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HDT 3.2 > Stem cell transplantation > Flashcards

Stem cell transplantation Flashcards

1
Q

what is an autologous stem cell transplant (SCT)?

A

Haematopoietic stem cells harvested FROM PT

Administer high dose chemotherapy to patient
– BEAM or LEAM for lymphoma
– Melphalan for myeloma
* “Rescue” bone marrow by re-infusing stem cells after chemo has finished

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2
Q

where are Haematopoietic stem cells harvested from?

A

bone marrow
peripheral blood (G-CSF priming)

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3
Q

describe bone marrow HSC harvesting

A

invasive procedure

HSC( Hematopoietic stem cells)

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4
Q

describe peripheral blood HSC harvesting

A

(G-CSF priming)
endogenous hormone = drive WBC proliferation

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5
Q

how long does it take for stem cells to repopulate after inf?

A

10-14 days

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6
Q

why is autologous (SCT) better than chemo?

A

less toxicity than large dose of chemo

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7
Q

What is an allogeneic SCT?

A

Haematopoietic stem cells harvested FROM A DONOR AND TRANSFERRED TO THE PT

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8
Q

who can be a donor in allogeneic SCT?

A

sibling (1 in 4 chance of match)
unrelated
parent
child

MUST BE A SIMILAR MATCH

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9
Q

what can be a source for stem cells?

A

PB
bone marrow
umbilical cord

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10
Q

what are complications of allogenic SCT?

A

rejection rarely occurs due to immunosuppression

  1. graft vs host disease
  2. infection - opportunistic
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11
Q

what is graft vs host disease?

A

graft stem cells form a new immune systems that attacks the host cells
driven by T cells

occurs to 50% of pts
chronic/acute forms
commonly affects skin/gut/liver

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12
Q

how can graft vs host cells be prevented?

A

decrease T CELL activity

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13
Q

name some opportunistic infections and treatment prophylaxis

A

cytomegalovirus - LETERMOVIR
pnuemonia - co-trimoxazole
candida - fluconazole
Herpes - aciclovir

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14
Q

when is prophylaxis given to opportunistic infections

A

where there is an increase in risk

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15
Q

what is cytomegalovirus/CMV?

A

herpes virus - latent virus
affects 70% of the population

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16
Q

what is CMV a complication of ?

A

allogeneic SCT

17
Q

what can CMV cause?

A

GVHD
bacterial/fungal infections

18
Q

what is given for CMV prophylaxis?

A

letermovir

19
Q

Why is an allogeneic SCT better than an autologous SCT?

A

No risk of stem cell infusion containing malignant cells (e.g. myeloma)
Immune mediated effects

20
Q

Consider what is the main cause of death in those patients who are not cured by an allograft?

A
  • infection
  • relapse of malignancy
  • graft vs host disease
  • donor lymphocyte infusion (DLI) = increase remission
  • pts with mild GVDH better outcome than those who do not
  • low ciclosporin levels
21
Q

what is the GVL effect?

A

graft vs leukaemia effect

immune system attacks and kills residual cancer cells remaining post transplant = increase survival rates

22
Q

what drugs prevent GVHD/suppress T cells?

A
  • Ciclosporin / Tacrolimus
    – Methotrexate
    – Mycophenolate mofetil
    – Alemtuzumab
    – ATG
23
Q

what Drugs to treat GVHD?

A

corticosteroids

24
Q

what is ciclosporin?

A

GVHD prophylaxis
4-6month treatment; start 1 day prior to transplant
NTW drug

suppress T cell activation

25
Q

what are side effects of ciclosporin?

A
  1. Nephrotoxicity – worse if concurrent amphotericin, vancomycin, gentamicin
  2. Hypertension – manage with Ca-channel blocker e.g. amlodipine 5-10mg od
  3. Hypomagnesaemia – very common. Give Mg aspartate sachets or Mg citrate table
  4. hepatotoxicity
  5. neurological syndromes
  6. Anorexia, nausea, vomiting, tremor – common but if severe, suggest high levels
  7. hirsutism
26
Q

what are the drug interactions for ciclosporin?

A

Enzyme inhibitors will ↑ levels:
– Azoles, clarithromycin, grapefruit juice
Enzyme inducers will ↓ levels:
– Phenytoin, rifampicin, carbamazepine, St John’s wort

As its METABOLISED BY CYTO P450

27
Q

MTX dosing for GVHD

A

8mg/m2 on days +2, 4, 8, 12
omit day 12 dose if mucositis is SEVERE

  • Give 3 doses of folinic acid 15mg, starting 12 hours after MTX
28
Q

what are side effects of Mycophenolate?

A

GI
risk of infection
thrombocytopenia

29
Q

what is Alemtuzumab?

A

prophylaxis and treatment of GVDH

monoclonal antibody (anti-CD52)

30
Q

what is ATG/ALG?

A

anti-lymphocyte immunoglobin
reduces systemic lymphocytes
from rabbits

31
Q

whats first line treatment of GVDH?

A

corticosteriods
- prednisolone
- methylprednisolone
- dexamethasone

32
Q

what are the side effects of corticosteroids?

A

adrenal suppression/endocrine effects - diabetes
musculoskeletal effects - muscle wasting
GI effects - GI bleeding
mood disturbances - psychosis

HDT 3.2 (17 decks)

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