Glossary Terms

Question 1

remission

Answer 1

5% or fewer blasts in the bone marrow post treatment

Question 2

treatment failure

Answer 2

failure to maintain remission after induction and consolidation within 6 months of diagnosis

Question 3

mini or non-myeloablative or reduced intensity transplant (RIC)

Answer 3

reduced intensity chemotherapy that decrease treatment toxicity to allow Allogeneic transplant with older patients or patients with substantial co-morbidities

Question 4

engraftment

Answer 4

the evidence of counts (CBC) post PSCT or BMT

Question 5

cytotoxic

Answer 5

a drug that is toxic to all fast dividing cells

Question 6

preconditioning

Answer 6

chemotherapy and radiation prior to peripheral stem cell (PSCT) or bone marrow transplantation (BMT)

Question 7

re-induction

Answer 7

repeat of induction chemotherapy if blasts are 25% or less after initial induction cycle

Question 8

mismatch

Answer 8

where < 10 tested HLA markers do not match.
A 10/10 is a “perfect” match.
Anything less, eg. 9/10 or 8/10 is a mismatch.
One can predict substantial greater risk of GVHD with a mismatch transplant

Question 9

count recovery

Answer 9

the return of counts (CBC) post chemotherapy

Question 10

salvage

Answer 10

chemotherapy given for induction failure that are 25% or greater blasts post induction

Question 11

chemotherapy

Answer 11

drugs used in the treatment of cancer and some autoimmune disorders

Question 12

VUD/MUD

Answer 12

volunteer unrelated donor/matched unrelated donor - a volunteer matched donor unrelated to the patient

Question 13

Induction

Answer 13

initial round of chemotherapy upon new diagnosis

Question 14

induction failure

Answer 14

failure to achieve remission (5% blasts or less) post induction

Question 15

relapse

Answer 15

disease returns 6 months or greater post initial treatment

Question 16

consolidation

Answer 16

subsequent rounds of chemotherapy once remission is achieved with Induction

Question 17

ANC

Answer 17

absolute neutrophil count = polys + bands (0.5 or < indicates neutropenia)

Question 18

Hematopoiesis

Answer 18

the process of producing and developing blood cells = production and development of blood cells

blood formation:
- primary at bone marrow
- at spleen and liver

Question 19

Stem cell

Answer 19

pluripotent stem cell - embryonic cell that can form different types of cells

primitive cells that are capable of self renewal and when stimulated give rise to any one of the committed cells

their proliferation can be stimulated by CSF (colony stimulating factors) or cytokines

Question 20

Erythrocytes (RBC)

Answer 20

• biconcave disk, composed of membrane, water, electrolytes, enzymes and hemoglobin
• primary function of Hgb: transport O2 to the tissue and return of CO2 from the tissue to lungs
• response to GHE (glycoprotein hormone erythropoietin) produced by kidneys

Hgb lab value:
M - 135-170 g/L
F - 120-155 g/L

***Critical value: <70 g/L usually requires transfusion (case based threshold)

Life span: ~120 days

BMT knowledge
- schistocyte - abnormal finding indicating breakdown of RBCs due to CSA
- SpO2 monitoring is required for pt with SOB/difficult breathing
- urine tests (Hemastix) once a day for potential hemorrhagic cystitis
- monitor closely and transfuse as required for pt who is actively bleeding

Question 21

Thrombocytes (platelets)

Answer 21

• cell fragments derived from megakaryocyte
• 1/3 are stored in spleen and released slowly when needed
• release SEROTONIN causing the smooth muscles of the vessel walls to constrict thereby reducing blood flow

Lab value: 150-400 x 10^9/L

***Critical value: < 10 requires transfusion

threshold can be increased if:
1. Temp>38C in the preceding 24hrs
2. fresh minor bleeding (petechiae/gums/sclera)
3. major bleeding (GI/CNS)
4. invasive procedure (LPs/HL insertion)
LP: >50 HL: >30
5. APL, DIC and other coagulation abnormalities

TMS PPO must be written prior to requesting platelet from TMS

Question 22

Proliferation

Answer 22

the division of cells to form two daughter cells

Question 23

Differentiation

Answer 23

the process of acquiring the specific functions and characteristics of the different types of blood cells

Question 24

Maturation

Answer 24

the process of developing into a fully functional active cell

Question 25

Etiology of Leukemia

Answer 25

1. high dose radiation exposure 2. alkylating agents i.e. cyclophosphamide, chlorambucil 3. chronic benzene exposure 4. some correlation with Down's Syndrome 5. unknown environment exposures

Question 26

Common Signs and Symptoms of Leukemia

Answer 26

1. persistent infection 2. easy bruising/bleeding 3. SOBOE, lack of energy 4. fever 5. night sweats

Question 27

Single donor platelets

Answer 27

higher concentration (~ = 7-8 units of concentrate) on first come first served basis to supplement the supply of standard platelets Reason to use: - when standard platelets are NOT a good therapeutic choice - normally reserved for pts who are actively bleeding - for pts with alloimmunization

Question 28

HLA matched platelets

Answer 28

Reason to use: - pts who developed alloimmunization to standard and single donor platelets - HLA antibodies present in pts' serum

Question 29

alloimmunization

Answer 29

the development of immunity to allogeneic antigens present on the cell wall of the platelets being transfused Indication: poor 15 minute to one hour post transfusion platelet count increment after a minimum of 2 unmatched transfusions

Question 30

Human Leukocyte Antigen

Answer 30

proteins on the cell surface in the body that play an important role in determining tissue compatibility

Question 31

Innate immunity

Answer 31

general, natural defense against non-self substances, present at all times and triggered as soon as foreign agent present 7 main protective mechanism ( NO PREVIOUS EXPOSURE) 1. intact skin - prevent attachment of potential invaders 2. mucous - traps bacteria and other foreign material (using enzyme) 3. gastric acid - destroy swallowed invaders (using PH) 4. antimicrobial substances *interferon - inhibits viral replication and activates macrophages * complement proteins - promotes bacterial lysing and signals to phagocytes to remove cells 5. fever - pathological response of IL-1 (interleukin-1) produced by macrophages after ingestion, intensify action of interferon 6. natural killer cells - destroy microbes and certain tumor cells via direct contact 7. inflammatory response - mobilizes leukocytes to phagocytose invaders

Question 32

Adaptive immunity

Answer 32

the response of lymphocytes to foreign agents and develop immunological memory CELL-MEDIATED RESPONSE: (T cells involvement) 1. Memory cells - recognize antigen and trigger 2nd immune response 2. Lymphokine-producing cells - activate macrophages 3. Cytotoxic T cells (killer T cells) - directly attack antigen 4. Helper T cells 5. Suppressor T cells - induce or suppress various functions of the immune system HUMORAL RESPONSE: (B cells involvement) 1. Helper T cells - activated by IL-1 released by macrophages after destroying an antigen and produced IL-2 2. Interferon and other chemicals are activated by same 3. B cells - activated by all chemicals and mature into plasma cells to produce antibodies to eliminate the antigen

Question 33

Leukocytes (WBCs)

Answer 33

5 times of leukocytes, classified morphologically into granulocytes and agranulocytes

Question 34

Granulocytes

Answer 34

- from myeloid line - contain toxic granules that is capable of killing invaders - called polymorphonuclear (PMN's) granulocytes or "Polys" 1. Neutrophils (no stain) 2. Eosinophils (eosin = red dye) 3. Basophils (deep blue dye)

Question 35

Neutrophils

Answer 35

- 60% of WBC - first defence - finds a foreign particle and phagocytize it releasing enzymes and other chemicals to kill it - immature neutrophils (band/stab cells) are released by bone marrow when there is great demand for neutrophils Lab values: Leukocytes/WBC --> 4.0-11.0 x 10^9/L neutrophils --> 2.0-8.0 x 10^9/L Life span: ~ 10-12 hrs BMT knowledge: - first cell to recover after BMT and seen as polys and band cells in CBC/Diff - ANC (polys + band cells) <=0.5 indicating neutropenia **pt with neutropenia are very susceptible to infections till ANC is > 0.5

Question 36

Eosinophils

Answer 36

- 2-4% of WBC - defence for the skin and lungs during ALLERGIC reactions and parasitic infections

Question 37

Basophils

Answer 37

- <1% WBC - contain histamine partly responsible for inflammatory reactions to allergies - contribute to hypersensitivity reactions

Question 38

Agranulocytes

Answer 38

- no granules within cytoplasm 1. Monocytes (from MYELOID COMMITTED CELL LINE) 2. Lymphocytes (from LYMPHOID COMITTED CELL LINE)

Question 39

Monocytes

Answer 39

- from myeloid committed cell line - 6% of WBC - 2nd defence - largest cell in the blood - becomes macrophage when entering tissues - remove injured and dead cells, cell fragments and micro-organisms via phagocytosis Life span: ~ weeks to months

Question 40

Lymphocytes

Answer 40

- 30% WBC - work horses of the immune system - from lymphoid committed cell line 1. T lymphocytes 2. B lymphocytes 3. Null cells

Question 41

T Lymphocytes

Answer 41

- mature in thymus gland - provide cellular immunity 5 Major functions: 1. protection against viruses and fungi 2. rejection of transplanted organ (cells) 3. immunological surveillance against cancer cells 4. mediation of cutaneous delayed hypersensitivity 5. modulation of the overall immune response with helper or suppressor cells

Question 42

B lymphocytes

Answer 42

- mature and stay in marrow - circulate between the spleen and lymph nodes - can differentiate into: 1. antibody secreting plasma cells 2. memory B cells

Question 43

Blood plasma

Answer 43

cells that differentiate from B cells and secrete large amounts of antibodies 5 classes of antibodies (immunoglobulins and gammaglobulins) IgA, IgD, IgE, IgG, IgM

Question 44

GCSF

Answer 44

granulocyte colony stimulating factors to increase neutrophils (a type of granulocyte)