Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MCS > Day 18, Lecture 1: Transplant Medicine > Flashcards

Day 18, Lecture 1: Transplant Medicine Flashcards

1
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hematopoetic Stem Cells are capable of

A
  • Capable of reconstituting the ability to make blood
  • Can be translplanted from one individual to another
  • Can be used to create a new immune system in the recipient
  • In other words, the cellular components of blood and everything derived from them can be produced from hematopoietic stem cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

General indications for hematopoietic stem cell transplantation

A
  • To treat a hematologic (blood derived) malignancy (cancer) that is unlikely to be cured using a standard chemotherapy regimen
  • To replace defective bone marrow and/or as pre-emptive treatment to prevent the development of hematologic malignancy
  • As a rescue after treatment of a non-hematologic malignancy kills the normal bone marrow
  • To treat an immunodeficiency
  • To suppress or eliminate an auto-immune disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Autologous

A
  • Harvested from patient and stored in freezer in cryopreservative
  • Typically used in treating malignancies not involving the marrow such as neuroblastoma, infant brain tumors, and lymphoma in first remission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Syngeneic

A
  • genetically identical donor (twin)
  • very unusual
  • useful in treating malignancies but not for gene defects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Allogeneic

A
  • Partly or fully HLA-matched donor
  • Used in hematologic malignancies and broad variety of gene defects including things like sickle cell disease, Hurler syndrome, and SCID
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Allogeneic donors by order of preference

A
  • HLA-matched sibling
  • Matched unrelated donor (MUD)
  • Partially matched unrelated donor (8/10 or better)
  • Umbilical cord blood stem cells (4/6 or better)
  • Haploidentical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Unrelated donors are typed at ____ loci allowing mismatches at numerous ___ loci

A
  • Unrelated donors are typed at five loci allowing mismatches at numerous minor loci
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Sources of Stem Cells

A
  • Bone Marrow
  • Umbilical cord blood stem cells
  • Peripheral blood stem cells
  • Someday:
    • iPSC differentiated into HSCT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bone marrow harvest

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Peripheral blood stem cell harvest

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Umbilical cord blood stem cells

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatments of patient prior to stem cell infusion

A
  • Patients must be treated prior to the stem cell infusion to allow the new stem cells to grow
  • Treatments:
    • Chemotherapy:
      • +/- radiation accomplishes several things
        • suppression of the donor’s immune system
        • Creates space for the new stem cells to grow
        • Treatment of the malignancy
    • Many different preparative regimens are used and have a range of intensities
      • Myeloablative
        • Full dose that ablates the marrow
      • Reduced intensity
        • Lower doses but ablative
      • Non-myeloablative
        • marrow may recover with mixed chimerism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Graft versus host disease (GVHD)

A
  • Occurs in allogenic transplants when the new immune system derived from the donor attacks the recipient (the patient)
  • GVHD prophylaxis is almost always essential in allogeneic transplants. Different combination of medications are used including durgs like:
    • A calcineurin inhibitor (cyclosporine or tacrolimus)
    • Antibodies that kill off lymphocytes (ATG or Alemtuzumab)
    • Post-Transplant methotrexate or cyclophosphamide
    • Mycophenolate
    • Rapamycin (Sirolimus)
    • Glucocorticoids (Prednisone or Prednisolone)
  • Dr. Craword’s usual regiment:
    • Tacrolimus + Methotrexate +/- ATG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Infectious disease prophylaxis in transplant

A
  • Amoxicillin
    • for Gram-positive organisms
  • Fluconazole for fungi
  • Acyclovir for HSV
17
Q
A
18
Q

Unavoidable Transplant Complications

A
  • Nausea and Vomiting
  • Diarrhea
  • Anorexia
  • Febrile neutropenia +/- overt infection
  • Painful mucositis
  • Platelet and PRBC transfusions
  • Alopecia
  • Sterility (often)
19
Q

Severe Common Complications of HSCT

A
  • Serious Bacterial or fungal infection
    • ​empiric treatment for bacteria and fungi
  • Graft-versus-host disease
    • ​Prophylaxis
  • Sinusoidal Obstruction syndrome (SOS)/veno-occlusive disease (VOD)
    • Severe liver damage caused by chemotherapy often accompanied by multi-organ failure
  • Diffuse Alveolar hemorrhage
    • Bleeding in the lungs
  • Viral reactivation
    • CMV, HSV, VZV, and adenovirus
  • Post-transplant lymphoproliferative disease
    • Usually driven by EBV
  • Renal Failure
    • Highly associated with poor outcome
  • Acute cardiac toxicity
    • Rare complication but very bad
20
Q

Acute graft versus host disease (GVHD)

A
  • usually occurs within the firs 100 days after transplant
  • Skin GVHD
    • Erythematous maculopapular (flat and raised) rash
  • Liver GVHD
    • Elevations in bilirub (hyperbilirubinemia)
  • Gut GVHD
    • Diarrhea (sometimes bloody) and/or persistant nausea and vomiting
  • more than one organ is frequently affected
  • A scoring system defines severity
21
Q

Chronic Graft vs. Host disease (GVHD)

A
  • Occurs after day +100
  • more likely in patients that had severe acute GVHD
  • Clinical features
    • Dermal
      • Lesions like lichen planus and scleroderma
    • Hepatic
      • Cholestatic jaundice
    • Ocular
      • Dry eyes with buring, irritation, and pain
    • Oral
      • Dryness and sensitivity
    • Pulmonary
      • Obstructive lung disease
    • GI
      • Dysphagia
    • Genitourinary
      • Vaginitis and Vaginal Strictures
22
Q

Sinusoidal obstruction syndrome (SOS) or hepatic veno-occlusive disease (VOD)

A
  • Hepatic sinusoid injury characterized by:
    • Painful hepatomegaly
    • Fluid retention with weight gain
    • Jaundice
  • Severity
    • Mild
      • Resolves spontaneously without treatment
    • Moderate
      • Requires treatment with analgesics and diuretics but resolves
    • Severe
      • Multi-organ failure or fails to resolve with treatment by day 100
23
Q

Diffuse Alveolar Hemorrhage

A
  • Characterized by diffuse infiltrates, cough, dyspnea, and hemoptysis
  • Diagnosed by bronchoscopy
  • Toxic damage to lung by chemo and XRT
  • Older age is a risk factor
  • Usually occurs in first 30 days
  • Mortality is high
  • Treatment with high dose steroids and recombinant factor VIIa (rFVIIa)
24
Q
A

MCS (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions