HSCs Flashcards
Maximum volume marrow collection
20mL/kg
Donor characteristic associated with enhanced survival
Age
% decrease in survival for each HLA mismatch
5-10%
Cell surface antigen used to identity HSCs
CD34
Advantages of UCB
Less stringent HLA matching required
More rapidly available
Factors affecting engraftment
HLA match
Dose
Source
Rates of engraftment
Greatest with peripheral blood (14 day)
Marrow (21 days)
Then cord blood
Minimum dose for marrow collection for efficient engraftment
2-3 x10^8 nucleated cells/kg
Minimum dose for peripheral blood HSCs
2x10^6 CD34+ cells/kg
Most common mobilization agent for PB Collection
G-CSF
Cryoprotectant used most commonly for HSC storage
DMSO
Storage temp
Generally
UCB Collection consent and health history from:
Mother (father consent and history not necessary)
History and donor testing for UCB required within:
7 days of collection
Testing of UCB for hemoglobinopathies
Sickle or thalassemia trait may be banked
Homozygous abnormal or compound heterozygous abnormal are unsuitable for transplant
In utero UCB collection
Performed by OB after delivery- no dedicated CBB collection personnel required
More training, education, and competency assessment needed
Ex utero UCB collection
Performed by CBB staff
Allows for standardized methods and greater control
Allows for manipulation to increase collection volume
Lack of collectors may limit opportunities for collections
HLA typing of UCB
Performed before cryopreservation
Must be verified after thaw using an integrally attached segment
Transport considerations
Must be labeled ‘do not x-ray’
UCB thaw solution
10% dextran with a protein source (usually albumin at 2.5-4.2%)
Infusion of UCB
Infuse without delay after thaw/processing
Infuse by IV drip or push directly into central line (no needle or pump)
Vitals taken before, immediately after (infusion only 15-30 min) and 1 hr after
Usual UCB volume
60-100 ml
Additional infectious disease testing required
CMV
G-CSF adverse symptoms in order of frequency
Bone pain Myalgia Head ache Fatigue Insomnia Nausea Flu like symptoms Sweats Loss of appetite
engraftment delay after abo mismatch
Red cells delayed 40-60 days
Other cell lines unaffected
Minor abo mismatch hemolysis
7-14 days post transplant
Passenger lymphocytes in the graft produce antibodies to patient RBCs
HPC candidates with an HLA identical sibling
30-40%
=1-.75^n
HPC-A complication
Hypokalemia
In part due to citrate metabolism
Low ionized calcium, low magnesium, prolonged QT intervals
Marrow grafts regulated by
Public health services act
Cellular therapies (P-HSCs and umbilical) regulated by
Title 21 CFR part 1271
Products with positive infectious disease test
Labeled with biohazard
Stored in vapor phase nitrogen to minimize risk of contaminating other products
