Hematopoietic Stem Cell Transplant

Question 1

There are three types of HSCT

Answer 1

1. Autologous (patient’s own stem cells)
2. Syngeneic (identical twins)
3. Allogenic

Question 2

Why might a patient receiving HSCT to fortify stem cell population after chemotherapy prefer syngeneic transplant over autologous transplant?

Answer 2

Because there is a risk that the autologous transplant would be contaminated with cancer cells

Question 3

Cord blood

Answer 3

Blood from the placenta and umbilical cord containing HSCs

Question 4

Performing an autologous HSCT as part of chemotherapy

Answer 4

Performed on cancer patients with peripheral blood HSCs obtained at 7 to 10 days after a dose of chemotherapy with G-CSF stimulation.

Question 5

Myeloid output following HSCT

Answer 5

Question 6

Pre-engraftment period

Answer 6

Characterized by profound immunodeficiency and transfusion dependence

Question 7

Nearly all post-transplant patients will have ___.

Answer 7

Nearly all post-transplant patients will have mucositis.

Particularly of the soft palate and esophagus, causing swallowing to be painful and difficult. Potential sites of entry of pathogenic bacteria.

Question 8

Post-transplant veno-occlusive disease

Answer 8

Caused by damage to endothelial cells lining the venous sinusoids of the liver. Injury induces fibrin deposition and obstruction of hepatic sinusoids. Blockage of blood flow causes liver engorgement and tender hepatomegaly and can lead to hypoxic centrilobular hepatic necrosis and liver failure in severe cases.

Question 9

It takes ___ post-transplant for neutrophil numbers to return

Answer 9

It takes 2-3 weeks post-transplant for neutrophil numbers to return

Question 10

GVHD

Answer 10

Initial trigger is thought to be caused by conditioning regimen, proinflammatory stimulus, or infection. Converges on activation of naive graft T cells for host antigens.

Chronic GVHD is associated with more subtle forms of tissue injury that lead to fibrosis, atrophy, and loss of function. Skin, GI, liver, and lung are most often involved, but any tissue can be.

Question 11

Acute post-transplant GVHD

Answer 11

Caused by mature T cells from the donor that survived. Can be mitigated by adding anti-T cell antibodies prior to transplant, however, this is a trade-off, as it increases the risk of post-transplant lymphoproliferative disorder (EBV or CMV reactivation).

Acute GVHD presents with rash, diarrhea, and elevated liver function tests. Severe acute GVHD often leads to sepsis and a fatal outcome.

Question 12

What is the likely diagnosis?

Answer 12

The characteristic rash of acute GVHD

Question 13

Chronic GVHD of the skin can have changes that mimic ___.

Answer 13

Chronic GVHD of the skin can have changes that mimic scleroderma.

Question 14

Treatment options for GVHD

Answer 14

• T cell activation inhibitors (cyclosporine, tacrolimus, sirolimus)
• T cell proliferation inhibitors (methotrexate, mycophenylate)
• T cell eliminators (antithymocyte globulin, prednisone)

Question 15

HSCT in leukemia and GVHD

Answer 15

Relapse in leukemia occurs most frequently in syngeneic transplant recipients and least frequently when donors suffer from some degree of acute and/or chronic GVHD