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73 Cards in this Set
- Front
- Back
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What is Hematopoietic Stem Cell Transplantation (HSCT)?
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Referred to in the past as bone marrow transplantation- original source of stem cells
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What is the goal of Hematopoietic Stem Cell Transplantation (HSCT)?
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Goal is cure
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What is the objective of Hematopoietic Stem Cell Transplantation (HSCT)?
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Eradicate tumor cells and/or clear the marrow of its components to make way for engraftment of the transplanted stem cells by administering higher than normal doses of chemotherapy and/or radiation
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What malignant disease are indications for HSCT?
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1. Leukemias (Acute and chronic AML, acute ALL)
2. Hodgkin’s Lymphoma 3. Multiple Myeloma 4. Myelodysplastic syndrome 5. Ovarian cancer 6.Testicular cancer 7. Sarcoma 8. Neuroblastoma |
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What non-malignant disease are indications for HSCT?
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1. Hematologic diseases - aplastic anemia, chronic granulomatous disease, Sickle cell disease (severe), Thalassemia
2. Immunodeficiency diseases |
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What are the types of Hematopoietic Stem Cell Transplantation (HSCT)?
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1. Allogeneic transplantation
2. Syngeneic transplantation 3. Autologous transplantation |
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What is Allogeneic transplantation?
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Stem cells are acquired from a donor who is HLA-compatible with the recipient
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What is Syngeneic transplantation?
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Stem cells obtained from identical twin
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What is Autologous transplantation?
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Patient receives own stem cells back following myeloablative (destroying bone marrow) chemotherapy
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What are the procedures for harvesting stem cells?
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1. Multiple bone marrow aspirations
2. Peripheral stem cell pheresis 3. Umbilical cord blood aspiration |
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How are stem cells extracted via multiple bone marrow aspirations?
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500ml-1000ml of marrow is aspirated. Stem cells less mature.
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What is the advantage of peripheral stem cell pheresis?
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Stems cells more mature, but fewer than in the bone marrow
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What is the advantage of umbilical cord blood aspiration?
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Stem cells can be cryopreserved for later use
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What are the steps of bone marrow transplantation (BMT)?
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1. Conditioning regimen
2. Transplantation 3. Engraftment |
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What is the conditioning regimen?
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Includes high dose chemo and /or total body irradiation. May take 3-5 days.
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What are the purposes of the conditioning regimen?
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1. Wipes out client’s own bone marrow to prepare for optimal graft take
2. Higher than normal doses of chemo and XRT gets rid of cancer cells (myeloablation) |
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What is transplantation?
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Bone marrow, stem cells or cord blood is infused through a central line over 30 mins. May be given direct IV.
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What is the precaution of transplantation?
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Separated from conditioning by at least 2 days to make sure chemotherapy have been eliminated from the body
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What is engraftment?
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1. Successful take of the transplanted cells in the client’s bone marrow
2. Takes 8-12 days for PBST (more mature) 3. Takes 12-28 days for bone marrow stem cell transplantation (less mature cells) 4. Growth factors may be given to aid in engraftment ( GCSF, GM-CSF) |
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When does engraftment occur?
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Engraftment occurs when WBC, RBC and platelet counts begin to rise
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What are the complications of Hematopoietic Stem Cell Transplantation (HSCT)?
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1. Pancytopenia
2. Infections- bacterial, fungal, viral 3. Graft-versus-host-disease (GVHD) 4. Failure to engraft 5. Veno-occlusive disease |
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What causes the Graft-versus-host-disease (GVHD)?
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T-lymphocytes from the donated marrow recognize the recipient (patient) as foreign and begin to attack certain organs such as the skin, liver, and GI tract
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How is Graft-versus-host-disease (GVHD) managed?
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Managed by using immunosuppressants (Cytoxan, steroids, Methotrexate)
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What causes engraftment failure?
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1. Insufficient number of cells transplanted
2. Attack or rejection of donor cells by the remaining immune system cells of the recipient (patient) 3. Infection of tranplanted cells 4. Unknown biologic factors |
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Why is engraftment failure a concern?
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Potentially fatal
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What is veno-occlusive disease?
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Occlusion of liver blood vessels by clotting and inflammation
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What are the clinical manifestations of veno-occlusive disease?
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1. Jaundice
2. Pain in RUQ 3. Ascites 4. Weight gain 5. Hepatomegaly |
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What is the treatment for veno-occlusive disease?
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Treatment is supportive- pain management, fluid management
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What is bone marrow transplantation a standard treatment for?
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Leukemia
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What else is bone marrow transplantation (BMT) used for?
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1. Lymphoma
2. Aplastic anemia 3. Sickle cell disease 4. Solid tumors |
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What is the site of production of leukemic cells?
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Bone marrow
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What is required before BMT?
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It can be difficult to ensure that all leukemic cells have been eradicated during induction therapy; therefore, before BMT, additional chemotherapy treatments and total body irradiation are given to purge (condition) the marrow of leukemic cells. These treatments are lethal to the bone marrow, and without replacement of bone marrow through transplantation, the client would die of infection or hemorrhage.
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What are the intervention activities for the client with leukemia or the client undergoing bone marrow/stem cell transplantation?
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1. Infection Protection: Prevention and early detection of infection in a client at risk
2. Bleeding Precautions: Reduction of stimuli that may induce bleeding or hemorrhage in at-risk clients 3. Energy Management: Regulating energy use to treat or prevent fatigue and optimize function |
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What did BMT start with?
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BMT started with the use of allogeneic bone marrow transplantation
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What is an allogeneic bone marrow transplantation?
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Transplantation of bone marrow from a (non-twin) sibling
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What has BMT advanced to?
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The use of human leukocyte antigen (HLA)-matched stem cells from the umbilical cords of unrelated donors
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What are autologous transplants?
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Clients receive their own stem cells (which were collected before high-dose therapy)
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What are syngeneic transplants?
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Those with the stems cells taken from the client's own identical sibling
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What are allogeneic transplants?
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A closely HLA-matched sibling or an unrelated but matched donor provides the stem cells
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What are the sources of stem cells for transplantation?
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1. Bone marrow harvest
2. Peripheral stem cell pheresis 3. Umbilical cord blood stem cell banking |
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What are the phases of transplantation?
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1. Stem cell obtainment
2. Conditioning regimen 3. Transplantation 4. Engraftment 5. Post-transplantation recovery |
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How much bone marrow is collected to obtain sufficient stem cells for transplantation?
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About 500 to 1000 mL of marrow is aspirated
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What are the phases of obtaining peripheral blood stem cells (PBSCs)?
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1. Mobilization
2. Collection 3. Reinfusion |
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What is mobilization?
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During the mobilization phase, chemotherapy or hematopoietic growth factors are given to the client. These agents increase the numbers of stem cells and WBCs in the peripheral blood.
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How are stem cells collected?
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The stem cells are then collected by pheresis
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What is pheresis?
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Withdrawing whole blood, filtering out the cells, and returning the plasma to the client
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How many pheresis procedures are needed to obtain enough stem cells from the donor for transplantation?
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One to five pheresis procedures, each lasting 2 to 4 hours
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How are the stem cells stored for reinfusion?
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The stem cells are then frozen and stored for reinfusion after the conditioning regimen
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What are the complications of pheresis?
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1. Catheter clotting
2. Hypocalcemia |
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What causes hypocalcemia?
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Anticoagulants
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What are the signs and symptoms of hypocalcemia?
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1. Chills
2. Numbness 3. Abdominal or muscle cramping 4. Chest pain |
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How is hypocalcemia treated?
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Oral calcium supplements
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What is the nursing care for hypocalcemia?
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Monitor vital signs at least every hour during pheresis. The client may become hypotensive from fluid volume changes during the procedure.
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What is the purpose of the conditioning regimen prior to transplantation?
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1. To "wipe out" the client's own bone marrow, thus preparing the client for optimal graft take
2. To give higher than normal doses of chemotherapy and/or radiotherapy to rid the person of cancer cells (myeloablation) |
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What is myeloablation?
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Removal of cancer cells
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What are the early (present) side effects of the conditioning regimen?
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1. Nausea and vomiting
2. Mucositis 3. Capillary leak syndrome 4. Diarrhea 5. Bone marrow suppression |
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What are the late (future) side effects of the conditioning regimen?
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1. Veno-occlusive disease (VOD)
2. Skin toxicities 3. Cataracts 4. Lung fibrosis 5. Second cancers 6. Cardiomyopathy 7. Endocrine complications 8. Neurologic complications |
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What indicates successful conditioning regimens?
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The client has few circulating WBCs, indicating successful conditioning
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What are the side effects of transplantation?
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The client may have fever and hypertension as a reaction to the preservative used in stem cell storage
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How are transplantation side effects prevented?
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1. To prevent these reactions, acetaminophen (Tylenol), hydrocortisone, and diphenhydramine (Benadryl) are given before the infusion
2. Antihypertensives or diuretics may be needed to treat fluid volume changes 3. The client may have red urine as a result of red blood cell hemolysis in the infused stem cells |
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What is engraftment?
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Successful "take" of the transplanted cells in the client's bone marrow
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How long does engraftment take?
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8 to 12 days for peripheral blood stem cell transplantation and 12 to 28 days for bone marrow stem cell transplantation
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How is engraftment aided?
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To aid engraftment, growth factors, such as granulocyte colony-stimulating factor or granulocyte-macrophage colony-stimulating factor, may be given. When engraftment occurs, the client's WBC, RBC, and platelet counts begin to rise
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What are the complications of BMT?
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1. Pancytopenia
2. Failure to engraft 3. Development of graft-versus-host disease (GVHD) 4. VOD |
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What is pancytopenia?
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Too few circulating blood cells
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What causes failure to engraft?
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1. Insufficient numbers of cells transplanted
2. Attack or rejection of donor cells by the remaining immune system cells of the recipient 3. Infection of transplanted cells 4. Unknown biologic factors |
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What happens if there is failure to engraft?
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If the transplanted cells fail to engraft, the client will die unless another transplantation is successful
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When does Graft-versus-host disease (GVHD) occur?
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Mostly in allogeneic transplants
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Which tissues are usually damaged in graft-versus-host-disease (GVHD)?
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1. Skin
2. Intestinal tract 3. Liver |
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What is the management of GVHD?
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1. Limiting the activity of donor T-cells by using immunosuppressive drugs such as cyclosporine, methotrexate, corticosteroids, and antithymocyte globulin
2. Care is taken to avoid suppressing the new immune system to the extent that either the client is at risk for infection or the transplanted cells stop engrafting |
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What is veno-occlusive disease (VOD)?
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Occlusion of liver blood vessels by clotting and inflammation (phlebitis)
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What are the clinical manifestations of VOD?
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1. Jaundice
2. Pain in the right upper quadrant 3. Ascites 4. Weight gain 5. Liver enlargement |
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What is the management of VOD?
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1. Supportive treatment
2. Fluid management |
