13 HPCT

Question 1

What does HLA stand for

Answer 1

Human Leukocyte antigen

Question 2

What are HLAs?

Answer 2

antigens (proteins found on the cells that help recognize what is foreign)

Question 3

What is a haplotype?

Answer 3

Each individual inherits half their antigens from each parent, which is one haplotype.

Question 4

What is the chance that siblings have all antigens identical?

Answer 4

1 in 4

Question 5

What is syngeneic and why isnt it great

Answer 5

Stem cells from identical twin. lack of graft v tumor effect, and greater chance that they will have the same diease.

Question 6

When are auto transplants used?

Answer 6

patients with solid tumors.

Question 7

What is the difference between allogeneic and unrelated?

Answer 7

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

Question 8

Name 3 solid tumors that may be treated with HPCT

Answer 8

neuroblastoma, ewings, sarcomas and brain tumors

Question 9

How does BMT work for hematologic and genetic syndromes?

Answer 9

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

Question 10

What is the difference between myeloablative regimens vs nonmyeloablative? what is reduced intensity?

Answer 10

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

Question 11

What is the desired stem cells for transplant?

Answer 11

CD34

Question 12

How do you mobilize the donor for collection of stem cells? How do you mobilize the recipient?

Answer 12

Healthy donor - just GCSF

Patient - cyclophosphamide regimen, GCSF, collect after nadir as cells begin to recover.

Question 13

What is the desired collection amount when harvesting bone marrow?

Answer 13

10 to 20 ml/kg of recipients weight. 400-600 mL of aspirate - 5% of the bodys marrow pool

Question 14

When do you collect cord blood?

Answer 14

within 15 minutes of delivery. HLA typed and screened for infections/genetic disorders.

Question 15

Where can cord blood be donated to?

Answer 15

a sibling or relative, or the national cord blood registry

Question 16

What are autologous and cord stem cells stored in? What are allo cells stored in?

Answer 16

Auto/cord -dimethyl sulfoxide (dmso)

Allo - given fresh, within a few - 48 h from time of collection. can be frozen if needed

Question 17

How long does engraftment tak - auto? allo?

Answer 17

Auto - 7 to 10 days
Allo - 14-21 days
cord blood takes longer.

Question 18

What defines ‘engraftment’

Answer 18

the first consecutive 3 days of an ANC above 500

Question 19

What is the cause of capillary leak syndrome?

Answer 19

release of cytokines (IL 2) and tumor necrosis factor from tissue damage during the conditioning. leads to ascites and pulmonary edema. needs diuretics/albumin

Question 20

When is the highest risk of capillary leak syndrome?

Answer 20

7-14 days after transplant.

Question 21

What is SOS (sinusoidal obstruction syndrome) - formerly knon as VOD, veno occlusive disease

Answer 21

hepatic enlargement, ascites, elev bili/LFTs, jaundice. usually within 7-12 days after stem cell transplant

Question 22

Pt has RUQ pain, elevated bili/LFTs, jaundice and weight gain about 7 days after transplant. What is it? What is treatment?

Answer 22

sinusoidal obstruction syndrome (formerly VOD). treat with diurtics, fluids, defibrotide (antithrombotic) and consider actigall/ursodeoxycholic acid

Question 23

What is the most common side effect of TBI

Answer 23

hypothyroidism

Question 24

What is the increased risk of secondary malignancy after transplant?

Answer 24

4-7 fold

Question 25

What is the new name for pneumocystis carinii?

Answer 25

pneumocystis jiroveci

Question 26

When is the cutoff for acute vs chronic GVH

Answer 26

100 days after transplant

Question 27

3 most common acute GVH issues

Answer 27

skin, GI, Liver`

Question 28

What stage of GVH involves skin but nothing else

Answer 28

1

Question 29

what stage of GVH involves stage 3 skin, or liver involvement, or GI

Answer 29

2

Question 30

What stage of GVH has 0-3 skin, 2-3 liver, and 2-3 GI?

Answer 30

3

Question 31

What stage of GVH has stage for skin, liver or GI involvement

Answer 31

4

Question 32

What are stages 1-4 for skin GVH

Answer 32

1 -rash less than 25% BSA
2-rash 25-50 %
3 - rash greater than 50%
4-generalized and desquamation greater than 5%

Question 33

When does primary graft failure occur? vs secondary

Answer 33

within the first 2 months. secondary is within the first year.

Question 34

Typical criteria before being discharged after transplant? Considerations from nurse?

Answer 34

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.