Stem Cell Transplant Flashcards
What is stem cell transplant
Killing individual bone marrow by chemo and radiotherapy and replacing with another
First bone marrow transplant date
1939
First success
1968
Child with combined immunodeficiency
Malignant heam ex
AML ALL CLL Myeolodysplastic syndrome Hodgkin lymphoma NHLs Myelofibrosis
Non malignant heam dx
Aplastic anemia Fanconi anemia Thalassemia Sickle cell anemia Congenital pure red cell aplasia Paroxysmal hemoglobinuria Severe combine immunodeficiency Wiskott Aldrich syndrome
Malignancies requiring transplant
Neuroblastoma
Breast ca
Lung ca \
brain ca
Sources of hematopoietic
Marrow
Peripheral blood
Umbilical cord
Dose required for stable long term engraftment
2x10^8
Phénotype of stem cells
CD34+
CD38-
Treatment done in transplant to mobilize
G-CSF treatment
GM-CSF
IL3
TPO
Conditioning Purpose of transplant
Eradicate underlying disease
Provide sufficient immunosuppressive for administration of graft without rejection
Conditioning of radiation based transplant
Fractionated radiation
Fractionated TBI + cyclophosphamide
Fractionated TBI + etoposide
Fractionated TBI + etoposide + cyclophosphamide
Donor characteristics in transplant
Good health
Good performance status for safe collection of cells
Normal cardiac, pulmonary , hepatic and renal functions
Level of hematopoietic stem cell in peripheral blood
Low
Treatment done to mobilize stem cell in circulation
G-CSF
GM CSF
IL3
Thrombopoietin
Name of the machine That helps collect stem cells from the blood
Leukophoresis machine
What are some non-radiation based regiments before transplant
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
Types of Transplantation
Autologous
Allogeneic
syngeneic
What is a allogeneic bone marrow transplant
grafting of Bone marrow from a donor into a recipient of the same species
Types of donor in allogenic bone marrow
HLA compatible sibling
Partially matched family members
Closely matched unrelated volunteer donros
How long does it take for transplanted marrow to regenerate
2 to 4 weeks
How do you protect patient from infection
Isolation
Broad spectrum antibiotics
How long does it take to granulocyte to go back to 0.5x10^9
20 days
Requirements for discharge of patient after graft
0.5x10^9/l count or more granulocyte
Adequate oral nutrition
Do patients require blood transfusion , red cell and platelets during aplasia following marrow grafting
Yes
Main complication of graft
Oral mucositis Gastroenteritis Impaired cellular immunity HSV Bacterial fungal infection Neurological disorder Cataracts Endocrine disorders Recurrent dx, malignancies
When does acute graft versus host disease manifest
About 90 days after marrow transplantation
Presentation of acute graft versus host disease
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
Grades of graft versus host disease
Stage I
stage II
stage III
stage IV
Stage one graft versus host disease manifestation
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
Stage two acute graft versus host disease manifestation
Maculopapular rash 25 to 50% body surface
51 to 102 µmol liver bilirubin
diarrhea 1000 to 1500 mL per day loss
Stage three acute graft versus host disease manifestation
Generalized erythroderma
102- 255 µmol liver bilirubin
diarrhea more than 1500 mL per day
Stage four acute graft versus host disease manifestation
Desquamation and bullae
more than 255 µmol liver bilirubin
diarrhea more than 1500 mL per day
pain without ileus
Pathogenesis of graft versus host disease
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
Percentage of people that will develop chronic graft versus host disease after 100 days of allogeneic bone marrow Transplant
30 to 40%
Signs of chronic graft versus host disease
Debilitating skin disease oral mucositis Dry eyes chronic liver disease Weight loss neurologic disorders susceptibility to bacterial infection Obstructive liver disease
Treatment of chronic graft versus host
Anti-thymocyte Globulin Glucocorticoids Irradiation Cyclophosphamide Cyclosporine Azathioprine thalidomide Prednisolone Prednisolone and azthorprine
What is autologous marrow transplant
Own patient marrow cell transplanted
Is there gvhd in autologous
No
Is pre transplant immunosupression required in autologous
No
Medication care of autologous
Thiotepa Melphalan Etoposide Cytosine arabinoside 6 thioguanine
Supportive care of autologous
Blood component Antibiotics Parentéral nutrition Protective isolation Growth factors
