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16 Cards in this Set
- Front
- Back
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in a bone marrow transplant, what are the three phases along with their lengths of time of immunisuppression?
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neutropenia (from infusion to 20 or so days after), then acute graph vs host disease as well as induced immunosuppression to help keep GVHD in check (day 30 to 85 or so), then chronic GVHD happens for months
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describe timeline of infections seen in post marrow transplants.
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first with the neutropenia you will see bac infections followed by some viral (usually HSV), maybe fungal (candida), and possible viral, non bac, pneumonia. Once acute GVHD hits, you can see CMV, aspergillosis, still can see bac infections and nonbac pneumonia, later more adenovirus appears. as you move into chronic GVHD you will see encapsulated bac infections and VZV
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how long does it usually take for the immune system to fully reconstruct after marrow transplant??
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8 to 12 months
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consequence of mismatched marrow?
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GVHD, graft immune system rejects the host,
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what must be doen is no compatable donor is available?
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remove all the mature T cells from the marrow so there is no memory
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significance of normal WBC count?
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less likely to be bacterial
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latent EBV infections have what serology? What can this virus cause if it is tranplanted with the marrow?
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anti EBNA and anti VCA IgG. Post transplant lymphoproliferative disease from taking out the 5% T cells that normally are needed to keep EBV in check
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is serology useful when checking for EBV induced post transplant lymphproliferative disease?
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no, immune system is all messed up
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lack of T cells to EBV results in what ?
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leukemia/lymphoma
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where do most of the EBV infected cells come from in transplant situations?
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the donor
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describe GVHD in leukemic patients?
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bc of the donor's T cells activating, they get rid of the growing leukemia, can also give donor T cells after BMT to get rid of leukemia
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what is a weird side effect seen in post CD 8 T cell thereapy for GVHD and leukemia?
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soft palate defect full of EBV infected B cells, and the cells begin to lyse
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what is the ideal treatment for one with leukemia and bone marrow transplant?
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treat prophylactically with EBV specefic cytotoxic T cells during time patient is at greatest risk (1-12 months bost BMT)
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composition of EBV specefic T cells?
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CD3, CD8, and CD4 as well as a neomycin resistance gene marked…
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has there been a later relapse of EBV in post BMT and CTL treatment?
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yes, but the CTL treatment still protected pt even 1.5 yrs later, know this by the neomycin gene marker in the CTLs. Question is how long does this protection last? Need life long monitoring.
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describte CTL therapy in this patient in terms of tumor levels, viral levels, and immunity.
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anti viral (EBV) effects, anti tumor effects and reconstituted immunity to EBV
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