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Heme / Onc > SM_267b: Stem Cell Transplantation > Flashcards

SM_267b: Stem Cell Transplantation Flashcards

1
Q

Stem cell transplant is ___

A

Stem cell transplant is use of hematopoietic progenitor cells to restore qualitative or quantitative marrow function (bone marrow rescue) AND / OR create long-term alloreactivity against a malignancy (graft vs tumor effect)

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2
Q

Autologous stem cell transplant is ___

A

Autologous stem cell transplant is when patients receive their own stem cells

  • Allows for high dose chemo for specific blood cancers (myeloma and lymphoma)
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3
Q

Allogeneic stem cell transplant is ___

A

Allogeneic stem cell transplant is when patients receive stem cells from someone other than themselves

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4
Q

Describe manipulated cell therapy

A

Manipulated cell therapy

  • Selection and / or engineering of specific types of hematopoietic cells: allogeneic SCT with T cells removed, allogeneic SCT with only ZCD34+ cells
  • Chimeric angien receptor T cells
  • Many types of SCTs are investigational: some types of chimeric antigen receptor T cells, mesenchymal stem cells
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5
Q

Describe rationale for hematopoietic stem call transplant in non-malignant conditions

A

Rationale for hematopoietic stem call transplant in non-malignant conditions

  • Reconstitute some / all of patient’s hematopoietic tissue
    • Erythroid; severe aplastic anemia, thalassemia, sickle cell
    • Immune: severe combined immunodeficiency
    • Enzymatic: Gaucher’s disease
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6
Q

Describe rationale for hematopoietic stem call transplant in malignant conditions

A

Rationale for hematopoietic stem call transplant in malignant conditions

  • Permit treatment with high dose chemo / radiotherapy: myeloablative (permanent cytopenia) versus near or non-myeloablative (temporary cytopenia)
  • Graft vs tumor
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7
Q

Describe indications for allogeneic and autologous stem cell transplant

A

Allogeneic and autologous stem cell transplant

  • Pediatric: neuroblastoma, Ewing’s sarcoma, Wilms tumor, and autoimmune diseases
  • Adult / pediatric: germ cell tumors, lymphomas, multiple myeloma
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8
Q

Autologous HSCT may be beneficial for ___

A

Autologous HSCT may be beneficial for multiple myeloma

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9
Q

Allogeneic HCST may be useful for ___

A

Allogeneic HCST may be useful for AML

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10
Q

Risk factors for HCST are ___, ___, ___, and ___

A

Risk factors for HCST are age, comorbidities, donor availability, and status of disease at the time of HCST

  • More comorbidities -> worse outcomes
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11
Q

Describe general preferences for a stem cell source

A

General preferences for a stem cell source

  1. Fully matched sibling donor
  2. Fully matched unrelated donor
  3. Alterative donor: umbilical cord blood, haploidentical related donor, mismatched unrelated donor

HLA match

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12
Q

Describe histocompatability antigens

A

Histocompatability antigens

  • HLA: engage T cells for immune recognition, inherited as co-dominant alleles from patients, important for matching donor or recipient
  • Non-HLA antigens: minor, killer inhibitory receptor and HLA-I
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13
Q

Describe histocompatability matching

A

Histocompatability matching

  • Matching bone marrow / peripheral blood
  • 10/10 allele level match preferred
  • HLA class I antigens: HLA - A, B, C
  • HLA class II antigens: HLA - DR > DQ > DP
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14
Q

Describe HLA inheritance

A

HLA inheritance

  • 25% chance of having a match to a full sibling
  • 50% chance of having a half match to a full sibling
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15
Q

Describe alternative stem cell sources

A

Alternative stem cell sources

  • Cord blood: less match required (4/6 or 5/6 acceptable)
  • HLA mismatched donors: 9/10 or 8/10, haploidentical (5/10)
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16
Q

Describe process of stem cell transplant

A

Stem cell transplant

  1. Stem cells removed from donor
  2. Recipient conditioned
  3. Recipient receives stem cells
17
Q

Conditioning is requires prior to stem cell transplant to ___

A

Conditioning is requires prior to stem cell transplant to prevent rejection

18
Q

Post-HSCT phases are ___, ___, and ___

A

Post-HSCT phases are pre-engraftment, early post-engraftment, and late post-engraftment

19
Q

Describe pathogens in post-HSCT phases

A

Pathogens in post-HSCT phases

20
Q

Discuss recipient risk factors in post-HSCT phases

A

Recipient risk factors in post-HSCT phases

21
Q

Describe common acute complications of HSCT

A

Common acute complications of HSCT

  • Relapse of disease
  • Infection / sepsis
  • Toxicity from chemo or medications
  • Acute and chronic graft vs host disease
  • Sinusoidal obstructive syndrome of liver
  • Engraftment syndrome
22
Q

Describe common chronic complications of HSCT

A

Common chronic complications of HSCT

  • Adults / pediatric: relapse of disease, infection, chronic graft vs host disease, secondary malignancies, and psychological disorders
  • Pediatric: growth retardation, learning disabilities
23
Q

Describe acute graft vs host disease

A

Acute graft vs host disease

  • Primarily occurs in skin, liver, or gut
  • Caused by activation of donor T cells in setting of inflammation from pre-SCT conditioning regimen (chemotherapy and/or radiation)
  • Incidence as high as 30%
  • Symptoms usually present within 100 days
  • 50% response rate to steroids
24
Q

Describe chronic graft vs host disease

A

Chronic graft vs host disease

  • Multi-organ disorder characterized by immune dysregulation, inflammation, fibrosis, and impaired organ function
  • Incidence as high as 70%
  • Symptoms usually present within 1-3 years after HSCT and associated with high morbidity
  • Associated with decreased incidence of relapse but increased risk of non-relapse mortality -> overall worse survival
25
Q

___ is used for refractory B cell malignancy

A

CAR T-cell therapy is used for refractory B cell malignancy

  • Transgenic autologous T cells with Ag specific CARs
26
Q

____ is a form of CAR T-cell therapy used to treat B cell precursor acute lymphoblastic leukemia

A

Tisagenlecleucel is a form of CAR T-cell therapy used to treat B cell precursor acute lymphoblastic leukemia

27
Q

____ is a CAR-T cell therapy used for large B cell lymphoma

A

Axicabtagene ciloleucel is a CAR-T cell therapy used for large B cell lymphoma

28
Q

Describe adverse effects of CAR T cell therapy

A

Adverse effects of CAR T cell therapy

  • Insertional mutagenesis
  • Myelosuppression: anemia, leukopenia / neutropenia / lymphopenia, thrombocytopenia
  • Cytokine release syndrome: high fevers, flu-like symptoms, life-threatening hypotension, capillary leak syndrome, nephrotoxicity, CNS toxicity (seizures, altered mental status)

Heme / Onc (41 decks)

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