Exam 3: Hematopoietic Stem Cell Transplantation And Oncologic Emergencies Flashcards by Raven Demerath

Bone marrow transplant and peripheral stem cell transplantation allows for:

Safe use of very high doses of chemotherapy agents and/or radiation therapy in patients whose tumors have developed resistance (refractory) or failed to respond to standard doses of chemotherapy and radiation

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Hematopoietic Stem Cell Transplantation

Procedure with many risks, including death
Highly toxic
Overall cure rates still low but increasing
Tumor cells are eradicated and bone marrow is rescued by infusing healthy cells

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HSCT can be categorized as

Allogeneic
Syngeneic
Autologous

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Sources of cells for HSCT include

Bone marrow
Peripheral blood
Umbilical cord blood

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Autologous Stem Cell Transplant

Patient receives their own stem cells back following myeloablative (destroying bone marrow) chemotherapy.
Enables patient to receive chemotherapy and/or radiation by supporting them with their previously harvested stem cells until their marrow generates blood cells again on its own.

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Autologous Transplants are typically used to treat

Hematologic malignancies if there is no donor or the patient cannot undergo allogeneic transplantation

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HSCT: Stem Cells from Bone Marrow Procedure

Procedure is performed in OR under general or spinal anesthesia
Multiple aspirations are carried out to obtain adequate number of stem cells (Usually from iliac crest or sometimes from sternum)
Marrow is processed to remove bone fragments
Cells are cryopreserved until infused

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HSCT: Stem Cells from Peripheral Blood Procedure

Outpatient procedure
Cell separation equipment sorts stem cells out, and other cells are returned to donor
Procedure takes 2 to 4 hours
Multiple collections may be needed

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HSCT: Stem Cells from Cord Blood

Umbilical cord blood is rich in hematopoietic stem cells.
Umbilical cord blood can be HLA-typed and cryopreserved
Disadvantage is that it may have insufficient numbers of stem cells to permit transplant to adults
Research is ongoing

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Preparative Regimens and Stem Cell Infusion: Conditioning Regimens

Myeloablative dosages of chemotherapy with or without adjunctive radiation to treat underlying disease
Total body irradiation can be used for immunosuppression or to treat disease

*Read notes!

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What are complications of HSCT?

Bacterial, viral and fungal infections are common. (Prophylactic ABT therapy)
Graft-versus-host disease

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Graft-versus-host disease

T lymphocytes from donor stem cells recognize recipient as foreign and attacks organs such as the skin, liver and GI tract

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What kind of stem cells produce fewer complications?

Peripheral blood stem cells cause fewer and less severe complications.
This is because they are more mature than stem cells from bone marrow.

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Complications of Cancer: Oncologic Emergencies

Life-threatening

- Occur as the result of disease or treatment

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Make sure you know Table 15-19 page 263!!!

!!!!

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Oncologic Emergencies can be

Obstructive
Metabolic
Infiltrative

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Oncologic Emergencies: Obstructive Emergencies are primarily caused by

Primarily caused by tumor obstruction of an organ or blood vessel.

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Oncologic Emergencies: Metabolic Emergencies

Are caused by the production of ectopic hormones directly from the tumor or are secondary to metabolic alterations caused by the tumor or by cancer treatment.
Ectopic hormones arise from tissues that do not normally produce these hormones.
Cancer cells return to a more embryonic form, thus allowing the cells’ stored potential to become evident.

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Metabolic Emergencies include

SIADH secretion
Hypercalcemia
Tumor lysis syndrome
Septic shock
Disseminated intravascular coagulation

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Oncologic Emergencies: Infiltrative Emergencies

occur when malignant tumors infiltrate major organs or secondary to cancer therapy.

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What are the most common infiltrative emergencies?

Cardiac tamponade

- Carotid artery rupture.

Oncologic Emergencies include

Superior vena cava syndrome
Spinal cord compression syndrome
Third space syndrome
Intestinal obstruction

Obstructive Emergencies: Superior Vena Cava Syndrome

Obstruction by tumor or thrombosis

Signs of Superior Vena Cava Syndrome include

Facial and periorbital edema
Distention of veins of head, neck, and chest
Seizures
Headache

Obstructive Emergencies: Spinal Cord Compression

Tumor in the epidural space of spinal cord

Signs of Spinal Cord Compression include

- Intense, localized, persistent back pain - Motor weakness - Sensory paresthesia and loss - Change in bladder or bowel function

Obstructive Emergencies: What is third space syndrome?

-Shifting of fluid from vascular space to interstitial space

What are signs of third space syndrome?

Signs of hypovolemia including hypotension, tachycardia, low central venous pressure, and ↓ urine output

What is the treatment for third space sydnrome?

Replacement of: - Fluids - Electrolytes - Plasma Protein

Metabolic Emergencies caused by production of ectopic hormones include

- Syndrome of inappropriate antidiuretic hormone (ADH) secretion - Hypercalcemia - Tumor lysis syndrome - Septic shock - Disseminated intravascular coagulation (DIC)

Oncologic Emergencies: SIADH

- Abnormal or sustained production - Cancer cells are able to manufacture, store, and release ADH. - Some chemotherapeutic agents stimulate release.

How do you treat SIADH?

- Fluid restriction or IV of 3% NaCl in severe cases | - Demeclocycline may be needed for moderate SIADH

Oncologic Emergencies: Hypercalcemia

- Parathyroid hormone–like substance secreted from cancer cells in absence of bony metastasis - Can be life-threatening

Signs of Hypercalcemia include

- Apathy, depression, fatigue, weak muscles | - Electrocardiogram changes, polyuria, nocturia, anorexia, nausea, vomiting

Treatment of Hypercalcemia

- Aimed at primary disease - Hydration - Diuretic administration - Bisphosphonate

Chronic hypercalcemia can result in

- Nephrocalcinosis | - Irreversible renal failure

Tumor lysis syndrome

- Triggered by chemotherapy’s rapid destruction of large numbers of tumor cells: - ↑ Serum phosphate causes calcium to go ↓ resulting in hypocalcemia. - Can cause biochemical changes resulting in renal failure - Can be fatal

What are four hallmark signs of tumor lysis syndrome?

- Hyperuricemia - Hyperphosphatemia - Hyperkalemia - Hypocalcemia

When does tumor lysis syndrome usually occur?

- Within 24-48 hours after chemotherapy | - May persist for 5-7 days

What are early symptoms of tumor lysis syndrome?

- Weakness - Muscle cramps - Diarrhea - Nausea/Vomiting

What is the primary goal for treatment of tumor lysis syndrome?

Preventing renal failure and severe electrolyte imbalance

Tumor lysis syndrome: Primary treatments

- Increase urine production with hydration therapy | - Decrease uric acid concentrations

What are other Oncologic emergencies?

- Septic shock | - Disseminated intravascular coagulation

Infiltrative Emergencies: Cardiac Tamponade

Fluid accumulation in pericardial sac, constriction of pericardium by tumor, or pericarditis

What are clinical manifestations of cardiac tamponade?

- Heavy feeling over the chest - Shortness of breath - Dysphagia - Tachycardia - Cough, hoarseness, hiccups - Extreme anxiety - ↓ Level of consciousness - Pulsus paradoxus - Distant, muted heart sounds - Nausea, vomiting, excessive perspiration

Cardiac Tamponade: Management is aimed at

Decreasing fluid around heart and includes: - Surgical establishment of pericardial window - Indwelling pericardial catheter

Supportive therapy for cardiac tamponade include

- Oxygen therapy - Intravenous hydration - Vasopressor therapy

Infiltrative Emergencies: Carotid Artery Rupture

-Invasion of the artery wall by either a tumor or to erosion following surgery or radiation

Carotid Artery Rupture: Bleeding

Can manifest as minor oozing or spurting of blood in case of a blowout (pressure should be applied in case of a blowout)

Management of Carotid Artery Rupture includes

- IV fluids (to stabilize for surgery) - Blood administered (to stabilize for surgery) - Surgery: involves ligation of carotid artery above and below the rupture site and reduction of local tumor