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Haematology > Stem cell transplantation > Flashcards

Stem cell transplantation Flashcards

1
Q

What is stem cell transplantation

A

Eliminating an individuals heam and immune system by chemo or radiotherapy and replacing it with stem cells from another individual or with previously harvested stem cells

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2
Q

Non malignant haem dx

A 
Aplastic anemia
fanconi anemia
Thallasemia
SSD
Congenital pure red cell aplasia
Paraxosymal haemoglobinuria
Severe combined immunodeficiency
Wiskott aldrich syndrome
Glanzmanns thrombastenia
hereditary storage disorders
osteoporosis
Conenital leukocyte dysfunction syndromes
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3
Q

requirements of transplant donors

A

Good health

Have good performance status that will permit safe collection of cells from marrow or blood

Normal cardiac, pulmonary, hepatic, renal fxns

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4
Q

Sources of hematopoietic stem cells

A

Marrow,
Peripheral blood
Umbilical cord blood

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5
Q

Stem cell dose for stable long term engraftment

A

2*10^8 nuclear cells per kg of recipient body weight

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6
Q

Phenotype of stem cells should be

A

CD34+ AND CD38+

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7
Q

What is mobilisation

A

A process in which certain drugs are used to cause movement of stem cells from bone marrow into blood because hematopoietic stem cells circulate in the peripheral blood at extremely low levels

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8
Q

Drugs used in mobilisation

A

G-CSF
GM-CSF
IL3
Thrombopoietin

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9
Q

After mobilisation is

A

APheresis

where a technology seperates blood passed through where it takes out one particular component i.e stem cells and returns the rest to circulation

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10
Q

What can be used in combo with CSF

A

c-kit

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11
Q

What is conditioning

A

A process to eradicate underlying dx and to provide sufficient immunosuppression to allow for the administration of the graft without host rejection

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12
Q

Types of conditioning

A

Radiation based

non radiation based

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13
Q

Radiation based conditioning

A

use of radiation

Fractionated TBI+ CYCLOPHOSPHAMIDE
Fractionated TBI= ETOPOSIDE

Best result is Fractionated TBI+ CYCLOPHOSPHAMIDE=ETOPOSIDE

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14
Q

Non radiation based regimens

A 
Oral busulphan 4 days, 16mg/kg
cyclophosphamide 2days, 120mg/kg
Etoposide+Busulphan
SCarmusitine+Etoposide+Ara C +Melphanan
Cisplatin+ Carboplatin;
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15
Q

Non radiation regimen with best result

A

Etoposide+ Busulphan

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16
Q

This non radiation regimen is used in lymphomas

A

Carmusitine+ Etoposide+ Ara C +Melphanan

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17
Q

Types of transplantation

A

Autologous
Allogenic
Syngernic

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18
Q

Allogeneic bone marrow transplant

A

Grafting of marrow from a donor into recipient of same sp

19
Q

Examples of allogenic donors

A

HLA compatible siblings
Partially matched family members
Closely matched volunteer donors

20
Q

What to do and expect immediately after post grafting

A

After high dose chemotheraoy- neausea and vomiting

Intravenous hyperalimentation must be administered to maintain caloric balance

21
Q

How long does it take transplanted marrow to regenerate

A

3-4 wks

22
Q

Precautions for patient after transplantation

A

Protected from infection by isolation or broad spectrum antibiotics till they have a have a platelet count of 0.5*10^9 or more granulocytes

23
Q

Mean time for granulocyte count to return to 0.5*10^9/l

A

20 days

with platelet and RBC lagging a few steps behind

24
Q

Post transplant supportive care

A

blood transfusion

red cells and platelets following aplasia after marrow grafting

25
Q

Patients can develop these post transplant

A

oral mucositis

gastroenteritis

26
Q

What happens secondary to chemotherapy and total body irradiation

A

decrease in caloric intake

decrease in intestinal absorption

27
Q

How to manage the patient post chemo

A

parenteral nutrition

GM-csf

28
Q

Complication of allogenic bone transplant

A

Patients are immunocompromised with breakdown of skin and mucosal barriers

Decreased immunoglobulin production

Bacterial, fungal, HSV can easily cause infection

29
Q

Other complications of Allogeneic transplant

A

Neurological disorder
cataracts
endocrine disorders
recurrent dx and other malignancies

30
Q

Treatment of Complications of allogeneic transplantation

A

Antibiotics for GI decontamination
Keep rooms with high efficiency particulate air filters
Give low dose amphotericin B to prevent fungal infection
Give broad spectrum antibiotics

31
Q

What is acute graft vs host dx

A

Occurs 90 days after marrow transplant affecting skin, GIT, liver

32
Q

How is skin affected in GVHD

A

Maculopapular rash
generalised erythrodema
bullae formation
Desquamation

33
Q

How gut is affected in GVHD

A 
Anorexia
Nausea
vomiting
diarrhea
abdominal crampa
34
Q

pathophysiology GVHD

A

Donor T cells are activated by recognition of antigens on host tissues

The activated T cells proliferate and differentiate

They proliferate and produce cytokines that promote inflammatory response leading to tissue damage and necrosis

35
Q

What is chronic GVHD

A

A major complication of allogenic BMT occurring in 30-40% of patients that suffer more than 100 days

36
Q

Signs of chronic GVHD

A 
Debilitating dx
oral mucosistis
dry eyes
chronic liver dx
weight loss
neurologic disorders
increasing succeptibility to bacteria
severe obstruction liver dx
37
Q

Treatment of chronic GVHD

A 
Antithymocyte globulin
Glucocorticoids
Irradiation
Cyclophosphamide
Cyclosporine
Azathioprine
Thalidomide
Prednisolone
Prednisolone and azathioprine
38
Q

Autologous marrow transplant

A

The patients own hematopoietic stem cells are used

No HLA matching, no GVHD, no immunosuppression

39
Q

Four principal phases of autologous bone marrow transplantation

A

Stem cell collection, purge, storage
Autologous bone marrow transplant
Discharge
Recovery

40
Q

Supportive care- autologous

A 
blood components
antibiotics
parenteral nutrition
protective isolation
growth factors
41
Q

How is autologous grafting done

A

AT time of grafting, the marrow or peripheral blood is rapidly thawed at patients bedside and infused via IV without further processing

42
Q

Complications- Autologous process

A 
nausea
abdominal cramps
coughing
flushing
hypertension
43
Q

To prevent renal toxicity from cell lysis in BM

A

Adequate hydration

brisk diuresis

Haematology (29 decks)

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