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LVL H - CLNCORE > Stem-cell transplantation > Flashcards

Stem-cell transplantation Flashcards

1
Q

What are haematological malignancies?

A

A heterogenous group of diseases that include leukaemia, lymphoma, and other lympho-myeloproliferative disorders. Essentially, they are cancers that begin in the blood and blood-forming tissues such as bone marrow or immune system.

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2
Q

What nutritional implications can impact haematological malignancies? (3)

A
  • nutrient absorption
  • nutrient losses
  • altered energy and protein metabolism
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3
Q

WHat are some examples of haematolocial malignanies? (4)

A
  • acute/chronic myeloid leukaemia
  • acute/chronic lymphocytic leukaemia
  • Hodgkin’s lymphoma
  • Non-Hodgkin’s lyphoma
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4
Q

What is the need for nutritional intervention ifor someone with haematological malignancies? (5) WHat is the cause of nutiritonal impairment in these popualtions?

A
  • maintenance of nutritional status
  • improves tolerance to chemotherapy/radiotherapy
  • Reduce infection complaications
  • maintenance of immunocompetance
  • reduction of mucositis of the gastrointestinal tract

Cause: consequence of therapeutic intervention such as chemotherapy, radiotherapy and HSCT.

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5
Q

How does mucositis of the gastrointestinal tract negitively impact an individual undergoing HSCT, radio or chemotherapy? (5)

A
  • decreased oral intake
  • nutrient malabsorption (due to proliferation of cells in the oropharyngeal and gastrointestinal mucosa follwoing cytotoxic effects of chemo, radio and HSCT therapies).
  • vomiting, diarrhoea
  • impaired metabolism/metabolic processes (lipid malabsoprtion, impaired glucose tolerance)
  • malabsorption of water
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6
Q

How long is food intake and nutrient absorption reduced following chemo- radio or HSCT therpaies?

A

2-3 weeks

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7
Q

WHat is HSCT?

A

A well-established therapeutic procedure involving the administration of high-dose chemo-radiotherapy followed by an intravenous infusion of haematopoietic stem-cells.

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8
Q

What are the three different sources of haematopoietic stem cells?

A
  1. bone-marrow (by transplantation, allo-HSCT, a-HSCT)
  2. peripheral blood-progenitor cell transplant (PBPCT)
  3. umbilical cord blood transplantation (CBT)
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9
Q

What term has ‘haematopoietic stem cell transplantation’ replaced?

A

bone-marrow transplantation

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10
Q

WHat are the two types of HSCT?

A
  1. allogenic HSCT (allo-HSCT)
  2. autologous HSCT (a-HSCT)
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11
Q

For allo-HSCT, when are best results seen? What is a limiatation?

A

Best results seen following HLA-genotypically macthing sibling donor - limitation: only 30% of patients have such a donor

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12
Q

What international registry was founded for volunteer donors and when?

A

Bone marrow donors worldwide BMDW founded in 1989 to find donors for people who cannot recieve from family donor

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13
Q

When were stem cells from the umbilical cord identified?

A

1970s

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14
Q

What year was the first allo-HSCT transplant successfully performed?

A

1989

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15
Q

What is a significant risk factor of recieving allo-HSCT?

A

High risk for graft-versus-host disease where the donor T cells view the patients healthy cells as foreign and attack/damage them. GVHD can be mild, mod or severe

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16
Q

What does allo-HSCT involve?

A

A procedure in which the patient recieves stem cells from a helathy donor

17
Q

What does a-HSCT involve?

A

The use of the patients own marrow to re-establish haematopoietic cell function following chemotherapy

18
Q

What are the advantages of a-HSCT? (3) What about limitations? (3)

A

A:
- ready availability
- absence of GVHD
- reduced mortality and cost

L:
- potential for tumour-cell contamination within the graft
- higher risk of relapse
- lack of graft-versus-tumour effect (the ability of donor T cells to eliminate malighnant cells)

19
Q

What does PBPCT involve?

A

Haematopoietic stem cell treatment from collected peripheral blood which contains both autologous and allogenic infusions

20
Q

For PBPCT, what must the healthy donor recieve prior to blood donation? WHY?

A

granulocyte growth factors (G-CSF) 3-5 days before donation. G-CSF ensures there is a spill over/adequate stem cells in the blood of the health donor.

21
Q

What are the advantages of PBPCT vs HSCT? (3)

A
  • stem cell collection without the need for anaesthetic or painful bone marrow collection
    -more rapid engraftment
  • decreased tmour contamination risk
22
Q

What does CBT involve?

A

The collection of haematopoietic stem cells from umbilical cord and placental blood immediately after delivery

23
Q

WHat is the main advantage of CBT? Disadvantage?

A

A:
- umblinical cord blood cells are phenotypically different than other forms of stem cells and therefore have a higher proliferative effect/potential compared with bone-marrow cells.

D:
- Hard to collect a sufficient number of cells to treat an adult (often used in childeren mainly for this reason)

24
Q

**Irrespective of the type of HSCT, conditioning regimens, have tremendous and deleterious consequences for the anatomical and functional integrity of the gastrointestinal tract (mucositis)

A

n/a

25
Q

What is mucositis?

A

Inflammation of the gastrointestinal tract following intensive rasio- chemo- therapies

26
Q

**Differences exist in the impact on nutritional status exerted by autologous and allogeneic transplantation

A

n/a

27
Q

WHat are some nutritional/metabolic implications following HSCT? (9)

A
  • allo-HSCT specifically demonstrates increased severity and prolongation of mucositis
  • GVHD increases mucositis with absonimal pain and diarrhoea
  • high-dose steroid drugs used for GVHD management further contributes to malnutrition (specifically carbohydrate metabolism)
  • increased energy needs? (data inconclusive)
  • impaired micronutrient, protein and energy metabolism
  • impaired glucose tolerance (HSCT negitively impacts pancreatic beta-cells)
  • trace element deficiency (zinc def correlates with mortality following BMT)
  • micronutrient deficiencies (due to intake, mucositis, malabsorption (water and lipid) and GVHD.
  • veno-occlusive disease of the liver (VOD) (serious and often fatal)
28
Q

WHat are some GVHD nutritonal complications? (3)

A
  • large fluid and protein losses
  • can cause severe cholestasis in the liver following bile-duct destruction
  • serum bilirubin concentrations elevate due to liver impairment
29
Q

What are the GVHD conditions affecting the mouth, oesophageal, hepatic and intestinal sections? What do they impair?

A

Oral (mucositis, sicca/Sjogren’s syndrome*), oesophageal (dysphagia), hepatic (cholestasis, hyperbilirubinaemia), and intestinal (mucositis, malabsorption).
Involvement of these conditions may impair both nutrient oral intake and intestinal nutrient absorption
* can also have concequences on growth in paediatric patients

30
Q

WHy is it difficult to assess nutritional status in HSCT patients? (3)

A
  • Biochmeical assessment doesnt reflect nutritional changes accurately due to exsisting complications (GVHD, sepsis)
  • Anthropometric measures influencced by electrolyte and fluid imbalances
  • Urine collection difficult due to vomiting, diarrhoea etc.
31
Q

What is the most accurate nutritional assessment for HSCT patients?

A

nitrogen balance measurement to measure protein breakdown and synthesis, however vomiting and diarrhoea can still provide inaccurate nitrogen results

32
Q

What are some nutitional support strategies for HSCT patients? (7)

A
  • appetite regulation to increase energy and nutrient intake (higher demands due to bodies catabolic state)
  • enteral nutriton (increased use over parenteral)
  • parenteral nutiriton (allows for more accurate modulation and provision of fluids, elecrolytes and macros which is of pivotal importance following HSCT compliactions such as GVHD and VOD.
  • increase PA
  • neutropenic diet
  • decrease insoluable fibre to redue diarrhoea
  • glutamine (AA) supplementation evidenced to decrease intestinal inflammation/damage (mucositis) (muratore et al., 2023)

LVL H - CLNCORE (6 decks)

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