HSCT and Blood Cancer Cytogenetics Flashcards
Definition
Elimination of patients haematopoietic and immune system by preparative regimen
Replace with stem cells
Types of HSCT
Autologous vs Allogeneic
- potential donors
- characteristics (benefits)
- limitations
- applications
Syngeneic = identical twins
Most important factor determining success of HSCT
Genetic matching!
- MHC/HLA - surface proteins involved in Ag presentation and can induce immune response
— rejection can occur both ways
— 6 genes on 2 classes (chr6)
— 25% siblings have 2 haplotypes, 50% have 1, 25% have none
- MiHA weaker effect
- ABO less important in HSCT
Collection of stem cells
Bone marrow - how much needed?
Peripheral blood - G-CSF to stimulate growth; requirement for transplantation?
Umbilical cord blood - for who and why
Preparative/Conditioning regimens
Purpose - aplasia and immunosuppression
Types of regimens - effect, indications, relative mortality
myeloablative vs non-myeloablative
Post-transplant recovery
1-3 wks: severe pancytopenia
3-12 mths: profound immunodeficiency
1-2 yrs: BM reserve impaired
Complications of HSCT
Early (<100 days)
- graft rejection — host vs graft, inadequate stem cells
- infection risk (pre and post engraftment)
- haemorrhage, haemorrhagic cystitis, cardiac failure all due to cytotoxic effects of chemoRT
- Acute GvHD - mechanism, clinical features, treatment
Chronic (>100 days)
- infection (late engraftment)
- Chronic GvHD - mechanism, clinical features, variable outcomes
- AI disorders, chronic pulmonary disease, second malignancy
Prevention of complications
- isolation, transfusion support
- antibiotic prophylaxis
- immunosuppressants
Graft vs tumour effect
Pathophysiology
Effect on relapse rate in GvHD and twins
Infused donor leukocytes may cure relapsed leukaemia
Chimeric antigen receptor T cell therapy
Mechanism and procedure
Indication
Side effects
