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23 Cards in this Set
- Front
- Back
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Common "Curable" Malignancies
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Hodgkin's Disease
NHL Several subgroups of leukemia |
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Three Keys to Stem Cell Transplants
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1. Kill the tumor
2. Immunosuppress the Patient 3. Give them an adequate dose of new stem cells |
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What is the Stem Cell surface marker?
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CD34+
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Which seems to be all around better, BM stem cell transplant or peripheral blood stem cell transplants?
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Peripheral Blood on just about every level
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Autologous Transplant Complicatiosn
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N&V&D
Pancytopenia (fever/sepis and may need transfusions for RBC's and Platetlets) |
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Diseases Autologous SCT can be used for:
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1. AML (more or less standard)
2. HD (resistant or relapsed) 3. NHL (mostly relapsed) 4. MM (standard) |
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2 Disadvantages to Syngeneic Transplant
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1. Higher Relapse Rate
2. No immunologic attack on tumor cells |
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Where can allogeneic SC's come from?
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1. HLA-matched sibling
2. Matched unrelated donor (MUD) 3. Haplo-identical donor (sibling, child, parent) usually deplete T-cells in graft which reduces effect on tumor and leads to longer reconstituion |
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New things you can treat with Allogeniec Transplant
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Nonmalignant hematologic and autoimmune disorders:
1. aplastic anemia 2. Hemoglobinopathies, e.g. thalassemia 3. PNH 4. autoimmune disorders |
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Complications with AlloSCT
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N&V
mucositis depressed immunity --> infection GVHD |
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what is the mortality that comes along with a AlloSCT?
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10-30%
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Pathogenesis of GVHD?
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Donor T-cells attach host tissues.
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When does GVHD usually occur?
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within 3 months
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target organs?
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skin, gut, liver, less often lungs, eyes, neuromuscular
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GVHD Prevention
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Corticosteroids
Anithymocyte globulin Cyclosporine(tacrolimus) |
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2 ways to suppress relapses
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1. give donor lymphocytes after transplant
2. if patient develops some degree of GVHD |
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2 deals that increase risk of relapse
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1. syngeneic transplant
2. T-cell depleted grafts |
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Delayed Effects post-transplant
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1. Chronic GVHD (looks like scleroderma or sjorgen's)
2. Amenorrhea: loss of fertility in women AND men 3. hypothyroidism 4. impaired G&D in kids 5. increased secondary malignancies 6. Psychiatric issues |
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AlloSCT's and Leukemias
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1. Poor prognosis
2. 2nd remission after relapse 3. Acute Leukemia of mixed lineage 4. Philadelphia chromosome 5. Secondary Leukimia or Refr. anemia with excess blasts |
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Mortality of aplastic anemia w/ only supportive care
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50% in 6 months
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Aplastic Anemia Rx
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Immunosuppressive therapy or AlloSCT
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What is up with Nonmyeloablative Transplants?
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For folks who can't take high dose chemo. You give pt enough chemo and maybe radiation to hopefully allow engraftment.
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who is cord blood transplants especially useful for?
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kids
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