Bmt

Front 1

HCT is the transfer of _____ and ____ for therapeutic purpose

Back 1

hematopoietic progenitor

and

Stem cells

Front 2

What is a syngeneic transplant and is it auto or allo

Back 2

transplant from identical twin

Treate like auto, but is officially Allo

Front 3

4 Steps in Auto HCT

Back 3

1. Regular Chemo to kill cancer
   
2. BM harvest
   
3. HD chemo - kills residual disease and BM
   
4. BM cells given back
   

Front 4

Which pt should get auto transplant

Back 4

Left; no benefit from HD chemo so no need for auto

Front 5

*When is AutoHCT indicated

Back 5

When Cytoreduction is effective (via chemo) like:

1. Germ cell tumors
   
2. Large cell lymphoma
   
3. Myeloma
   

1. Rescue therapy
   

Front 6

Steps in Allo

Back 6

Chemo to kill cancer

HD chemo

Donor cells added

Wait

Front 7

*Indications for allo

Back 7

Replacement of hematopoiesis

Graft vs Tumor effect

Prevent Relapse

Front 8

What is an allo transplant really:

Back 8

A bet against the future; must decide after being told they are disease free to do allo transplant to prevent relapse (35% vs 5% for allo vs no BMT)

Front 9

T/F NPM1+ it is best to do allo transplant as 1st line therapy

Back 9

F

Front 10

MUD = what type of transplant

Back 10

Matched unrelated donor; Allo

Front 11

T/F is is best to do MUD transplant in relapsed pts with unfavorable genotype

Back 11

T

Front 12

What are the 2 immunological effects of allogeneic grafts

Back 12

GVHD

GV tumor

Front 13

6 Steps in reduced intensity AlloBMT

Back 13

1. Chemo to kill cancer
   
2. Immunosupression - just enough to accept donor
   
3. Add donor cells
   
4. Wait
   
5. Chimera forms (both donor and host cells)
   
6. Donor takes over
   

Front 14

T/F All auto are myeloablative

Back 14

T

Front 15

What cell type does Bu, Mel and TBI destroy

Back 15

HSC

Front 16

What cell type does Fludarabine destroy

Back 16

CLP

Front 17

What cell type does Cyclophosphamide destroy

Back 17

CLP

CMP

Front 18

T/F Giving HD of cells --> increased survival

Back 18

T

Front 19

What is responsible for GVHD and Graft Rejection

Back 19

MHC (HLA)

Front 20

*Chance of matched sibling =

Back 20

1 - (3/4)^# of siblings

Front 21

Billingham criteria *

Back 21

1. Graft must have immunocompetant cells
   
2. Host must be (Ag) different than Donor so it can stimulate donor cells
   
3. Host must not be able to mount response against Donor
   

Front 22

What is acute GVHD

Back 22

Rxn between Donor cells against Host cells

20-50% develop it

Front 23

What can be given prophylactically to prevent Acute GVHD (3)

Back 23

1. Calcineurin inhibitor and Methotrexate
   
2. T cell depletion
   
3. Post transplant Cyclophosphamide
   

Front 24

How does cyclophosphamide, post-graft, protect against GVHD

Back 24

T t cells that react against host start to proliferate and Cy attacks those cells keeping GVHD at bay

Front 25

How does billingham's hypothesis explain how post-transplant cyclophos prevents acute GVHD

Back 25

Billingham's criteria state that the donor cells must be reactive against host. As these cells start to proliferate after activation of reactive cells, cy is able to target the rapidly expaning cells, keeping GVHD at bay

Front 26

What is the major cause of log term mortality other than relapse

Back 26

cGVHD