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26 Cards in this Set

  • Front
  • Back
two types of transplant
1. autologous-- allowed high dose therapy
2. allogeneic-- intentive chemo permitted and discovery of graft v host and graft v leukemia
can recontstitute host hematopoiesis entirely; gnerally occur in bonemarrow; just a few can repopulate an individual; occur in bone marrow; CD34+; lineage negative, not in cell cycle (Go phase); give rise to determined progenitor cells
allogeneic transplant
sibling; unrelated; haploidentical (rarely done)
types of hematopoeitic transplant
autologous; allogeneic; BMT; peripheral blood stem cell transplantation (PBSCT); cord blood transplantation
advantages of allogenous transplant
stem cells are inherently healthy; chance of cure due to graft vs leukemia effect
disadvantages of allogenous transplants
limited by HLA identity; acute complications are most often caused by GVHD; chronic complications may be due to protracted immunosuppression and chronic GVHD; mortality 5-25%
advantages of autologous transplant
patients' own stem cells are harvested; mortality 0-3%
disadvantages of autologous transplant
stem cells may be damaged by previous chemo or contaminated with tumor cells; main negative outcome is tumor recurrence
complications of stem cell transplantation-1
infections; bleeding; transplant failure; GVH reactions; microangiopathy; veno-occlusive disease
treatment of pneumonias; PCP prophylaxis; treatment of CMV infections; tx and prophylaxis of other herpes virus infxns
transplant failure
definition: pancytopenia following SCT with hypocellular marrow following 21 d after SCT or 28 d after BMT;
risk factors for autologous transplant failure
heavy pretreatment with cytostatic drugs, purging
risk factors for allogeneic transplant failure
T cell depletion, low numbers of progenitor cells, HLA incompatibility
GVHD- acute
0-100 d post SCT skin- erythema; gut: diarrhea; liver- increased liver enzymes. prophylaxis: CSA, MTX; tx: steroids and anti T cell antibodies
chronic GVHD
>100 d; skin- scleroderma like changes; liver- fibrosis; gut- chronic diarrhea; tx: immunosuppression, supportive measures
veno-occlusive disease of the liver
sudden appearance of ascites, hepatomegaly, increased bilirubin; damage to endothelial cells caused by chemo and/or radiation; risk factors: previous hepatic disease; tx: mainly supportive, thrombolysis (experimental)
thrombotic microangiopathy
realted to hemolytic-uremic syndrome; signs: new anemia, thrombocytopenia, increased LDH occuring 1-6 mo after SCT; tx: plasma infusions or plasma exchange
indication for SCT (1)
leukemias, myelodysplastic syndromes
autologous is under study for all leukemias; allogeneic is mostly used for high risk patients in first or second remission; used for younger patients in MDS. only used in certain circumstances for CML b/c of imatiunib.
indication for SCT (2)
lymphomas: hodkin's: use autologous in 2nd remission; NHL (low grade): use autologous in 2nd remission/experimental; allogeneic is experimental; NHL (high grade): autologous in second remission
indications for SCT (3)
aplastic anemias: allogeneic for young pts with severe dz; congenital immunodeficiencies: allogeneic; MM: NHL high grade--autologous in 2nd remission and allogeneic in young with matched donor; solid tumors: autologous only in studies
cord blood transplantation
adv: less stringent matching required, speedy, reduced GVHD, lower viral transmission; Disadv: paucity of progenitors; prolonged time for neutrophil and platelet engraftment, higher rate of failure, concern ab reduced antitumor or antiinfectious activity, inability to get additional cells, and concerns about quality
cord blood transplant in kids
good reconstitution
CBT in adults:
consierable early transplant related mortality (57% in 3 mo in one study)
how to improve results of CBT?
pooling of 2 units; reduced intensity conditioning, validate procedures
new development in allogeneic SCT
metastatic renal cell carcinoma
article conclusions
- allogeneic HSCT for metastatic RCC is feasible; overall survival around 30% at 2 yrs; factors assoc with tumor response/survival are :chronic GVHD, DLI, less than 3 metastatic sites.