BMTCN STUDY EXAMS ALL QUESTIONS AND
ANSWERS SURE A+
✔✔Chemomobilization disadvantages - ✔✔may need to be hospitalized to receive
cheom, side effects and toxicities of chemo, hemorrhagic cystitis, cardiac toxicity, risk of
anaphylactic rxn, causes decrease in T cells which could have a negative impact on
immunity. Unsure if benefits outweigh risks
✔✔Plerixafor - ✔✔chemokine antagonist, used with G-CSF for mobilization. side
effects: leukocytosis, thrombocytopenia, nausea, erythma at injection site, dizziness,
diarrhea, fatiguen]
✔✔RIC conditioning - ✔✔results in mixed chimerism. stem cell support is given with the
goal of generating a new graft, or immune system. allow for transplant for patients who
might not be eligible for full ablation d/t age or comorbities. Goal is not to completely
eradicate tumor cells but to achieve immunosuppression for donor's immune system to
engraft. Higher risk of relapse
✔✔Nonmyeloablative conditioning - ✔✔given with the goal of generating a new graft, or
immune system. hematologic recovery is likely even without stem cell support
✔✔Likelihood of GVHD - ✔✔depends of the maturity of T cells from graft. UCB= lowest
maturity, lowest risk of GVHD. PBSCT have the most mature T cells= highest risk of
GVHD
✔✔ATG during conditioning - ✔✔immunosuppressive agent- inhibits cells involved in
cellular-mediated immunity (T cells, NK cells, dendritic cells). Used to deplete residual
host T cells prior to getting the infused graft T cells. used to prevent graft failure and
enhance engraftment
✔✔DMSO toxicity symptoms - ✔✔abd cramps, bradycardia, chest tightness,
dysrhythmias, fever, flushing, HTN, nausea, SOB, tachycardia, vomiting, wheezing
, ✔✔Acute hemolytic reaction (major ABO incompatibility) - ✔✔chest/back pain, fever,
chills, dyspnea, shock, abnormal bleeding, DIC
✔✔Management of acute hemolytic rxn (major ABO incompatibility) - ✔✔stop infusion,
call provider, maintain IVF, administer O2- may need additional blood products to
correct any coagulopathy
✔✔characteristics of TLS - ✔✔hyperkalemia, hyperuricemia, hyperphosphatemia,
hypocalcemia, acute renal failure
✔✔Minor ABO incompatability - ✔✔MINOR: O --> A/B/AB
recipient is A, B, or AB; donor is O
donor O blood has antibodies to A, B, AB
risk for acute or delayed hemolytic reactions
delayed hemolysis would occur once the graft produces anti-A and anti-B antibodies to
the recipient's current blood type
helpful to reduce the plasma in the cellular product
✔✔Major ABO incompatability - ✔✔MAJOR: A/B/AB --> O
recipient is O, donor is A, B, or AB
recipient already has antibodies to A and B, causing risk for acute hemolysis.
helps to red-cell deplete the cellular product and give significant IVF support to promote
excretion
✔✔ What type of transplants commonly have PTLD as a secondary malignancy? -
✔✔Allo HSCT with T-cell depleted graft
✔✔Therapies associated with therapy-related acute leukemia and MDS - ✔✔alkylating
agents (eg. Cytoxan, cisplatin, melphalan, busulfan, ifos) , radiation, topoisomerase II
inhibitors (eg. doxorubicin, etoposide, mitoxantrone)
✔✔Genetic predispositions that increase risk of primary and secondary cancers -
✔✔neurofibromatosis type 1, Fanconi anemia
✔✔Risk factors for PTLD - ✔✔T-cell depleted graft, mismatched related or unrelated
donor.
Busulfan, ATG, mAbs, TBI
patient w/ primary immunodeficiency, acute or extensive GVHD, EBV
✔✔Risk factors for secondary solid tumors - ✔✔younger age at HSCT, TBI, chronic
GVHD, increasing time from transplant, infections, genetic predisposition, lifestyle
factors
ANSWERS SURE A+
✔✔Chemomobilization disadvantages - ✔✔may need to be hospitalized to receive
cheom, side effects and toxicities of chemo, hemorrhagic cystitis, cardiac toxicity, risk of
anaphylactic rxn, causes decrease in T cells which could have a negative impact on
immunity. Unsure if benefits outweigh risks
✔✔Plerixafor - ✔✔chemokine antagonist, used with G-CSF for mobilization. side
effects: leukocytosis, thrombocytopenia, nausea, erythma at injection site, dizziness,
diarrhea, fatiguen]
✔✔RIC conditioning - ✔✔results in mixed chimerism. stem cell support is given with the
goal of generating a new graft, or immune system. allow for transplant for patients who
might not be eligible for full ablation d/t age or comorbities. Goal is not to completely
eradicate tumor cells but to achieve immunosuppression for donor's immune system to
engraft. Higher risk of relapse
✔✔Nonmyeloablative conditioning - ✔✔given with the goal of generating a new graft, or
immune system. hematologic recovery is likely even without stem cell support
✔✔Likelihood of GVHD - ✔✔depends of the maturity of T cells from graft. UCB= lowest
maturity, lowest risk of GVHD. PBSCT have the most mature T cells= highest risk of
GVHD
✔✔ATG during conditioning - ✔✔immunosuppressive agent- inhibits cells involved in
cellular-mediated immunity (T cells, NK cells, dendritic cells). Used to deplete residual
host T cells prior to getting the infused graft T cells. used to prevent graft failure and
enhance engraftment
✔✔DMSO toxicity symptoms - ✔✔abd cramps, bradycardia, chest tightness,
dysrhythmias, fever, flushing, HTN, nausea, SOB, tachycardia, vomiting, wheezing
, ✔✔Acute hemolytic reaction (major ABO incompatibility) - ✔✔chest/back pain, fever,
chills, dyspnea, shock, abnormal bleeding, DIC
✔✔Management of acute hemolytic rxn (major ABO incompatibility) - ✔✔stop infusion,
call provider, maintain IVF, administer O2- may need additional blood products to
correct any coagulopathy
✔✔characteristics of TLS - ✔✔hyperkalemia, hyperuricemia, hyperphosphatemia,
hypocalcemia, acute renal failure
✔✔Minor ABO incompatability - ✔✔MINOR: O --> A/B/AB
recipient is A, B, or AB; donor is O
donor O blood has antibodies to A, B, AB
risk for acute or delayed hemolytic reactions
delayed hemolysis would occur once the graft produces anti-A and anti-B antibodies to
the recipient's current blood type
helpful to reduce the plasma in the cellular product
✔✔Major ABO incompatability - ✔✔MAJOR: A/B/AB --> O
recipient is O, donor is A, B, or AB
recipient already has antibodies to A and B, causing risk for acute hemolysis.
helps to red-cell deplete the cellular product and give significant IVF support to promote
excretion
✔✔ What type of transplants commonly have PTLD as a secondary malignancy? -
✔✔Allo HSCT with T-cell depleted graft
✔✔Therapies associated with therapy-related acute leukemia and MDS - ✔✔alkylating
agents (eg. Cytoxan, cisplatin, melphalan, busulfan, ifos) , radiation, topoisomerase II
inhibitors (eg. doxorubicin, etoposide, mitoxantrone)
✔✔Genetic predispositions that increase risk of primary and secondary cancers -
✔✔neurofibromatosis type 1, Fanconi anemia
✔✔Risk factors for PTLD - ✔✔T-cell depleted graft, mismatched related or unrelated
donor.
Busulfan, ATG, mAbs, TBI
patient w/ primary immunodeficiency, acute or extensive GVHD, EBV
✔✔Risk factors for secondary solid tumors - ✔✔younger age at HSCT, TBI, chronic
GVHD, increasing time from transplant, infections, genetic predisposition, lifestyle
factors
