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

BONE MARROW MICROENVIRONMENT
… (4)

Answer 2

1. Multipotent CD34+ cells
2. Different types of cells
3. Growth factors
4. Chemokines

Question 2

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

Answer 2

anti-malignancy

Question 3

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

Answer 3

• Totipotent
• Pluripotent
• Multipotent

Question 4

COMMON HCT INDICATIONS
Non-malignant
(3) …

Answer 4

1. Aplastic anemia
2. Hemoglobinopathies
3. Bone marrow failure syndromes

Question 5

¿What are 7 COMMON HCT INDICATIONS?

Answer 5

1. Malignant disease
2. Leukemia
3. Lymphoma
4. Myeloma
5. Hodgkin’s and NH disease
6. Myelodisplastic
7. Solid tumors

Question 6

COMMON …
Immunodeficiencies
Autoimmune disease
Inborn error of metabolism
Other

Answer 6

HCT INDICATIONS

Question 7

HCT PATHWAY
- Planning requires multidisciplinary approach to patient management.
Factors including … (4) need to be considered before decisions regarding the type of transplantation to be performed and medications to be used.

Answer 7

• patient age
• performance status
• underlying disease
• previous complications and donor selection

Question 7

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

Answer 7

• patient
• donor
• Stem cell infusion

Question 8

STEM CELL SOURCES
… (2)

Answer 8

1. Bone marrow
2. Peripheral blood

Question 9

BONE MARROW
1) Soft, sponge-like tissue inside of bones
2) Collected by bone marrow harvest (multiple aspirations of …)

Answer 9

posterior iliac crest

Question 10

BONE MARROW
3) Collection goal … /kg cells (… L max)
4) Less graft versus … (not needed in non-malignant disease)

Answer 10

• 2-4 x 10^8
• 1.5
• leukemia effect

Question 11

PERIPHERAL BLOOD
1) …% concentration in comparison of bone marrow
2) Requires … and mobilization with medications (…)

Answer 11

• 1
• bone marrow stimulation
• filgrastim

Question 12

PERIPHERAL BLOOD
3) Collection goal …/kg cells (… L max)
4) Most commonly used / preferred graft source for …

Answer 12

• 2-6 × 10°6
• 1.5
• malignant disease

Question 12

CORD BLOOD
1) Cells are located in the …
2) Collection at time of delivery of a healthy baby
3) Collection goal … /kg cells (… mL)
4) Needs cryopreservation

Answer 12

• placenta
• 2.5-3 x 10^7
• 20-150

Question 13

¿Cuál es el contenido de células madre en la médula ósea, PBSC y sangre de cordón?
Respuesta:

Médula ósea: …
PBSC (sangre periférica): …
Sangre de cordón: … .

Answer 13

• Adecuado.
• Adecuado
• Bajo

Question 14

Pregunta: ¿Cómo varía el contenido de células T en estas fuentes?
Respuesta:

Médula ósea: … .
PBSC: …
Sangre de cordón: …

Answer 14

• Bajo
• Alto
• Bajo (inmaduras).

Question 15

Pregunta: ¿Qué fuente tiene mayor riesgo de contaminación tumoral en trasplantes autólogos?
Respuesta:
Médula ósea: …
PBSC: …
Sangre de cordón: …

Answer 15

• Alto.
• Bajo
• No aplicable.

Question 15

Pregunta: ¿Qué diferencia hay en el emparejamiento de HLA?
Respuesta:

Médula ósea y PBSC: …
Sangre de cordón: …

Answer 15

• Más restrictivo.
• Menos restrictivo

Question 16

Pregunta: ¿Cuál es el tiempo de injerto según la fuente?
Respuesta:

PBSC: Más rápido (… días).
Médula ósea: Moderado (… días).
Sangre de cordón: Más lento (>…).

Answer 16

• 13-15
  -16-18
• 3 semanas

Question 17

Pregunta: ¿Cómo varía el riesgo de enfermedad injerto contra huésped (EICH) aguda?
Respuesta:

Médula ósea y PBSC: …
Sangre de cordón: …

Answer 17

• Similar (++).
• Menor riesgo (+)

Question 18

Pregunta: ¿Qué fuente tiene mayor riesgo de EICH crónica?
Respuesta:

PBSC: …
Médula ósea: …
Sangre de cordón: …

Answer 18

• Mayor (+++).
  -Moderado (++).
• Menor (+).

Question 19

Pregunta: ¿Qué fuente tiene mayor riesgo de fallo del injerto?
Respuesta:

Sangre de cordón: …
PBSC y médula ósea: …

Answer 19

• Mayor (+++).
• Similar (++).

Question 20

Pregunta: ¿Cuál es el riesgo de recaída según la fuente?
Respuesta:

Sangre de cordón y PBSC: …
Médula ósea: …

Answer 20

• Mayor (+++).
• Menor (++).

Question 21

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

Answer 21

- Autologous - Allogenic

Question 22

TYPES OF ALLOGENIC TRANSPLANT 1. ... : twins 2. ... : siblings 3. ... : parents

Answer 22

- Syngenic - Matched family or unrelated - Haploidentical

Question 23

HLA AND COMPATIBILITY The degree of ... 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.

Answer 23

- donor-host Human Leukocyte Antigen (HLA)

Question 24

COMPLICATIONS 1) ... : because of the high dose quimiotherapy 2) ... 3) ... 4) ...

Answer 24

- Myelosupression - Infection - Graft versus host disease - Chemo toxicity