10 - Hematopoietic Stem Cell Transplantation Flashcards Preview

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Flashcards in 10 - Hematopoietic Stem Cell Transplantation Deck (28):
1

Two types of stem cell transplantation

Allogeneic
Autologous

2

Allogeneic Stem Cell Transplant

Donor is not recipient

3

Autologous Transplant

Donor is recipient

4

3 sources for hematopoietic progenitor cells

Bone Marrow
Peripheral Blood
Umbilical Cord Blood

5

Top Indications for autologous hematopoietic stem cell transplants

Multiple Myeloma (though it does not cure)
Non-Hodgkin Lymphoma
Hodgkin's Disease

6

Top indications for allogeneic hematopoietic stem cell transplants

AML
ALL
MDS/MPD

7

Peripheral Blood Stem Cell Transplant (PBSCT)

Stem cells collected peripherally (using apheresis)
Outpatient procedure
Results in more rapid hematopoietic recovery than bone marrow
No difference in treatment outcome
Quickly replacing traditional bone marrow

Cytokine stimulation (G-CSF injections)
Bone Marrow releases large number of CD34 stem cells into circulation
Stem cells harvested via peripheral line

Increased graft vs. host disease, though, so for things like sickle cell, bone marrow is still preferred

8

Stem Cell Mobilization

Granulocyte Colony Stimulating Factor (G-CSF)
Dislodges CD34+ Progenitor cell
Cells harvested via leukapheresis (mononuclear layer)

Side effect: Maybe hypocalcemia because of anticoagulants. Give calicum.

9

Bone Marrow - Hospital Stay

63% can be discharged same day
36% have to spend one night at the hospital
1% spend more than one night

10

Peripheral blood stem cell donation side effects

Common:
Headache
Bone or muscle pain
Nausea
Trouble sleeping
Tiredness
Decrease in blood platelet count

Less common:
Allergic reactions
Rapid heart rate
Dizziness
Shortness of breath
Itching or rash
Eye swelling

Least common:
Shortness of breath and chest pain
Bleeding of the spleen
Bleeding in the head
Blood vessel swelling

11

Peripheral - When do we collect?

If we only have 10 CD34+ cells per microliter of blood, we ad a second drug.
Once we hit 20 CD34+ cells per microliter, we harvest

12

Peripheral - How many cells?

We need 2 million!!!

13

Autologous Stem Cell Procedure

5 days of SC cytokine injections to mobilize stem cells (G-CSF)
Days 5 & 6 - Peripheral blood collected and apheresed to isolate CD34+ Stem Cells
Volume 200mL cryopreserved in DMSO, stored cold
High dose chemo +/- TBI given over 2 - 5 days
2 - 3 days alter stem cells thawed and infused through central line
Bone marrow recovery takes 14 days
Patient supported with transfusions (PLT

14

How long after allogeneic transplant can the patient be taken off of immunosuppression?

3 months-ish

15

Mechanisms of Immunological Tolerance - Allo Transplant

Central:
Deletional - Cells reactive against the donor are deleted in the thymus

Peripheral:
Active suppression - Regulatory T cells suppress effector cells which may reject the graft.

16

Within a family - Match Probability

25% - Full Match
50% - Half Match
25% - No Match

17

Allo Transplant - HLA Matching

HLA-A
HLA-B
HLA-C
DRB1
DQB1
DPB1

Each has 2 loci

Best is 12/12 match

18

Allo Transplant - Donors

Matched sibling (best for major and minor antigens)
Matched unrelated (BMT bank now over 22 million donors)
Mismatched (Single mismatch 9/10, or haploidentical 5/10)

19

Allo Transplant - Racism

White people have more donors than minorities

20

2 intensities of transplant

Myeloablative
Non-myeloablative (Transplant Lite)

21

Classic acute Graft Vs Host

Gut
Skin
Liver

3 phases:
Tissue damage (gut)
Translocation of LPS into circulation
Cytokine release
Donor T cells activated
Migration of those into target organs, organ damage

22

Classic Chronic Graft Vs host

Skin
Eyes
Mouth
GI
Liver
Musculoskeletal
Lungs
GU

23

Graft Vs. Leukemia

Convenient. Not explained how it happens as opposed to Graft Vs Host

24

Gut GVHD

Diagnosed histologically
DDX for diarrhea
drug toxicity
CMV
GVHD

Treat with steroids

25

Therapy of acute GVHD

PPX
Cyclosporine +/0 MTX
T-Cell depletion of the graft
In vivo T-cell depletion

1st line:
1mg/kg BID prednisone or methylprednisone

26

Cause of death after autologous transplant

Primary underlying disease recurring

27

Cause of death after HLA-identical sibling transplant

Primary disease recurring
Maybe GVHD, but probably not

28

Cause of death after unrelated donor transplants

Probably primary disease but maybe GVHD