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Hematology > Stem Cell Transplant > Flashcards

Stem Cell Transplant Flashcards

1
Q

What is stem cell transplant

A

Killing individual bone marrow by chemo and radiotherapy and replacing with another

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2
Q

First bone marrow transplant date

A

1939

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3
Q

First success

A

1968

Child with combined immunodeficiency

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4
Q

Malignant heam ex

A 
AML
ALL
CLL
Myeolodysplastic syndrome 
Hodgkin lymphoma 
NHLs
Myelofibrosis
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5
Q

Non malignant heam dx

A 
Aplastic anemia 
Fanconi anemia 
Thalassemia
Sickle cell anemia 
Congenital pure red cell aplasia 
Paroxysmal hemoglobinuria
Severe combine immunodeficiency 
Wiskott Aldrich syndrome
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6
Q

Malignancies requiring transplant

A

Neuroblastoma
Breast ca
Lung ca \
brain ca

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7
Q

Sources of hematopoietic

A

Marrow
Peripheral blood
Umbilical cord

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8
Q

Dose required for stable long term engraftment

A

2x10^8

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9
Q

Phénotype of stem cells

A

CD34+

CD38-

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10
Q

Treatment done in transplant to mobilize

A

G-CSF treatment
GM-CSF
IL3
TPO

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11
Q

Conditioning Purpose of transplant

A

Eradicate underlying disease

Provide sufficient immunosuppressive for administration of graft without rejection

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12
Q

Conditioning of radiation based transplant

A

Fractionated radiation

Fractionated TBI + cyclophosphamide

Fractionated TBI + etoposide

Fractionated TBI + etoposide + cyclophosphamide

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13
Q

Donor characteristics in transplant

A

Good health
Good performance status for safe collection of cells
Normal cardiac, pulmonary , hepatic and renal functions

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14
Q

Level of hematopoietic stem cell in peripheral blood

A

Low

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15
Q

Treatment done to mobilize stem cell in circulation

A

G-CSF
GM CSF
IL3
Thrombopoietin

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16
Q

Name of the machine That helps collect stem cells from the blood

A

Leukophoresis machine

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17
Q

What are some non-radiation based regiments before transplant

A

Oral busulphan (16mg/kg for 4 days )
Cyclophosphamide 120mg/kg for 2 days
Etoposide + busulphan
Carmustine + etoposide + Ara C + melpphalan when lymphomas
Cisplatin + carboplatin when breast cancer or ovarian cancer

18
Q

Types of Transplantation

A

Autologous
Allogeneic
syngeneic

19
Q

What is a allogeneic bone marrow transplant

A

grafting of Bone marrow from a donor into a recipient of the same species

20
Q

Types of donor in allogenic bone marrow

A

HLA compatible sibling
Partially matched family members
Closely matched unrelated volunteer donros

21
Q

How long does it take for transplanted marrow to regenerate

A

2 to 4 weeks

22
Q

How do you protect patient from infection

A

Isolation

Broad spectrum antibiotics

23
Q

How long does it take to granulocyte to go back to 0.5x10^9

A

20 days

24
Q

Requirements for discharge of patient after graft

A

0.5x10^9/l count or more granulocyte

Adequate oral nutrition

25
Q

Do patients require blood transfusion , red cell and platelets during aplasia following marrow grafting

A

Yes

26
Q

Main complication of graft

A 
Oral mucositis
Gastroenteritis
Impaired cellular immunity 
HSV 
Bacterial fungal infection 
Neurological disorder 
Cataracts 
Endocrine disorders
Recurrent dx, malignancies
27
Q

When does acute graft versus host disease manifest

A

About 90 days after marrow transplantation

28
Q

Presentation of acute graft versus host disease

A

Skin - Mild maculopapular rash or generalized erythroderma and bullae formation with desquamation

Gut- anorexia ,nausea ,vomiting ,abdominal cramping pain

Liver - Hyperbilirubinemia, Transaminase and alkaline phosphatase high

29
Q

Grades of graft versus host disease

A

Stage I
stage II
stage III
stage IV

30
Q

Stage one graft versus host disease manifestation

A

Maculopapular rash less than 25% body surface

34 to 51 µmol liver bilirubin

diarrhea with 500 to 1000 mL per day loss
or persistent nausea

31
Q

Stage two acute graft versus host disease manifestation

A

Maculopapular rash 25 to 50% body surface

51 to 102 µmol liver bilirubin

diarrhea 1000 to 1500 mL per day loss

32
Q

Stage three acute graft versus host disease manifestation

A

Generalized erythroderma

102- 255 µmol liver bilirubin

diarrhea more than 1500 mL per day

33
Q

Stage four acute graft versus host disease manifestation

A

Desquamation and bullae

more than 255 µmol liver bilirubin

diarrhea more than 1500 mL per day
pain without ileus

34
Q

Pathogenesis of graft versus host disease

A

Donor T cells activated by antigen recognition on host tissue
Activated T cell proliferate and differentiates and produce cytokines promoting inflammatory response

tissue damage and necrosis

35
Q

Percentage of people that will develop chronic graft versus host disease after 100 days of allogeneic bone marrow Transplant

A

30 to 40%

36
Q

Signs of chronic graft versus host disease

A 
Debilitating skin disease 
oral mucositis
Dry eyes 
 chronic liver disease 
Weight loss  
neurologic disorders 
susceptibility to bacterial infection 
Obstructive liver disease
37
Q

Treatment of chronic graft versus host

A 
Anti-thymocyte Globulin
Glucocorticoids
Irradiation
Cyclophosphamide
Cyclosporine
Azathioprine
thalidomide
Prednisolone 
Prednisolone and azthorprine
38
Q

What is autologous marrow transplant

A

Own patient marrow cell transplanted

39
Q

Is there gvhd in autologous

A

No

40
Q

Is pre transplant immunosupression required in autologous

A

No

41
Q

Medication care of autologous

A 
Thiotepa
Melphalan
Etoposide
Cytosine arabinoside
6 thioguanine
42
Q

Supportive care of autologous

A 
Blood component 
Antibiotics 
Parentéral nutrition
Protective isolation 
Growth factors

Hematology (24 decks)

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