the preferred donor

Question 29

Unmatched Related Donors

Answer 29

 Typically haploidentical donors (parents) |  Only considered out of necessity

Question 30

Matched Unrelated Donors

Answer 30

 Requires allele matches (HLA-A, B, C, DR, and DQ (10/10)) | May require up to 6 months

Question 31

Class I Region of HLA

Answer 31

All nucleated cells | HLA A/B/C

Question 32

Class II Region of HLA

Answer 32

Immune System Cells | HLA-DR/DQ

Question 33

Course of BMT

Answer 33

Mobilize cells → collect cells → store cells → conditioning → transplant → post-BMT period → Engraftment

Question 34

Define Conditioning

Answer 34

High dose chemotherapy to wipe out patient's marrow of normal cells and cancer cells

Question 35

Post-BMT Period

Answer 35

 Stem cells will take 7-21 days to make new stem cells and to differentiate into other cells  High risk of infection  High risk of bleed  Chemo-radio therapy side effects

Question 36

Define Engraftment

Answer 36

Hemoglobin, WBC and platelets are normalized

Question 37

Options for Mobilization Regimen

Answer 37

 Myelosuppressive chemotherapy with or without CSFs  CSFs alone (G-CSF or GM-CSF)  Plerixafor – prevents stem cells from staying in the bone marrow

Question 38

Allogeneic Course Differences

Answer 38

GVHD and risk of infection

Question 39

Allogeneic Risk of Infection

Answer 39

Can try to prevent Early: gram negative/positive, candida, aspergillus, HSV Mild (2-3months post): same + CMV/PJP Late (>3 months post): varicella zoster, mold, PJP