Bone Marrow Transplants - Margolis Flashcards
What cell is the major cause of graft-vs-host disease, as well as chronic graft rejection?
T cells (likely mostly CD8+)
Name seven disease categories that can be treated with a bone marrow transplant.
- Hematopoietic cancers
- Non-hematopoietic cancers
- Bone marrow failure (aplastic anemia)
- Hemoglobin abnormalities
- Primary immunodeficiencies
- Other inborn errors of metabolism
- Autoimmune diseases (possibly?)
Can you name three examples of non-hematopoietic cancers that are treated with BMT?
- Neuroblastoma
- Ewing sarcoma
- Brain tumors
Name a specific disease of inborn metabolism that can be treated with BMT.
Hurler’s Syndrome
(A lysosomal storage disease; an enzyme deficiency that leads to accumulation and tissue deposition of glycosaminoglycans, which presents in early childhood and can cause death by organ failure. Also called gargoylism due to its unique facies.)
What is meant by an “HLA Matched Donor”?
All major histocompatibility complexes are matched; only minor antigens differ
Name a type of disease where autologous BMT might be more succesful than allogenic.
- Leukemias, Lymphomas, or other Proliferative diseases.
- Healthy stem cells are taken before ablative chemotherapy / radiation is used to kill off the cancerous stem cells. Then the healthy stem cells are transplanted back into the patient.
- While there is always a risk of relapse, autologous transplant eliminates the possibility of rejection / GvHD seen with allogenic transplants.
Name a type of disease where allogenic BMT would be more succesful than autologous.
Inherited genetic defects - e.g. SCD, Thalassemias, inborn errors of metabolism. All of the patient’s stem cells will contain the defect and thus an autologous transplant cannot treat the condition.
Name three sources of hematopoietic progenitor cells and their relative therapeutic value.
- Bone Marrow
- Gold Standard
- Cord Blood
- Lower risk of GvHD for the same tissue match
- Peripheral Blood
- Higher risk of GvHD for the same tissue match
Before a patient is given a BMT, what process do they go through?
Conditioning: treatments with chemo +/- radiation therapy.
Varies with disease & donor
Compare myeloablative with nonmyeloablative conditioning.
From what I understand:
- Myeloablative is aimed at purging the marrow to eliminate malignancies, etc.
- Myeloablative obviously results in a lesser chance of cancer relapse
- Nonmyeloablative is aimed at providing enough immunosuppression to prevent graft rejection, but not wiping out the pt’s marrow cells
- Nonmyeloablative is less harsh on the pt, and protects against the effects of aplasia / pancytopenia
- Overwhelming infection, lack of O2 transport, coagulability issues, etc.
- Nonmyeloablative is less harsh on the pt, and protects against the effects of aplasia / pancytopenia
- Choice is made based on the disease, the donor, and the patient’s underlying medical issues
Low counts of what immune cell type will result in an infection from:
- Bacteria?
- Fungus?
- Virus?
- Neutrophils
- Neutrophils
- Lymphocytes (specifically, T cells)
Name some potential bacterial infections of concern in immunosuppressed patients.
- Staph
- Strep
- “Hard to Kill” G- rods
- Clostridium species
Name some potential **fungal **infections of concern in immunosuppressed patients.
- Inhaled & angioinvasive:
- Aspergillus
- Mucor (a genus of molds)
- Disseminate from GI/GU tract
- Candida species
Name some potential **viral **infections of concern in immunosuppressed patients.
- Herpes family
- Simplex 1 & 2
- CMV
- EBV
- VZV
- HHV-6
- Community acquired: follows seasonal patterns of infection
- RSV
- Influenza
- Adenovirus
- Enterovirus
