What does HLA stand for
Human Leukocyte antigen
What are HLAs?
antigens (proteins found on the cells that help recognize what is foreign)
What is a haplotype?
Each individual inherits half their antigens from each parent, which is one haplotype.
What is the chance that siblings have all antigens identical?
1 in 4
What is syngeneic and why isnt it great
Stem cells from identical twin. lack of graft v tumor effect, and greater chance that they will have the same diease.
When are auto transplants used?
patients with solid tumors.
What is the difference between allogeneic and unrelated?
Allo - matched sibling, related donor or umbilical cord
Unrelated - matched but not related
MSD: (sibling)6/6 antigen match
MRD: (related) at least 3/6 to 5/6
UCB: (umbilical) 3/6 to 6/6
Unrelated donors include the following:
MUD: 5/6 , 6/6, 7/8, or 8/8
UCB: 3/6 to 6/6
Name 3 solid tumors that may be treated with HPCT
neuroblastoma, ewings, sarcomas and brain tumors
How does BMT work for hematologic and genetic syndromes?
chemo is given to eradicate cells in the bone marrow to make space for engraftment of healthy stem cells that will produce normal blood cells and replace the missing enzyme or gene in congenital disorders
What is the difference between myeloablative regimens vs nonmyeloablative? what is reduced intensity?
myeloablative - cause irreversible cytopenia, making stem cell support mandatory.
nonmyeloablative - min/mod cytopenia, doesnt require stem cell
reduced intensity - do not fit criteria for either - cause cytopenia of a variable duration, may be reversible, but is usually given with stem cells
What is the desired stem cells for transplant?
How do you mobilize the donor for collection of stem cells? How do you mobilize the recipient?
Healthy donor - just GCSF
Patient - cyclophosphamide regimen, GCSF, collect after nadir as cells begin to recover.
What is the desired collection amount when harvesting bone marrow?
10 to 20 ml/kg of recipients weight. 400-600 mL of aspirate - 5% of the bodys marrow pool
When do you collect cord blood?
within 15 minutes of delivery. HLA typed and screened for infections/genetic disorders.
Where can cord blood be donated to?
a sibling or relative, or the national cord blood registry
What are autologous and cord stem cells stored in? What are allo cells stored in?
Auto/cord -dimethyl sulfoxide (dmso)
Allo - given fresh, within a few - 48 h from time of collection. can be frozen if needed
How long does engraftment tak - auto? allo?
Auto - 7 to 10 days
Allo - 14-21 days
cord blood takes longer.
What defines ‘engraftment’
the first consecutive 3 days of an ANC above 500
What is the cause of capillary leak syndrome?
release of cytokines (IL 2) and tumor necrosis factor from tissue damage during the conditioning. leads to ascites and pulmonary edema. needs diuretics/albumin
When is the highest risk of capillary leak syndrome?
7-14 days after transplant.
What is SOS (sinusoidal obstruction syndrome) - formerly knon as VOD, veno occlusive disease
hepatic enlargement, ascites, elev bili/LFTs, jaundice. usually within 7-12 days after stem cell transplant
Pt has RUQ pain, elevated bili/LFTs, jaundice and weight gain about 7 days after transplant. What is it? What is treatment?
sinusoidal obstruction syndrome (formerly VOD). treat with diurtics, fluids, defibrotide (antithrombotic) and consider actigall/ursodeoxycholic acid
What is the most common side effect of TBI
What is the increased risk of secondary malignancy after transplant?
What is the new name for pneumocystis carinii?
When is the cutoff for acute vs chronic GVH
100 days after transplant
3 most common acute GVH issues
skin, GI, Liver`
What stage of GVH involves skin but nothing else
what stage of GVH involves stage 3 skin, or liver involvement, or GI
What stage of GVH has 0-3 skin, 2-3 liver, and 2-3 GI?
What stage of GVH has stage for skin, liver or GI involvement
What are stages 1-4 for skin GVH
1 -rash less than 25% BSA
2-rash 25-50 %
3 - rash greater than 50%
4-generalized and desquamation greater than 5%
When does primary graft failure occur? vs secondary
within the first 2 months. secondary is within the first year.
Typical criteria before being discharged after transplant? Considerations from nurse?
Common criteria for discharge after HPCT include:
Patient has ANC >500/mm3 for 3 consecutive days.
Patient is afebrile and off antibiotics for 48 hours.
N&V are controlled, and patient is able to take oral medications.
Patient has an adequate oral intake of calories and fluids. If not, patient may be discharged on nasogastric feedings or TPN until able to tolerate sufficient oral intake.
Family able to manage CVAD, medications, and nutritional support.
Family and caregivers understand discharge instructions, including:
When to call the care provider
Follow-up clinic visit
How to take temperature
Caring for CVAD
Managing TPN and enteral feedings
Importance of talking with team regarding such issues as taking
medications or immunizations, swimming, pets, and school reentry.