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CCHS SBB > Hematopoietic Progenitor Cells (Transplant) > Flashcards

Hematopoietic Progenitor Cells (Transplant) Flashcards

1
Q

who oversees HPC marrow transplants that have been minimally manipulated and collected from unrelated donors?

A

Health Resources and Services Administration

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2
Q

who oversees HPC marrow transplants that have been more than minimally manipulated?

A

FDA

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3
Q

cells in the bone marrow that are capable of becoming any of the mature cells

A

hematopoietic stem cells

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4
Q

cells capable of differentiation and self-renewal, not committed to particular blood cell lineage

A

hematopoietic stem cells

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5
Q

cells not capable of differentiation and self-renewal; more mature cells that are multi-potent or committed to a particular blood cell lineage

A

hematopoietic progenitor cells

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6
Q

most common indication for HPC transplant

A

malignant diseases

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7
Q

what percentage of circulating white cells are stem cells (CD34+)?

A

<0.05%

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8
Q

what are stem cell mobilization regiments used for?

A

to increase levels of circulating CD34+ cells in preparation for HPC collection of peripheral blood by apheresis

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9
Q

is stem cell mobilization typically used for bone marrow harvesting?

A

no

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10
Q

what is used for stem cell mobilization in allogeneic donors?

A

G-CSF

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11
Q

what is used for stem cell mobilization in patients with malignant diseases undergoing autologous stem cell transplant?

A

chemotherapy

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12
Q

indication for autologous HPC transplantation

A

rescue of patient with patient’s own HPCs following otherwise lethal or near-lethal dose of radiation or chemotherapy given to treat malignancies or marrow and metastatic or recurrent solid tumors

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13
Q

what CBC parameter decreases during autologous HPC apheresis collection?

A

platelets

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14
Q

apheresis collection goal of CD34 cells for single autologous transplant

A

2x10^6 CD34 cells/kg to 5x10^6

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15
Q

in what type of HPC transplant are the host and donor the same individual?

A

autologous

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16
Q

what is the risk of graft rejection in autologous HPC transplant?

A

low (no immunologic rejection)

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17
Q

what is the risk of GVHD is autologous HPC transplant?

A

none

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18
Q

autologous HPC transplant donor eligibility screening concerns:

A

medical condition of patient
sensitivity of malignancy to myeloablative regimen
possibility of tumor cells in harvested marrow
sufficient number of cells collected to reconstitute the marrow after myeloablation

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19
Q

how long is posttransplant immunosuppression for allogeneic HPC transplant?

A

6 months

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20
Q

what transplant type is useful in genetic and all stem cell diseases?

A

allogeneic

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21
Q

related MHC match allogeneic transplant

A

host and donor are fully genotypically matched at the MHC locus

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22
Q

related MHC partial match allogeneic transplant

A

host and donor differ at least one major MHC locus

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23
Q

unrelated MHC match allogeneic transplant

A

host and donor may be phenotypically partially or fully MHC matched but are genotypically disparate

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24
Q

T-cell depleted allogeneic transplant

A

cells are manipulated to remove T-cells or T-cell subset

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25
Q

transplant type in which host and donor and fully matched at both major and minor histocompatibility antigens, usually due to host and donor being identical twins

A

syngeneic

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26
Q

transplant type in which host and donor are disparate individuals who may or may not match at major histocompatibility complex locus and are usually not matched at minor histocompatibility loci

A

allogeneic

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27
Q

when is syngeneic transplant indicated?

A

acquired diseases in which entire progenitor cell population is abnormal

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28
Q

type of transplant with human recipient and live HPCs from nonhuman animal source or human cells with no ex-vivo contact

A

xenogeneic

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29
Q

sources of HPC

A

bone marrow
peripheral blood
umbilical cord blood

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30
Q

traditional source of progenitor cells

A

bone marrow

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31
Q

what HPC source is used predominantly in allografting?

A

bone marrow

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32
Q

HPC source used predominantly in autografting

A

peripheral blood

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33
Q

target collection for autologous transplant

A

> 2.0x10^8 nucleated cells per kg recipient body weight

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34
Q

target collection for allogeneic transplant

A

> 3.0x10^8 nucleated cells per kg of recipient body weight

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35
Q

what is used in combination with G-CSF for mobilization of CD34 cells in autologous transplant patients with multiple myeloma and non-Hodgkin lymphoma

A

adhesion-blocking agents and cytokines

36
Q

what defines poor HPC mobilization?

A

failure to achieve minimum level of 5-20 CD34 cells/uL in PB after completion of mobilization regiment
OR
inability to collect at least 1x10^6 CD34 cells/kg during single apheresis procedure
OR
failure to collect total of 5x10^6 CD34 cells/kg in all collections

37
Q

what is the current most popular source for HPC collection in both autologous and allogeneic transplants in adults?

A

apheresis

38
Q

is apheresis or marrow collection more practical currently?

A

apheresis

39
Q

infectious disease testing of autologous and allogeneic donors should be done in what time frame?

A

within 30 days of scheduled collection

40
Q

donor testing included in autologous and allogeneic transplant

A 
HBsAg
anti-HBc
anti-HTLV
anti-HIV-1
anti-HIV-2
HIV-1 p24 antigen
anti-HCV
syphilis
CMV
41
Q

what is one of the leading causes of posttransplant mortality in allogeneic setting?

A

CMV infection

42
Q

tumor purging

A

removal or destruction of tumor cells than can contaminate an autologous product

43
Q

what cell causes GVHD?

A

T cells

44
Q

autologous HPC storage

A

refrigerated or cryopreserved until infused

45
Q

expiration date of HPC for marrow transplant

A

no expiration date defined

46
Q

storage of allogeneic HPC of un-manipulated marrow

A

3 days at 2-8C or 18-24C for vitality

47
Q

purpose of cryopreservation

A

to freeze HPC marrow products that will be capable of maintaining viability and potency of stem and progenitor cells

48
Q

what preservative are HPCs stored in?

A

DMSO and hydroxyethyl starch

49
Q

storage temp of cryopreserved HPC

A
  • 180C or colder at liquid phase

- 145 to -185C in vapor phase

50
Q

transport storage of cryopreserved components

A

liquid nitrogen dry shipper that can maintain temp at -180C for 10-14 days with continuous temp monitoring

51
Q

HPC infusion rate

A

5-20 ml/min

52
Q

side effects of HPC infusion

A

bradycardia, diarrhea, flushing, nausea, hypertension, abdominal pain

53
Q

what percentage of HPC show signs of bacterial contamination?

A

0.2-4%

54
Q

QC of HPC

A 
cell counts
viability
microbial culture
CD34 enumeration
cytoplasmic aldehyde dehydrogenase
colony-forming cell assays
bioluminescence assays
tumor cell detection
engraftment data
55
Q

best QC test predictor of engraftment

A

CD34+ cell dose

56
Q

what does measurement of cytoplasmic aldehyde dehydrogenase correlate to in transplant?

A

speed of neutrophil engraftment

57
Q

what cells have been found to be responsible for short-term engraftment?

A

committed progenitor cells

58
Q

what cells have been found to be responsible for long-term, sustained engraftment?

A

pluripotent stem cells

59
Q

what aspect of transplant correlates with intracellular adenosine triphosphate concentration?

A

cell proliferation

60
Q

transplant success rate depends on what?

A 
disease of patient
stage of disease
degree of disease prior to treatment
age and condition of patient
degree of HLA match between patient and donor (in allogeneic patients)
61
Q

overall survival rates of HPC transplant

A

30-60% for otherwise fatal diseases

62
Q

what is the most important risk factor for GVHD?

A

MHC incompatibility between donor and recipient

63
Q

all donors and recipients are typed for what HLA antigens?

A

HLA class I (-A, -B, -C) and HLA Class II (-DR, -DQ, -DP)

64
Q

optimal allele-level match important mainly for what HLA antigens?

A

HLA-A, -B, -C, -DR

65
Q

HLA match degree: A

A

4 antigens match

66
Q

HLA match degree: B1U

A

3 antigens detected in donor, all match

67
Q

HLA match degree: B1X

A

3 donor antigens match, 1 cross-reactive

68
Q

HLA degree match: B2U

A

2 antigens detected in donor, both match

69
Q

HLA degree match: B2UX

A

3 antigens detected in the donor, 2 match and 1 cross-reactive

70
Q

HLA degree match: B2X

A

2 donor antigens match, 2 cross-reactive

71
Q

HLA degree match: C

A

1 antigen in donor not present in recipient and not cross-reactive

72
Q

HLA degree match: D

A

2 antigens in donor not present in recipient and not cross-reactive

73
Q

what is best donor choice for HPC transplant?

A

HLA-identical siblings

74
Q

3 requirements for development of GVHD

A

graft must contain immunologically competent cells
recipient must be incapable of rejecting transplanted cells
recipient must express tissue antigens that are not present in donor

75
Q

broad attack against host tissues mediated by donor T lymphocytes

A

graft vs host disease

76
Q

acute GVHD occurs when after transplant

A

a few days to 100 days

77
Q

chronic GVHD occurs when after transplant

A

100 days

78
Q

2 approaches employed with major ABO incompatibilities in HPC transplant

A

1) removal of or decrease in isoagglutinin levels in recipient through large-volume plasma exchange
2) removal of red cells in donor marrow

79
Q

resolution of minor ABO incompatibility in transplant

A

removing incompatible plasma by centrifugation before transplant

80
Q

is ABO incompatibility a risk factor for GVHD?

A

no

81
Q

what allows successful engraftment of HPC transplant regardless of ABO compatibility between recipient and donor?

A

non-committed and very early committed HPCs do not possess ABH antigens

82
Q

major red cell incompatibility

A

recipient has antibodies against donor red cell antigens (Ex: group O recipient and group A donor)

83
Q

minor red cell incompatibility

A

donor has antibodies against recipient red cell antigens (Ex: group A recipient and group O donor)

84
Q

allogeneic transplant with ABO ___ mismatch results in delayed red cell recovery due to destruction of engrafted red cell progenitors by recipient isohemagglutinins

A

major

85
Q

in ABO ___ mismatch transplant, red cell recovery is generally delayed 40-60 days after transplant and correlates with decreased anti-donor isoagglutinin levels

A

major

86
Q

recipients of ABO ___ incompatible transplant may experience delayed hemolysis mediated by donor lymphocytes 7-14 days after infusion; red cell recovery is not delayed

A

minor

87
Q

autologous HPC transplant recipients receive blood components that are:

A

ABO identical or compatible

CCHS SBB (40 decks)

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