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35 Cards in this Set
- Front
- Back
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Rejection is:
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Host Tcells recognizing donor tissue as foreign.
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GVHD is:
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Donor Tcells recognizing recipient as foreign.
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What tissues are especially targeted in rejection and GVHD?
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-Liver
-Skin -Gut |
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Why the liver/skin/gut?
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Because they present a large number of antigens.
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What is the goal in using BMT to treat leukemia?
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To balance GVHD and GVL using Tcell depletion
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What type of balance do we want?
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-Maximize GVL
-Minimize GVHD |
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Best histocompatibility match:
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Self or identical twins
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2nd best HLA match:
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HLA-matched sibling
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What is different between perfectly matched HLA siblings?
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minor HLA antigens
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What is just worse than being matched HLA siblings?
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Matched unrelated
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What is worst match?
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Mismatched
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What are some minor HA's?
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-Blood groups
-Ha-1 |
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What is the first step in a BMT?
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Conditioning regimen
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What does the conditioning regimen consist of?
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-Bone marrow ablatement to eradicate the cancer
-Immunosuppression to prevent rejection |
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What are 3 sources of stem cells for a BMT?
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-Peripheral blood
-Bone marrow -Cord blood |
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Which stem cell source is gold standard?
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Bone marrow
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What must be done before giving a BMT with cells from the peripheral blood?
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Give Granulocyte-CSF
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Why is peripheral blood not so preferable for a BMT?
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Because it contains so many mature cells it has a much higher risk of causing GVHD
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What is the Stem cell Marker?
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CD34
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What is the major side effect of a BMT?
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You destroyed the entired immune system.
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What happens if you give a BMT recipient blood transfusions that are not irradiated?
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They can get transfusion-associated GVHD from the immunocompetent WBCs that are present in the blood.
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What does irradiating blood products do to prevent GVHD via a transfusion?
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It prevents the WBCs from dividing.
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Why do DNA viruses cause problems in BMT recipients?
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Because they lie dormant from when you had them as a kid, then wake up when you immunosuppress them.
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What disorder results from awakening EBV via immunosuppression?
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PTLD - post transfusion lymphoproliferative disorder.
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What cells are targeted by EBV?
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Bcells
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What is difference between HLA-matched siblings, and identical twins in terms of a BMT?
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minor HLA antigens
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What are the goals of reduced intensity conditioning?
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-Preserved neutrophils
-Decreased tissue damage -Ablated lymphoid tissue |
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How do autologous BMT transplants work?
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More is better - dose intensification
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What is the gold standard for a BMT?
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HLA-matched siblings
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What post-transplant side effects are BMT physicians most worried about?
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-Blood problems
-Immune problems -Liver problems |
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T/F: Immunosuppressed patients should get irradiated blood transfusions
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True
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T/F: A post-BMT patient suffering from GVHD and currently on steroid treatment should get a live vaccination
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False
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What type of infection is the bane of all transplant doctors?
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Herpes
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Why is herpes so bad in immunosuppressed patients?
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Because the primary infection is followed by a latent period which allows the virus to reactivate later.
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What are the pro/con of giving a BMT from an identical twin?
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Pro: no GVHD
Con: NO GVL!! -hence the gold standard is an HLA matched sibling |
