Bone Marrow Transplant

Question 1

what is an autologous transplant

Answer 1

obtain cd34+ve stem cells from patients bone marrow

give high dose chemotherapy

reinfuse stem cells to patient

can only be used in diseases that can be put into complete remission

acute leukaemia

solid tumours

autoimmune disease (such as multiple sclerosis)

myleoma, lymphoma and CLL is a holding treatment not a cure

Question 2

allogeneic transplant stem cell

Answer 2

disease they have is unlikely to be managed by chemotherapy

high dose chemo/radiotherapy to ablate bone marrow then transfer donor

all leukaemias myeloma lymphoma BM failure, immune deficiencies

Question 3

cross matching HLA for transplant? which ones are most important

Answer 3

HLA on chromsome 6

matched for class I A B C

class II DR

(improvements DP DQ)

DNA testing most accurate

Question 4

stem cell transplant harvesting procedurs

Answer 4

CD34+ve cells surrogate marker for stem cells

success depends on no. of cd34 stem cells/kg

Gold standard for stem cell harvest is perpheral blood due to larger vol:

Day 1: G-CSF (5-16ug/kg) granulocyte colony stimulating factor

Day 4-5 measure CD34+ harvest when >10-20/ul

3 sources bone marrow, peripheral blood, umbilical cord stem cells from placenta (only good for small people)

Question 5

factors affecting ASCT outcomes (EMBT RISK)

Answer 5

0 1 2

age : <20 20-40 , >40

disease phase: early intermediate late

gender: female into male bad (1pt)

time to BMT <1yr >1yr

Donor : sibling, unrelated

Question 6

two important infections post transplant patients

Answer 6

aspergilllous significant mortality 92%

CMV due to lack of t-lymphocyte function

remains latent in body

20% of your t -cells are working to suppress CMV every day

Question 7

acute GVHD (within 100 days), triad

Answer 7

skin :rash blister desquamation, (bullous rash)

GIT: N+v bloody diarrhoea , litres and litres

Liver: ranges from slight raised bilirubin or fulminant liver failure

Question 8

chronic GVHD >100 days presentation?

Answer 8

skin

mucosal membranes

lungs

liver

eyes+joints

leads to cytokine production , cytokine storm

Question 9

treatment of GVHD

Answer 9

steroids (immunosuppresive pt more so they get aspergillous /cmv)

prevention: cyclosporin + steroids methotrexate can be used as prevention

T-cell depletion reduces risk of grafts v host disease in acute however they had a worse survival experienced early disease relapse.

lymphocyte infusion restores remission