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Path Week 2 > Ha - Stem Cell Transplantation > Flashcards

Ha - Stem Cell Transplantation Flashcards

1
Q

when should transplants be given ideally

A

early on in disease

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2
Q

how can genetics be used to decide when to transplant

A

if someone has adverse genes, transplant them early

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3
Q

what needs to be matched in BM transplant

A

HLA
RBC group

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4
Q

what 2 physiological scenarios do 2 people swap immune cells

A

preg
blood transfusion

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5
Q

what 3 conditions are autologous transplants good for

A

AID - scleroderma / MS
acute leukaemia
solid tumour eg germ cell

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6
Q

describe autologous transplant process

A

growth factor to patient
collect stem cells and freeze
thaw and reinfuse
put into pt
give chemo

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7
Q

what is the benefit of autologous transplant

A

allows larger dose of chemo to be given that would normally have killed them

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8
Q

in what condition is autologous transplant curative

A

diffuse large b cell (high grade lymphoma)

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9
Q

why is autologous transplant done in myeloma /CLL

A

old people dont do well with GVHD

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10
Q

why is autologous transplant done in AID

A

not fatal but GVHD can be

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11
Q

what conditions is allogenic transplant done in

A

acute / chronic leukaemia
myeloma
lymphoma

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12
Q

mx process of allogenic transplant

A

treat to remission
get donor
give pt myeloablative treatment
infuse stem cells
continue immune suppression

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13
Q

what mx is done post allogenic transplant and why

A

lifelong immune suppression
prevent GVHD

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14
Q

where are stem cells obtained from

A

BM biopsy
peripheral blood if given PCSF to make SC go peripherally
umbilical cord

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15
Q

how many CD34+ cells are needed for adult BM transplant

A

2x10^6 /kg

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16
Q

complications of allogenic transplant

A

graft failure
infections
GVHD
relapse

17
Q

what is the cut off for acute vs chronic GVHD

A

100 days

18
Q

what organs does acute GVHD affect

A

skin, GIT, liver

19
Q

what organs does chronic GVHD affecr

A

skin, mucous membranes, lungs, liver, eyes, joints

20
Q

how is GVHD graded and what do they mean

A

1 to 4
1= not bad, 4 = fatal

21
Q

risk factors of GVHD

A

HLA disparity
recipient age
conditioning regime
R/D gender combination
stem cell source
disease phase - worse later
viral infections

22
Q

Tx of acute GVHD

A

corticosteroids
calcineurin inhibitors
mycophenylate mofetil
monoclonal ABs
photophoresis
total lymphoid irridation
mesenchymal stromal cells

23
Q

how is acute GVHD prevented

A

methotrexate
corticosteroids
calcineurin inhibitors
T cell depletion
cyclophosphadime

24
Q

what is chronic GVHD

A

end organ dysfunction with immune dysregulation

25
Q

when does chronic GVHD appear / go away

A

appears within 6 months
lasts 2-5 years

26
Q

risk factors of chronic GVHD

A

acute GVHD
general GVHD risk factors - eg age, disease, mismatching

27
Q

why is infection in the first few weeks post transplant the worst

A

low neutrophils

28
Q

when do you get HSV infection post transplant

A

immediately

29
Q

when do you get CMV infection post transplant

A

30-100 days later

30
Q

when do you get EBV infection post transplant

A

1 year later

31
Q

why is fungal infection post transplant such bad news

A

poor treatment for it
low monocytes to fight off fungus

32
Q

how do gram + / - bacteria get into a person with a transplant

A

+ = central line
- = GIT

33
Q

which bacteria type kills in transplant pts

A

gram -

34
Q

preventative measures for bacterial infection post transplant

A

isolation
avoid uncooked food
broad spec ABx

35
Q

define neutropenic sepsis

A

temp >38 degrees for 1hr
or
1 off temp of >39
when neutrophils <1x10^9/L

36
Q

Tx for neutropenic sepsis

A

broad spec ABx IV immediately

37
Q

where does fungus come from in transplant patients

A

catheter, mucosa, sinuses

38
Q

manifestations of CMV reactivation in transplant pts

A

pnuemonitis
retinitis
encephalitis
gastritis

Path Week 2 (18 decks)

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