28. Transplantation

Question 1

what are the 4 types of transplants that we discussed?

Answer 1

• blood
• marrow
• cord blood
• “mini” allogeneic transplant (NON myeloablative)

Question 2

where can we find stem cells?

Answer 2

• marrow
• blood (peripheral blood stem cells)
• umbilical cord

Question 3

what do 90% of transplant patients have?

Answer 3

hematologic malignancy (leukemia, lymphoma, myeloma)

Question 4

autologous transplant means what?

Answer 4

pt receives OWN stem cells.

Question 5

allogeneic transplant means what?

Answer 5

donor is sib or stranger.

Question 6

generally, for stem cell disorders, what type of transplant do we do?

Answer 6

ALLOgeneic

Question 7

which type of transplnat is more freq done (Auto v Allo)?

Answer 7

Auto.

Question 8

what type of transplant would we do in multiple myeloma (allo or auto)?

Answer 8

stem cell dz, but would do AUTO. mortality with allo transplant is too high.

Question 9

what are the molecules that we are interested in typing prior to transplant?

Answer 9

HLA (histocompatibility) aka MHC I and II. (present antigen to T cells)

Question 10

how many parameters do we look at for matching? what is ideal?

Answer 10

we look at 6. ideal is to match all 6. still will see some rejection because we don’t look at everything.

Question 11

GVHD: what parts of the body does it affect?

Answer 11

skin, liver, GI tract

Question 12

what will we see with skin, liver, GI if GVHD?

Answer 12

skin: rash
liver: incr LFTs
GI: nausea, vom, diarr.

Question 13

Autologous: how long will pt generally be in hosp? rate of engraftment?

Answer 13

3 wks. relatively faster engraftment.

Question 14

Autologous: do we give immune suppression?

Answer 14

no

Question 15

Autologous: do we see GVHD?

Answer 15

no

Question 16

Autologous: do we see infections?

Answer 16

fewer than with allo.

Question 17

Autologous: how soon can pts go back to work?

Answer 17

3-5 months

Question 18

Allogeneic: source of transplant cells?

Answer 18

sib or stranger

Question 19

Allogeneic: how long will pt generally be in hosp? rate of engraftment?

Answer 19

4+ weeks, relatively slower engraftment

Question 20

Allogeneic: do we give immune suppression?

Answer 20

yes

Question 21

Allogeneic: do we see GVHD?

Answer 21

yes, high likelihood

Question 22

Allogeneic: incidence of infections?

Answer 22

high

Question 23

Allogeneic: how soon can pts go back to work?

Answer 23

9-12 months

Question 24

Similarities between Autologous and Allogeneic transplants?

Answer 24

• use blood or marrow cells

- high dose chemotherapy to kill marrow cells

Question 25

what is the biggest change in the heme field lately?

Answer 25

doing stem cell transplant upfront for high-risk patients (if they have a high-risk genetic translocation)

Question 26

advantages of PBSC collection vs marrow collection?

Answer 26

eliminates anesthesia, less discomfort, more rapid engraftment upon transplant

Question 27

if you are receiving your own cells, is blood or marrow better? what about if you are receiving cells from someone else?

Answer 27

self: blood (more T cells, blood count returns more quickly) other: marrow. (fewer T cells, less GVHD)

Question 28

what is the main role for cord blood transplant now?

Answer 28

kids who have acute leukemia and don't have another option for transplant. survival is 50% (better than 0%)

Question 29

what is the theory behind non-myeloablative (mini-allogeneic) stem cell transplant?

Answer 29

treat patient with low dose chemo. infuse donor cells. pt now has 2 lines of cells, and self cells are weak. donor cells hopefully take over.