Hematopoietic Stem Cell Transplantation Flashcards
1
Q
Types
A
- autologous transplantation (from patient)
- allogeneic (from donor)
2
Q
Autologous
A
- stem cell isolation (either BM harvest or peripheral harvest)
- undergo myeloablative regimen prior to engraftment
3
Q
Allogeneic transplantation
A
- siblings, matched unrelated donors, umbilical cord blood, haploidentical donors
- peripheral or bone marrow harvest, reintroduced intravenously
- engraftment can take 2-4 weeks, depending on the donor type
4
Q
Preparative conditioning regimen
A
- chemotherapy w/ or w/o radiation
- goal: consolidating tx of underlying disease and suppressing recipient immune system to prevent graft rejection
- depends on patient age and co-morbidities
- myeloablative - destroy hematopoietic cells in BM –> profound pancytopenia –> restored by stem-cell infusion (young, healthy patients)
- nonmyeloablative - minimal cytopenia - prevents host defenses from rejecting donor cells
- reduced intensity - intermediate regimens may cause prolonged cytopenias and require stem-cell support
5
Q
Complications
A
- persistent sytopenias beyond 3-4 weeks - graft failure
- GVHD unique to allogeneic transplantation
6
Q
Complications
A
- day 0 - neutropenia, thrombocytopenia, mucositis, bacteremia, candida, HSV
- day 30 - idiopathic PNA, acute GVHD, aspergillum, CMV, adenovirus
- Day 75 - encapsulated bacteria, VZV
- day 90 - chronic GVHD
7
Q
Acute GVHD
A
- maculopapular rash, liver dysfunction, diarrhea (main target of attack are skin, liver, GI tract)
- major cause of morbidity and mortality
- immunosuppressive agents (MTX, sirolimus, cyclosporine, tacrolimus for prevention; steroids used for tx)
8
Q
Chronic GVHD
A
- rash or sclerodermatous skin changes: sick syndrome, obliterative bronchiolitis; liver dysfunction, cholestasis and bile duct degeneration, diarrhea, upper GI symptoms, myalgia
- most will develop some form of chronic GVHD
- reduced risk of relapse
- tx involves immunosuppressive agents
- high risk for infection
