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)
2
Q
plerixafor (mozobil) mechanism
A
CXCR4 antagonist
3
Q
Risks of auto - HSCT
A
- transplanting malignant cells
- ## ***higher risk of treatment related MDS + leukemia long term
4
Q
Risks of allo - HSCT
A
- death (transplant related mortality)
- GVHD
- DAH
5
Q
Chromosome on which MHC is found (Site of HLA antigen)
A
Chromosome 6
6
Q
Most import HLA antigens for matching
A
A, B, C, + DR
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
8
Q
Management of ABO mismatch
A
- RBCs can be removed from donor infusion or PLEX recipient ABO antibodies prior to transplant
9
Q
Complications of ABO mismatch in transplant
A
- immediate or delayed hemolysis
- *delayed RBC recovery
- *pure red blood cell aplasia
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
11
Q
Transplant with highest and lowest risk of GVHD
A
peripheral blood is highest
umbilical cord is lowest
12
Q
Transplant with highest graft vs tumor effect
A
peripheral blood
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
14
Q
Why we don’t use umbilical cord for stem cell graft
A
- slow to engraft
- prolonged myelosuppression
- higher infection risk
15
Q
Busulfan SE’s
A
- seizures
- veno-occlusive disease
- restrictive lung disease/pulmonary fibrosis
- hyperpigmentation
16
Q
GVHD RF’s
A
- gender
- type of transplant
- alloimmunization (woman who had prior pregnancies is donor)
17
Q
Acute GVHD presentation
A
- hyperbili
- skin toxicity
- GI tract involvement
- hepatotoxicity
18
Q
GVHD prophylaxis options
A
- tacrolimus or cyclosporine w/ MTX
(CONFIRM)
19
Q
First line for GVHD acute treatment
A
- steroids
20
Q
Management of steroid refractory GVHD
A
ruxolitinib (jakafi)
21
Q
First line for chronic GVHD
A
steroids
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
23
Q
CMV prophylaxis for patient with positive PCR post transplant
A
letermovir
24
Q
CMV reaction treatment post transplant
A
ganciclovir
25
First important component of matching
HLA status
26
DAH treatment
- steroids
- transfuse platelets + FFP to correct coagulopathy
27
Drug associated with highest risk of VOD
busulfan
28
VOD clinical features
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
Bronchiolitis obliterans presentation + 2) timeframe post transplant
- respiratory symptoms (coughing, wheezing, crackles) + bronchiolar dilatation on imaging
- months post transplant
30
Bronchiolitis obliterans management
supportive care
31
Post transplant microangiopathy 1) clinical presentation 2) drugs precipitating it
- TTP like syndrome
- post cyclosporine or tacrolimus (inducing podocyte damage)
32
Management of BK virus hemorrhagic cystitis
- ***decrease immunosuppression
- platelet transfusion
- bladder irrigation
33
Types of transplant (non-auto_
- Sibling donor
- Mathced unrelated donor (MUD)
- haploidentical (50% HLA match)
- syngeneic (identical twin, which is the same as autologous)
34
Benefit but downside of peripheral blood for transplant
- faster engraftment but higher risk of chronic GVHD
35
Preferred donor
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
What is a haploidentical donor?
50% HLA match
37
IS gender a GVHD RF?
Yes, Y chromosome serves as minor HLA mismatch
38
Consequences of minor ABO incompatability?
- acute hemolysis
- delayed hemolysis secondary to passenger lymphocyte syndrome
39
What is passenger lymphocyte syndrome?
Donor B lymphocyte production of antibiodies targeted recipient RBCs
*typically in setting of minor ABO mismatch
40
Standard conditioning regimens used in AML/MDS
- Busulfan/cyclophosphamide
- Fludarabine/busulfan
41
Typical conditioning regimen used in ALL
Total body irradiation/cyclophosphamide
42
Conditioning regimen used for for haplo's
Flu/cy/TBI
43
HL conditioning regimen
BEAM - BCNU/etoposide/cytarabine/melphalan
44
Busulfan SE profile
- VOD
- seizures
- pulmonary fibrosis
- secondary malignancies
45
Cyclophosphamide SE's
- hemorrhagic cystitis
*cardiomyopathy
*SIADH
- pulmonary
46
Fludarabine SE to know
- T-cell immunosuppression
47
Melphalan SE's
- mucositis
- diarrhea
- secondary malignancies
48
GVHD RF's
- 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
Primary means of preventing GVHD now
*post transplant cytoxan
- ATG
- ex-vivo T cell depletion (graft engineering and manipulation)
50
Lung syndrome associated with chronic GVHD
bronchiolitis obliterans
51
Second line options for chronic GVHD
- ibrutinib
- ruxolitinib
52
Third line for chronic GVHD
- KD025/belumosidil (ROCK2 inhibitor)
53
When to initiate treatment for CMV
- persistent viremia (treat before developing CMV end organ disease)
54
Most frequent cause of mortality after transplant
Relapse of disease
55
What to think of in altered patient in peri-transplant period
calcineurin-inhibitor-associated PRES
(tacrolimus and cyclosporin)
56
Clinical features of idiopathic pneumonia syndrome
- post transplant
- mimics pneumonia but infectious workup (BAL) is negative
57
Consequences of HLA mismatch
- mortality- progressive decrease in survival for each HLA allele mismatch
- higher rates of GVHD
58
Drug contraindicated with 6-MP
allopurinol
59
Clinical benefit of post transplant maintenance rituximab in MCL
OS
60
Typical cause of hematuria 2 months after post transplant cytoxan
BK virus
61
Problems with haplo donors
- higher GVHD risk because only half HLA matched
62
Best CMV status
CMV- recipient and CMV- donor
63
Ideal donor if recipient is CMV seropositive
seropositive donor (immunity restored faster)
64
Benefit of ATG in transplant
less GVHD
