Test 3 Stem Cell Therapy

Question 1

stem cell

Answer 1

Cells with the capacity for unlimited or prolonged self-renewal & can produce at least one type of highly differentiated descendant

Question 2

3 unique properties of a stem cell

Answer 2

• They are capable of dividing and renewing themselves for long periods
• They are unspecialized
• They can give rise to specialized cell types

Question 3

Autologous HSCT

Answer 3

• Use of pts own bone marrow or peripheral blood stem cells
• no disease in the bone marrow
• lymphoma and myeloma patients

Question 4

Allogeneic HSCT

Answer 4

• Stem cells from another donor

- leukemia and aplastic anemia patients

Question 5

Collection of Stem Cells: sources

Answer 5

• bone marrow: less graft-versus-tumor effect
• peripheral blood: faster time to engraftment
• umbilical cord: less graft-versus-tumor effect

Question 6

Preparative phase

Answer 6

administer chemotherapy and/or total body radiation (TBI) to recipient in preparation for stem cell infusion

Question 7

What does supportive care consist of?

Answer 7

to help patients that experience

• neutropenic fever
• mucositis
• Sinusoidal Obstruction Syndrome (SOS): liver toxicity due to high dose of chemo
• Graft-versus-host disease (GVHD)

Question 8

Engraftment

Answer 8

Defined as absolute neutrophil count > 500/mm^3 x 3 days and platelets > 20 x 10^9/L

Question 9

Engraftment time

Answer 9

• Usually occurs 2-3 weeks after transplant
• Autologous > Allogeneic
• peripheral blood stem cell > bone marrow > cord blood

Question 10

5 complications of HSCT

Answer 10

• Mucositis
• Pancytopenia
• Infectious Complications / Prevention
• Sinusoidal occlusive syndrome (SOS)
• Graft-versus-host disease (GVHD)

Question 11

Mucositis

Answer 11

• most common with fully myeloablative patients

- as WBC count return, mouth improves

Question 12

Pancytopenia

Answer 12

• Expected complication
• start to recover on D+14
• if it’s prolonged, that’s UNEXPECTED -> recover 14-21 days

Question 13

potential causes of prolonged pancytopenia

Answer 13

• infection
• drug reaction
• graft failure
• graft rejection

Question 14

Sinusoidal Occlusive Syndrome (SOS)

Answer 14

• AKA venoocclusive disease (VOD)

- occurs within the first 3 weeks

Question 15

Risk Factors for SOS

Answer 15

• Presence of elevated liver function test pre HSCT
• Previous history of hepatitis
• TBI preparative regimen
• Busulfan/carmustine
• Methotrexate as GVHD prophylaxis
• Advanced stage disease (heavily pretreated)
• Previous chemotherapy received (gemtuzumab)
• Age (older > younger)

Question 16

Graft-Versus-Host Disease (GVHD)

Answer 16

• Occurs in 10-80% of allogeneic HSCT
• Acute target organs: skin, liver, GI tract
• Chronic target organs: skin, eyes, mouth, esophagus

Question 17

GVHD risk factors

Answer 17

• HLA differences between donor and recipient
• Sex or age mismatch
• Parity of female donors
• Stem cell source (PBSC vs. BM vs. cord blood)
• Type of conditioning
• T-cell status of stem cell source
• Presence of acute GVHD

Question 18

Mechanism of Action of Cyclosporine and Tacrolimus

Answer 18

Inhibits calcineurin, blocking T cell activation & IL2 production

Question 19

Mechanism of action of mycophenolate mofetil (MMF)

Answer 19

Inhibits inosine monophosphate dehydrogenase, blocking synthesis of purines in T and B lymphocytes

Question 20

treatment of acute GVHD

Answer 20

• continue prophylactic agents

- add methylprednisolone 1-2 mg/kg/day divided BID taper over months

Question 21

Cyclosporine and Tacrolimus adverse effects

Answer 21

• narrow TI = monitor levels closely
• Nephrotoxicity
• Hypertension
• Hyperglycemia
• CNS: tremor, headache, seizures

Question 22

mycophenolate mofetil adverse effects

Answer 22

• GI upset and diarrhea (most common)

- Leukopenia / thrombocytopenia