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35 Cards in this Set

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