Stem Cell Transplant Flashcards
Acute GVHD usually occurs during which time period?
Around 2 weeks post transplant
What infection can occur during acute GVHD?
CMV and other infections
What is the benefit of using a non-myeloablative regimen for an elderly patient?
They are able to proceed with a allo transplant and the regimen is associated with less treatment related mortality.
What is a example of a non-myeloablative regimen?
Flu/TBI 200-400cGy
What is the biggest benefit to using a haploidentical matched donor for transplant? What are you required to give to these patients?
There is a lower incidence of GVHD (and transplant rejection) because you give post-transplant cyclophosphamide to deplete T-cells for this to happen.
What are the disadvantages to using matched haploidential donor?
You have delayed immune reconstitution and increased risk of opportunistic infection.
What are some factors that affect the risk of GVHD?
Related donor <unrelated donor
HLA disparity
Minor HLA antigen disparity
Collection of cells from bone marrow (less risk) vs peripheral
What are the benefits to using post-transplant cyclophosphamide?
It reduces GVHD but does not increase relapse risk. It reduces GVHD with post-transplant anti-PD1 therapy. It reduces HLA barriers in haploidential tx.
What are the manifestations of acute GVHD?
Skin rash, diarrhea, N/Abdominal pain (loss of appetite), infection (bacteria, fungus, viral), elevated bilirubin-progressive liver failure
What is the first line treatment for Acute GVHD?
Steroids
When confronted with skin lesions concerning for Acute GVHD what should the workup be?
Patients should get a skin biopsy looking for apoptotic bodies. Keep in mind the skin rash could be a drug rxn which cannot be differentiated in the first 3 weeks.
What are second line options for acute GVHD? (more so remember the first line option than the others).
First line option is Ruxolitinib! Other options-infliximab, etanercept, basiliximab, ECP photophoresis, mycophenolate, pentostatin, Alemtuzumab.
What should make you concerned for acute upper GI GVHD and what is the tx?
If they have N/V more so with loss of appetite you should think about this. You can give systemic steroids w/ topical steroids beclomethasone and budesonide.
Every patient suspected of having GI Acute GVHD what should be the next best step in management?
They should get a biopsy for sure to help confirm the diagnosis.
What clinical manifestations are concerning for chronic GVHD?
Lichen planus-skin thickening, scarring (e.g. of the scalp), dry eyes/mouth, esophageal stenosis, nail/hair dystrophy, bronchiolitis obliterans, joint stiffness/pain
To re-emphasize again which type of transplant is associated with a higher risk of GVHD?
Auto transplant.
What are the chronic GVHD skin symptoms that differ from acute GVHD?
Depigmentation, lichen planus like sclerosis, sweat impairment, can also have hyperpigmentation.
What is the acute treatment of chronic GVHD? What duration of therapy is needed?
Steroids 1mg/kg. In the presentation he mentions about cyclosporine and tacrolimus-but ASH says there was no benefit.
What are the treatment options for steroid refractory chronic GVHD?
Ruxolitinib and Ibrutinib for steroid refractory. Patients often will require 1 year of therapy. You also have Belumosudil to use after 2-5 lines of therapy.
What anti-viral therapy helps prevent CMV? What are the options for preemptive tx this infection?
Letermovir for prophylaxis. Preemptive tx- ganciclovir, valganciclovir, and foscarnet.
EBV in transplant patients who are severely immunosuppressed can cause what?
Posttransplantation lymphoproliferative disease. Tx-withdrawal of immunosuppression, use Rituximab.
When should you suspect IPS and what is the best next step in management?
Fever, cough, dyspnea, hypoxemia, and restrictive airway physiology. Get BAL as the next step to rule out DAH and infection.
What is the tx of idiopathic pneumonia syndrome?
Supportive with High dose steroids w/ etanercept.
What should make you think of DAH in post-transplant setting as a complication?
They may complain of hemoptysis, SOB, cough. Increasing bloody returns on BAL washings, patchy alveolar infiltrates on CXR. Tx-supportive, high dose steroids.
