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69 Cards in this Set
- Front
- Back
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transplant from donor stem cells
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allogenic
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transplant from identical twin
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syngeneic
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transplant from self
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autologous
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SCT source: BM vs PB-
engraftment time |
faster w/ PB
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SCT source: BM vs PB-
hospitalization |
less w/ PB
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SCT source: BM vs PB-
amount of stem cells collected |
more w/ PB
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SCT source: BM vs PB-
# T cells, monocytes, NK cells |
increased w/ PB
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SCT source: BM vs PB-
survival |
no difference
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harvest method for PB
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leukapheresis
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Autologous vs Allogenic-
relapse |
higher w/ autologous
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Autologous vs Allogenic-
GVHD |
higher w/ allogenic
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Advantages to umbilical cord blood:
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1) lower immunogenicity = decreased GVHD
2) decreased disease & genetic diseases 3) faster availability |
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Disadvantages to umbilical cord blood:
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1) low number stem cells
2) prolonged engraftment time |
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What type of transplant, conditioning regimen, and when for ALL
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Allo or NSTafter 2nd complete remission due to increased DFS. Conditioning regimen benefitted with TBI.
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What type of transplant and when?
Aplastic anemia |
Allo only
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What type of transplant and when?
CLL, CML |
Allo or NST
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What type of transplant and when?
Germ cell |
Auto only
for replased disease or induction failure |
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What type of transplant and when?
Mantle cell Multiple Myeloma NHL |
any type
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What type of transplant and when?
MDS |
Allo or NST
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more precise HLA typing=
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1) improved OS
2) decreased chronic & acute GVHD 3) improved rate engraftment |
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mobilization regimen for G-CSF alone
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10-16 mcg/kg/d on days 1-5 with leukapheresis on day 5
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signs of DMSO toxicity
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nausea, bradycardia, garlic-like odor from recipient x24hr
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definition of engraftment
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ANC>0.5x109/L and platelets >20x109/L (1st day of 3 consecutive days of this recovery)
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treatment of mucositis (2):
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1) saline mouthwashes (no chlorhexidine, magic mouthwash)
2) palifermin |
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yeast prophylaxis in allo
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fluconazole 400mg/d PO/IV day 0 to engraftment or 7 days after ANC >1000
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HSV prophylaxis
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acyclovir 200mg PO TID or 250mg/m2 IV Q12H from start of preparative regimen until engraftment or mucositis resolves
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VZV prophylaxis
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acyclovir 800mg BID or valacyclovir 500mg QD-BID
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PCP prophylaxis
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TMP/SMX DS QD TIW or TMP/SMX SS QD
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Diseases sensitive to GVM effects are: (4)
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CLL, low grade lymphoma, CML, mantle cell
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Diseases INsensivite to GVM effects are: (2)
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ALL, high grade lymphoma
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HSCT in AML- Autologous or allogeneic, when, and source?
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Allogeneic preferred. After CR1 in young, healthy patients with poor risk cytogenetics or after CR2 if suitable donor. PBSCT is recommended.
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plerixafor normal dose, max dose/day, and when to decrease dose
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normal= 0.24mg/kg/d SQ
max dose= 40mg/d decrease to 0.16mg/kg/d when CrCl<50 |
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plerixafor is only used in combination with
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G-CSF
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when should plerixafor be started?
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On day 4 following G-CSF
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What diseases can plerixafor be used in?
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NHL or MM
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Dose of cyclophosphamide used in mobilization?
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4g/m2, unless paclitaxel is also given, then 3g/m2
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Treatment of DLBCL after 1st relapse
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Salvage chemo w/ accepted regimen. If response after 2 cycles, can move to HD chemo and auto transplant. If no chemo responsive, no transplant.
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Purpose of non-myeloablative prep
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suppress host immunity
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When to do a tandem auto transplant in MM
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only when no response to initial treatment
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Preparative regimens containing fludarabine are
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Non-Myeloablative (NST)
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MTX effect on mucositis
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MTX can increase severity of mucositis
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Proper diagnosis of aGVHD in skin
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biopsy- look for lymphocytic infiltrates, eosinophil bodies
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Typical liver manifestation of aGVHD
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hyperbilirubinemia
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Typical diagnosis of aGVHD in gut
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look for "crypt cell degeneration" in gut biopsy
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aGVHD in lung manifestation
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BOOP- bronchiolitis obliterans w/ or w/o organizing pneumonia
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1st line treatment of aGVHD
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prednisone or MP 2mg/kg/d. May also consider CyA or tacrolimus if not in prophylactic regimen.
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2nd line treatment of aGVHD
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ATG most common, may also utilize mycophenolate or MABs
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typical dose of ATG (horse)
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10-15 mg/kg QOD x 7-14 days. Rabbit formula use 1/10th of dose.
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distinctive skin feature of cGVHD vs aGVHD
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depigmentation, lichen planus-like features
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typical organs affected by cGVHD and not seen with aGVHD
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nails, scalp, eyes, genitalia, muscles
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treatment of BOOP in lungs
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steroids
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typical 1st line treatment of cGVHD
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alternating day steroids (prednisone 1mg/kg QOD) with CyA (4-6 mg/kg Q12H)
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bioavailability of cyclosporine products
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cyclosporine modified emulsion (Neoral/Gengraf) has better bioavailability than cyclosporine. Changing formulations will affect blood levels.
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Toxicities of CyA or tacrolimus
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nephrotoxicity, hypertension, hypomagnesium, hyperkalemia, hyperglycemia
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Toxicities of sirolimus
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similar to CyA and tacrolimus, but thrombotic microangiopathy also
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Toxicity of MTX
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mucositis
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Toxicity of mycophenolate
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diarrhea
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tacrolimus dose adjustment based on
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increasing Scr= decrease dose
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tacrolimus blood level range
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5-20 ng/ml
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IV tacrolimus to PO tacrolimus adjustment
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1:3-4
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reduce MTX dose based on
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hepatic or renal dysfunction, severe mucositis, fluid retention
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antifungal prophylaxis post allogeneic STC
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fluconazole 400mg/d
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HSV prophylaxis post allogeneic STC
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acyclovir 200mg TID
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VZV prophylaxis post STC
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acyclovir 800mg BID or valacyclovir 500mg QD/BID
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PCP prophylaxis post allogeneic STC
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SMZ/TMP DS TIW or SMZ/TMP SS QD
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treatment of CMV infection drug and dose
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ganciclovir 5mg/kg IV q12h plug IVIG 500mg/kg IV QOD x 21d
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treatment of VZV infection
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acyclovir 10mg/kg IV q8h x 7-14 days
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treatment of PCP
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SMZ/TMP 20mg/kg/d IV in divided doses. If pt has sulfa allergy, pentamidine 4mg/kg IV QD
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voriconazole is never used in what fungal infection
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zygomycete infections. Use amphotericin B or posaconazole
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