Haematology 11 - BMT Flashcards
CD marker for stem cells
CD34
Which body system is most resistant to radiation?
CNS
Risk of dying from BMT
> 50%
Probability of being 100% HLA matched
0%
Outline the process of autologous SCT
GCSF given to obtain a CD34+ population of cells from BM (stem cells), these are preserved in teh freezer, irradiated with chemo and then reinfused in to the patient
Which cancers is autologous SCT suitable for?
Acute leukaemias, solid tumours, autoimmune disease, myeloma, CLL, lymphoma
Allogenic transplant process
Host’s BM irradiated then transplanted stem cells from a donor
Allogenic transplant suitable for which diseases
Acute leukaemias, myeloma, CLL, lymphoma, congenital immune deficiencies, thalassaemia, SCD
Serological vs DNA donor matching, difference in resolution
Serological = low resolution
DNA matching = high resolution
3 different ways to harvest stem cells
Bone marrow sampling
Peripheral blood + GCSF
Umbilical cord
Out of the 3 different ways to harvets stem cells, which yields the greatest volume of CD34+ Stem cells?
Peirpheral blood + G-CSF (umbilical cord the least hence only used in children which require low volumes)
How many stem cells are required for a transplant?
2 million cD34+ stem cells/Kg recipient weight
Score used to prognosticate outcome of BMT
EBMT score
Factors affecting the outcome of the transplant
Age, R/D sex (make –> female higher risk), time to BMT (<1yr or >1 yr), Disease phase, Donor (sib or VUD)
Which infection is the causative agent in 10-15% of transplant deaths?
ASPERGILLOSIS
What is GvHD?
Donor cells recognise recipient cells as foreign
Acute GvHD number of days post transplant vs chronic
<100, >100
Effects of acute and chronic GvHD
Acute: Skin, GIT, liver
Chronic: similar to Sjrogen’s : skin, liver mucosal membranes dry, SOB, dry eyes , arthritis
Pathophysiology of GvHD
Cytokine storm
Risk of twins to have GvHD
No risk
Treatment of GvhD
Corticosteroids, ciclospoin A, tacrolimus, mycophenolate mofetil
Goal of autologous SCT
Kill ALL leukaemia with radio/chemotherpay
Goal of allogenic SCT
Accepted that you cannot kill all leukaemia with radio/chemo so rely on BM from donor
Why can you not just deplete donor lymphocytes prior to transplantation?
Increased risk of relapse also risk of CMV infection
