Stem Cell Transplant

Question 1

What is stem cell transplant

Answer 1

Killing individual bone marrow by chemo and radiotherapy and replacing with another

Question 2

First bone marrow transplant date

Answer 2

1939

Question 3

First success

Answer 3

1968

Child with combined immunodeficiency

Question 4

Malignant heam ex

Answer 4

AML
ALL
CLL
Myeolodysplastic syndrome 
Hodgkin lymphoma 
NHLs
Myelofibrosis

Question 5

Non malignant heam dx

Answer 5

Aplastic anemia 
Fanconi anemia 
Thalassemia
Sickle cell anemia 
Congenital pure red cell aplasia 
Paroxysmal hemoglobinuria
Severe combine immunodeficiency 
Wiskott Aldrich syndrome

Question 6

Malignancies requiring transplant

Answer 6

Neuroblastoma
Breast ca
Lung ca \
brain ca

Question 7

Sources of hematopoietic

Answer 7

Marrow
Peripheral blood
Umbilical cord

Question 8

Dose required for stable long term engraftment

Answer 8

2x10^8

Question 9

Phénotype of stem cells

Answer 9

CD34+

CD38-

Question 10

Treatment done in transplant to mobilize

Answer 10

G-CSF treatment
GM-CSF
IL3
TPO

Question 11

Conditioning Purpose of transplant

Answer 11

Eradicate underlying disease

Provide sufficient immunosuppressive for administration of graft without rejection

Question 12

Conditioning of radiation based transplant

Answer 12

Fractionated radiation

Fractionated TBI + cyclophosphamide

Fractionated TBI + etoposide

Fractionated TBI + etoposide + cyclophosphamide

Question 13

Donor characteristics in transplant

Answer 13

Good health
Good performance status for safe collection of cells
Normal cardiac, pulmonary , hepatic and renal functions

Question 14

Level of hematopoietic stem cell in peripheral blood

Answer 14

Low

Question 15

Treatment done to mobilize stem cell in circulation

Answer 15

G-CSF
GM CSF
IL3
Thrombopoietin

Question 16

Name of the machine That helps collect stem cells from the blood

Answer 16

Leukophoresis machine

Question 17

What are some non-radiation based regiments before transplant

Answer 17

Oral busulphan (16mg/kg for 4 days )
Cyclophosphamide 120mg/kg for 2 days
Etoposide + busulphan
Carmustine + etoposide + Ara C + melpphalan when lymphomas
Cisplatin + carboplatin when breast cancer or ovarian cancer

Question 18

Types of Transplantation

Answer 18

Autologous
Allogeneic
syngeneic

Question 19

What is a allogeneic bone marrow transplant

Answer 19

grafting of Bone marrow from a donor into a recipient of the same species

Question 20

Types of donor in allogenic bone marrow

Answer 20

HLA compatible sibling
Partially matched family members
Closely matched unrelated volunteer donros

Question 21

How long does it take for transplanted marrow to regenerate

Answer 21

2 to 4 weeks

Question 22

How do you protect patient from infection

Answer 22

Isolation

Broad spectrum antibiotics

Question 23

How long does it take to granulocyte to go back to 0.5x10^9

Answer 23

20 days

Question 24

Requirements for discharge of patient after graft

Answer 24

0.5x10^9/l count or more granulocyte

Adequate oral nutrition

Question 25

Do patients require blood transfusion , red cell and platelets during aplasia following marrow grafting

Answer 25

Yes

Question 26

Main complication of graft

Answer 26

``` Oral mucositis Gastroenteritis Impaired cellular immunity HSV Bacterial fungal infection Neurological disorder Cataracts Endocrine disorders Recurrent dx, malignancies ```

Question 27

When does acute graft versus host disease manifest

Answer 27

About 90 days after marrow transplantation

Question 28

Presentation of acute graft versus host disease

Answer 28

Skin - Mild maculopapular rash or generalized erythroderma and bullae formation with desquamation Gut- anorexia ,nausea ,vomiting ,abdominal cramping pain Liver - Hyperbilirubinemia, Transaminase and alkaline phosphatase high

Question 29

Grades of graft versus host disease

Answer 29

Stage I stage II stage III stage IV

Question 30

Stage one graft versus host disease manifestation

Answer 30

Maculopapular rash less than 25% body surface 34 to 51 µmol liver bilirubin diarrhea with 500 to 1000 mL per day loss or persistent nausea

Question 31

Stage two acute graft versus host disease manifestation

Answer 31

Maculopapular rash 25 to 50% body surface 51 to 102 µmol liver bilirubin diarrhea 1000 to 1500 mL per day loss

Question 32

Stage three acute graft versus host disease manifestation

Answer 32

Generalized erythroderma 102- 255 µmol liver bilirubin diarrhea more than 1500 mL per day

Question 33

Stage four acute graft versus host disease manifestation

Answer 33

Desquamation and bullae more than 255 µmol liver bilirubin diarrhea more than 1500 mL per day pain without ileus

Question 34

Pathogenesis of graft versus host disease

Answer 34

Donor T cells activated by antigen recognition on host tissue Activated T cell proliferate and differentiates and produce cytokines promoting inflammatory response tissue damage and necrosis

Question 35

Percentage of people that will develop chronic graft versus host disease after 100 days of allogeneic bone marrow Transplant

Answer 35

30 to 40%

Question 36

Signs of chronic graft versus host disease

Answer 36

``` Debilitating skin disease oral mucositis Dry eyes chronic liver disease Weight loss neurologic disorders susceptibility to bacterial infection Obstructive liver disease ```

Question 37

Treatment of chronic graft versus host

Answer 37

``` Anti-thymocyte Globulin Glucocorticoids Irradiation Cyclophosphamide Cyclosporine Azathioprine thalidomide Prednisolone Prednisolone and azthorprine ```

Question 38

What is autologous marrow transplant

Answer 38

Own patient marrow cell transplanted

Question 39

Is there gvhd in autologous

Answer 39

No

Question 40

Is pre transplant immunosupression required in autologous

Answer 40

No

Question 41

Medication care of autologous

Answer 41

``` Thiotepa Melphalan Etoposide Cytosine arabinoside 6 thioguanine ```

Question 42

Supportive care of autologous

Answer 42

``` Blood component Antibiotics Parentéral nutrition Protective isolation Growth factors ```