HSCT

Question 1

WHAT is the Maximum tolerated dose of irradiation by organ?

Answer 1

Bone marrow - tolerates least so is MOST susceptible
GI
Cerebrovascular - most

Question 2

Haemopoietic cells derived from the umbilical cord of an infant are____ likely to cause GvHD?

Answer 2

less

Question 3

what are the steps in an Autologous Transplant?

Answer 3

Inject Growth factor – GCSF; colony stimulating factor

collect stem cells and freeze

thaw and reinfuse

high dose chemotherapy

Question 4

what are indications for Autologous Transplant?

Answer 4

Acute leukaemia
Solid tumours
Autoimmune disease

Also for
Myeloma
Lymphoma
Chronic lymphocytic leukaemia

Question 5

what are the principles of transplant?

Answer 5

patient to receive high dose chemotherapy +/- radiotherapy (treat the condition to remission)

Give patient myeloablative therapy

from donor: get bone marrow or peripheral blood stem cells and infuse into patient

Continue immunosuppression

Question 6

How do we choose a donor in HSCT? who are the best donors?

Answer 6

Well matched for tissue (HLA) type

Ideally a sibling (one in four chance of matching with each sib)

If not, a volunteer unrelated donor or minimally mismatched family member

More recently, better success with haplo (half)-identical donors

Question 7

what are the 3 sites that Stem cell can be harvested?

who receives what?

which site has greatest harvest?

Answer 7

Bone marrow

Peripheral blood - gives most stem cells

Umbilical cord - gives least stem cells. usually given to young kids

Question 8

what marker is found on stem. cells?

Answer 8

CD34+

Question 9

what are the components of the EBMT Prognostic Score

for transplant?

Answer 9

Age	<20=0,20-40=1,>40=2
Disease phase	Early=0, int=1, late=2
Gender of R/D	Female into male = 1
Time to BMT	<1 yr = 0, >1 yr = 1
Donor	Sib = 0, VUD = 1

Question 10

what is the common factor in development of infections post transplant eg CMV and aspergillosis?

Answer 10

Lack of T-cell function

Question 11

what are benefits/negatives if you deplete lymphocyte from graft?

Answer 11

Removing the lymphocyte:
Prevent graft vs host disease
Leukaemia replase
CMV disease

Keeping lymphocyte:
graft vs host disease
no relapse
control infection

Question 12

the cytokine storm is behind ___ ?

Answer 12

GVHD

the chemo that the patient is on causes release of proteins and cytokines etc from tumour cells.

these are picked up and presented by APCs

lymphocytes/ t cells from grafts detect these - be activated and cause more cytokine release