Stem Cell Transplantation Flashcards by Sydney Perry

Blood stem cells are produced in the _________ and can become any kind of blood cell the body needs

bone marrow

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Stem cells are constantly dividing and maturing into different types of _________, replacing older and worn ones in the body

blood cells

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They produce billions of new blood cells _______
If the stem cells cannot make enough new blood cells, many serious health problems can occur

every day

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______ are immature blood cells that are removed from the blood or bone marrow of the patient or a donor, then ______ and stored

stem cells
frozen

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High doses of chemotherapy and/or radiation therapy are needed to __________ that is producing the cancerous cells, followed by the transplant.

The infused stem cells replace the blood
destroyed by the cancer treatment by growing into and restoring the body’s blood cells

kill existing bone marrow

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Currently, 85% of transplants performed at UPMC Cancer Center use stem cells from _______ blood

peripheral

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SCT has the potential to cure a variety of benign & hematologic diseases that may be incurable with conventional therapy. This will ______, not necessarily cure

add years of life

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common diseases treated with SCT

leukemia
lymphoma
myelodysplastic syndrome
multiple myeloma
aplastic anemia

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SCT allows high doses of chemotherapy and/or radiation therapy to be used on these diseases

________ becomes depressed due to the higher doses used and the transplanted stem cells will eventually restore normal blood cell production

Bone marrow

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_____ is from self

Stem cells are harvested from the patient prior to other __________, purged of ________ cells, and transplanted into the patient

Auto SCT is commonly used for lymphomas, myeloma and testicular cancer, less commonly used for _______

Predominant type of transplant used in _______

Autologous

cancer treatments
abnormal

leukemia

older adults

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_______ is from another person

Physicians collect and transplant stem cells from a donor who matches the recipients’ cells

either from __________ or __________

Allogenic

Sibling (SIB)
Matched unrelated donor (MUD)

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Identicle twin is ________

syngenic

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Umbilical Cord Blood Transplants

Stem cells are harvested from umbilical cord blood and transplanted

research has shown that umbilical transplants are_________ as transplants from unrelated donors

just as effective

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_____________

Half-matched bone marrow transplant that has been successful in “curing” patients of some cancers and blood disorders

Physicians administer just enough chemotherapy to suppress the immune system, which keeps patients from rejecting the donated marrow without harming their organs
Milder side effects
Expands the potential donor pool, making more patients eligible for the transplant

Haploidentical Transplantation

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in the Haploidentical Transplantation physicians administer ____________ to suppress the immune system, which keeps patients from ___________ without harming their organs
______ side effects
Expands the potential donor pool, making more patients eligible for the transplant

just enough chemotherapy
rejecting the donated marrow
Milder

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SCT consists of three major parts:

Conditioning phase
Infusion of SCT
Engraftment

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Conditioning phase is Designed to ______________ without causing fatal organ toxicity

The choice of conditioning regimen varies based on patient and disease characteristics as well as donor availability

After conditioning is complete, patient receives the stem cell infusion

destroy tumor cells resistant to conventional doses of chemo

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Stem cell infusion
cells are infused through patients’ _______ over several _______

Patients are closely monitored for fever, chills, hives, lowblood pressure & shortness of breath

central line
hours

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________ is when donated stem cells take hold & begin producing normal blood cells

Defined at UPMC SHY, WBC are considered in this stage when the ANC is ______ for ____ consecutive days or ______ on one day

defined as an unsupported count greater than _______

engraftment

> 500
two
1000 cells

20,000

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Advantages of Autologous

No HLA matching requirement

No GVHD

No need for immune suppression

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Advantages of Allogenic

Stem cells have not been exposed to chemotherapy

Stem cells product is free of tumor

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Disadvantages of autologous

Possibility of stem cell damage from prior therapy leading to delay in engraftment

Possibility of contamination with tumor

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Disadvantages of allogenic

Donor availability uncertain
GVHD
Higher risk of complications

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Autologous has _____ Risk of complications, ______ risk of relapse

lower
Higher

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Allogenic has _____ Risk of complications, ______ risk of relapse

higher lower

Outcome of SCT depends on many patient factors such as

age disease factors donor factors transplantation factors

problems impacting intake

appetite GI symptoms mucositis, stomatitis, xerostomia taste alterations

After transplantation, patients should receive a __________ comprised of food that contains low numbers of potentially harmful microbes

low microbial diet

low microbial diet include...

- Avoid raw honey – Do not keep leftovers for >3 days – Do not share food and drinks with other people – Make sure all dairy products are pasteurized

UBW/pre-illness weight IBW adjusted weight for IBW >______ weight loss history _________ patients prognosis is less favorable

120% Underweight

biochemical data that is looked at Serum Proteins – – Liver function tests (LFT’s) Absolute Neutrophil Count (ANC) Platelets, WBC

serum proteins - albumin - pre albumin (desired) BMP liver function tests absolute neutrophil count platelets, WBC

Low absolute neutrophil count (ANC) of <______ recommended low microbial diet

500

Energy/Calorie Needs Immediate post transplant needs ________ kcal/kg/actual weight, however usually go between _______kcal/kg Use _________ if pt is overweight/obese

25 to 35 30 to 35 adjusted body weight

Protein Needs SCT - _______ gm/kg metabolic stress, corticosteroids treatment, GVHD - _____ gm/kg adjusted for renal failure and/or hepatic encephalopathy - ____

1.3 to 1.5 1.5-2 0.8

for nausea and vomiting Recommend _________ foods, __________ meals throughout the day, open dishes on _________, eat when not nauseated or after ________ given

cold bland small frequent other side of room antiemetic

anorexia/loss of appetite Small frequent meals. Even if not hungry at all, encourage pt to eat at least a little, but not too much. Sometimes it’s ok if they _____________

can’t eat much for a couple days

diarrhea May be afraid to eat, encourage adequate hydration & may need __________

soft GI diet/low fiber diet

_______ Caused by injury to the mouth tissue from conditioning regimens and/or radiation Severe can lead to severe pain, hemorrhage, infection, upper airway edema & airway compromise Supportive care includes ______________ Preventive care includes _______ and _______ therapy

Mucositis opioids, good oral hygiene, avoidance of spicy, acidic, hard and hot food/beverages & use of saline rinses cryotherapy and laser

Mucositis is one of the main reasons why _____ is not frequently used. Feeding tube can______ the mucous membranes, making it difficult to place a tube. ______ may be required

EN irritate TPN

a noninvasive simple and atraumatic therapeutic management corresponding to a local application of a high-density monochromatic narrow-band light source to prevent mucositis

Low Level Laser Therapy (LLLT)

LLLT is becoming more common in the clinical setting as a treatment option for preventing and treating oral mucositis Promotes _____ Reduces oral mucositis incidence and its ______

pain relief severity

xerostomia recommendations

Mouthwashes without alcohol Sugarless gum or hard candies Mouth moisturizer, artificial saliva Moist foods with extra sauces and gravies

hypoguesia is _________ dysguesia is ________

reduced ability to taste things distortion of the sense of taste (ex: metallic taste)

tips for taste changes include using _______, ________, something _____ before the meal, _______

plastic utensils and plates seasonings tart (lemon drop) saline or baking soda mouth rinse

one of the reason EN not used is because placing tube may cause _______

irritation with bleeding

Major complications that can occur after an allogenic SCT in which the newly transplanted material attacks the transplant recipient's body

graft versus host disease (GVHD)

Acute GVHD... onset is _____ s/p SCT

≤100

organs mostly affected by acute GVHD

skin liver gut

symptoms of acute GVHD

maculopapular rash anorexia diarrhea abdominal cramps ileus or hepatitis

how do they diagnose acute GVHD

biopsy

MNT for acute GVHD general

specialized diets in five stages

syndrome that has features resembling autoimmune and other immunologic disorders

chronic GVHD

chronic GVHD symptoms usually appear ____ after all SCT and often proceeded by a history of ______

3 years acute GVHD

chronic GVHD manifestation can be ____ or _____

one organ or widespread

Diagnosis of chronic GVHD requires what

1. distinction from acute GVHD 2. at least one clinical sign of chronic GVHD or at least one manifestation confirmed by biopsy or other tests 3. exclusions of other possible diagnoses

It is important to alter ____when making the diagnosis of GVHD of the gut, once diagnosis is confirmed The phase of the diet refers to the patients symptoms and guides the dietitian/clinician as to which stage diet should be followed Progression of diet occurs as ________________ and can vary patient to patient

diet symptoms improve

phase one symptoms

cramping voluminous diarrhea nausea emesis

phase one diet plan

NPO for bowel rest TPN with increased calorie and protein needs (35 kcal/kg and 1.8 g/kg)

phase 2 symptoms

diarrhea volume decreasing forming of stool less to no cramping no emesis

phase 2 diet

TPN if already started clear, isotonic, low residue, lactose free beverages

phase 3 symptoms

stool is formed (pudding like) no emesis decreasing diarrhea toleration phase 2 diet

phase 3 diet

wean TPN as oral intake increases progress to solid foods limit fat intake (20g/day), lactose free, low insoluble fiber, no gastric irritants, high soluble fiber

phase 4 symptoms

formed stool minimal cramping tolerating >50% of needs orally

phase 4 diet

wean TPN expand diet by adding more starches, protein, and fatty foods. continue lactose free

phase 5 symptoms

no GI cramping normal stool normal transit time

phase 5 diet

discontinue TPN advance diet to regular by adding one new food per day and assess tolerance

The patient’s nutritional status, ability to eat and degree of oral and GI toxicity determine if TPN is indicated – For patients with a high degree of ________ including GVHD of the gut, TPN may be initiated. For patients with ________ conditioning regimens, the period of inadequate oral intake may extend longer before TPN is considered – At Shadyside the ______________ team will determine if patients are deemed appropriate for TPN

GI toxicity less toxic Nutrition Support Service (NSS)

For post transplant Discharge: – Engraftment – There is no indication of ________ – Tolerance of ________ – Able to eat and drink to get sufficient fluids and nourishment – No severe treatment complications – The patient is medically stable and physically able to function outside the hospital

infection medications

Shorter recovery period after _________ stem cell transplantation than after __________ stem cell transplantation.

autologous allogeneic

Autologous transplant often takes the immune system ________ to recover Allogenic transplant often takes ___________ to recover nearly normal blood cell levels and immune cell function Immune recovery can take longer if the patient has ______

3 to 12 months at least 6 to 12 months GVHD

early recovery post transplant diet

well balances for recovery and repair blood glucose control electrolytes

tips for early recovery dining out... Eat early to ______ Ask that food be made ______ Avoid ___________ when dining out Do not eat salsa or other __________ that are not refrigerated Ask for __________ condiment packages Avoid salad bars, buffets, etc. Check the overall condition of the restaurant

avoid crowds fresh raw fruits and vegetables fresh condiments single-serving

Long-term complications – _____ complications – ______ system – Risk for bone loss and subsequent _______ – Infertility – Chronic GVHD – Mental health – Relapse – Secondary cancer

Organ Endocrine osteoporosis

“Alternative” and “Complementary” often used interchangeably, but the two terms refer to different concepts: – If a non-mainstream approach is used together with conventional medicine, it’s considered “________.” – If a non-mainstream approach is used in place of conventional medicine, it’s considered “________.”

complementary alternative

A substantial amount of scientific evidence suggests that some complementary health approaches may help to manage some symptoms of cancer and side effects of treatment. For other complementary approaches, the evidence is more limited Disease treatment. At present, there is no convincing evidence that any complementary health approach is ________ in curing cancer or causing it to go into remission Cancer prevention. A 2012 study indicated that taking a _________ supplement may slightly reduce the risk of cancer in older men. No other complementary health approach has been shown to be helpful in preventing cancer

effective multivitamin/mineral

CAM approaches for cancer

acupuncture ginger massage therapy mindfulness stress reduction yoga hypnosis herbal supplements