Week 2 Flashcards
t/f- JAK2 inhib can be used for HSCT patient
t/f- inhib of jak/stat causes increase chance of replase
T - blocks T cell proliferation …used for GVHD!!
False - does not
clinical pres of AML
INC MYELOBLASTS»_space; dec everything downstream
- low grade fever/infection (pt interview = flu!) – low mature WBC
- fatigue/palpitations roaring in ears - low RBC
- bruising and bleeding - low platelets
T/F - hyperviscocity of blood is feature of AML
TRUE… why they get visionchanges, dyspnea and roaring in ears
how do we diagnose AML?
bone marrow biopsy - see >20% blasts
and test for myeloidbladt markers (MPO+, auer bodies)
what test do we do to distinguish good vs bad prognosis in AML?
Good: t(15, 17); t(8,21), Inv16
Poor: chrom 5, 7, 8, complex
Intermediate: Normal karyotype
good or bad prognosis in AML:
- chr 5,7,8 complex
- t(15,17)
- normal karyoptyr
- inv 16
- t(8,21)
Good: t(15, 17); t(8,21), Inv16
Poor: chrom 5, 7, 8, complex
Intermediate: Normal karyotype
T/F - majority of AML patients have normal karyoptyr which had more favorable prognosis than translocations like t(15,17)
false - is most common, but trans actually have GOOD prognosis
- *principles of AML therapy
- give ____ as induction therapy , when?»_space;> follow up eith BM biopsy» then do ____ if CR and _____ if not CR
- when do we do transplant?
induce with a month of anthracycline araC (if active disease)
-then consolidate ALL! with high dose AraC
CR = residual leukemia burden just below the level of detection Cure = CR beyond 5 years
- if low risk»_space; consolidate and observe
- if high risk» consolidate and transplant (esp if relapse)
we use retinoic acid and arsenic for ____ leukemia
acute promyelocytic leukemia
T/F - relapse AML has dismal prognosis in young and old patients
true
dx? 62 year old F presents with fatigue, RBC is 8, WBC is 21K, smear shows abnormal promyelocytes with primary granules. Neutrophil count is low. BM biopsy shows esterase+, myeloperoxidase+, t(15,19) mutation
AML»_space; specifically acute promyelocytic leukemia
what is difference between allogenic and autologous HSCT?
allo = from someone else (1/2 match dad/mom/sib) , stranger or cord blood
auto = own stem cells
what are indications for BM transplant in AML patient?
- if patient relapses
- or if patient at high risk and doesn’t respond
- *do risk startification during first block of induction treatment»_space; still have cancer 2 weeks later?»_space; then consolidate with another hig hdose ArC then»_space; TRANSPLANT
what are indications for hematopoteic stem cell transplant (big 3) - are they mostly allo or auto
MYELOMA #1 - almost all auto
NHL #2 - mostly auto
AML #3 - mostly allo
others less common = ALL, Hodgkins, MDS, CML
what is first step for HSCT:
- preparative regimen
- stem cell collection
- insurance approval
- engraftment
-insurance approval! and establish indication obv
GVHD occurs ____(after stem cell infusion or after engraftment)
AFTER ENGRAFTMENT ! before that there are no T cells ! becuase stem cells haven’t grafted into BM and started differentiationg
describe GVHD… what are acute v. chronic signs?
APC is from ____(host or donor)
T cells are from ____(host or donor)
GVHD = when donor T cells attack patient tissue (recognize antigens»_space; IL-12»_space; Th1»_space; IFN-gam + IL2»_space; NK and and CTL »_space; KILLL!
Acute = liver damage (big belly), skin (rash, no hair) and GI Chronic = arbritary > 100 days post engraftment = SKIN (rash, necrosis), oral ulcers, DRY EYES and DRY MOUTH, TIGHT skin/muscles/joints
are following pre- or post-engraftment complications:
- neutropenic fevers and sepsis
- nausea vomitting, mucositis
- anorexia
T/F- liver toxicity is common pre-engraftment complication
- all PRE
- liver/kidney/lungs are NOT common
T/F - GVHD is number 1 cause of death in HSCT patients
FALSE. its #2 .. behind “primary disease” (~40-50%)
GVHD and infection are tied #2/#3 - around ~15%
JAK2 kinase inhibitors block ____ cell activation in GVHD patient
T-cell
how do we “prepare” patient prior to HSCT (chemo, radiation, immunotherapy?)
-chemo +/- whole body radiation
HSCT permits ____(chemotherapy, immunotherapy) in allogenicc patient and ______ therapy in autogenic patient
chemotherapy in auto +/- immuno (TNF-alpha inhib) in allo
ENGRAFTMENT??
- need ___ and ____ adhesion molecules
- how do we “measure”
- homing of stem cells into bone marrow (occurs ~10 days post infusioN) … so for 1st ten days NO IMMUNE CELLS (need to tranfuse platelts, RBC, everything)
- VLA-4 and CD34
MEAURE - via chromosomes and variable # tandem repeats (VNTR) … basically a PCR band to make sure donor = host
are each part of innate or adaptive
- granulocytes
- NK
- T cells
- dendritic
T/F - innate immune system shaped by pathogen exposure
all innate except T
-innate NOT shaped by pathogen exposure,l only adaptive