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Hematology, oncology > Hematopoetic stem cell transplantation supportive care > Flashcards

Hematopoetic stem cell transplantation supportive care Flashcards

1
Q

How to prevent mucositis

A
  • Sodium chloride + sodium bicarb mouth rinse
  • oral cryotherapy
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2
Q

oral cryotherapy + in which cancer it is used for

A

Iceing during administration during chemotherapy (standard in high dose melphalan)

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3
Q

Common indication for TPN in BMT

A

undergoing HCT + severe mucositis

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4
Q

Testing prior to transplant for all patients

A

Hep panel

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5
Q

SOS/VOD pathophys

A

Injury to the sinusoidal epithelium

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6
Q

SOS/VOD diagnosis

A

Clinical
*liver bx not needed

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7
Q

Criteria included in VOD diagnosis

A

*variable depending on criteria
- timing
- total t bili
- hepatomegaly
- RUQ pain
- Ascites
- Weight gain

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8
Q

Medication approved for treatment of pts with SOS/VOD with renal or pulmonary dysfunction

A

defibrotide (protects the sinusoidal endothelium)

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9
Q

Management of SOS/VOD

A

primarily supportive
- fluid restriction and diuretics to treat ascites
- paracentesis
- pain control
- minimize exposure to hepatotoxins

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10
Q

Pulmonary complication of HCT

A

Idiopathic pneumonia syndrome (IPS)

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11
Q

IPS presentation

A
  • acute onset cough, dyspnea, hypoxemia, +/- fever, that often progresses rapidly to respiratory failure
  • People are very sick (60% mortality rate)
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12
Q

Imaging of IPS

A

Diffuse infiltrates

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13
Q

IPS management

A
  • Bronch to rule out infection
  • High dose steroids (but usually doesn’t work)
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14
Q

medication used for CMV ppx in seropositive patients

A

letermovir

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15
Q

how long does engraftment take?

A

usually 2-3 weeks

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16
Q

platelet indication for transfusion

A

10K

17
Q

Blood product tranfusion requirements post-transplant + why

A
  • Irradiated (inactive lymphocytes and reduce risk of GVHD
  • leukocyte reduced (prevent HLA alloimmunization and reduce risk of CMV transmission)
18
Q

common cause of prolonged anemia post transplant + why

A

ABO mismatch (they are inherited independently of HLA complex and they are not considered primary criteria for donor selection)

19
Q

ABO mismatch may lead to what syndrome?

A

early or delayed hemolytic transfusion reactions

20
Q

how hemolysis is prevented in major and minor ABO mismatch

A

Major: Deplete RBCs from graft
Minor: Plasma depletion from graft

21
Q

Role of prophylactic platelet transfusion in transplant patients

A

controversial (they have a short half life and also accelerate alloimmunization against platelets)
- has shown to reduce bleeding but not mortalitity

22
Q

When CSFs are used

A
  • auto transplants (have been shown to accelerate neutrophil engraftment and reduce duration of neutropenia)
  • less well defined in PBC autos or allos
23
Q

Role for TPO-Ras

A
  • May be considered in patients with severe, prolonged thrombocytopenia after HCT
    (retrospective studies have shown benefit but larger prospective studies are needed)
24
Q

Differential for pancytopenia after HCT

A
  • poor engraftment
  • drugs
  • relapse
25
Q

Management of pancytopenia after HCT

A
  • BM biopsy to rule out relapse
  • check donor chimerism
  • avoid marrow suppressive drugs
  • G-CSF
  • Consider TPO-receptor agonists
26
Q

Other location for chronic GVHD presentation

A

Oral
- skin, nails, hair
- muscle, fascia, joints
- lungs
- genitalia
- serous membranes

27
Q

Treatment of oral chronic GVHD

A

Oral dexamethasone rinses

28
Q

Pulmonary sequelae of chronic GVHD

A
  • Bronchiolitis obliterans syndrome
  • Cryptogenic organizing pneumonia
29
Q

Only FDA approved treatment for chronic GVHD

A

Ibrutinib

30
Q

What is extracorporeal photophoresis?

A
  • investigational approach to GVHD treatment in which ECP induces apoptosis of leukocytes, which are reinfused to generate cytokines and induce tolerance
31
Q

Post HCT vaccinations

A
  • *inactivated flu vaccine 3 months post transpland and then annually
  • 1 year post transplant: meningococcal, pneumococcal, polio, hep A and B, TDap, HIB
  • **NO live vaccines until 2 years post transplant
32
Q

Late effects post transplant

A
  • metabolic syndrome
  • hypothyroidism, AI, hypogonadism
  • bone complications (osteopenia, AVN)
  • iron overload (very common)
  • neuropsychological
  • subsequent malignancies (2-3x that of general population)
33
Q

Management of iron overload syndrome post transplant

A
  • phlebotomy
  • if anemic, iron chelators
34
Q

Iron overload correlated to mortality?

A

A meta-analysis says none

35
Q

Major vs. Minor ABO mismatch

A

Major = RECIPIENT anti-donor ABO antibodies
Minor = DONOR anti-recipient ABO antibodies

Hematology, oncology (218 decks)

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