Haematology 15 - Bone Marrow Transplant

Question 1

Which CD marker is expressed on haematopoietic stem cells?

Answer 1

CD34

Question 2

Recall the process of autologous transplant

Answer 2

1. Give G-CSF - lots of stem cells leak out from bone marrow into the blood
2. Freeze them (drop temp and store in liquid N2)
3. Patient has chemo/radio to permanently destroy their haematopietic system
4. Whip stem cells out of freezer and re-infuse

Question 3

What is autologous stem cell transplant used for?

Answer 3

To allow a higher dose of chemo/radio to be given
Biggest use in: Myeloma/ lymphoma/ CLL
*these patients don’t have much reserve for allogeneic stem cell transplant

Question 4

Describe the process of allogeneic stem cell transplant

Answer 4

Give G-CSF to DONOR with normal BM
Treat patient with high-dise chemo and radio
Give patient harvested cells

Question 5

When should allogenic stem cell transplant be used?

Answer 5

Bone marrow failure - because in autologous need a functioning bone marrow
Any patient where bone marrow can’t be cleared (eg acute leukaemias)

Question 6

How is patient’s room pressure adjusted to prevent infection during BM transplant?

Answer 6

Make it a higher pressure than corridor so that air flows out rather than in

Question 7

Recall some principles of donor choice for a bone marrow transplant

Answer 7

1. HLA-matched
2. Ideally a sibling (1 in 4 chance of matching with each sibling)

Question 8

Which patients can receive umbilical cord blood cells?

Answer 8

Only children - as you can only harvest a small volume so patient needs to be of a low weight

Question 9

How many types of HLA are there?

Answer 9

>20,000!

Question 10

What are the two classes of HLA molecules?

Answer 10

Class I: HLA A, B C
Class II: HLA DP, DQ, DR

Question 11

Which HLA types do we routinely match for?

Answer 11

HLA-A, B
HLA DR

DR A B

Question 12

What are the complications of stem cell transplant?

Answer 12

• graft failure - not very common
• infections
• graft vs host disease
• relapse

Question 13

What happens in graft versus host disease?

Answer 13

GRAFT attacks HOST
Donor immune system recognises patient as foreign
Mounts an immune response

This happens because when you kill cancer cells with chemo, the dying cells release a lot of cytokines
So when you insert donor cells, the lymphocytes get attracted to cytokines–>stimulate the immune system

Question 14

Acute vs chronic graft vs host disease

Answer 14

Acute (first 3 months): skin, GI tract and liver
Chronic: skin, mucosal membranes, liver, lungs, joints, eyes - it’s like scleroderma

Question 15

What is staging and grading of GVHD based on?

Answer 15

Extent to which the following are affected:

a) skin
b) liver
c) GI tract

Question 16

Risk factors for acute GVHD

Answer 16

older age

conditinoing regimen- blood is worse than bone marrow

female donor, male recipient

disease phase- more aggressive

viral ifnections

Question 17

Treatment of acute GVHD

Answer 17

Question 18

Prevention of acute GVHD

Answer 18

Question 19

Risk factors for chronic GVHD

Which is the strongest prognostic factor?

Answer 19

same as acute

and also previous acute GVHD

^strongest prognostic factor

Question 20

After transplant which infections are most common: bacterial, viral or fungal?

Answer 20

Bacterial

With time, viral

Fungal - can affect anytime

Question 21

What are the sources of bacterial infections post transplant?

Answer 21

Gram positive: vascular access

Gram negative: gastrointestinal access

Question 22

How can CMV reactivation manifest in immunosuppressed patients?

Answer 22