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29 Cards in this Set
- Front
- Back
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What is the purpose of stem cell transplant?
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Bone marrow toxicity limits the maximum chemotherapy dose for cancer treatment. With stem cell support, tumor cell kill is greatly increased as the chemotherapy doses may be administered as very high doses (10 times normal dose). This may allow for cure.
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What are the sources of stem cells?
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1. Bone marrow
2. Peripheral blood 3. Umibilical cord |
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What is the pluripotent hemopoietic stem cell?
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It is CD34+. It can differentiate and renew. It is the basis for bone marrow treatment.
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What are the 3 types of stem cell transplants?
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1. Autologous
2. Syngenic 3. Allogeneic |
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What is an autologous stem cell transplant?
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Patient receives own stem cells for transplantation.
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What is a syngenic stem cell transplant?
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The donor and recipient are identical twins (genetically identical)
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What is an allogeneic stem cell transplant?
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The donor shares common tissue antigens but is not genetically identical.
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For which types of cancer are autologous transplants considered the standard therapy?
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Multiple myeloma
Non-Hodgkin's lymphoma Hodgkin's lymphoma Testicular cancer Neuroblastoma |
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What are the indications for allogeneic transplants?
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Non-cancer indications include aplastic anemia and rheumatoid arthritis. Cancer indications include leukemia, myeloma, lymphomas, and myelodysplastic syndrome.
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General Matched Related Donor info.
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Each individual has 6 antigens that are evaluated for BMT (HLA-A 1&2, HLA-B 1&2, and HLA-DR 1&2). There is a 30% chance of having a matching sibling (6/6 match is considered matching)
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General Mismatched Related Donor info.
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In mismatched-related donors, the donor is usually a sibling or parent that is matched with at least 3/6 HLA antigens. The higher the degree of mismatched HLA the more complications with engraftment and graft versus host syndrome.
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What are Hematopoietic stem cells or CD34+ cells?
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Pluripotent stem cells that replicate indefinitely and can become stem and progenitor cells of all tissues.
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General info on bone marrow collection.
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It is taken from the posterior ileac crest, anterior ieac crest, or the sternum. It yields 200-1500 mL. It is given to the recipient 12-24 hours post collection. Peripheral stem cell collection produces a lower yield and requires more sessions.
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How many cells do you need for transplant?
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The more CD34+ cells, the quicker the recovery (neutrophils and platelets recover faster). 2x10^6 CD34+ cells/kg improves neutrophil recovery and 5x10^6 CD34+ cells/kg improves platelet recovery.
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What is the purpose of conditioning regimens?
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Patients must be prepared prior to the infusion of cells. The goal is to kill as many malignant cells as possible. High dose chemo would be life-threatening without cell infusion.
Single agent regimens include melphalan, cyclophosphamide, carmustine, and ifosphamide. |
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What is the conventional dose and stem cell therapy dose for thiotepa?
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Conventional: 20-50 mg/m2
SCT: 1125 mg/m2 |
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What is the conventional dose and stem cell therapy dose for etoposide?
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Conventional: 300-600 mg/m2
SCT: 2400 mg/m2 |
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What is the conventional dose and stem cell therapy dose for busulfan?
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Conventional: 2 mg/m2
SCT: 450 mg/m2 or 12-16 mg/kg |
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What is the conventional dose and stem cell therapy dose for melphalan?
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Conventional: 16-40 mg/m2
SCT: 200 mg/m2 |
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What is the conventional dose and stem cell therapy dose for carmustine?
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Conventional: 200 mg/m2
SCt: 1200 mg/m2 |
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What is the conventional dose and stem cell therapy dose for carboplatin?
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Conventional: 400 mg/m2
SCT: 2000 mg/m2 |
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What is the conventional dose and stem cell therapy dose for cyclophosphamide?
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Conventional: 1000 mg/m2
SCT: 7500 mg/m2 |
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What is the conventional dose and stem cell therapy dose for ifosfamide?
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Conventional: 5000 mg/m2
SCT: 18,000 mg/m2 |
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What are common complications of stem cell transplant?
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1. infections
2. pulmonary complications 3. hepatic veno-occlusive disease 4. graft failure 5. GVHD |
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What is hepatic veno-occlusive disease?
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It is also known as SOS (sinusoidal obstructive syndrome). It is chemo-induced dilation of hepatic sinusoids that leads to death of hepatocytes and portal hypertension. It typically occurs in the first 3 weeks after transplant. Severe disease is fatal in up to 75%.
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What are some common causes of graft failure?
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-immunologic reaction between donor and host
-heavy pretreatment with chemo or radiation -insufficient number of stem cells infused -viral infection -recurrence of primary hematologic malignancy |
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What causes graft-versus-host disease?
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It is caused by donor T-cells reacting against recipient/host antigens. Donor T-cells recognize host as foreign, become activated, proliferate, and attack recipient tissue.
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What is acute GVHD?
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It occurs in the first 100 days post-transplant. It primarily involves the skin, liver, and gut.
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Treatment and prevention of acute GVHD?
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Treatment is difficult so prevention is the key. This can be done by blocking activation of T cells with immunosuppressants (cyclosporine, tacrolimus, mycophenolic acid, oral steroids). Most regimens combine two or more agents.
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