Stem cell transplantation

Question 1

What is stem cell transplantation

Answer 1

Eliminating an individuals heam and immune system by chemo or radiotherapy and replacing it with stem cells from another individual or with previously harvested stem cells

Question 2

Non malignant haem dx

Answer 2

Aplastic anemia
fanconi anemia
Thallasemia
SSD
Congenital pure red cell aplasia
Paraxosymal haemoglobinuria
Severe combined immunodeficiency
Wiskott aldrich syndrome
Glanzmanns thrombastenia
hereditary storage disorders
osteoporosis
Conenital leukocyte dysfunction syndromes

Question 3

requirements of transplant donors

Answer 3

Good health

Have good performance status that will permit safe collection of cells from marrow or blood

Normal cardiac, pulmonary, hepatic, renal fxns

Question 4

Sources of hematopoietic stem cells

Answer 4

Marrow,
Peripheral blood
Umbilical cord blood

Question 5

Stem cell dose for stable long term engraftment

Answer 5

2*10^8 nuclear cells per kg of recipient body weight

Question 6

Phenotype of stem cells should be

Answer 6

CD34+ AND CD38+

Question 7

What is mobilisation

Answer 7

A process in which certain drugs are used to cause movement of stem cells from bone marrow into blood because hematopoietic stem cells circulate in the peripheral blood at extremely low levels

Question 8

Drugs used in mobilisation

Answer 8

G-CSF
GM-CSF
IL3
Thrombopoietin

Question 9

After mobilisation is

Answer 9

APheresis

where a technology seperates blood passed through where it takes out one particular component i.e stem cells and returns the rest to circulation

Question 10

What can be used in combo with CSF

Answer 10

c-kit

Question 11

What is conditioning

Answer 11

A process to eradicate underlying dx and to provide sufficient immunosuppression to allow for the administration of the graft without host rejection

Question 12

Types of conditioning

Answer 12

Radiation based

non radiation based

Question 13

Radiation based conditioning

Answer 13

use of radiation

Fractionated TBI+ CYCLOPHOSPHAMIDE
Fractionated TBI= ETOPOSIDE

Best result is Fractionated TBI+ CYCLOPHOSPHAMIDE=ETOPOSIDE

Question 14

Non radiation based regimens

Answer 14

Oral busulphan 4 days, 16mg/kg
cyclophosphamide 2days, 120mg/kg
Etoposide+Busulphan
SCarmusitine+Etoposide+Ara C +Melphanan
Cisplatin+ Carboplatin;

Question 15

Non radiation regimen with best result

Answer 15

Etoposide+ Busulphan

Question 16

This non radiation regimen is used in lymphomas

Answer 16

Carmusitine+ Etoposide+ Ara C +Melphanan

Question 17

Types of transplantation

Answer 17

Autologous
Allogenic
Syngernic

Question 18

Allogeneic bone marrow transplant

Answer 18

Grafting of marrow from a donor into recipient of same sp

Question 19

Examples of allogenic donors

Answer 19

HLA compatible siblings
Partially matched family members
Closely matched volunteer donors

Question 20

What to do and expect immediately after post grafting

Answer 20

After high dose chemotheraoy- neausea and vomiting

Intravenous hyperalimentation must be administered to maintain caloric balance

Question 21

How long does it take transplanted marrow to regenerate

Answer 21

3-4 wks

Question 22

Precautions for patient after transplantation

Answer 22

Protected from infection by isolation or broad spectrum antibiotics till they have a have a platelet count of 0.5*10^9 or more granulocytes

Question 23

Mean time for granulocyte count to return to 0.5*10^9/l

Answer 23

20 days

with platelet and RBC lagging a few steps behind

Question 24

Post transplant supportive care

Answer 24

blood transfusion

red cells and platelets following aplasia after marrow grafting

Question 25

Patients can develop these post transplant

Answer 25

oral mucositis | gastroenteritis

Question 26

What happens secondary to chemotherapy and total body irradiation

Answer 26

decrease in caloric intake | decrease in intestinal absorption

Question 27

How to manage the patient post chemo

Answer 27

parenteral nutrition | GM-csf

Question 28

Complication of allogenic bone transplant

Answer 28

Patients are immunocompromised with breakdown of skin and mucosal barriers Decreased immunoglobulin production Bacterial, fungal, HSV can easily cause infection

Question 29

Other complications of Allogeneic transplant

Answer 29

Neurological disorder cataracts endocrine disorders recurrent dx and other malignancies

Question 30

Treatment of Complications of allogeneic transplantation

Answer 30

Antibiotics for GI decontamination Keep rooms with high efficiency particulate air filters Give low dose amphotericin B to prevent fungal infection Give broad spectrum antibiotics

Question 31

What is acute graft vs host dx

Answer 31

Occurs 90 days after marrow transplant affecting skin, GIT, liver

Question 32

How is skin affected in GVHD

Answer 32

Maculopapular rash generalised erythrodema bullae formation Desquamation

Question 33

How gut is affected in GVHD

Answer 33

``` Anorexia Nausea vomiting diarrhea abdominal crampa ```

Question 34

pathophysiology GVHD

Answer 34

Donor T cells are activated by recognition of antigens on host tissues The activated T cells proliferate and differentiate They proliferate and produce cytokines that promote inflammatory response leading to tissue damage and necrosis

Question 35

What is chronic GVHD

Answer 35

A major complication of allogenic BMT occurring in 30-40% of patients that suffer more than 100 days

Question 36

Signs of chronic GVHD

Answer 36

``` Debilitating dx oral mucosistis dry eyes chronic liver dx weight loss neurologic disorders increasing succeptibility to bacteria severe obstruction liver dx ```

Question 37

Treatment of chronic GVHD

Answer 37

``` Antithymocyte globulin Glucocorticoids Irradiation Cyclophosphamide Cyclosporine Azathioprine Thalidomide Prednisolone Prednisolone and azathioprine ```

Question 38

Autologous marrow transplant

Answer 38

The patients own hematopoietic stem cells are used No HLA matching, no GVHD, no immunosuppression

Question 39

Four principal phases of autologous bone marrow transplantation

Answer 39

Stem cell collection, purge, storage Autologous bone marrow transplant Discharge Recovery

Question 40

Supportive care- autologous

Answer 40

``` blood components antibiotics parenteral nutrition protective isolation growth factors ```

Question 41

How is autologous grafting done

Answer 41

AT time of grafting, the marrow or peripheral blood is rapidly thawed at patients bedside and infused via IV without further processing

Question 42

Complications- Autologous process

Answer 42

``` nausea abdominal cramps coughing flushing hypertension ```

Question 43

To prevent renal toxicity from cell lysis in BM

Answer 43

Adequate hydration | brisk diuresis