Haem: Bone Marrow Transplantation Pt.2 Flashcards
List some complications of stem cell transplantation.
- Graft failure
- Infections
- GvHD
- Disease relapse
What is graft-versus-host-disease and what are the 2 types
When mature donor T cells within stem cell graft attack host cells
Two types:
* Acute: occurs within 100 days
* Chronic: occurs after 100 days
List some risk factors for graft-versus-host disease.
- Degree of HLA disparity
- Donor and receipent age
- Donor and recipient sex (male recipients with female donors have worse GvHD)
- Donor lymphocyte infusion
- Conditioning regimen type
- Stem cell source (PB>BM>UCB)
- Disease phase
- Viral infections
Which parts of the body are affected in acute graft-versus-host disease?
- Skin - painful rash and desquamation
- GI tract - abdominal pain and diarrhoea
- Liver - jaundice and hepatomegaly
Which parts of the body are affected in chronic graft-versus-host disease?
- Skin - sclerosis, ulcers, nail dystrophy
- Mucosal membranes - ulcer
- Lungs - bronchiolitis obliterans
- Liver - dysfunction and jaundice
- Dry eyes
- Polymyositits
List some treatment options for acute GvHD.
- Corticosteroids (mainstay)
- Calcineurin inhibitors: cyclosporin, tacrolismus
- Mycophenolate mofetil
- Monoclonal antibodies
- Photophoresis
- Total lymphoid irradiation
List some drugs used to prevent GvHD.
- Methotrexate
- Corticosteroids
- Calcineurin inhibitors
CsA + MTX or mycophenolate is the standard prevention regime
- T cell depletion - monoclonal antibodies
- Post-transplant cyclophosphamide
Which component of the transplanted cells is responsible for GvHD?
It is the mature lymphocytes within the cell population (i.e. not the stem cells) that are responsible for GvHD
Why can you not just remove mature lymphocytes from donor graft
These mature lymphocytes are important in preventing graft rejection, leukaemia relapse, an opportunistic infection
What is the prognosis of chronic GvHD
Can last up to 5 years with 85% of patients being able to discontinue treatment at that time
What are the 2 most common sources of infection in neutropenic patients
Gram positive infections: vascular access procedures and lines
Gram negative infections: GI tract
Management neutropenic spesis
Emergency
- Definition: temperature >38 sustained for 1 hour or single fever >39, in a patient with neutrophils <1 x10^9
- Investigations - Blood cultures, MSU, CXR
Emperical treatment
Broad spectrum antibiotics and supportive care
Role of CMV and transplantation
Nearly everyone is infected with CMV as a child but infection is latent
Reactivation occurs during immunocompromise - e.g. HSCT transplant
How can CMV disease manifest
- Pneumonitis
- Retinitis
- Colitis
- Encephalitis
How is CMV disease prevented and treated?
Monitoring: twice weekly blood PCR to detect viraemia
If detected, treatment is with ganciclovir/valganciclovir
