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YEAR 5: Haematology AS > Haem: Bone Marrow Transplantation > Flashcards

Haem: Bone Marrow Transplantation Flashcards

1
Q

Which organ in the body is most resistant to radiation?

A

CNS

NOTE: bone marrow is very vulnerable to radiation

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2
Q

What is the main cellular marker of stem cells?

A

CD34

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3
Q

What is the risk of dying from bone marrow transplant?

A

More than 50%

It is the most expensive and risky elective procedure

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4
Q

Outline the process of autologous stem cell transplantation.

A
  • Growht factor is given to the patient to stimulate the production of cells from the bone marrow
  • Cells are sampled from the patient’s bone marrow (some of them will be CD34+ stem cells)
  • These are preserved in a freezer
  • High-dose chemotherapy is given to the patient to eradicate their bone marrow
  • Stem cells are re-infused
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5
Q

What are the most common reasons for autologous stem cell transplantation?

A
  • Myeloma
  • Lymphoma
  • CLL
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6
Q

When is allogeneic bone marrow transplantation used?

A
  • When it is very unlikely that the patient’s disease will be eratdiacted from the bone marrow by standard chemotherapy

NOTE: suitable for acute leukaemia, chronic leukaemia, myeloma, lymphoma, bone marrow failure, congenital immune deficiencies

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7
Q

List some parameters used to gauge outcome of transplantation techniques.

A
  • Overall survival
  • Disease-free survival
  • Transplant-related mortality
  • Relapse incidence
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8
Q

State an equation that relates the probability of having a sibling with a matching tissue type to the number of siblings a patient has.

A

Probability of match = 1 — (3/4)number of siblings

NOTE: there is a 25% chance that your sibling has the same tissue type as you

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9
Q

What are the main classes of HLA based on?

A
  • Serological reactions (e.g. HLA-A)
  • It can be increasingly specified by DNA sequencing
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10
Q

Name three ways of harvesting stem cells.

A
  • Bone marrow sampling
  • Peripheral blood sampling
  • Umbilical cord stem cells
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11
Q

Why is bone marrow sampling a difficult process?

A
  • It involves anaesthetising the patient and sampling bone marrow from the pelvis
  • Puncturing the bone causes damage and only sampling a small number of stem cells means that re-puncturing of the bone is necessary
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12
Q

Outline the process of peripheral blood sampling for stem cells.

A
  • Hormones (e.g. G-CSF) is given to stimulate granulocyte production
  • This leads to the bone marrow producing some stem cells along with the granulocytes
  • G-CSF is given for 5 days and stem cells are harvested on the 5th day
  • The donor is connected to a centrifuge which spins the blood, removes the white cell component, reassembles the red cells and plama and reinfuses it into the patient
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13
Q

What proportion of a sample taken during stem cell sampling actually contains stem cells?

A

1%

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14
Q

What factor (related to stem cell harvesting) does the success of a bone marrow transplant depend on?

A

Number of CD34 cells per kg of weight of the recipient

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15
Q

List some complications of stem cell transplantation.

A
  • Graft failure
  • Infections
  • GvHD
  • Relapse
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16
Q

Listsome other factors affecting the outcome of a bone marrow transplant.

A
  • Age
  • Disease phase (early or late)
  • Gender of recipient and donor
  • Time to BMT
  • Donor (sibling or not)

NOTE: this is used to calculate the EBMT risk score

17
Q

List some risk factors for infection that are related to bone marrow transplantation.

A
  • Neutropaenia
  • Breakdwon of protective barriers
  • Decreased antibody levels
  • Depressed T cell responses
18
Q

What are the risk factors for CMV infection following bone marrow transplantation?

A
  • Patient and donor serological status
  • Type of stem cells
  • Type of transplant
  • CMV viral load
19
Q

Which parts of the body are affected in acute graft-versus-host disease?

A
  • Skin
  • GI tract
  • Liver
20
Q

Which parts of the body are affected in chronic graft-versus-host disease?

A
  • Skin
  • Mucosal membranes
  • Lungs
  • Liver
  • Eyes
  • Joints
21
Q

Why must patients receiving chemotherapy or radiotherapy have a treatment-free interval before stem cell transplantation?

A

Chemotherapy and radiotherapy can damage tissues leading to the release of loads of cytokines which activate antigen-presenting cells which present antigens to donor lymphocytes.

22
Q

List some risk factors for acute graft-versus-host disease.

A
  • Degree of HLA disparity
  • Recipient age
  • Conditioning regimen
  • Recipient and donor gender combination (male donors with female patients have worse GvHD)
  • Stem cell source
  • Disease phase
  • Viral infections
23
Q

List some treatment options for GvHD.

A
  • Corticosteroids
  • Ciclosporin A
  • FK506
  • Mycophenolate mofetil
  • Monoclonal antibodies
  • Photophoresis
  • Total lymphoid irradiation
24
Q

List some drugs used to prevent GvHD.

A
  • Methotrexate
  • Corticosteroids
  • Ciclosporin A
  • FK506
  • T cell depletion
  • Post-transplant cyclophosphamide
25
Q

Which component of the transplanted cells is responsible for GvHD?

A
  • It is the mature lymphocytes within the cell population (i.e. not the stem cells) that are responsible for GvHD
  • You cannot, however, remove these mature lymphocytes from the sample because they are important in preventing relapse

YEAR 5: Haematology AS (20 decks)

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