Bmt Therapeutics Test 3

Front 1

what are the types of BMT

Back 1

autologous
syngeneic
allogeneic

Front 2

what are the types of allogeneic BMT

Back 2

HLA matched sibling
HLA matched unrelated donor (MUD)
HLA mismatched related donor

Front 3

what are syngeneic BMT

Back 3

from identical twin

Front 4

what are the sources of stem cells

Back 4

peripheral blood
bone marrow
chord blood

Front 5

with HLA matching the degree of mismatch correlates with risk of

Back 5

graft failure
GVHD
survival

Front 6

what are the methods for collection of stem cells

Back 6

apheresis
bone marrow harvesting

Front 7

what is apheresis

Back 7

mobilization of bone marrows into peripheral blood

this is done with growth factors (G-CSF, GM-CSF)

Front 8

what are the advantages of peripheral blood stem cells

Back 8

decrease time to engraftment
decrease cost
decrease contamination with malignant cells

Front 9

what are the disadvantages of peripheral blood stem cells

Back 9

higher T cell number
increase incidence of GVHD
autologous patients unable to mobilize

Front 10

what are the advantages of bone marrow stem cells

Back 10

one procedure (harvest)
decrease risk of chronic GVHD

Front 11

what are the disadvantages of Bone Marrow stem cells

Back 11

increase time of engraftment
pain/soreness with procedure
risk of general anesthesia

Front 12

what are the advantages of core blood stem cells

Back 12

more rapid availability compared to MUD donor
higher degree of HLA mismatch acceptable
decrease GVHD

Front 13

what are the disadvantages of cord blood stem cells

Back 13

deficient in T cells
slower engraftment
increase risk of graft failure
low cell count (in adults)

Front 14

what are the preparative regimens

Back 14

meyloablative
reduced intensity

Front 15

what is done in the myeloablative regimen

Back 15

high doses of chemo used to destroy malignant cells
immunosuppression to allow engraftment of donor blood stem cells
infusion of stem cells required to restore hematopoiesis

Front 16

what is the rationale for reduced intesity

Back 16

in allogenic stem cell transplant Graft vs Leukemia causes the most antitumor activity

immunosuppressive to prevent rejection and allow engraftment of donor stem cells and development of GVL

Front 17

when is GVL seen

Back 17

after development of full donor T cell chimerism

Front 18

what are the disadvantages of Reduced intensity conditioning regimens

Back 18

increase risk for no engrafment
increase risk of relapse

Front 19

what are the transplant related complications

Back 19

GVHD
graft rejection
infection
relapse

Front 20

what are the regimen related toxicities

Back 20

mucositis
diarrhea
Sinusoidal obstruction syndrome (SOS)
hemorrhagic cystitis
pulmonary complications
N/V

Front 21

what is done to manage mucositis

Back 21

liquid diet
nutritional supplements
pain mgmt
oral meds > liquid/IV
prophylaxis

Front 22

what is done in mucositis prophylaxis

Back 22

oral cryotherapy (5FU, melphalan)
oral rinses (chlorhexidine)
caphosol (calcium phosphate rinse)
palifermin

Front 23

what is the MOA of palifermin

Back 23

cell proliferation and increase epithelial thickness

Front 24

how is palifermin dosed

Back 24

3 doses before and 3 doses after chemotherapy for a total of 6 doses

do not administer 24 hrs before, during, or within 24 hrs after chemo

Front 25

what occurs in Sinusoidal Obstruction Syndrome

Back 25

toxic injury to the liver as a result of high dose of chemo

Front 26

what are the triad of symptoms of SOS

Back 26

painful hepatomegal
ascites
jaundice
weight gain (>5% baseline)

Front 27

what are the supportive care options for SOS

Back 27

low dose dopamine
spironolactone (for ascites)
remove hepatotoxic drugs

Front 28

what drugs are used to treat SOS

Back 28

TPA
Defibrotide - no significant anticoagulant effects (adv over TPA)

Front 29

what can be used to prevent SOS

Back 29

heparin
prostaglandin E1
pentoxifyline

Front 30

how do you prevent hemorrhagic cystis and treatment

Back 30

prevention:
hydration
mesna (is due to cyclophosphamide or ifosfamide)

treatment:
hydration
bowel irrigcation
cystoscopy with clot evacuation
electrical cauterization

Front 31

what are the pulmonary complications

Back 31

diffuse alveolar hemorrhage
engraftment syndrome
idiopathic pneumonia syndrome

Front 32

how do you treat diffuse alveolar hemorrhage (DAH)

Back 32

high dose sterioids are primary form of treatment

Front 33

what drugs are used in the treatment of CMV

Back 33

ganciclovir
valganciclovir
foscarnet

Front 34

if a pt developed neutropenia while on ganciclovir what do you do

Back 34

switch to foscarnet

Front 35

what are the primary target organs in acute GVHD

Back 35

skin - maculopapular rash
liver - increased LFTs
gut - diarrhea/N/V

Front 36

what are the target organs in chronic GVHD

Back 36

skin - scleroderma like skin changes
mouth - mucositis
eyes - dryness
liver - chronic cholestatic liver disease
thrombocytopenia

Front 37

what is the most important risk factor of GVHD

Back 37

HLA antigenic differences

Front 38

what agents are most commonly used in GVHD prophylaxis

Back 38

methotrexate or corticosteroids and cyclosporine or tacrolimus

Front 39

what is used in the treatment of GVHD

Back 39

cyclosporin, tacrolimus, steroids (methylprednisolone, prednisone)
if steroid refractory GVHD
-ATG
-monoclonal antibodies