Transplante médula osea

Question 1

Hepatopoietic cell transplantation (HCT) is an advanced therapeutic intervention that is required for a number of malignant and nonmalignant medical conditions.
This procedure typically involves the administration of … followed by … procured from a donor.

Answer 1

• high-dose chemotherapy
• infusion of hematopoietic stem cells

Question 2

COALS OF HCT
To reconstitute a patient’s hematopoietic and immune system by delivering the appropiate amount and type of stem cells.
Generate anti-malignancy effect.
To replace or rectify an underlying deficiency.

Question 3

WhERE DO STEM CElLS COME FrOM?
1. Totipotent: Capable of developing a complete organism. Zygote, early embryo
2. Pluripotent: Form cells of all germ layers. Early embryo and blastocyte stage
3. Multipotent: Seen in specific lineage and found in umbilical cord, fetal and somatic tissue. Hematopoietic, mesenchymal, neuronal

Question 4

BONE MARROW MICROENVIRONMENT
1. Multipotent CD34+ cells
2. Different types of cells
3. Growth factors
4. ¿Chemokines

Question 5

COMMON HCT INDICATIONS
Malignant disease
Leukemia
Lymphoma
Myeloma
Hodgkin’s and NH disease
Myelodisplastic
Solid tumors

Question 6

COMMON HCT INDICATIONS
Non-malignant
Aplastic anemia
Hemoglobinopathies
Bone marrow
failure syndromes

Question 7

COMMON HCT INDICATIONS
Immunodeficiencies
Autoimmune disease
Inborn error of metabolism
Other

Question 8

HCT PATHWAY
- Planning requires multidisciplinary approach to patient management.
Factors including patient age, performance status, underlying disease, previous complications and donor selection need to be considered before decisions regarding the type of transplantation to be performed and medications to be used.

Question 9

HCT PATHWAY
1- Identify: Disease indication, Best donor, Type of transplant, Stem cell source
2- Chemotherapy administration (patient), Stem cell procurement (donor)
3- Stem cell infusion, Hepatopoietic and immune reconstitution

Question 10

PREVENTION

Question 11

STEM CELL SOURCES
1. Bone marrow
2. Peripheral blood

Question 12

BONE MARROW
1) Soft, sponge-like tissue inside of bones
2) Collected by bone marrow harvest (multiple aspirations of posterior iliac crest)
3) Collection goal 2-4 x 10^8/kg cells (1.5 L max)
4) Less graft versus leukemia effect (not needed in non-malignant disease)

Question 13

PERIPHERAL BLOOD
1) 1% concentration in comparison of bone marrow
2) Requires bone marrow stimulation and mobilization with medications (filgrastim)
3) Collection goal 2-6 × 10°6/kg cells (1.5 L max)
4) Most commonly used / preferred graft source for malignant disease

Question 14

CORD BLOOD
1) Cells are located in the placenta
2) Collection at time of delivery of a healthy baby
3) Collection goal 2.5-3 x 10^7/kg cells (20-150 mL)
4) Needs cryopreservation

Question 15

CELL SOURCE CHARACTERISTICS

Question 16

TYPES OF TRANSPLANT
1. … : Patient receives their
own cells
2. … : Patient receives cells from a related or unrelated donor

Answer 16

• Autologous
• Allogenic

Question 17

TYPES OF ALLOGENIC TRANSPLANT
1. Syngenic: twins
2. Matched family or unrelated: siblings
3. Haploidentical: parents

Question 18

HLA AND COMPATIBILITY
The degree of donor-host Human Leukocyte Antigen (HLA) compatibility is one of the most important factors affecting outcome after HCT.
Initial donor search focuses on identifying a sibling matched at the allele level for HLA-A, B and C loci.

Question 19

HLA AND COMPATIBILITY
If a suitable sibling donor is not available, search for an haploidentical, a matched unrelated or compatible unrelated cord blood unit.

Question 20

HALF AND COMPATIBILITY
Patient HLA
A 1 / 2
B 5 / 8
С 10 / 15
DRB1 17 / 20
DOA1
7 / 19
DPA1 41 / 52

Question 21

COMPLICATIONS
1) Myelosupression: because of the high dose quimiotherapy
2) Infection
3) Graft versus host disease
4) Chemo toxicity