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Heme boards > Transplant > Flashcards

Transplant Flashcards

1
Q

Consequences of HLA mismatch with transplant

A

1) Decrease in post-HCT survival with each HLA allele mismatch (each mismatch reduces probability of 5 yr OS by 10%)
2) GVHD
3)

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2
Q

plerixafor (mozobil) mechanism

A

CXCR4 antagonist

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3
Q

Risks of auto - HSCT

A
  • transplanting malignant cells
  • ## ***higher risk of treatment related MDS + leukemia long term
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4
Q

Risks of allo - HSCT

A
  • death (transplant related mortality)
  • GVHD
  • DAH
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5
Q

Chromosome on which MHC is found (Site of HLA antigen)

A

Chromosome 6

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6
Q

Most import HLA antigens for matching

A

A, B, C, + DR

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7
Q

9/10 Matched related donor vs. 10/10 matched unrelated donor superior

A
  • matched related donor superior since minor histocompability mismatch superior that isn’t included in HLA screening process
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8
Q

Management of ABO mismatch

A
  • RBCs can be removed from donor infusion or PLEX recipient ABO antibodies prior to transplant
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9
Q

Complications of ABO mismatch in transplant

A
  • immediate or delayed hemolysis
  • *delayed RBC recovery
  • *pure red blood cell aplasia
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10
Q

Types of stem cell transplants

A
  • bone marrow (need to be infused within 24h)
  • peripheral blood (most common since they engraft faster)
  • umbilical cord
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11
Q

Transplant with highest and lowest risk of GVHD

A

peripheral blood is highest
umbilical cord is lowest

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12
Q

Transplant with highest graft vs tumor effect

A

peripheral blood

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13
Q

Why does there always have to be an MD present during stem cell graft transfusion?

A

DMSO (preservative) can cause an allergic reaction during infusion

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14
Q

Why we don’t use umbilical cord for stem cell graft

A
  • slow to engraft
  • prolonged myelosuppression
  • higher infection risk
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15
Q

Busulfan SE’s

A
  • seizures
  • veno-occlusive disease
  • restrictive lung disease/pulmonary fibrosis
  • hyperpigmentation
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16
Q

GVHD RF’s

A
  • gender
  • type of transplant
  • alloimmunization (woman who had prior pregnancies is donor)
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17
Q

Acute GVHD presentation

A
  • hyperbili
  • skin toxicity
  • GI tract involvement
  • hepatotoxicity
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18
Q

GVHD prophylaxis options

A
  • tacrolimus or cyclosporine w/ MTX
    (CONFIRM)
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19
Q

First line for GVHD acute treatment

A
  • steroids
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20
Q

Management of steroid refractory GVHD

A

ruxolitinib (jakafi)

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21
Q

First line for chronic GVHD

A

steroids

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22
Q

Infectious risk during transplant phases 1) when pts are at risk for PJP 2) CMV risk

A
  • neutropenic pre engraftment phase – bacterial infections
  • PJP around 2 months
  • CMV 100 days post
    **finish this
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23
Q

CMV prophylaxis for patient with positive PCR post transplant

A

letermovir

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24
Q

CMV reaction treatment post transplant

A

ganciclovir

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25
Q

First important component of matching

A

HLA status

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26
Q

DAH treatment

A
  • steroids
  • transfuse platelets + FFP to correct coagulopathy
27
Q

Drug associated with highest risk of VOD

A

busulfan

28
Q

VOD clinical features

A

fulminant liver failure + painful hepatomegaly + weight gain/edema/ascites + renal/respiratory failure
thrombocytopenia (earliest sign, refractory to transfusion) + elevated serum aminotransferases and/or alkaline phosphatase + hyperbilirubinemia (mostly conjugated bilirubin, develops later)

29
Q

Bronchiolitis obliterans presentation + 2) timeframe post transplant

A
  • respiratory symptoms (coughing, wheezing, crackles) + bronchiolar dilatation on imaging
  • months post transplant
30
Q

Bronchiolitis obliterans management

A

supportive care

31
Q

Post transplant microangiopathy 1) clinical presentation 2) drugs precipitating it

A
  • TTP like syndrome
  • post cyclosporine or tacrolimus (inducing podocyte damage)
32
Q

Management of BK virus hemorrhagic cystitis

A
  • ***decrease immunosuppression
  • platelet transfusion
  • bladder irrigation
33
Q

Types of transplant (non-auto_

A
  • Sibling donor
  • Mathced unrelated donor (MUD)
  • haploidentical (50% HLA match)
  • syngeneic (identical twin, which is the same as autologous)
34
Q

Benefit but downside of peripheral blood for transplant

A
  • faster engraftment but higher risk of chronic GVHD
35
Q

Preferred donor

A

1) Matched sibling donor (less GVHD + fast and cost-effective)
2) Fully HLA matched unrelated donor (fully matched has similar survival to matched sibling but takes longer)
3) Alternative donor - haplo or cord blood
4) Mismatched MUD

36
Q

What is a haploidentical donor?

A

50% HLA match

37
Q

IS gender a GVHD RF?

A

Yes, Y chromosome serves as minor HLA mismatch

38
Q

Consequences of minor ABO incompatability?

A
  • acute hemolysis
  • delayed hemolysis secondary to passenger lymphocyte syndrome
39
Q

What is passenger lymphocyte syndrome?

A

Donor B lymphocyte production of antibiodies targeted recipient RBCs
*typically in setting of minor ABO mismatch

40
Q

Standard conditioning regimens used in AML/MDS

A
  • Busulfan/cyclophosphamide
  • Fludarabine/busulfan
41
Q

Typical conditioning regimen used in ALL

A

Total body irradiation/cyclophosphamide

42
Q

Conditioning regimen used for for haplo’s

A

Flu/cy/TBI

43
Q

HL conditioning regimen

A

BEAM - BCNU/etoposide/cytarabine/melphalan

44
Q

Busulfan SE profile

A
  • VOD
  • seizures
  • pulmonary fibrosis
  • secondary malignancies
45
Q

Cyclophosphamide SE’s

A
  • hemorrhagic cystitis
    *cardiomyopathy
    *SIADH
  • pulmonary
46
Q

Fludarabine SE to know

A
  • T-cell immunosuppression
47
Q

Melphalan SE’s

A
  • mucositis
  • diarrhea
  • secondary malignancies
48
Q

GVHD RF’s

A
  • HLA mismatch
  • Age
  • Unrelated vs. sibling donor (sibling preferred)
  • female to male
  • myeloablative vs. RIC (myeloablative is higher risk due to tissue damage)
  • peripheral blood is higher risk
49
Q

Primary means of preventing GVHD now

A

*post transplant cytoxan
- ATG
- ex-vivo T cell depletion (graft engineering and manipulation)

50
Q

Lung syndrome associated with chronic GVHD

A

bronchiolitis obliterans

51
Q

Second line options for chronic GVHD

A
  • ibrutinib
  • ruxolitinib
52
Q

Third line for chronic GVHD

A
  • KD025/belumosidil (ROCK2 inhibitor)
53
Q

When to initiate treatment for CMV

A
  • persistent viremia (treat before developing CMV end organ disease)
54
Q

Most frequent cause of mortality after transplant

A

Relapse of disease

55
Q

What to think of in altered patient in peri-transplant period

A

calcineurin-inhibitor-associated PRES
(tacrolimus and cyclosporin)

56
Q

Clinical features of idiopathic pneumonia syndrome

A
  • post transplant
  • mimics pneumonia but infectious workup (BAL) is negative
57
Q

Consequences of HLA mismatch

A
  • mortality- progressive decrease in survival for each HLA allele mismatch
  • higher rates of GVHD
58
Q

Drug contraindicated with 6-MP

A

allopurinol

59
Q

Clinical benefit of post transplant maintenance rituximab in MCL

A

OS

60
Q

Typical cause of hematuria 2 months after post transplant cytoxan

A

BK virus

61
Q

Problems with haplo donors

A
  • higher GVHD risk because only half HLA matched
62
Q

Best CMV status

A

CMV- recipient and CMV- donor

63
Q

Ideal donor if recipient is CMV seropositive

A

seropositive donor (immunity restored faster)

64
Q

Benefit of ATG in transplant

A

less GVHD

Heme boards (58 decks)

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