Ha - Stem Cell Transplantation Flashcards
when should transplants be given ideally
early on in disease
how can genetics be used to decide when to transplant
if someone has adverse genes, transplant them early
what needs to be matched in BM transplant
HLA
RBC group
what 2 physiological scenarios do 2 people swap immune cells
preg
blood transfusion
what 3 conditions are autologous transplants good for
AID - scleroderma / MS
acute leukaemia
solid tumour eg germ cell
describe autologous transplant process
growth factor to patient
collect stem cells and freeze
thaw and reinfuse
put into pt
give chemo
what is the benefit of autologous transplant
allows larger dose of chemo to be given that would normally have killed them
in what condition is autologous transplant curative
diffuse large b cell (high grade lymphoma)
why is autologous transplant done in myeloma /CLL
old people dont do well with GVHD
why is autologous transplant done in AID
not fatal but GVHD can be
what conditions is allogenic transplant done in
acute / chronic leukaemia
myeloma
lymphoma
mx process of allogenic transplant
treat to remission
get donor
give pt myeloablative treatment
infuse stem cells
continue immune suppression
what mx is done post allogenic transplant and why
lifelong immune suppression
prevent GVHD
where are stem cells obtained from
BM biopsy
peripheral blood if given PCSF to make SC go peripherally
umbilical cord
how many CD34+ cells are needed for adult BM transplant
2x10^6 /kg
complications of allogenic transplant
graft failure
infections
GVHD
relapse
what is the cut off for acute vs chronic GVHD
100 days
what organs does acute GVHD affect
skin, GIT, liver
what organs does chronic GVHD affecr
skin, mucous membranes, lungs, liver, eyes, joints
how is GVHD graded and what do they mean
1 to 4
1= not bad, 4 = fatal
risk factors of GVHD
HLA disparity
recipient age
conditioning regime
R/D gender combination
stem cell source
disease phase - worse later
viral infections
Tx of acute GVHD
corticosteroids
calcineurin inhibitors
mycophenylate mofetil
monoclonal ABs
photophoresis
total lymphoid irridation
mesenchymal stromal cells
how is acute GVHD prevented
methotrexate
corticosteroids
calcineurin inhibitors
T cell depletion
cyclophosphadime
what is chronic GVHD
end organ dysfunction with immune dysregulation
when does chronic GVHD appear / go away
appears within 6 months
lasts 2-5 years
risk factors of chronic GVHD
acute GVHD
general GVHD risk factors - eg age, disease, mismatching
why is infection in the first few weeks post transplant the worst
low neutrophils
when do you get HSV infection post transplant
immediately
when do you get CMV infection post transplant
30-100 days later
when do you get EBV infection post transplant
1 year later
why is fungal infection post transplant such bad news
poor treatment for it
low monocytes to fight off fungus
how do gram + / - bacteria get into a person with a transplant
+ = central line
- = GIT
which bacteria type kills in transplant pts
gram -
preventative measures for bacterial infection post transplant
isolation
avoid uncooked food
broad spec ABx
define neutropenic sepsis
temp >38 degrees for 1hr
or
1 off temp of >39
when neutrophils <1x10^9/L
Tx for neutropenic sepsis
broad spec ABx IV immediately
where does fungus come from in transplant patients
catheter, mucosa, sinuses
manifestations of CMV reactivation in transplant pts
pnuemonitis
retinitis
encephalitis
gastritis
